Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019

Issue 3-The occupational burden of respiratory diseases, an update

INTRODUCTION AND AIMS

Workplace exposures are widely known to cause specific occupational diseases such as silicosis and asbestosis, but they also can contribute substantially to causation of common respiratory diseases. In 2019, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published a joint statement on the occupational burden of respiratory diseases. Our aim on this narrative review is to summarise the most recent evidence published after the ATS/ERS statement as well as to provide information on traditional occupational lung diseases that can be useful for clinicians and researchers.

RESULTS

Newer publications confirm the findings of the ATS/ERS statement on the role of workplace exposure in contributing to the aetiology of the respiratory diseases considered in this review (asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, infectious pneumonia). Except for COPD, chronic bronchitis and infectious pneumonia, the number of publications in the last 5 years for the other diseases is limited. For traditional occupational lung diseases such as silicosis and asbestosis, there are old as well as novel sources of exposure and their burden continues to be relevant, especially in developing countries.

CONCLUSIONS

Occupational exposure remains an important risk factor for airways and interstitial lung diseases, causing occupational lung diseases and contributing substantially in the aetiology of common respiratory diseases. This information is critical for public health professionals formulating effective preventive strategies but also for clinicians in patient care. Effective action requires shared knowledge among clinicians, researchers, public health professionals, and policy makers.

Age, gender, and race differences in nasal morphology: Linking air conditioning and filtration efficiency to disparities in air pollution health outcomes and COVID-19 mortality

COVID-19 mortality disparities underscore the critical role of environmental factors, age, sex, and racial demographics. This study investigates how individual variations in nasal morphology - specifically its air conditioning (temperature and humidity regulation) and filtration functions - may influence respiratory health and contribute to differential COVID-19 outcomes. Analysis reveals significant differences in nasal structure and function across racial, sex, and age groups, demonstrating associations with disparities in respiratory vulnerability to environmental stressors such as air pollution, infectious aerosols, and climatic conditions. Specifically, wider nasal cavities (more common in certain populations), larger male nasal passages, and age-related changes like mucosal atrophy and increased endonasal volume impair air conditioning and filtration efficiency. These morphological variations influence the nose's protective capacity, which is critical for shielding the middle and lower airways from environmental exposures. Populations with inherently reduced nasal filtration and conditioning efficiency demonstrate higher vulnerability, aligning with U.S. mortality patterns for both COVID-19 and air pollution across demographic groups. This suggests a direct link between nasal anatomy and population-level health disparities. These findings provide novel insights into the role of nasal anatomy in mediating respiratory health disparities by modulating individual responses to environmental exposures, air pollution, and pathogens. They highlight the need to address critical gaps in understanding how airway characteristics influence susceptibility to environmental stressors and to develop targeted interventions aimed at reducing health disparities.

Global trends in staphylococcus aureus-related lower respiratory infections from 1990 to 2021: findings from the 2021 global burden of disease report

BACKGROUND

Lower respiratory infections (LRIs) represent a significant global health issue, especially affecting low- and middle-income countries. In this study, we explored the mortality and disability-adjusted life years (DALYs) associated with Staphylococcus aureus-related LRIs from 1990 to 2021, highlighting trends by age, sex, and Socio-Demographic Index (SDI).

METHODS

Data were derived from the 2021 Global Burden of Disease (GBD) database. Temporal trends in age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) rates (ASDR) for S. aureus-related LRIs were analyzed based on the average annual percent change (AAPC), in terms of sex, 20-age groups, 21 regions, 204 countries, and 5 SDI quintiles.

RESULTS

In 2021, S. aureus-related LRIs contributed to 423,837 deaths (95% UI: 382,183-458,926), a 67.56% increase since 1990. In comparison, the global ASMR was 5.43 per 100,000 (95% UI: 4.89-5.90), and the ASDR was 156.80 per 100,000 (95% UI: 139.44-176.08), both exhibiting a declining trend compared to 1990. Rates were higher in low SDI regions, with Central Sub-Saharan Africa reporting the highest ASMR, while Eastern Europe had the lowest. Among the 204 countries analyzed, Zimbabwe recorded high ASMR and ASDR, at 24.84 (95% UI: 19.44-30.16) and 754.34 (95% UI: 591.05-923.06), respectively.

CONCLUSIONS

Although the global ASMR and ASDR decreased in 2021, the number of deaths from S. aureus-related LRIs significantly increased driven by the growing population and proportion of aged individuals. Additionally, the emergence of multidrug-resistant strains has made treatment more complex, particularly in low SDI regions, highlighting the urgent need for more targeted strategies, therapies, and vaccines.

The safety and efficacy of non-typeable Haemophilus influenzae and Moraxella catarrhalis vaccine in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

Background

Non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) are major pathogens implicated in bacterial exacerbations of chronic obstructive pulmonary disease (COPD). Their involvement contributes to antibiotic resistance and poses significant immune challenges, underscoring the need for targeted vaccine strategies. This systematic review and meta-analysis assessed the safety and efficacy of NTHi-Mcat/NTHi vaccines in COPD patients.

Research design and methods

Randomized controlled trials (RCTs) assessing the safety and efficacy of NTHi-Mcat/NTHi vaccines for COPD were systematically searched across four databases (PubMed, CENTRAL, Embase, and Medline) from inception to October 2024. Meta-analyses were conducted using random-effects or fixed-effects models, with subgroup analyses to investigate possible sources of heterogeneity.

Results

This analysis included eight RCTs involving 1,574 participants, primarily conducted in Europe (n = 3) and Australia (n = 2), with interventions administered orally or intramuscularly at varying frequencies (twice or three times). The Meta-analyses revealed that the NTHi-Mcat/NTHi vaccine did not affect the incidence of acute exacerbations of COPD (relative risk (RR): 1.02, 95% confidence interval (CI): 0.76 to 1.36), all-cause mortality (RR: 0.91, 95% CI: 0.38 to 2.21), and hospitalization rate (RR: 0.50, 95% CI: 0.09 to 2.77). Regarding safety, the NTHi-Mcat/NTHi vaccine did not significantly increase the risk of serious adverse events (RR: 1.00, 95% CI: 0.84 to 1.19) or grade 3 serious events (RR: 1.20, 95% CI: 0.93 to 1.53). However, it was associated with a higher risk of local and systemic reactions, including pain (RR: 5.33, 95% CI: 1.98 to 14.33), swelling (RR: 12.15, 95% CI: 4.67 to 31.67), redness (first dose: RR: 12.74, 95% CI: 3.48 to 46.59; second dose: RR: 11.55, 95% CI: 3.90 to 34.22), headaches (RR: 1.20, 95% CI: 1.00 to 1.43), erythema (RR: 15.38, 95% CI: 5.64 to 41.92), and fever (after the second dose: RR: 2.33, 95% CI: 1.24 to 4.38).

Conclusion

Although the NTHi-Mcat/NTHi vaccines were well-tolerated in COPD patients, they did not significantly reduce the risk of exacerbations or mortality. These findings suggest that further research is needed to validate these results and identify potential subgroups that may derive clinical benefit.

Systematic review registration

The study was registered in PROSPERO (ID: CRD42023381488).

Molecular Targeting of Intracellular Bacteria by Homotypic Recognizing Nanovesicles for Infected Pneumonia Treatment

Although extensive antibiotic regimens have been implemented to address pathogen-infected pneumonia, existing strategies are constrained in their efficacy against intracellular bacteria, a prominent contributor to antibiotic resistance. In addition, the concurrent occurrence of a cytokine storm during antibiotic therapy presents a formidable obstacle in the management of pneumonia caused by pathogens. In the present study, an infection-targeting system that leverages M2-macrophage-derived vesicles [exosomes (Exos)] as vehicles to convey antibiotics (antibiotics@Exos) was developed for effective pneumonia management. The proposed system can enable antibiotics to be specifically delivered to infected macrophages in pneumonia through homotypic recognition and was found to exhibit an exceptional intracellular bactericidal effect. Moreover, M2-type vesicles exhibit a high degree of efficiency in reprogramming inflammatory macrophages toward an anti-inflammatory phenotype. As a result, the administration of antibiotics@Exos was found to substantical decrease the level of the infiltrated inflammatory cells and alleviate the inflammatory factor storm in the lungs of acute lung injury mice. This intervention resulted in the alleviation of reactive-oxygen-species-induced damage, reduction of pulmonary edema, and successful pneumonia treatment. This bioactive vesicle delivery system effectively compensates for the limitations of traditional antibiotic therapy regimens with pluralism effects, paving a new strategy for serious infectious diseases, especially acute pneumonia treatment.

Spatiotemporal analysis of the burden of lower respiratory infections in the older adult population due to air pollution: trends from 1990 to 2021 and predictions for the next 30 years

Background

Lower respiratory infections (LRI), caused by various pathogens, have significant impacts on global health. Air pollution is a major environmental factor in the development of LRI, and with ongoing urbanization and industrialization, it has become a critical public health concern. The older adult population, with declining immune function and physiological capabilities, exhibits reduced resistance to air pollution, making them a high-risk group for LRI. However, the spatiotemporal trends of LRI burden in the older adult and their association with air pollution remain understudied. This study analyzes the trends in LRI burden from 1990 to 2021 in relation to air pollution and predicts future trends from 2022 to 2050.

Methods

Using data from the Global Burden of Disease (GBD 2021) database, this study examines mortality rates and disability-adjusted life years (DALY) at global, regional, and national levels from 1990 to 2021. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were used to compare burdens across regions and time periods. A Bayesian age-period-cohort (BAPC) model was applied to predict future trends. Data analysis was conducted using R programming to explore differences in burden across genders, age groups, and socioeconomic levels.

Results

From 1990 to 2021, the global burden of LRI due to air pollution generally declined, with the largest reduction in household air pollution from solid fuels. Regional differences were observed, with Asia and Africa showing increasing LRI burden from ambient particulate matter, especially in regions with lower socioeconomic development. Gender and age-specific analysis revealed that men and older populations face a higher burden, with the gap widening with age. The burden was negatively correlated with socioeconomic development. Predictions indicate a continued decrease in LRI burden due to secondhand smoke, while the LRI burden caused by ambient particulate matter and household air pollution may experience a rebound around 2035.

Conclusion

While the global burden of air pollution-related LRI in older adults has decreased, regions with lower economic development, particularly in parts of Asia and Africa, continue to face high and rising burdens. Efforts should focus on strengthening the resilience of high-risk groups and implementing targeted interventions.

Performance of the World Health Organization (WHO) severe acute respiratory infection (SARI) case definitions in hospitalized children and youth: cross-sectional study

Background

Respiratory tract infections with viral pathogens are frequently identified using the World Health Organization (WHO) case definition of severe acute respiratory infection (SARI), defined as fever of ≥38°Celsius, cough, onset within 10 days, and hospitalization. While there is extensive research in adults, less is known about the WHO SARI case definition performance in children and youth. We aimed to determine the performance of the WHO SARI and modified case definitions in identifying viral respiratory tract infections in hospitalized children and youth.

Methods

Retrospective observational cross-sectional study of hospitalized children (0-18 years) with an acute respiratory infection and who received a respiratory viral test at two large Canadian children's hospitals from July 2022 to June 2023. The WHO SARI and modified SARI case definitions were evaluated overall, by virus and age, with reporting of sensitivity and specificity.

Findings

There were 2333 hospital admissions, with a median age of 2.4 years (IQR 0.8-5.0). 78% (n = 1828) had one or more viruses identified, most commonly respiratory syncytial virus (30%, n = 709). The WHO SARI definition had a sensitivity of 58% and specificity of 49% for identifying infections with a microbiologically confirmed virus. For Influenza only, the sensitivity was 71% and specificity 44%. The lowest sensitivity was among young children <3 months (28%) and 3 to <6 months (45%). Modified SARI definitions had similarly poor performance, with trade-offs of sensitivity and specificity.

Interpretation

The widely implemented WHO SARI case definition has sub-optimal performance among children and youth hospitalized with acute respiratory infections. Public health surveillance based on these case definitions may inadequately detect and monitor known and emerging infections, highlighting the need to develop an accurate and reliable SARI case definition for children and youth globally.

Funding

Public Health Agency of Canada, SickKids Foundation, BC Children's Hospital.

Maintaining Immunizations for Vaccine-Preventable Diseases in a Changing World

Immunization has saved an estimated 154 million lives over the past 50 years since the launch of the Essential (formerly Expanded) Program on Immunization in 1974, representing 6 lives saved every minute, every year, for 50 years. But achieving and maintaining high immunization coverage have required sustained political and public commitment, financial resources, strong partnerships, research and innovation, and communication and advocacy. New and evolving challenges to maintaining high immunization coverage have emerged alongside long-standing stubborn obstacles. We review some of these key challenges to immunization in this dynamic, changing world and summarize some promising solutions. Success in some regions of the world in eliminating polio, measles, and rubella, and reducing morbidity and mortality from other vaccine-preventable diseases, should provide hope that progress can be made in achieving and maintaining high immunization coverage. We cannot afford to do otherwise.

Increased circulation of adenovirus in China during 2023-2024: Association with an increased prevalence of species B and school-associated transmission

OBJECTIVES

We report on the surge in human adenovirus (HAdV) cases in China starting in October 2023 and analyze the key drivers behind this increased circulation in the post-COVID-19 period.

METHODS

We analyzed targeted next-generation sequencing (tNGS) data from 1,875,862 hospitalized acute respiratory infection (ARI) cases across 4758 hospitals in 314 cities throughout all 31 provinces of mainland China. An in-house script was used to analyze the positivity rates of different HAdV species nationwide and across various provinces. We also assessed the age-specific infection risk for HAdV species B and C using restricted cubic splines (RCS), and we tested differences in HAdV infection rates between vacation periods and school terms using the Kruskal-Wallis test.

RESULTS

We identified an increased prevalence of HAdV species B replacing circulating species C, and this increase was associated with elevated HAdV activity in China from October 2023 to August 2024. Age-specific analysis indicates that, compared to HAdV species C, HAdV species B has a higher infection rate in school-aged children. Comparison of HAdV incidence rates during school terms and vacations showed that schools are the primary transmission setting for HAdV species B. These findings strongly support the conclusion that school-associated cluster infections caused by HAdV species B are the drivers of the ongoing increased circulation of HAdV in China.

CONCLUSION

This study found that changes in susceptible populations and transmission settings due to an increased prevalence of HAdV species B were the key factors driving the elevated HAdV activity in China starting in October 2023.

Ambient formaldehyde combined with high temperature exposure and respiratory disease admissions among children: a time-series study across multiple cities

INTRODUCTION

Ambient formaldehyde (HCHO) is globally distributed, posing significant exposure to vast populations, particularly vulnerable demographics such as children. Investigations into the correlation between ambient HCHO exposure and children's respiratory ailments are deficient.

METHODS

Ambient HCHO exposure was retrieved from the TROPOspheric Monitoring Instrument. A two-stage time-series analysis was conducted to examine the relationship between HCHO exposure and hospital admission of respiratory diseases among 198 704 children in Jiangsu Province, China, from 2019 to 2021. Additionally, 12 exposure patterns were defined to further discern potential synergistic effects of HCHO and high temperature combined exposure.

RESULTS

After controlling for relevant covariates, our findings revealed HCHO exposure was associated with respiratory-related hospital admissions. Specifically, we identified a pronounced effect at lag 3 day, demonstrating a 1.14% increase (95% CI: 0.60%, 1.69%). Subgroup analyses further identified that warm season, 3-7 years old group and disadvantaged economic areas showed higher admission risk. Moreover, we found HCHO combined with high temperature exposure would trigger the elevated risk of hospital admission. Notably, in specific exposure scenarios, the cumulative relative risk reached up to 1.051 (95% CI: 1.025, 1.078), highlighting the synergistic effect of combined exposure on the respiratory health of children.

CONCLUSIONS

Ambient HCHO exposure increased hospital admission risks for respiratory diseases in children, and high temperature could trigger the elevated risk. To have an in-depth understanding of ambient HCHO health impact is critical for intervention strategies aimed at mitigating ambient HCHO pollution and regarding adverse impacts on children under a changing climate.

Non-exclusive breastfeeding is associated with pneumonia and asthma in under-five children: an umbrella review of systematic review and meta-analysis

BACKGROUND

Despite numerous reviews examining the impact of exclusive breastfeeding on preventing childhood pneumonia and asthma, a comprehensive and up-to-date synthesis is lacking. This umbrella review aims to consolidate the current evidence on the link between non-exclusive breastfeeding and the risk of pneumonia and asthma in under-five children.

METHODS

A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar to identify systematic review and meta-analysis (SRM) studies evaluating the effect of exclusive breastfeeding on preventing childhood pneumonia and asthma globally. The latest search was conducted on January 25/2025. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews Two (AMSTAR-2) tool. A weighted inverse variance random-effects model was employed to generate pooled estimates. Summary effect estimates were expressed using odds ratios (OR) with 95% confidence intervals (CI). We evaluated the quality of evidence for each association using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, categorising it as convincing (class I), highly suggestive (class II), suggestive (class III), and weak (class IV).

RESULTS

Twelve SRMs, including 270 primary studies with over ten million participants, were analysed. The random-effects model revealed a highly suggestive association between non-exclusive breastfeeding and an increase in the risk of pneumonia (OR 2.34; 95% CI 1.89, 2.78, GRADE: highly suggestive). Similarly, there was highly suggestive evidence that non-exclusive breastfeeding was associated with a 29% higher risk of childhood asthma (OR 1.21; 95% CI 1.07, 1.34, GRADE: highly suggestive).

CONCLUSION

Our results highlighted that non-exclusive breastfeeding is associated with an increased risk of pneumonia and asthma in under-five children. These findings emphasise the critical role of exclusive breastfeeding in reducing the risk of respiratory health issues, highlighting the need for policies and initiatives that promote breastfeeding as a key strategy for improving children's health outcomes.

Epidemiological and molecular characteristics of human parainfluenza virus in southern China during 2016-2020

Human parainfluenza viruses (HPIV) are common viral pathogens in acute respiratory infection (ARI). We aimed to describe the epidemiological and molecular characteristics of HPIV from ARI patients. This cross-sectional study was conducted using respiratory samples from 9,696 ARI patients between 2016 and 2020 in southern China. All samples were analyzed by quantitative real-time polymerase chain reaction to determine the presence of HPIV and other common respiratory viruses. Descriptive statistics were performed to determine the temporal and population distribution of HPIV. The full-length hemagglutinin-neuraminidase (HN) gene of HPIV3-positive samples was sequenced for phylogenetic analysis. A total of 577 (6.0%) patients tested positive for HPIV, with HPIV3 being the predominant serotype, accounting for 46.8% of cases. Notably, 66.0% of these HPIV-positive cases were children aged 0-2 years. The prevalence of HPIV infections showed a decreased trend and altered peak during 2016-2020. Cough, fever, sputum production, and rhinorrhea were common respiratory symptoms in HPIV-positive patients. The majority of cases had pneumonia (63.4%). Human rhinovirus (HRV) and human coronavirus (HCoV) were the most common coinfection viruses in HPIV-positive cases, with proportions of 20.1% and 14.4%, respectively. Phylogenetic analysis revealed that the predominant lineage of HPIV3 was C3f (86.0%), followed by lineage C3a (8.0%), C3d (4.0%), and C3b (2.0%). These findings help to better understand the epidemiology of HPIV, and improve public health strategies to prevent and control HPIV infections in southern China.

Integrating DNA and RNA sequencing for enhanced pathogen detection in respiratory infections

BACKGROUND

The clinical value of shotgun metagenomic next-generation sequencing (mNGS) in improving the detection rates of respiratory pathogens is well-established. However, mNGS is complex and expensive. This study designed and evaluated the performance of targeted NGS (tNGS) in diagnosing respiratory infections.

METHODS

We retrospectively included samples from 281 patients with lower respiratory tract infections to establish thresholds of pathogens. Subsequently, target pathogens were selected and a probe hybridization system was established. The performance and clinical manifestations of tNGS for 306 pathogens were evaluated using clinical and simulated samples.

RESULTS

The tNGS method took 16 h with sequencing data sizes of 5 M reads. The limit-of-detection of tNGS was 100-200 CFU/mL, respectively. Bioinformatics simulation confirmed the method's high specificity and robustness. In 281 patients of clinical validation cohort, tNGS exhibited a sensitivity of 97.73% and specificity of 75.41% compared to the composite reference standard, which notably surpasses those of culture-based and conventional microbiological methods (CMT). In detecting bacterial and viral infection, tNGS demonstrated superior sensitivity relative to CMT. Notably, 61.40% of target viruses were subtype-resolved with the initial establishment of reliable typing cutoffs, with the subtyping results being completely consistent with the PCR results. tNGS allowed for concurrent identification of antimicrobial resistance (AMR) markers and viral subtyping. 80.56% of AMR markers identified by tNGS were consistent with antimicrobial susceptibility testing.

CONCLUSION

This research established the robust performance of our tailored tNGS assay in the simultaneous detection of DNA and RNA pathogens, underscoring its prospective suitability for widespread use in clinical diagnostics.

Pulmonary Immunocompromise in Human Immunodeficiency Virus Disease

The spectrum of pulmonary disease in people with human immunodeficiency virus (PWH) across the lifespan has shifted from acute, infectious, and acquired immunodeficiency syndrome (AIDS)-defining illnesses to a greater burden of chronic, non-communicable processes. Here, the authors review the epidemiology and risk factors of pulmonary disease in PWH across the lifespan during the contemporary antiretroviral therapy era. The authors focus on recommendations for clinical care of pulmonary disease relevant to PWH, including emerging data from recent and ongoing clinical trials.

Unintended impacts of COVID-19 on the epidemiology and burden of paediatric respiratory infections

Acute respiratory infections (ARI), especially lower respiratory infections (LRI), are a leading cause of childhood morbidity and mortality globally. Non-pharmaceutical interventions (NPI) employed during the COVID-19 pandemic have impacted on the epidemiology and burden of paediatric ARI, although accurately describing the full nature of the impact is challenging. For most ARI pathogens, a reduction was observed in the early phase of the pandemic, correlating with the most stringent NPI. In later phases of the pandemic resurgence of disease was observed as NPI eased. This pattern was most striking for seasonal viruses, such as influenza and respiratory syncytial virus. The impact on ARI-associated bacterial disease varied; marked reductions in invasive Streptococcus pneumoniae and Streptococcus pyogenes were observed, followed by a resurgence that correlated with increases in respiratory viral infections. For Corynebacterium diphtheriae,Bordetella pertussis, andMycoplasma pneumoniae, a sustained reduction of disease was observed well into 2022 in most regions. Proposedmechanisms for the varied epidemiological disruption amongst ARI pathogens includedifferential effects of NPI on specific pathogens, population-level immunological effects, and ecological and genetic pathogen adaptations. Additionally, important indirect effects of pandemic restrictions on paediatric respiratory infections have been identified. These occurred as a result of disruptions to routine health services, reductions in vaccination coverage, and disruptions to respiratory infection research and surveillance activities. Impacts have been disproportionately borne by those in low resource settings. We discuss opportunities to leverage pandemic learnings to support improved understanding of the epidemiology of paediatric respiratory infections to inform future prevention and health system strengthening.

Subnational Evidence for the Attributable Burden of Respiratory Infections in China's Population under 20: Challenges from Particulate Matter Pollution

Respiratory infections and tuberculosis ranked as the second leading global causes of mortality in 2021. Following the methodology from the Global Burden of Disease Study (GBD) 2021, we aimed to estimate the attributable burden and risk factors of respiratory infections and tuberculosis among China's population under 20 from 1990 to 2021. In 2021, there were 652 million new cases and 12 699 deaths of respiratory infections and tuberculosis among people under 20 years old in China. We estimated 9054 (71.2%) deaths and 818 498 (54.6%) disability-adjusted life years (DALYs) from respiratory infections attributed to all evaluated risk factors. Mortality rates were the highest in Xizang, Xinjiang, and Qinghai in 2021, while they constantly decreased since 1990. Ambient particulate matter pollution was the second leading cause of death among males and first among females, accounting for nearly 1/5 of deaths from respiratory infections and tuberculosis in 2021. In 23 of 33 provinces, ambient particulate matter pollution was the first leading cause of death and DALY, while in Xizang and Gansu, it was not the major contributor to the burden. From 1990 to 2021, the burden from household air pollution declined remarkably in all 33 provinces except for Xizang and Gansu, while the population attributable fraction (PAF) of ambient particulate matter pollution continuously increased. The overall burden of respiratory infections and tuberculosis showed a declining trend, while it remained a fatal threat to infants in relatively less developed regions. The raised hazard of ambient particulate matter pollution underscored the necessity of the shift into the formulation of prevention and intervention strategies.

Effect of PM2.5 air pollution on the global burden of neonatal diarrhea from 1990 to 2019

The primary risk factor for global disease burden is prolonged exposure to particulate matter (PM) air pollution, which results in health problems and death. However, the global burden of diarrheal diseases attributable to PM2.5 remains unclear. Here, we offer a thorough evaluation of the burden of neonatal diarrheal illnesses caused by PM2.5 at the national, regional, and worldwide levels from 1990 to 2019. Information on disease burden related to PM2.5 was extracted from the Global Burden of Disease study 2019. The number and rates of mortality, disability-adjusted life years (DALYs) and the corresponding average annual percentage change (AAPC) were estimated according to disease, age, sex, sociodemographic index and location. In newborns, diarrhea caused by PM2.5 was a common cause of death (10,386 fatalities, 95% uncertainty interval [UI] 8295-13,008). Between 1990 and 2019, the estimated number of fatalities from diarrhea declined by 5.13% (95% UI 5.07-5.18). Diarrhea was also a leading cause of DALYs (929,000 DALYs, 743,000 to 1,161,000), with a decline of 5.11% (95% UI 5.06-5.16). Between 1990 and 2019, the burden of diarrheal illnesses linked to PM2.5 has declined, with a greater decline in household PM2.5 than in ambient PM2.5. In contrast to the global trend of declining diarrheal burden caused by household PM2.5, the burden of diarrheal illnesses caused by ambient PM2.5 increased in approximately one-fifth of the nations. The burden is asymmetrically distributed in less-developed countries. In conclusion, PM2.5-attributable diarrheal diseases continue to threaten public health. More effective strategies should be developed considering regional conditions worldwide to lower PM2.5-related burdens. This study includes evidence-based recommendations for reducing PM2.5 air pollution and preventing diarrheal illnesses.

Epidemiological Changes in Hospitalized Bronchiolitis in Children Under 2 Years of Age in Hangzhou Before and After COVID-19 Restriction Easing

Background

Bronchiolitis is a common cause of hospitalization in infants under 2 years of age. The epidemiological effects of changes in hygiene and social behaviors during COVID-19 restrictions on the disease is still debated. This study aimed to analyze the changes in the viral etiology of bronchiolitis in Hangzhou during the COVID-19 restriction period (2022) compared to the period following the easing of restrictions(2023).

Methods

This study collected data on patients under 2 years of age who were admitted for bronchiolitis to the Department of Pulmonology at the Children's Hospital, Zhejiang University School of Medicine (Hangzhou) from January, 1, 2022, to December 31, 2023. It also investigated seasonal variations in the incidence of bronchiolitis and pathogen distribution across different years.

Results

This study included a total of 697 children with bronchiolitis, with a median age of 7.5 (4.2-12.0) months. Of these, 68.9% were boys and 31.1% were girls. Compared to 2022, the number of bronchiolitis cases in 2023 (388 versus 309) and their proportion of lower respiratory tract infections (39.1% versus 28.2%) have significantly increased (p < 0.001). Whether in 2022 or 2023, respiratory syncytial virus (RSV) was the primary pathogen causing bronchiolitis among children under 12 months of age, while human rhinovirus (HRV) was the main pathogen in children aged 12-24 months. There was a shift in the timing of the peak of several viruses including RSV, human metapneumovirus (HMPV) and parainfluenza virus (PIV) infections in 2023. However, the epidemic trend of HRV presented no significant changes between 2022 and 2023.

Conclusion

The findings suggest that bronchiolitis hospitalizations increased markedly after COVID-19 restriction easing, particularly among children aged 12-18 months. There was a shift in the timing of the peak of several viruses including RSV, HMPV and PIV infections in 2023, emphasizing the need for hospitals to anticipate potential irregularities in time in the future.

The burden of acute respiratory infection attributable to fine particulate matter brought by dust storms among children under 5 years of age in low- and middle-income countries

BACKGROUND

Long-term exposure to fine particulate matter brought by dust storms (dust PM2.5) poses a significant risk to children's health, particularly those in low- and middle-income countries (LMICs). To quantify the impact of dust PM2.5 on children, current research focuses on acute respiratory infection (ARI) as a key health outcome, given its significant contribution to child mortality. However, the relationship used to evaluate the disease burden is mainly based on the total PM2.5 concentration, neglecting the specific effect of dust PM2.5 distinct from other PM2.5.This study aimed to develop a dust-specific exposure-response function (ERF) of ARI in children <5 years of age (U5-ARI) for future risk assessments.

METHOD

We combined population data derived from the Demographic and Health Survey covering 53 LMICs, with environmental data, including the gridded concentration of dust PM2.5. ARI in children <5 years of age (U5-ARI) was the outcome of interest, which was defined by a standard questionnaire-based method. The dust PM2.5 exposure was derived from the integration of two well-recognized datasets, and matched to each participant at the community level. We analyzed the linear association between the annual average dust PM2.5 concentration and the odds of U5-ARI with logistic regression and fixed effects after adjusting for multiple covariates. We also used the spline method to develop a dust-specific ERF. Based on the function, we estimated the burden of dust-associated U5-ARI across 100 LMICs and compared it with the results from two well-established functions of total PM2.5 mass.

RESULTS

The analysis of 1,223,118 children showed that a 10 μg/m3 increase in dust PM2.5 was associated with a 7.43% (95% confidence interval [CI]: 4.77-10.15%) increase in the odds of U5-ARI. The spline model indicated that the risk of U5-ARI increased monotonically and linearly with dust PM2.5 concentration with no evident effect threshold. In 2017, based on the dust-specific ERF, across the 100 LMICs, the number of dust-associated U5-ARI was estimated to be 159,000 (95% CI: 153,000-165,000), which was consistently higher than the estimates from ERFs based on total PM2.5 mass (142,000 [95% CI: 97,000-181,000] or 114,000 [95% CI: 80,000-153,000]). The long-term dust PM2.5 exposure contributed to 12-13% of all the children affected by U5-ARI between 2000 and 2017. The geographic hotspots were the arid and populous areas of South Asia and Africa.

CONCLUSION

This study provides critical insight into the association between long-term exposure to dust PM2.5 and the health of children in LMICs, highlighting the need for specific ERFs to distinguish the adverse effects of different PM2.5 components. Personal protection during sand dust storms can be an effective intervention to safeguard the respiratory health of children.

The role of viral interaction in household transmission of symptomatic influenza and respiratory syncytial virus

The role of viral interaction-where one virus enhances or inhibits infection with another virus-in respiratory virus transmission is not well characterized. This study used data from 4029 total participants from 957 households who participated in a prospective household cohort study in Southeast Michigan, U.S.A to examine how viral coinfection and cocirculation may impact transmission of symptomatic influenza and respiratory syncytial virus infections. We utilized multivariable mixed effects regression to estimate transmission risk when index cases were coinfected with multiple viruses and when viruses cocirculated within households. This analysis included 201 coinfections involving influenza A virus, 67 involving influenza B virus, and 181 involving respiratory syncytial virus. We show that exposure to symptomatic coinfected index cases was associated with reduced risk of influenza A virus and respiratory syncytial virus transmission compared to exposure to singly infected cases, while infection with another virus was associated with increased risk of acquisition of these viruses. Exposure to coinfected cases among contacts infected with other viruses was associated with increased risk of influenza B virus acquisition. These results suggest that viral interaction may impact symptomatic transmission of these viruses.

Clinical evaluation of a highly multiplexed CRISPR-based diagnostic assay for diagnosing lower respiratory tract infection: a prospective cohort study

OBJECTIVE

Accurate and rapid identification of causative pathogens is essential to guide the clinical management of lower respiratory tract infections (LRTIs). Here we conducted a single-centre prospective study in 284 patients suspected of lower respiratory tract infections to evaluate the utility of a nucleic acid test based on highly multiplexed polymerase chain reaction (PCR) and CRISPR-Cas12a.

METHODS

We determined the analytical and diagnostic performance of the CRISPR assay using a combination of reference standards, including conventional microbiological tests (CMTs), metagenomic Next-Generation Sequencing (mNGS), and clinical adjudication by a panel of experts on infectious diseases and microbiology.

RESULTS

The CRISPR assay showed a higher detection rate (63.0%) than conventional microbiological tests (38.4%) and was lower than metagenomic Next-Generation Sequencing (72.9%). In detecting polymicrobial infections, the positivity rate of the CRISPR assay (19.4%) was higher than conventional microbiological tests (3.5%) and lower than metagenomic Next-Generation Sequencing (28.9%). The overall diagnostic sensitivity of the CRISPR assay (67.8%) was higher than conventional microbiological tests (41.8%), and lower than metagenomic Next-Generation Sequencing (93.2%).

CONCLUSIONS

Considering the low cost, ease of operation, short turnaround time, and broad range of pathogens detected in a single test, the CRISPR assay has the potential to be implemented as a screening tool for the aetiological diagnosis of lower respiratory tract infections patients, especially in cases where atypical bacteria or coinfections are suspected.

A 32-year trend analysis of lower respiratory infections in children under 5: insights from the global burden of disease study 2021

Objectives

Lower respiratory infections are the most significant health threat to children under 5 years old, leading to the highest disease burden across all age groups. This study aims to provide an up-to-date assessment of the global burden of lower respiratory infections in children under 5 years of age.

Methods

This study utilizes data and methodologies from the Global Burden of Disease Study 2021 to analyze changes in the burden of lower respiratory infections from 1990 to 2021, focusing on incidence, mortality, and disability-adjusted life years. A jointpoint model is employed to calculate trends and the average annual percentage change in the disease burden among children under 5 years old over the period 1990-2021. Additionally, frontier analysis is used to visually depict the potential for burden reduction in each country or region based on their level of development.

Results

In 2021, the global burden of lower respiratory infections in children under 5 years old included 37,828,159 incidence cases, 501,909.50 deaths, and 44,779,174.70 disability-adjusted life years. From 1990 to 2021, the global burden of LRIs in this age group showed a marked decline. Incidence, mortality, and disability-adjusted life years decreased by 54.02, 37.57, and 39.49%, respectively. The average annual percent change for age-standardized incidence rate, age-standardized mortality rate, and age-standardized disability-adjusted life years rate were -3.35, -4.53%, and -4.52%, respectively. The disease burden was notably higher in children under 1 year old compared to those aged 2-4 years and the overall under-5 age group, with significant gender differences observed. Additionally, there was a strong negative correlation between the burden of lower respiratory infections in children under 5 and the socio-demographic index. Frontier analysis indicated that countries or regions with higher socio-demographic index values showed greater potential for reducing the burden.

Conclusion

The global burden of lower respiratory infections in children under 5 years old has declined significantly from 1990 to 2021. However, given the substantial disease burden, particularly in low-SDI countries, it is crucial to address risk factors and implement more effective interventions to further reduce the impact of lower respiratory infections on this vulnerable population.

Utilizing Targeted Next-Generation Sequencing for Rapid, Accurate, and Cost-Effective Pathogen Detection in Lower Respiratory Tract Infections

Objective

To evaluate the diagnostic performance and clinical impact of targeted next-generation sequencing (tNGS) in patients with suspected lower respiratory tract infections.

Methods

Following propensity score matching, we compared the diagnostic performances of tNGS and metagenomic next-generation sequencing (mNGS). Furthermore, the diagnostic performance of tNGS was compared with that of culture, and its clinical impact was assessed.

Results

After propensity score matching, the coincidence rate of tNGS was comparable to that of mNGS (82.9% vs 73.9%, P=0.079). The detection rates for bacterial, viral, fungal, and mixed infections were not significantly different (P>0.05). Bacterial-viral co-infection (16.7%) was the most common mixed infection detected by tNGS. tNGS showed a higher detection rate than culture (75.2% vs 19.0%, P<0.01). The positive detection rate by tNGS was not significantly different between immunocompromised and immunocompetent patients (88.6% vs 80.5%, P=0.202), but was significantly higher than that by culture (P<0.001). Moreover, 65 patients (44.5%) had their medications modified based on the tNGS results, and the majority exhibited notable improvement regardless of treatment adjustment.

Conclusion

tNGS performs comparably to mNGS and surpasses culture in detecting lower respiratory tract infections. Nevertheless, tNGS is faster and more cost-effective than mNGS, making it highly significant for guiding rational treatment.

Assessing and projecting the global impacts of Alzheimer's disease

Background

This study aims to assess the global burden of Alzheimer's disease (AD) from 1990 to 2030, with a focus on incidence, mortality, and disability-adjusted life years (DALY).

Methods

Data on the incidence rates, DALY rates, and death rates of AD across various geographic populations from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Generalized Additive Models (GAMs) were employed to forecast the disease burden from 2022 to 2030.

Results

The projected global burden of Alzheimer's disease from 2022 to 2030 indicates a decrease in DALYs, with an Estimated Annual Percentage Change (EAPC) of -1.44 (95% CI: -1.45, -1.42). Similarly, death rates and incidence rates also show a decline, with EAPCs of -1.80 (95% CI: -1.83, -1.77) and -1.27 (95% CI: -1.29, -1.26) respectively. Gender-specific analysis reveals that the projected global incidence EAPC from 2022 to 2030 is estimated at -1.73 (95% CI: -1.75, -1.70) for males and -1.03 (95% CI: -1.04, -1.02) for females. Regionally, Andean Latin America and the Caribbean exhibit the highest positive EAPCs for DALYs at 0.94 (95% CI: 0.93, 0.94) and 0.59 (95% CI: 0.59, 0.60) respectively, while Eastern Europe shows the lowest EAPC at -16.31 (95% CI: -18.60, -13.95). Country-specific projections highlight Cyprus and Serbia with the highest positive EAPCs for DALYs at 12.55 (95% CI: 11.21, 13.91) and 9.6416 (95% CI: 8.86, 10.4333) respectively. On the other hand, Bahrain and Armenia exhibit significant negative EAPCs at -87.28 (95% CI: -94.66, -69.70) and -85.41 (95% CI: -92.80, -70.41). An analysis based on the Socio-Demographic Index (SDI) reveals that regions with higher SDI values have greater burdens of AD, with countries having SDI ≥ 0.8 showing significantly higher age-standardized Incidence Rates (ASIR), age-standardized Death Rates (ASDR), and age-standardized DALY rates compared to those with SDI < 0.8.

Conclusion

From 1990 to 2030, global burden of AD is projected to decrease, with significant gender and regional disparities. Regions with higher SDI show higher disease burdens, underscoring the necessity for targeted interventions and customized public health strategies to effectively address AD in varied socio-economic settings.

Sociodemographic index-age differences in the global prevalence of cardiovascular diseases, 1990-2019: a population-based study

BACKGROUND

This study aims to assess the global burden and trends in cardiovascular diseases (CVDs) prevalence, stratified by sociodemographic index (SDI) categories and age groups, across 204 countries and territories.

METHODS

Utilizing data from the Global Burden of Disease Study 2019, this study analyzed trends in the age-standardized prevalence rate of overall and type-specific CVDs, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory diseases. Age-standardized prevalence rates were stratified by SDI categories (low, low-middle, middle, high-middle, and high) and age groups (0-14, 15-49, 50-69, and ≥ 70 years). The corresponding average annual percentage change was calculated to assess temporal trends.

RESULTS

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (95% UI 6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13). When stratified by SDI category, the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries but increased in middle, low-middle, and low SDI countries. By age group, the age-standardized prevalence rate of CVD declined in the 50-69 and ≥ 70 years groups but increased in the 0-14 and 15-49 years groups. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and age groups. Low SDI countries consistently showed the highest age-standardized prevalence rates of CVD in the younger age groups (0-14 and 15-49 years), while high-middle SDI countries had the highest rates in the older age groups (50-69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0-14 and 15-49 years groups and positively associated with SDI levels in the 50-69 and ≥ 70 years groups. Type-specific CVDs such as rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease showed increased age-standardized prevalence rates from 1990 to 2019.

CONCLUSIONS

This study highlights significant disparities in CVD prevalence across sociodemographic and age groups. While the global prevalence of CVD has generally decreased, the rise in CVD prevalence in lower SDI countries and younger populations calls for tailored intervention strategies. Addressing these disparities is crucial to mitigating the growing burden of CVD and promoting cardiovascular health on a global scale.

Circulating levels of adiponectin and AdipoR expression in peripheral blood mononuclear cells are associated with lower respiratory tract Infection

Objective

The role of adiponectin (APN) in regulating inflammation is well recognized in metabolic disease, but the dysregulation of APN in lower respiratory tract infection (LRTI) remains controversial. We aimed to measure APN and its signaling receptors, adiponectin receptor (AdipoR), in peripheral blood mononuclear cells (PBMCs) from LRTI patients to explore their potential roles in the LRTI process.

Methods

A total of 99 LRTI patients from the Second Xiangya Hospital of Central South University were categorized into acute (n=35) and non-acute (n=64), and non-severe (n=62) and severe (n=37) groups. Serum APN was quantified using ELISA, and mRNA levels of PBMC AdipoRs were determined by RT-qPCR.

Results

Both levels of APN in circulation and AdipoR1 mRNA were significantly elevated in the LRTI patients (P=2.61E-04; P=2.49E-08), while no statistical difference was observed for AdipoR2. APN levels were increased in the non-acute group compared to the acute group (P=6.06E-04) and AdipoR1 levels were higher in the severe group (P=0.004). Increased APN and AdipoR1 mRNA levels were positively associated with LRTI even after adjustment for sex, age, BMI and blood lipids (OR=1.10; 95% CI 1.04-1.18; P=9.61E-04; OR=2.69; 95% CI 1.29-5.58; P=0.008). Subgroup analyses based on sex, age, and BMI revealed APN elevation in males, ≥65-year-olds, and overweight individuals, with higher AdipoR2 mRNA in females and those under 65; AdipoR1 was uniformly elevated. Additionally, APN was negatively correlated with lymphocyte count in acute and severe subgroup; AdipoR1 was positively correlated with indicators of inflammation in LRTI group.

Conclusion

Our study highlights that serum APN and AdipoR1 mRNA in PBMCs are associated with LRTI. Circulating APN and PBMC AdipoR1 have different significances in LRTI acute onset and severity.

Effect of diet low in omega-6 polyunsaturated fatty acids on the global burden of cardiovascular diseases and future trends: evidence from the Global Burden of Disease 2021

BACKGROUND

This research analyzes the worldwide impact of cardiovascular diseases (CVD) associated with low consumption of omega-6 polyunsaturated fatty acids, utilizing data from the 2021 Global Burden of Disease Study.

METHOD

The study explored the influence of diets deficient in omega-6 polyunsaturated fatty acids on CVD across global, regional, and national levels. It examined variations across different age groups and genders and analyzed the relationship between the disease burden and the socio-demographic index (SDI). Furthermore, it employed an ARIMA model to project the future prevalence of CVD linked to insufficient omega-6 intake until 2050.

RESULT

In 2021, insufficient omega-6 intake was linked to roughly 737.88 thousand deaths and 17.87 million disability-adjusted life years (DALYs) due to CVD, showing a decreasing trend in this health burden throughout the study period. The most significant effects were seen in individuals aged 75 and older, with a higher disease burden noted in males. Forecasts suggest likely declines in disease prevalence in regions with high SDI. On a national level, regions like Russia and various countries in North Africa and the Middle East might experience increasing challenges related to CVD due to low omega-6 intake by 2030 and 2050.

CONCLUSION

These results highlight the critical need for preventive strategies for CVD and stress the importance of managing dietary patterns to mitigate health risks.

Long-term exposure to air pollution and lower respiratory infections in a large population-based adult cohort in Catalonia

BACKGROUND

Evidence is limited regarding the role of air pollution in acute lower respiratory infections among adults. We assessed the influence of long-term air pollution exposure on hospital admission for lower respiratory infections and whether there are vulnerable subgroups.

METHODS

We used a populational cohort in Catalonia, Spain, comprising 3,817,820 adults residing in Catalonia as of January 1, 2015. Air pollution exposure was assigned to individuaĺs residential address using locally-developed models. We characterized the concentration-response functions between long-term air pollution exposure and hospital admission for lower respiratory infections between 2015 and 2019. We assessed interaction between exposure and clinical and socio-economic factors on multiplicative and additive scales.

RESULTS

An interquartile range exposure increase was associated with an 8 % (95 % Confidence Interval: 5 %-11 %) for Nitrogen Dioxide, 10 % (95 % Confidence Interval: 8 %-13 %) for Particulate Matter with diameter equal to or smaller than 2.5 µm, 5 % (95 % Confidence Interval: 3 %-7%) for Particulate Matter with diameter equal to or smaller than 10 µm and 18 % (95 % Confidence Interval: 14 %-22%) for ozone (adjusted by Nitrogen Dioxide) increase in hospital admissions for respiratory infections. Concentration-response functions were non-linear, with steeper slopes at exposures below the median or at most extreme high values. Associations were consistently greater for individuals over 65 years or with hypertension diagnosis and males.

CONCLUSIONS

Long-term exposure to air pollution was positively associated with hospital admission for lower respiratory infections. Individuals who were older than 65 years, hypertensive or male were most vulnerable.

Epidemiological characteristics of eleven common respiratory viral infections in children

BACKGROUND

Lower respiratory tract infections (LRTIs) are one of the leading causes of hospital admissions among children. In this study, we aimed to describe the epidemiological characteristics of viral pathogens associated with LRTIs in hospitalized children in Yan'an; this has yet to be reported in the literature and may guide public health interventions and resource allocation in this region.

METHODS

Between June 2021 and May 2023, we conducted a retrospective analysis of the results of viral detection using oral pharyngeal swabs from 4565 children with LRTIs in the Inpatient Department of Yan'an University Affiliated Hospital. Eleven respiratory viruses, including influenza A virus (Flu A), influenza A H1N1 virus (H1N1), seasonal influenza A H3N2 virus (H3N2), influenza B virus (Flu B), parainfluenza virus (HPIV), adenovirus (HADV), bocavirus (HBoV), rhinovirus (HRV), metapneumovirus (HNPV), coronavirus (HCoV), and respiratory syncytial virus (HRSV), were confirmed by applying a multiplex real-time polymerase chain reaction (PCR) kit for respiratory viruses. We evaluated the epidemiological features of infections caused by respiratory pathogens, including aging, gender and the seasonal variations of different pathogens, and explored the high-risk factors associated with virus-caused pneumonia.

RESULTS

At least one virus was detected in all 4565 cases; the positivity rate was 27.95%. We also detected a total of 1,276 cases with mixed infections (with two or more viruses). Of the positive cases, 59.3% were male and 40.7% were female (x2 = 0.41, P = 0.68). The highest positivity rates for respiratory pathogens were observed for HRSV, HRV, and HADV, at 5.98%, 5.67%, and 4.38%, respectively. We also observed variations in the number and positivity rates of respiratory pathogen infections by season, age and gender. HPIV (x2 = 12.05, P < 0.05) and HADV (x2 = 11.73, P < 0.05) were more common in children under three years-of-age. Notably, with the exception of the 1 to < 3 years age group, males consistently demonstrated elevated infection rates across other age groups.

CONCLUSIONS

Our analysis revealed that respiratory pathogen infections varied by gender, season, and age in the enrolled population of children.

A systematic analysis of the burden of disease attributable to occupational noise-induced hearing loss in China based on the 2019 global burden of disease study

BACKGROUND

Occupational noise has long been recognized as a significant risk factor for hearing loss, particularly among workers. This study aimed to assess the disease burden of hearing loss caused by occupational noise in China from 1990 to 2019, with a focus on differences across sex and age groups, so as to address the existing gaps in the Global Burden of Disease Study (GBD) reports. By analyzing changes in years lived with disability (YLDs) among different sex and age groups over the past 30 years, this study provides valuable insights for the development of occupational noise safety measures in China.

METHODS

We extracted data on the burden of hearing loss attributable to occupational noise from the 2019 Global Burden of Disease study. R software (version 4.12) was used to calculate the YLDs, age-standardized rates (ASRs), and average annual percent change (AAPC), stratified by age and sex. The Joinpoint regression model was used to analyze the trends in the burden of disease attributable to occupational noise exposure from 1990 to 2019.

RESULTS

In China, the YLDs attributable to occupational noise-induced hearing loss in 2019 were 2.3277 million [95% uncertainty interval (UI): 1.5779-3.3478 million, marking a 70.95% increase compared with that in 1990. Throughout the study period, YLD rates exhibited a declining trend, with rates of 127.7 per 100,000 (95% UI: 87.4-181.4) in 1990 and 119.8 per 100,000 (95% UI: 81.2-182.1) in 2019. Using the Joinpoint regression model, the annual percent change (APC) in age-standardized YLD rates for occupational noise-related hearing loss initially increased from 1990 to 2000, followed by a decline, reaching its lowest point in 2015. From a sex perspective, the burden of YLDs in Chinese males exceeded that in females, although the rate of decline was less pronounced in females. With regard to age, the number and rate of YLDs attributable to occupational noise-induced hearing loss generally increased with age, particularly among middle-aged individuals and older adults. However, from 1990 to 2019, the number of YLDs attributable to occupational noise-induced hearing loss decreased among young people aged 15-19 years, accompanied by a significant reduction in YLDs rates.

CONCLUSION

Hearing loss attributable to occupational noise represents a substantial public health concern, especially among middle-aged and older adult workers in China. These findings underscore the importance of implementing effective measures to mitigate occupational noise exposure.

Long-term trends and comparison of the burden of lower respiratory tract infections in China and globally from 1990 to 2021: an analysis based on the Global Burden of Disease study 2021

Background

This study aimed to describe the temporal trends in the age and sex burdens of lower respiratory infections (LRIs) in China and globally from 1990 to 2021 and to analyze their epidemiological characteristics to formulate corresponding strategies to control LRIs.

Methods

This study utilized open data from the Global Burden of Disease (GBD) database from 1990 to 2021 to assess the burden of disease based on the prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of LRIs in China and globally. Moreover, a comprehensive comparative analysis of the epidemiological characteristics of LRIs in China and globally was conducted via the Joinpoint regression model, age-period-cohort model (APC model), and stratified analysis of the study method from multiple dimensions, such as age, sex, and period. Finally, we used an autoregressive integrated moving average (ARIMA) model to predict the disease burden in LRIs over the next 15 years.

Results

From 1990 to 2021, China's age-standardized incidence, deaths, and disability-adjusted life year (DALY) rates per 100,000 people decreased from 5,481.13 (95% CI: 5,149.05, 5,836.35) to 2,853.81 (95% CI: 2,663.94, 3,067.55), from 60.65 (95% CI. 52.96, 66.66) to 14.03 (95% CI: 11.68, 17) and from 3,128.39 (95% CI: 2,724.11, 3,579.57) to 347.67 (95% CI: 301.28, 402.94). The global age-standardized incidence, deaths, and DALY rates per 100,000 people, on the other hand, decreased from 6,373.17 (95% CI: 5,993.51, 6,746.04) to 4,283.61 (95% CI: 4,057.03, 4,524.89) and from 61.81 (95% CI: 56.66, 66.74) to 28.67 (95% CI: 25.92, 31.07) and from 3,472.9 (95% CI: 3,090.71, 3,872.11) to 1,168.8 (95% CI: 1,016.96, 1,336.95). The decline in the aforementioned indicators is greater in the female population than in the male population, and the decrease in China is more pronounced than the global trend. In China, the age-standardized incidence and mortality rates of LRIs showed an annual average percentage change (AAPC) of -2.12 (95% CI: -2.20, -2.03) and -4.77 (95% CI: -5.14, -4.39), respectively. Globally, the age-standardized incidence and mortality rates for LRIs decreased by -1.28 (95% CI: -1.37, -1.18) and -2.47 (95% CI: -2.61, -2.32). By 2036, the incidence of lower respiratory infections (LRI) among men and women in China is projected to decrease by 36.55 and 46.87%, respectively, while the mortality rates are expected to decline to 12.67% for men and increase by 71.85% for women. In comparison, the global decline in LRI incidence is lower than that observed in China, yet the reduction in mortality rates is greater globally than in China.

Conclusions

Age-standardized incidence, mortality and disability-adjusted life years (DALYs) decreased more in China than at the global level between 1990 and 2021. Compared with the previous period, the COVID-19 pandemic has led to a significant decrease in the disease burden of LRIs. As the population continues to age, the disease burden of LRIs in the old adult population will become a major new public health challenge.

Weekly Vitamin D Supplementation to Prevent Acute Respiratory Infections in Young Children at Different Latitudes: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of weekly vitamin D supplementation in reducing the number of acute respiratory infections (ARI) in preschool children.

STUDY DESIGN

Randomized, double-blind, placebo-controlled trial in 303 children aged 1.5-3.5 years from 2014 to 2105 in 3 Chilean cities at different latitudes: Santiago (33°S, n = 101), Talcahuano (37°S, n = 103), and Punta Arenas (53°S, n = 99). Participants were allocated (1:1:1) to receive placebo, cholecalciferol (vitamin D3 (VD3)) 5600 IU/week (low-dose), or 11 200 IU/week (high-dose) for 6 months. Primary outcome was parent-reported number of ARI; secondary outcomes included number of ARI hospitalizations, change of serum 25-hydroxyvitamin D (25(OH)D) and LL-37/cathelicidin levels, and adverse events.

RESULTS

The mean age of participants was 26 ± 6 months; 45% were female. Baseline 25(OH)D was 24.9 ± 6.1 ng/ml, with 23% having 25(OH)D <20 ng/ml. No significant baseline clinical or laboratory differences were observed among groups. Overall, 64% (n = 194) completed study participation, without baseline differences between subjects lost to follow-up vs those completing participation or differences in completion rates across groups. After 6 months, a dose-dependent increase in serum 25(OH)D was observed from the VD3 intervention (P < .001), with a higher proportion of subjects ending the trial with 25(OH)D <20 ng/ml in the placebo group (30.8%) vs the low-dose (7.4%) and high-dose groups (5.1%). However, no group differences were observed in number of ARI (P = .85), ARI hospitalizations (P = .20), LL-37/cathelicidin change (P = .30), or adverse events (P = .41).

CONCLUSIONS

While weekly VD3 supplementation, in doses equivalent to 800 IU and 1600 IU daily, was associated with improved 25(OH)D levels in preschoolers, we did not find a reduced number of ARI in this sample.

Effect of water and sanitation, PM pollution and climate change of COPD and LRIs under different sociodemographic transitions

OBJECTIVES

To estimate the burden of chronic obstructive pulmonary disease (COPD) and lower respiratory tract infections (LRIs) stratified by geographic location, and social-demographic status for 21 regions across the world from 1990 to 2019.

STUDY DESIGN

The analysis utilized data from the Global Burden of Disease (GBD) Study, focusing on mortality and disability-adjusted life years (DALYs) as measures of COPD and LRI burden. Trend analyses using the Joinpoint model were conducted across five socio-demographic index (SDI) quintiles.

METHODS

We investigated the burden of COPD and LRIs employing restricted cubic splines to flexibly identify relationships between DALY rates and SDI. This method allowed for detailed examination of trends over time across different regions and socio-demographic contexts.

RESULTS

From 1990 to 2019, the ASMR of COPD attributed to PM for global and five SDI quintiles decreased 61.80 %, 53.41 %, 63.04 %, 63.00 %, 40.98 %, 12.14 % respectively. In terms of PM Pollution, there was an inverted U-shaped association between the DALY and SDI for COPD, the DALY rate associated with LRIs due to PM pollution exhibited a progressive decline as SDI increased.

CONCLUSION

Even though the trend in mortality and DALY of COPD and LRIs decreased globally, the COPD and LRI burden attributed to PM pollution remains high, particularly in lower SDI quintiles.

Etiological analysis of acute respiratory infections in hospitalized children after the relaxation of COVID-19 non-pharmacological interventions in Quzhou, China

BACKGROUND

Acute respiratory infections (ARIs) can cause morbidity and mortality in children. This study was to determine the characteristics of pathogens in hospitalized children with ARIs after the relaxation of COVID-19 non-pharmacological interventions (NPIs) in Quzhou, China.

METHODS

Hospitalized children with ARIs were enrolled between May and October 2023, and thirteen common respiratory pathogens were tested by fluorescent quantitative polymerase chain reaction. Mono- and co-infections were assessed, and the association between pathogens and age was explored using restricted cubic spline analysis.

RESULTS

A total of 1225 children were included, 820 of them detected one pathogen and 238 of them detected two or more pathogens. The dominant pathogen varies monthly. Mycoplasma pneumoniae (Mp) was the most common pathogen in monoinfection, followed by respiratory syncytial virus (RSV) and human rhinovirus (HRV), while influenza virus was detected at a lower rate. Mp + HRV was the most common combination of coinfections. The detection rates of Mp and HRV were higher in coinfections than in monoinfection, but there was no difference in the detection rate of RSV. Children aged 1-3 years had the highest positive detection rates and were more likely to be infected with multiple pathogens, with 40% of respiratory pathogen monoinfection and 47.48% of coinfections (χ2 = 4.245, P = 0.039). In the restricted cubic spline models, a J-shaped association was consistently observed between age and Mp infection, the risk of HRV first increased and then decreased, the risk of RSV was relatively flat until 1.5 years and then decreased rapidly.

CONCLUSION

Our study revealed the epidemiological characteristics of ARIs pathogens after the relaxation of NPIs. The positivity rates of Mp, RSV, and HRV are the highest, while those of influenza virus are still low. Additionally, age and season affect the distribution of respiratory pathogens. These findings underscore the importance of ongoing regional pathogen surveillance to guide local public health responses.

Trends in mortality from lower respiratory infections in children under 14 years, 1990-2019: An analysis of the Global Burden of Disease Study 2019

Background

Lower respiratory infections (LRIs) remain a leading cause of mortality among children, yet previous studies have primarily focused on children under 5 years of age as a whole, with limited research on more specific age groups. This study aimed to analyze the trends in mortality associated with lower respiratory infections (LRIs) among children under 14 years of age from 1990 to 2019, with particular attention to regional and age-specific disparities.

Methods

We collected annual lower respiratory infection (LRI) deaths and mortality rates for six age groups of children under 14 years from 1990 to 2019 using data from GBD 2019. Estimated annual percentage changes (EAPCs) were calculated by fitting a linear regression model to quantify temporal trends. Additionally, EAPCs for 12 risk factors by Socio-Demographic Index（SDI） and age group were calculated to assess their impact on changes in LRI mortality.

Results

Globally, LRI-related deaths among children under 14 years decreased by 68.81 %, from 2,290,115 (95 % UI 2,001,328 to 2,687,160) in 1990 to 714,315 (95 % UI 588,975 to 875,975) in 2019. The most substantial reduction was observed in East Asia, with an EAPC of -9.68 (95 % CI -9.98 to -9.38). The highest mortality occurred in the 28-364 days age group, with significant risk factors including child wasting (26.81 %), household air pollution from solid fuels (16.14 %), and low birth weight (10.15 %). In the low and lower-middle SDI regions, there was an upward trend in mortality due to ambient particulate pollution among children aged 10-14 years.

Conclusion

Despite a significant global decline in LRI mortality among children under 14 years from 1990 to 2019, regional disparities persist. Addressing these inequalities and considering the developmental stages of children are crucial for further reducing child mortality rates.

Effect of Inspiratory Muscle Training on Cough Strength in Older People With Frailty: A Single-Blind Randomized Controlled Trial

OBJECTIVE

To investigate the effect of inspiratory muscle training (IMT) on cough strength in older people with frailty.

DESIGN

Single-blind randomized controlled trial.

SETTING

Day health care centers at 2 sites.

PARTICIPANTS

Older people with frailty (N=60).

INTERVENTIONS

Eligible people were randomly assigned to receive IMT program in addition to general exercise training (IMT group), or general exercise training alone (control group). The IMT group performed training using a threshold IMT device with the load set at 30% of maximum inspiratory mouth pressure in addition to the general exercise training program throughout the 8 weeks. The IMT took place twice a day and each session consisted of 30 breaths.

MAIN OUTCOME MEASURES

Primary outcome was cough strength, measured as the cough peak flow (CPF), at the beginning and the end of the program.

RESULTS

Data from 52 participants (26 in each group) were available for the analysis. The mean age was 82.6 years; 33% were men. The change in CPF at the end of the program was 28.7±44.4 L/min in the IMT group and -7.4±26.6 L/min in the control group. A linear regression model showed that the presence or absence of IMT was associated with changes in CPF (mean difference between groups, 36.3; 95% confidence interval, 16.7-55.9; effect size, 0.99).

CONCLUSIONS

IMT may be a useful intervention to improve cough strength in frail older people.

Air Pollution Metabolomic Signatures and Chronic Respiratory Diseases Risk: A Longitudinal Study

BACKGROUND

Although evidence has documented the associations of ambient air pollution with chronic respiratory diseases (CRDs) and lung function, the underlying metabolic mechanisms remain largely unclear.

RESEARCH QUESTION

How does the metabolomic signature for air pollution relate to CRD risk, respiratory symptoms, and lung function?

STUDY DESIGN AND METHODS

We retrieved 171,132 participants free of COPD and asthma at baseline from the UK Biobank, who had data on air pollution and metabolomics. Exposures to air pollutants (particulate matter with diameter ≤ 2.5 μm [PM2.5], particulate matter with a diameter ≤ 10 μm, nitrogen oxide [NOX], and NO2) were assessed for 4 years before baseline considering residential address histories. We used 10-fold cross-validation elastic net regression to identify air pollution-associated metabolites. Multivariable Cox models were used to assess the associations between metabolomic signatures and CRD risk. Mediation and pathway analysis were conducted to explore the metabolic mechanism underlying the associations.

RESULTS

During a median follow-up of 12.51 years, 8,951 and 5,980 incident COPD and asthma cases were recorded. In multivariable Cox regressions, air pollution was positively associated with CRD risk (eg, hazard ratio per interquartile range increment in PM2.5, 1.09; 95% CI, 1.06-1.13). We identified 103, 86, 85, and 90 metabolites in response to PM2.5, particulate matter with a diameter ≤ 10 μm, NOX, and NO2 exposure, respectively. The metabolomic signatures showed significant associations with CRD risk (hazard ratio per SD increment in PM2.5 metabolomic signature, 1.11; 95% CI, 1.09-1.14). Mediation analysis showed that peripheral inflammatory and erythrocyte-related markers mediated the effects of metabolomic signatures on CRD risk. We identified 14 and 12 perturbed metabolic pathways (energy metabolism and amino acid metabolism pathways, etc) for PM2.5 and NOX metabolomic signatures.

INTERPRETATION

Our study identifies metabolomic signatures for air pollution exposure. The metabolomic signatures showed significant associations with CRD risk, and inflammatory- and erythrocyte-related markers partly mediated the metabolomic signatures-CRD links.

Sex differences in the impact of lower respiratory tract infections on older adults' health trajectories: a population-based cohort study

BACKGROUND

Lower respiratory tract infections (LRTIs) are a major global health concern, particularly among older adults, who have an increased risk of poorer health outcomes that persist beyond the acute infectious episode. We aimed to investigate the mid-term (up to 7 years) and long-term (up to 12 years) effects of LRTIs on the objective health status trajectories of older adults, while also considering potential sex differences.

METHODS

Cohort data of adults aged ≥ 60 years from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) collected between 2001 and 2016 was analyzed. Information on LRTIs was obtained from the Swedish National Patient Register, and objective health status was assessed using the Health Assessment Tool (HAT) which incorporates indicators of mild and severe disability, cognitive and physical functioning, and multimorbidity. The LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders. Mixed linear models were used to analyze the association between LRTIs and changes in HAT scores.

RESULTS

The study included 2796 participants, 567 of whom were diagnosed with a LRTI. LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period.

CONCLUSION

LRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age.

High sodium intake increases interstitial lung disease and pulmonary sarcoidosis based on the Global Burden of Disease study 1999-2019

This study investigated the relationships between dietary sodium intake and the incidence and prevalence of interstitial lung disease (ILD) and pulmonary sarcoidosis using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. This study assessed the strength of the abovementioned relationships via LASSO analysis and a generalized additive model with Poisson regression and determined the nonlinear and lagged effects via a distributed lag nonlinear model (DLNM). In the past three decades, global dietary sodium intake has decreased gradually. Two LASSO and generalized additive analyses both suggested that dietary sodium intake is obviously correlated with the incidence and prevalence of ILD and pulmonary sarcoidosis. The overall exposure‒response curve revealed a dose‒effect relationship between dietary sodium intake and the incidence and prevalence of ILD and pulmonary sarcoidosis. The maximum lag-specific RR of extremely high dietary sodium intake was 1.75 (95% CI: 1.61-1.91, lag 0 year) for incidence and 3.19 (95% CI: 2.24-4.53, lag 0 year) for prevalence relative to the reference. Our study suggests that dietary sodium intake is positively associated with the incidence and prevalence of ILD and pulmonary sarcoidosis. These findings may have important policy implications for dietary sodium intake-reduction strategies to decrease the burden of respiratory diseases and promote public health.

Systematic analysis and prediction of the burden of lower respiratory tract infections attribute to non-optimal temperature, 1990-2019

Background

Lower respiratory infections (LRIs) remain one of the most deadly infectious diseases in the world, and non-optimal temperature is a risk factor for LRIs. The aim of this study was to analyze the global burden of LRI attribute to non-optimal temperature and its trends from 1990 to 2019, and to project long-term trends.

Methods

Excerpts from the release of the 2019 Global Burden of Disease (GBD) study, which analyses the burden of lower respiratory infections due to non-optimal temperatures from 1990 to 2019 using data on deaths and disability adjusted life years (DALYs); explores differences across regions, populations and seasons, and projects future trends in burden.

Results

Between 1990 and 2019, there is a significant downward trend in the global burden of deaths and DALYs, but it remains high in infants and young children, the older adult, African countries and LOW SDI regions. Differences in geographical risk factors and economic levels lead to heterogeneous disease burdens across regions. In 2019, low SDI regions will have the highest burden, but high SDI regions will have the highest number of deaths. In addition, increasing SDI values were associated with decreasing trends in age-standardized mortality rates and disability-adjusted life years. BAPC model projections suggest a downward trend in the future burden of death and DALYs from the disease, but the improvement in the burden of death for women was not significant.

Conclusion

Our study comprehensively elucidates the distribution and dynamic trends in the burden of lower respiratory tract infections due to non-optimal temperatures from 1990 to 2019 along multiple dimensions. The burden of deaths and DALYs showed an overall decreasing trend, but the improvement was uneven in different regions. In addition, the results suggest that efforts should be made to reduce lower respiratory health losses in infants, young children, and older adult populations. Effective public health policies and interventions to reduce the burden of lower respiratory tract infections should be sustained globally.

Effect of air pollution on the global burden of cardiovascular diseases and forecasting future trends of the related metrics: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

This study assesses the worldwide cardiovascular disease (CVD) burden attributed to air pollution, utilizing data from the Global Burden of Disease Study 2021.

METHODS

We explored the impact of air pollution on CVDs globally, regionally, and nationally, while considering correlations with age, gender, and socio-demographic index (SDI). A decomposition analysis was conducted to discern the contributions of aging, population growth, and epidemiological shifts to the changes in disability-adjusted life years (DALYs) from 1990 to 2021. Additionally, an ARIMA model was used to forecast the future CVD burden through 2050.

RESULTS

In 2021, air pollution was responsible for approximately 2.46 million deaths and 58.3 million disability-adjusted life years (DALYs) attributable to CVDs, with a discernible decrease over the period studied. The greatest impacts were observed in individuals aged 75-79 and over 80, particularly among males. The decomposition analysis indicated that shifts in epidemiology were the primary factors driving these changes. Future projections suggest potential increases in mortality and DALY rates in regions with low and high-middle SDI, alongside rising age-standardized death and mortality rates in high SDI areas.

CONCLUSION

These findings underscore the urgency of implementing targeted CVD prevention and air pollution control strategies to mitigate the impact on public health.

Trend of gastrointestinal and liver diseases in China: Results of the Global Burden of Disease Study, 2019

BACKGROUND

China is one of the countries with the largest burden of gastrointestinal and liver diseases (GILD) in the world. The GILD constitutes various causes of mortality and disability. The study aimed to investigate the trend of GILD in China using the Global Burden of Diseases Study 2019 (GBD 2019) data resources from 1990 to 2019.

METHODS

The data on the age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) for GILD in China from 1990 to 2019 were collected from the GBD 2019 data resources. Furthermore, the ranking of the main causes of deaths and DALYs, as well as the trends of ASMR, DALYs, years of life lost (YLLs), and years of life lost due to disability (YLDs) per 1,000,000 in GILD were reported.

RESULTS

The ASMR and DALYs for stomach cancer, liver cancer, and esophageal cancer, which ranked top three among the GILDs from 1990 to 2019, were gradually decreasing. Significant decreases in the ASMR and DALYs were found in diarrheal diseases and acute hepatitis (A, E, and C). However, noteworthy increases were found in those of colon and rectum cancer (CRC) and pancreatic cancer. Trend of DALYs, mortality, and YLLs rates for most of GILD were decreasing from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trend. The DALYs, mortality and YLLs of most GILD diseases showed decreasing trends from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trends.

CONCLUSIONS

The result of the GBD 2019 showed that the rates of most GILDs decreased in China; however, gastrointestinal and liver cancer, such as stomach cancer still held the top ranking. Furthermore, the shift from infectious diseases to non-communicable causes among GILD burden is occurring.

Development of a rapid method for the simultaneous determination of aminophylline, doxofylline, bromhexine, and ambroxol by HPLC

Introduction: Antitussive and expectorant drugs such as aminophylline (APL), doxofylline (DXL), bromhexine hydrochloride (BXH), and ambroxol hydrochloride (AXH), either individually or in combination, are widely used in the prevention and treatment of respiratory diseases. The study aimed to establish a high-performance liquid chromatography (HPLC) method for the simultaneous determination of these four drugs and to investigate their stability in 0.9% sodium chloride injection or 5% glucose injection over 48 hours. Methods: An InertSustain C18 column (150 mm × 4.6 mm, 5 μm) was used. The mobile phase consisted of acetonitrile and 50 mmol·L-1 potassium dihydrogen phosphate solution (pH 4.0) with gradient elution. The flow rate was 0.8 mL·min-1, and the column temperature was maintained at 30°C. The stability of APL, DXL, BXH, and AXH in 0.9% sodium chloride and 5% glucose injections over 48 h was determined using HPLC. Results: APL, DXL, BXH, and AXH showed good linearity within the ranges of 0.01 to 0.20, 0.003-0.06, 0.015-0.30, and 0.016-0.16 mg·mL-1, respectively (r > 0.999). The intraday and interday relative standard deviations were <2%, with recovery rates between 98.4% and 102.2%. The four drugs remained colorless and clear in infusion mixtures. The pH value fluctuated within ±0.3 over 48 hours, and the relative percentage content of the drugs ranged from 95.0% to 105.0%. Conclusion: The established HPLC method is simple, reliable, and stable, allowing for the simultaneous determination of the four antitussive and expectorant drugs. APL, DXL, BXH, and AXH were stable within 48 hours when mixed with 0.9% sodium chloride and 5% glucose injections.

Disease Burden and Geographic Inequalities in 15 Types of Neonatal Infectious Diseases in 131 Low- and Middle-Income Countries and Territories

Background: The burden of neonatal infections in low- and middle-income countries and territories (LMICs) is a critical public health challenge, while our understanding of specific burden and secular trends remains limited. Methods: We gathered annual data on 15 types of neonatal infections in LMICs from 1990 to 2019 from the Global Burden of Disease 2019. Numbers, rates, percent changes, and estimated annual percentage changes of incidence and deaths were calculated. We also explored the association between disease burden, socio-demographic index (SDI), and universal health coverage index (UHCI). Results: Enteric infections and upper respiratory infections owned the top highest incidence rates for neonates in 2019. Neonatal sepsis and other neonatal infections, as well as otitis media, demonstrated an increasing trend of incidence across all 3 low- and middle-income regions. The top 3 causes of neonatal mortality in 2019 were neonatal sepsis and other neonatal infections, lower respiratory infections, and enteric infections. Between 1990 and 2019, all of the neonatal infection-related mortality rates suggested an overall decline. Sex differences could be found in the incidence and mortality of some neonatal infections, but most disease burdens decreased more rapidly in males. SDI and UHCI were both negatively associated with most of the disease burden, but there were exceptions. Conclusions: Our study serves as a vital exploration into the realities of neonatal infectious diseases in LMICs. The identified trends and disparities not only provide a foundation for future research but also underscore the critical need for targeted policy initiatives to alleviate on a global scale.

Effect of the lack of access to handwashing facilities on the global burden of lower respiratory infections, 1990-2019: A systematic analysis from the global burden of disease study 2019

A lack of access to handwashing facilities is a significant risk factor for lower respiratory infections(LRIs). However, no studies have reported epidemiologic changes in the burden of LRIs attributed to the lack of access to handwashing facilities. We conducted an integrated assessment of the burden of LRIs attributable to the lack of handwashing facilities from 1990 to 2019 using data from the Global Burden of Disease Study 2019. In 2019, 270,000 deaths were attributed to LRIs due to a lack of access to handwashing facilities, with DALYs reaching 14.02 million. The age-standardized mortality rate (ASMR) of LRIs caused by a lack of access to handwashing facilities was approximately 3.74, while the age-standardized DALY rate (ASDR) was reported to be 203.55 in 2019. Over the past 30 years, the burden of LRIs attributed to the lack of access to handwashing facilities has shown a global decline. In 2019, this burden was most pronounced in infants under 1 year of age and in those older than 95 years, reflecting the highest DALY (5591.83) and mortality rates (79.43), respectively. The burden of LRIs caused by the lack of access to handwashing facilities was found to be more severe in males and significantly more pronounced in regions with a low sociodemographic index (SDI), such as the Sahara African region. The development of targeted strategies to address the inadequate and unequal distribution of handwashing facilities holds important value in improving the disease burden of LRIs.

Respiratory infections in low and middle-income countries

OBJECTIVES

To investigate the epidemiology, aetiology, diagnostics and management of childhood pneumonia in low and middle income countries (LMICs).

DESIGN

Review of published english literature from 2019 to February 2024.

RESULTS

Lower respiratory tract infections (LRTIs) still result in significant mortality in children under 5 years of age in LMICs. Important studies have reported a change in the pathogenesis of LRTIs over the last 5 years with respiratory syncytial virus (RSV) resulting in a large burden of disease. SARS-CoV-2 had a significant direct and indirect impact in children in LMICs. Mycobacterium tuberculosis (MTB) remains a priority pathogen in all children. Nucleic acid amplification and rapid antigen tests have improved diagnostic accuracy for MTB and other bacterial pathogens. Point of care diagnostics may overcome some limitations, but there is a need for better cost-effective diagnostics. Access to shorter courses of TB treatment are now recommended for some children, but child friendly formulations are lacking. The role of chest X-ray in TB has been recognized and included in guidelines, and lung ultrasound to diagnose LRTI is showing promise as a lower cost and accessible option.

CONCLUSION

Advances in diagnostics and large multi-centre studies have provided increased understanding of the causative pathogens of LRTIs in LMICs. Increased access to preventive strategies such as vaccines, treatment modalities including antivirals, and addressing upstream factors such as poverty are essential if further declines in LRTIs in LMICs are to be realised.

Harnessing the potential of the NALT and BALT as targets for immunomodulation using engineering strategies to enhance mucosal uptake

Mucosal barrier tissues and their mucosal associated lymphoid tissues (MALT) are attractive targets for vaccines and immunotherapies due to their roles in both priming and regulating adaptive immune responses. The upper and lower respiratory mucosae, in particular, possess unique properties: a vast surface area responsible for frontline protection against inhaled pathogens but also simultaneous tight regulation of homeostasis against a continuous backdrop of non-pathogenic antigen exposure. Within the upper and lower respiratory tract, the nasal and bronchial associated lymphoid tissues (NALT and BALT, respectively) are key sites where antigen-specific immune responses are orchestrated against inhaled antigens, serving as critical training grounds for adaptive immunity. Many infectious diseases are transmitted via respiratory mucosal sites, highlighting the need for vaccines that can activate resident frontline immune protection in these tissues to block infection. While traditional parenteral vaccines that are injected tend to elicit weak immunity in mucosal tissues, mucosal vaccines (i.e., that are administered intranasally) are capable of eliciting both systemic and mucosal immunity in tandem by initiating immune responses in the MALT. In contrast, administering antigen to mucosal tissues in the absence of adjuvant or costimulatory signals can instead induce antigen-specific tolerance by exploiting regulatory mechanisms inherent to MALT, holding potential for mucosal immunotherapies to treat autoimmunity. Yet despite being well motivated by mucosal biology, development of both mucosal subunit vaccines and immunotherapies has historically been plagued by poor drug delivery across mucosal barriers, resulting in weak efficacy, short-lived responses, and to-date a lack of clinical translation. Development of engineering strategies that can overcome barriers to mucosal delivery are thus critical for translation of mucosal subunit vaccines and immunotherapies. This review covers engineering strategies to enhance mucosal uptake via active targeting and passive transport mechanisms, with a parallel focus on mechanisms of immune activation and regulation in the respiratory mucosa. By combining engineering strategies for enhanced mucosal delivery with a better understanding of immune mechanisms in the NALT and BALT, we hope to illustrate the potential of these mucosal sites as targets for immunomodulation.

Respiratory Viral Testing Rate Patterns in Young Children Attending Tertiary Care Across Western Australia: A Population-Based Birth Cohort Study

BACKGROUND

An understanding of viral testing rates is crucial to accurately estimate the pathogen-specific hospitalisation burden. We aimed to estimate the patterns of testing for respiratory syncytial virus (RSV), influenza virus, parainfluenza virus (PIV) and human metapneumovirus (hMPV) by geographical location, age and time in children <5 years old in Western Australia.

METHODS

We conducted a population-based cohort study of children born between 1 January 2010 and 31 December 2021, utilising linked administrative data incorporating birth and death records, hospitalisations and respiratory viral surveillance testing records from state-wide public pathology data. We examined within-hospital testing rates using survival analysis techniques and identified independent predictors of testing using binary logistic regression.

RESULTS

Our dataset included 46,553 laboratory tests for RSV, influenza, PIV, or hMPV from 355,021 children (52.5% male). Testing rates declined in the metropolitan region over the study period (RSV testing in infants: from 242.11/1000 child-years in 2012 to 155.47/1000 child-years in 2018) and increased thereafter. Conversely, rates increased in non-metropolitan areas (e.g., RSV in Goldfields: from 364.92 in 2012 to 504.37/1000 child-years in 2021). The strongest predictors of testing were age <12 months (adjusted odds ratio [aOR] = 2.25, 95% CI 2.20-2.31), preterm birth (<32 weeks: aOR = 2.90, 95% CI 2.76-3.05) and remote residence (aOR = 0.77, 95% CI 0.73-0.81).

CONCLUSION

These current testing rates highlight the potential underestimation of respiratory virus hospitalisations by routine surveillance and the need for estimation of the true burden of respiratory virus admissions.