Epidemiology of Lower Respiratory Tract Infections in Children

Impact of temperature variations on burden of lower respiratory infections under climate change (1990-2021)

OBJECTIVES

We aimed to evaluate the global burden and trends of lower respiratory infections (LRIs) attributable to non-optimal temperatures between 1990 and 2021, focusing on age, period, and cohort effects as well as health inequalities to inform targeted public health policies.

METHODS

Using the Global Burden of Disease 2021 database, we obtained the age-standardized mortality rate (ASMR) and disability-adjusted life-years rate (ASDR) for LRIs related to non-optimal temperatures. We calculated estimated annual percentage changes (EAPC) to assess LRIs burden trends and applied age-period-cohort modeling to quantify age, period, and cohort effects. Health inequalities were evaluated using the slope index of inequality and the concentration index.

RESULTS

In 2021, the highest ASDR for LRIs due to high temperatures occurred in children under 5 (347.66/100,000), whereas the highest ASMR for LRIs due to low temperatures occurred in adults aged ≥ 65 (338.49/100,000). Globally, the LRIs burden from non-optimal temperatures declined (EAPC: ASMR -2.48; ASDR -3.33). However, among the five climate zones, the LRIs burden in the boreal zone due to high temperatures increased (EAPC: ASMR 24.14; ASDR 45.14), whereas all other climate zones showed decreasing trends. In lower Sociodemographic Index (SDI) regions, the high-temperature-related LRIs burden was more pronounced. Relative inequities driven by non-optimal temperatures worsened in low-SDI regions.

CONCLUSION

From 1990 to 2021, the global burden of LRIs attributable to non-optimal temperatures declined overall; however, high-temperature-related LRIs increased in boreal zones. These health inequalities underscore the urgent need for targeted climate adaptation policies, such as providing international assistance, improving infrastructure, offering healthcare resources, and promoting vaccine coverage, particularly for vulnerable populations in low-SDI regions and boreal zones.

Etiology and Clinical Prediction of Community-Acquired Lower Respiratory Tract Infection in Children

BACKGROUND

Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection.

METHODS

Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005-July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed.

RESULTS

Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/bronchitis. Patients' median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/Mycoplasma pneumoniae. Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion).

CONCLUSION

In children with LRTI, various factors associated with viral or bacterial/M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription.

Metabolomics in pediatric lower respiratory tract infections and sepsis: a literature review

Lower respiratory tract infections (LRTIs) are a leading cause of morbidity and mortality in children. The ability of healthcare providers to diagnose and prognose LRTIs in the pediatric population remains a challenge, as children can present with similar clinical features regardless of the underlying pathogen or ultimate severity. Metabolomics, the large-scale analysis of metabolites and metabolic pathways offers new tools and insights that may aid in diagnosing and predicting the outcomes of LRTIs in children. This review highlights the latest literature on the clinical utility of metabolomics in providing care for children with bronchiolitis, pneumonia, COVID-19, and sepsis. IMPACT: This article summarizes current metabolomics approaches to diagnosing and predicting the course of pediatric lower respiratory infections. This article highlights the limitations to current metabolomics research and highlights future directions for the field.

Epidemiological studies on lower respiratory tract infection in children in the District Bannu, Khyber Pakhtunkhwa, Pakistan

Background

Lower respiratory tract infections are the leading cause of death in children globally and are transmitted by inhaling airborne droplets. The study demonstrated the prevalence of lower respiratory tract infections in children admitted to the Women and Children Hospital Bannu from February through November 2019. The cross-sectional study was conducted by obtaining indoor data from the official record maintained in the children’s wards.

Results

Males accounted for 649 (61.6%) and females 405 (38.4%) cases out of 1054 cases of the disease. Age group of ≤ 6 months showed 36.2% prevalence, followed by > 6 m ≤ 1 y (25.6%), > 1 y ≤ 2 y (17.1%), > 2 y ≤ 5 y (14.3%), > 5 ≤ 10 y (6.0%), and > 10 y ≤ 15 y (0.8%). Pediatric patients of age ≤ 2 y and ≤ 5 y contributed 78.9% and 93.3% to overall disease, respectively. The disease was at its peak in February (17.9%) while lowest in May (5.5%). The age group (≤ 6 m) was the dominant group in all months except August when replaced by the age group (> 6 m ≤ 1 y). The disease revealed higher prevalence during February-April and October-November.

Conclusions

Different age groups showed variation in the prevalence of the disease with an age group of ≤ 5 y contributing the largest share and seasonal peaks in the disease occurred. The present findings help in adopting strategies for effective control of the disease in different age groups of the children for their peak season.

Antibiotic use among hospitalized children with lower respiratory tract infections: a multicenter, retrospective study from Punjab, Pakistan

BACKGROUND

Lower respiratory tract infection (LRTI) is one of the triggering factors toward death in children below the age of five years necessitating appropriate antibiotic selection. This study aimed to evaluate antibiotic use among hospitalized children (≤5 years age) with LRTIs.

METHODS

A retrospective study was conducted in seven health facilities of the central region of Punjab province of Pakistan. The medical records of hospitalized children ≤5 years diagnosed with LRTI were thoroughly evaluated to get information on demographics, clinical characteristics, and details of prescribed antibiotics. The appropriateness of antibiotics was assessed according to guidelines of the British National Formulary due to a lack of indigenous standard treatment guidelines.

RESULTS

The medical records of 5926 children were searched with the majority (70.9%) diagnosed with community-acquired pneumonia (CAP) followed by acute bronchitis (14.1%). Ceftriaxone plus ampicillin and ceftriaxone plus ampicillin plus amikacin were prescribed to 39% and 11.7% study population, respectively. One-fourth of children were prescribed the wrong dose, and more than half were encountered with the incorrect route of antibiotic administration. Alarmingly, 90.2% of antibiotic prescriptions were inappropriate in our findings.

CONCLUSIONS

Current surveillance study revealed a worrying degree of antibiotic misuse among hospitalized LRTI children aged ≤5 years.

Acute lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia

BACKGROUND

Lower respiratory infections are a leading cause of morbidity and mortality worldwide, particularly in children younger than 5 years. Even if the burden of lower respiratory infections in children under 5 years old had decreased dramatically in the last 10 years, it is still the main cause of morbidity and mortality in children under-5 years old in developing countries, so the aim of this study was to assess the magnitude of lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital.

METHOD

A cross-sectional study was conducted from 1st to 30th April 2019, among under-five child/mother or caretaker pairs visiting Wolaita Sodo University Teaching and Referral Hospital. Child/mother or caretaker pairs who visits outpatient department for curative care service or follow up were recruited for the study. Data were collected using a semi-structured pre-tested interviewer-guided questionnaire. Epi-info (version 7.1.2.0) was used for data entry, and Statistical Package for Social Sciences version 20 was used for analysis. Bivariate and multivariate logistic regression, crude and adjusted odds ratios with their 95 % confidence intervals was computed. Finally, a p-value ≤ 0.05 was used to identify variables that had a significant association with acute lower respiratory infection.

RESULT

A total of 414 child/mother or caretaker pairs were recruited for the study. The magnitude of acute lower respiratory infections among under-five children was 40.3 % (95 % CI: 35.7- 44.9 %). Unvaccinated children (AOR: 2, 95 % CI, (1.27-3.16)), non-exclusive/replacement feeding (AOR: 1.85, 95 % CI, (1.18-2.91)), households mainly used unclean fuel for cooking (AOR: 2.12, 95 % CI, (1.07-4.19)), absence of separate kitchen (AOR: 1.7, 95 % CI, (1.09-2.65)), and absence of window in the kitchen room (AOR: 1.69, 95 % CI, (1.07-2.68)) showed significant association with acute lower respiratory infection.

CONCLUSIONS

The magnitude of acute lower respiratory tract infections among under-five children visiting outpatient department was 40.3 %. Unvaccinated children, non-exclusive/replacement feeding, using unclean fuel for cooking, absence of a separate kitchen, and absence of window in the kitchen showed significant association with acute lower respiratory infection. Therefore, special attention should be given to the environmental sanitation and family health components of health extension packages.

Acute Respiratory Tract Infections among Hospitalized Palestinian Patients (2011-2016): A Retrospective Study

Respiratory tract infections (RTIs) are a major public health concern. This study aims to investigate the profiles and epidemiological characteristics of acute RTIs and respiratory pathogens in Palestinian hospitalized patients. Clinical samples from hospitalized patients with symptoms of acute RTIs admitted between January 2011 and December 2016 were referred to the Palestinian Central Public Health Laboratory (PHCL) to identify the causative pathogen. Patients' demographic information and the results of the molecular identification were retrieved from the electronic database at the PHCL. A total of 15413 patients with acute RTIs were hospitalized during the study period. The causal agent was identified only in 28.7% of the patients. Overall, influenza viruses were the most common cause of RTIs among hospitalized Palestinian patients in the West Bank. Children and elderlies were the most affected with RTIs. The elderly population (≥60 years old) had the highest rates. After influenza A virus, respiratory syncytial virus (RSV), and Bordetella pertussis (B. pertussis) were the most common causes of acute RTIs among hospitalized Palestinian patients. Children showed the highest hospitalization rates for RSV, B. pertussis, adenovirus, enterovirus, and Streptococcus pneumoniae. On the other hand, elderlies had the highest rates of influenza. Outbreaks of RTIs occurred mainly during winter (between December and March). The resurgence of B. pertussis in spite of vaccination is alarming and requires further investigation.

Clinical and Epidemiological Determinants of Lower Respiratory Tract Infections in Hospitalized Pediatric Patients

Background

Lower respiratory tract infection (LRTI) is the main cause of pediatric mortality and morbidity in low- and middle-income countries.

Purpose

This study was carried out to determine the clinical and epidemiological characteristics of children with LRTI.

Method

A retrospective study was conducted on all pediatric patients who were hospitalized due to LRTI in Abuzar Hospital (Ahvaz, Iran) during one year. Incomplete medical records and children who were treated on an outpatient basis, as well as infants younger than 1 month of age, were excluded. The patients were evaluated in terms of epidemiological, clinical, and paraclinical characteristics.

Results

A total of 303 hospitalized children and infants were identified. Their mean age was 29.09 ± 38.96 months (range 1 month-15 years), and 59.4% of them were males. The highest frequency of patients was at the age below one year (50.8%, n = 154). Pneumonia and bronchitis were the most common LRTIs. Respiratory (54.6%) and neurological (21.6%) diseases were the most prevalent underlying medical conditions. Admission was more common in winter (n = 120, 39.6%) and spring (n = 79, 26.1%). The mean length of stay (LOS) in the hospital was 8.2 ± 5.5 days, and the overall mortality rate was 11.6%. In addition, 65 patients were severely underweight and 271 patients were malnourished. Moreover, there was a significant association between mortality and disease diagnosis (p < 0.05). Furthermore, there was a significant association between having an underlying disease and consanguineous parents (p < 0.01), as well as the frequency of hospitalization (p < 0.001).

Conclusion

Additional studies are required to determine factors contributing to disease severity among children with LRTI to develop appropriate preventive and therapeutic strategies.

Indoor microbiome and risk of lower respiratory tract infections among children under-five years: A meta-analysis

We investigated whether exposure to microbiome within the indoor environment is associated with risk of lower respiratory tract infections (LRTI) among children under 5 years of age. Electronic scientific repositories; PubMed, Scopus, Web of Science, GreenFILE, EMBASE, and Cochrane library were searched and screened through July 2019 for published reports for inclusion in the meta-analysis. Studies were eligible for inclusion if they reported an adjusted measure of risk for LRTI associated with IM exposure, including the relative risk (RR) or odds ratio (OR) and confidence interval (CI). The pooled OR was computed using the inverse of variance method for weighting. Sensitivity analysis was used to evaluate the effect of individual studies, while heterogeneity was evaluated by I² statistics using RevMan 5.3. Seven studies were eligible for inclusion in our meta-analysis. Exposure to a higher concentration of IM was associated with an increased risk of LRTI [OR:1.20 (1.11, 1.33), P < .0001]. The risk was stronger with exposure to total fungal concentration [OR:1.27 (1.13, 1.44), P < .0001] than visible molds [OR:1.20 (1.07, 1.34, P = .001]. Under-five children exposed to higher IM concentration are likely at increased risk of LRTI. Interventions addressing IM exposure should be considered in the management of LRTI among under-five children.

The characterization of bacterial communities of oropharynx microbiota in healthy children by combining culture techniques and sequencing of the 16S rRNA gene

The high incidence of bacterial respiratory infections has led to a focus on evaluating the human respiratory microbiome. Studies based on culture-based and molecular methods have shown an increase in the bacterial community that includes the bacterial phyla Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria in the oropharynx of healthy individuals. Therefore, recognizing this microbial compound and subsequently identifying those carriers of specific pathogens can be of great help in predicting future infections and their control. In this prospective study, we sought to characterize the bacterial communities of the respiratory microbiome in healthy children aged between 3 and 6 years old by combining both cultural techniques and sequencing of the 16S rRNA gene. Seventy-seven oropharynx samples using Dacron swabs were collected from 77 healthy children in the kindergartens of Ilam, Iran. Bacterial identification was performed by phenotypic methods and in house developed PCR-based sequencing (the V1-V9 hypervariable region of the bacterial 16S ribosomal RNA gene). In total, 346 bacterial isolates were characterized based on phenotypic and sequencing-based molecular methods. The 3 most predominant phyla were Firmicutes (74%), Proteobacteria (22%), and Actinobacteria (4%). At the level of the genus, Staphylococci (coagulase-positive and coagulase-negative) and Streptococci were dominant. Also, the most commonly identified potentially pathogenic colonisers were S. aureus (75%), Enterobacteriaceae spp. (40.1%), and A. baumannii (15.6%). The present study identified 3 phyla and 9 family of bacteria in the oropharyngeal microbiome. Remarkably, the presence of potential pathogenic bacteria in the nasopharynx of healthy children can predispose them to infectious diseases, and also frequent exposure to human respiratory bacterial pathogens are further risk factors.

Respiratory syncytial virus, human metapneumovirus, and influenza virus infection in Bangkok, 2016-2017

Children and adults residing in densely populated urban centers around the world are at risk of seasonal influenza-like illness caused by respiratory viruses such as influenza virus, human metapneumovirus (hMPV), and respiratory syncytial virus (RSV). In a large metropolitan of Thailand's capital city Bangkok, most respiratory infections are rarely confirmed by molecular diagnostics. We therefore examined the frequency of RSV, hMPV, and influenza virus in 8,842 patients who presented influenza-like illness and sought medical care at a large hospital in Bangkok between 2016 and 2017. Using a multiplex real-time reverse-transcription polymerase chain reaction (RT-PCR), 30.5% (2,699/8,842) of nasopharyngeal (NP) swab samples tested positive for one or more of these viruses. Influenza virus comprised 17.3% (1,528/8,842), of which the majority were influenza A/H3N2. Such infection was most prevalent among adults and the elderly. RSV was identified in 11.4% (1,011/8,842) and were mostly ON1 and BA9 genotypes. Of the hMPV-positive samples (3.6%, 318/8,842), genotypes A2, B1, and B2 were detected. A small number of individuals experienced co-infections (1.8%, 155/8,842), most commonly between RSV and influenza A/H3N2. RSV and hMPV co-infections were also found, but mainly in young children. Viral respiratory tract infection peaked locally in the rainy season (June to September). These findings support the utility of rapid nucleic acid testing of RSV, hMPV, and influenza virus in patients with ILI.

Probiotic Lactobacillus casei Shirota improves efficacy of amoxicillin-sulbactam against childhood fast breathing pneumonia in a randomized placebo-controlled double blind clinical study

The aim of the present study was to investigate the efficacy of oral administration of probiotic Lactobacillus casei Shirota and amoxicillin-sulbactam in treating childhood fast breathing pneumonia. 518 children diagnosed of fast breathing pneumonia were enrolled and randomly assigned to be administered either amoxicillin-sulbactam + Lactobacillus casei Shirota or amoxicillin-sulbactam + placebo. Primary outcome was defined as treatment failure before day 3, and secondary outcome was defined as treatment failure during follow-ups on day 6 and 12. Serum levels of tumor necrosis factor-α and interferon-γ were also examined at the end of day 3. Treatment failure rate before day 3 was significantly reduced in amoxicillin-sulbactam + Lactobacillus casei Shirota group compared to amoxicillin-sulbactam + placebo group. Serum levels of tumor necrosis factor-α and interferon-γ were both significantly reduced in amoxicillin-sulbactam + placebo group on day 3. On day 6 and 12, although treatment failure rates were higher than on day 3 in both groups, it was still significantly reduced in amoxicillin-sulbactam + Lactobacillus casei Shirota group. No severe adverse effects were observed in either treatment group. In conclusion, Probiotic Lactobacillus casei Shirota, in combination with amoxicillin-sulbactam, is more effective in treating childhood fast breathing pneumonia, which supports the potential clinical application of Lactobacillus casei Shirota as a safe supplement to amoxicillin-sulbactam therapy against childhood fast breathing pneumonia.

Resveratrol improves efficacy of oral amoxicillin against childhood fast breathing pneumonia in a randomized placebo-controlled double blind clinical trial

Childhood pneumonia has been considered as a major cause of child morbidity and mortality worldwide. We aimed to investigate the effect of resveratral in synergizing with oral amoxicillin to improve the treatment outcome of oral amoxicillin administration against childhood fast breathing pneumonia. 647 children diagnosed fast breathing pneumonia were recruited and randomized to receive oral amoxicillin plus either resveratrol (AX + RV) or placebo (AX + placebo). The primary outcome was defined as treatment failure up to day 3, while the secondary outcome was defined as treatment failure at day 6 and 12 upon follow up. Incidences of treatment failure up to day 3 was significantly lower in the AX + RV group than the AX + placebo group. From day 6-12, the incidences of treatment failure were increased in both treatment groups. However, treatment failure cases were still much lower in the AX + RV group on both revisits. No serious adverse reaction to treatment drugs were found in either of the two groups. Resveratrol improves efficacy of oral amoxicillin against childhood fast breathing pneumonia, supporting the clincial potential of reseveratrol as a potent adjuvent of oral amoxicillin in the treatment of childhood pneumonia with no adverse effects.

13-valent pneumococcal conjugate vaccine (PCV13) in preterm versus term infants

OBJECTIVES

This study evaluated the immune response and safety profile of 13-valent pneumococcal conjugate vaccine (PCV13) in preterm infants compared with term infants.

METHODS

This Phase IV, open-label, 2-arm, multicenter, parallel-group study enrolled 200 healthy infants (preterm, n = 100; term, n = 100) aged 42 to 98 days. All subjects received PCV13 at ages 2, 3, 4 (infant series), and 12 (toddler dose [TD]) months, together with routine vaccines (diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine and meningococcal group C conjugate vaccine).

RESULTS

Most subjects achieved an anticapsular immunoglobulin G (IgG) antibody concentration ≥ 0.35 μg/mL for all serotypes: >85% after the infant series (except preterm infants for serotypes 5, 6A, and 6B) and >97% after TD (except for serotype 3). Preterm infants had overall lower IgG geometric mean concentrations compared with term infants; however, geometric mean fold increases after TD were similar for all serotypes. Opsonophagocytic activity results were consistent with IgG results and titers increased after TD in both groups for all serotypes, including serotype 3. PCV13 was generally well tolerated, with similar safety profiles in all preterm subgroups.

CONCLUSIONS

Immune responses were lower in preterm infants than in term infants. However, the majority of subjects in both groups achieved both pneumococcal serotype-specific IgG antibody levels after the infant series that exceeded the World Health Organization-established threshold of protection and functional antibody responses. Responses were uniformly higher after TD, reinforcing the importance of a timely booster dose. PCV13 was well tolerated regardless of gestational age.