Search

Objective: To explore factors influencing the acceptance of allergen immunotherapy (AIT) for the treatment of allergic respiratory diseases by pediatric patients and their families. Methods: A total of 406 children (210 males and 196 females) attending the pediatric outpatient clinics and wards of the Renji Hospital, Shanghai Jiao Tong University School of Medicine from June 2020 to April 2022. Those who met the criteria for the AIT treatment, were included in the survey. An online 20-item questionnaire was developed. Data on patient's general characteristics, allergic disease status, family history of allergies, general family information, parental knowledge of allergic diseases, and whether the AIT treatment was recommended by a physician, were collected. The patients were divided into two groups according to their willingness to receive AIT: a reluctant or neutral group (n = 182), and a willing group (n = 224). A univariate analysis of the willingness to undergo AIT was done to detect parameters that significantly differed between the groups, and the identified factors were used as independent variables in the multifactorial logistic regression analysis. Results: The severity of allergic disease, presence of drug allergy, occurrence of severe allergic reactions, mother's education, distance from home to the hospital, parental knowledge of allergic diseases, and whether the doctor recommended AIT were all statistically different between the groups (p < 0.05). Multifactorial logistic regression analysis showed that the degree of allergic rhinitis (AR), or asthma (AS), parental knowledge of allergic diseases, and doctor's recommendation of AIT were the factors that influenced the willingness of pediatric patients to receive AIT. Conclusions: The severity of AR and AS, parental knowledge of allergic diseases, and doctor's recommendation influenced the willingness of pediatric patients to receive AIT. [ABSTRACT FROM AUTHOR]

This article examines the incidence of healthcare utilization for allergic and respiratory infectious diseases in children with asthma before and during the COVID-19 pandemic. The study analyzed data from the Korean Childhood Asthma Study (KAS) cohort and the Health Insurance Review and Assessment Service (HIRA) from March 2016 to March 2021. The findings showed significant decreases in hospital visits for allergic and respiratory diseases during the pandemic, with sustained reductions observed for one year. The decline in healthcare utilization may be attributed to factors such as reduced exposure to triggers and apprehension about accessing healthcare services. Further research is needed to explore the long-term effects of the pandemic on healthcare utilization. [Extracted from the article]

Background: The child mortality rate is one of the important indicators that is influenced by various factors such as the health, economic, political, and cultural status of societies. Objectives: The purpose of this study is to determine the causes related to the death of children aged 1 to 59 months in Zahedan University of Medical Sciences (ZAUMS) in the years 2018 to 2020 using the 10th edition of the International Classification of Diseases. Methods: The population of this descriptive study was children aged 1 - 59 months who died in the population covered by ZAUMS from 2018 to 2020. The research data were collected from the mortality surveillance system for children aged 1 to 59 months of the Vice-Chancellors for Health and Treatment Affairs of ZAUMS. The data collection tool was a checklist. The collected data was analyzed using descriptive statistics. Results: The death rates of children aged 1 to 59 months in 2018, 2019, and 2020 were 7.6, 7.9, and 6.9 per thousand live births, respectively. The highest percentage of deaths was related to boys ages 1 to 12 months. Most of the deceased were residents of urban areas. The most common causes of death were related to respiratory system diseases, injuries, poisonings, and other specific consequences of external causes, such as congenital malformations, deformations, and chromosomal abnormalities. Conclusions: Educating parents on timely treatment of respiratory system diseases in children, improving the knowledge of families to control accidents and take better care of children in high-risk environments where there is a possibility of burns, respiratory obstruction, poisoning, and drowning, reforming and promoting policies related to genetic screening plans to identify congenital abnormalities during pregnancy, and premarital counseling to prevent high-risk family marriages can improve children’s health index. [ABSTRACT FROM AUTHOR]

To elaborate the utility of multiplex quantitative polymerase chain reaction (multiplex qPCR) for the accurate diagnosis of severe respiratory tract infections (RTIs) in hospitalized children. In two separate periods during 2022, 76 respiratory specimens (combined throat/nasopharyngeal swabs) were submitted for multiplex qPCR regarding 26 respiratory pathogens. The specimens were obtained from children with severe RTIs hospitalized in the Institute for Respiratory Diseases in Children, Skopje. Multiplex qPCR detected at least one respiratory pathogen in all examined specimens (76/76), with 83% (63/76) rate of co-infections. Considering that positive results are only the ones with Ct value below 28, the rates of detected pathogens and co-infections decrease to 75% and 22%, respectively. The most commonly detected pathogens during the spring period were Parainfluenza type 3 (PIV3) followed by Adenovirus (AdV) and Respiratory syncytial virus type B (RSVB) with frequency rate of 23%, 19% and 19%, respectively. During the autumn period, the most common were RSVB and Streptococcus pneumoniae with frequency rate of 31% and 17%, respectively. Multiplex qPCR is a powerful tool for diagnosing RTIs. Semi-quantification of the viral load by reporting Ct values added higher level of evidence for accurate diagnosis. Seasonal detection of the examined viruses was notable with higher prevalence of PIV3 in spring and RSVB in autumn period. [ABSTRACT FROM AUTHOR]

Background: Free open access medical education (FOAM) resources have become increasingly popular in graduate medical education. Despite their accessibility, the assessment of FOAM resources' quality is challenging due to their decentralized nature and the diverse qualifications of their authors and distribution platforms. In this first pediatric systematic online academic resource (SOAR) review, we utilized a systematic methodology to aggregate and assess the quality of FOAM resources on pediatric respiratory infectious disease topics. Methods: We searched 177 keywords using FOAMSearch, the top 50 FOAM websites on the Social Media Index, and seven additional pediatric emergency medicine–focused blogs. Following a basic initial screen, resources then underwent full‐text quality assessment utilizing the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool. Results: The search yielded 44,897 resources. After 44,456 were excluded, 441 underwent quality assessment. A total of 36/441 posts (8% of posts) reached the high‐quality threshold score (rMETRIQ ≥ 16). The most frequent topics overall were pneumonia and bronchiolitis. A total of 67/441 posts (15% of posts) were found to have a rMETRIQ score of less than or equal to 7, which may indicate poor quality. Conclusions: We systematically identified, described, and performed quality assessment on FOAM resources pertaining to the topic of pediatric respiratory infectious disease. We found that there is a paucity of high‐quality posts on this topic. Despite this, the curated list of high‐quality resources can help guide trainees and educators toward relevant educational information and suggest unmet needs for future FOAM resources. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) infection is associated with significant morbidity in infants. Risk factors for severe disease beyond the first 2 years of life have not been fully defined. Methods: Children <5 years hospitalized with virologically confirmed RSV infection were identified over six respiratory seasons (10/2012–4/2018) and their medical records manually reviewed. Multivariable analyses were performed to define the age‐specific (<6, 6–24, and >24–59 months) risk factors associated with oxygen administration, PICU admission, mechanical ventilation, and duration of hospitalization. Results: We identified 5143 children hospitalized with RSV infection: 53.5% (n = 2749) <6 months; 31.7% (n = 1631) 6–24 months; and 14.8% (n = 763) >24–59 months. Rates of ICU admission were high (35%–36%) and comparable across age groups, while children >24–59 and 6–24 versus those <6 months required supplemental oxygen more frequently (73%; 71%; 68%, respectively; p =.003). The presence of comorbidities increased with age (25%, <6 months; 46%, 6–24 months; 70%, >24–59 months; p <.001). Specifically, neuromuscular disorders, chronic lung disease, and reactive airway disease/asthma were predictive of worse clinical outcomes in children aged 6–24 and >24–59 months, while RSV‐viral codetections increased the risk of severe outcomes in children aged <6 and 6–24 months of age. Conclusions: Almost half of children hospitalized with RSV infection were >6 months. Underlying comorbidities increased with age and remained associated with severe disease in older children, while RSV‐viral codetections were predictive of worse clinical outcomes in the youngest age groups. These data suggest the importance of defining the clinical phenotype associated with severe RSV according to age, and the persistent burden associated with RSV beyond infancy. [ABSTRACT FROM AUTHOR]

Introduction: Prenatal exposure to environmental chemicals may be associated with allergies later in life. We aimed to examine the association between prenatal dietary exposure to mixtures of chemicals and allergic or respiratory diseases up to age 5.5 y. Methods: We included 11,638 mother-child pairs from the French "Étude Longitudinale Française depuis l'Enfance" (ELFE) cohort. Maternal dietary exposure during pregnancy to eight mixtures of chemicals was previously assessed. Allergic and respiratory diseases (eczema, food allergy, wheezing and asthma) were reported by parents between birth and age 5.5 years. Associations were evaluated with adjusted logistic regressions. Results are expressed as odds ratio (OR[95%CI]) for a variation of one SD increase in mixture pattern. Results: Maternal dietary exposure to a mixture composed mainly of trace elements, furans and polycyclic aromatic hydrocarbons (PAHs) was positively associated with the risk of eczema (1.10 [1.05; 1.15]), this association was consistent across sensitivity analyses. Dietary exposure to one mixture of pesticides was positively associated with the risk of food allergy (1.10 [1.02; 1.18]), whereas the exposure to another mixture of pesticides was positively but slightly related to the risk of wheezing (1.05 [1.01; 1.08]). This last association was not found in all sensitivity analyses. Dietary exposure to a mixture composed by perfluoroalkyl acids, PAHs and trace elements was negatively associated with the risk of asthma (0.89 [0.80; 0.99]), this association was consistent across sensitivity analyses, except the complete-case analysis. Conclusion: Whereas few individual chemicals were related to the risk of allergic and respiratory diseases, some consistent associations were found between prenatal dietary exposure to some mixtures of chemicals and the risk of allergic or respiratory diseases. The positive association between trace elements, furans and PAHs and the risk of eczema, and that between pesticides mixtures and food allergy need to be confirmed in other studies. Conversely, the negative association between perfluoroalkyl acids, PAHs and trace elements and the risk of asthma need to be further explored. [ABSTRACT FROM AUTHOR]

Parechovirus A (PeV-A, Parechovirus, Picornaviridae) are human pathogens associated with mild to severe gastrointestinal and respiratory diseases in young children. While several studies have investigated the association of PeV-A with human disease, little is known about its epidemiology or detection in Latin America. Between the years 2014 and 2015, a total of 200 samples were collected from Panamanian pediatric patients aged < 16 years old exhibiting symptoms associated with respiratory (n = 64), gastrointestinal (n = 68), or neurological (n = 68) diseases. These samples were gathered from patients who had previously received negative diagnoses for the main respiratory viruses, rotavirus, and neurological viruses like herpes virus, enterovirus, and cytomegalovirus. The presence of PeV-A was analyzed by real time RT-PCR. Eight positive PeV-A infections (4.0%, 95% CI: 1.7 to 7.7) were detected: two in respiratory samples (3.0%, 95% CI: 0.3 to 10.8), five in gastrointestinal samples (7.3%, 95% CI: 2.4 to 16.3), and one in cerebrospinal fluid (1.5%, 95% CI: 1.4 to 7.9). The study provides evidence of PeV-A circulation in Panama and the data collectively, remarked on the importance of considering PeV-A in the Panamanian pediatric diagnostic landscape, especially when conventional testing for more common viruses yields negative results. Impact statement: The presence of Parechovirus A (PeV-A) in Latin America has been an unexplored area of research, although it has been associated with gastrointestinal and respiratory diseases in young children. The study was conducted between 2014 and 2015. Two hundred samples were collected from pediatric patients with symptoms related to respiratory, gastrointestinal, or neurological illnesses, with a negative diagnosis of common viruses. The findings revealed the presence of PeV-A in Panama with varying prevalence among the sample types: two in respiratory samples, five in fecal samples, and one in cerebrospinal fluid. Understanding the epidemiology and detection of PeV-A in Latin America can lead to better diagnosis and management of pediatric diseases and enhance public health efforts in this region. [ABSTRACT FROM AUTHOR]

Aim: The loosening of social distancing measures over the past two years has led to a resurgence of seasonal epidemics associated with respiratory viral infections in children. We aim to describe the impact of such infections through urgent hospitalizations in a pediatric emergency department. Methods: We performed a retrospective review of medical records of all children and adolescents with a positive nasal swab admitted at the children's hospital IRCCS Burlo Garofolo of Trieste, in Italy, from September 2021 to March 2022, and September 2022 to March 2023. Results: Respiratory Syncytial Virus and Influenza viruses accounted for up to 55% of hospitalizations for respiratory infections during the study periods. During the last season, the number of hospitalizations related to the Influenza virus was five times higher than those related to SARS-CoV-2 (25% vs. 5%). Respiratory Syncytial Virus was associated with a greater need for respiratory support, mostly HFNC (High Flow Nasal Cannula). Conclusions: Respiratory Syncytial Virus and Influenza virus had a more significant impact on urgent hospitalizations during the past wintery seasons than SARS-CoV-2. [ABSTRACT FROM AUTHOR]

• Nearly 5% of people with CF worldwide carry a nonsense mutation on both alleles resulting in a premature termination codon (PTC). For those patients, no efficient targeted therapy is available yet. Limited information is available on their clinical status. • Our study shows thatPwCF carrying at least one PTC exhibited a significantly faster rate of yearly respiratory decline until ∼ 30 years. • Mortality of children and adolescents with one or two PTC alleles was significantly higher than that of their F508del homozygous pairs. • Infection with Pseudomonas aeruginosa was more frequent in patients carrying 2 PTC when compared to PTC/F508del or F508del homozygous patients. • These data highlight the urgent need to develop targeted interventions for patients carrying nonsense mutations in the CFTR gene. Limited information is available on the clinical status of people with Cystic Fibrosis (pwCF) carrying 2 nonsense mutations (PTC/PTC). The main objective of this study was to compare disease severity between pwCF PTC/PTC, compound heterozygous for F508del and PTC (F508del/PTC) and homozygous for F508del (F508del+/+). Based on the European CF Society Patient Registry clinical data of pwCF living in high and middle income European and neighboring countries, PTC/PTC (n = 657) were compared with F508del+/+ (n = 21,317) and F508del/PTC(n = 4254).CFTR mRNA and protein activity levels were assessed in primary human nasal epithelial (HNE) cells sampled from 22 PTC/PTC pwCF. As compared to F508del+/+ pwCF; both PTC/PTC and F508del/PTC pwCF exhibited a significantly faster rate of decline in Forced Expiratory Volume in 1 s (FEV 1) from 7 years (-1.33 for F508del +/+, -1.59 for F508del/PTC; -1.65 for PTC/PTC, p < 0.001) until respectively 30 years (-1.05 for F508del +/+, -1.23 for PTC/PTC, p = 0.048) and 27 years (-1.12 for F508del +/+, -1.26 for F508del/PTC, p = 0.034). This resulted in lower FEV 1 values in adulthood. Mortality of pediatric pwCF with one or two PTC alleles was significantly higher than their F508del homozygous pairs. Infection with Pseudomonas aeruginosa was more frequent in PTC/PTC versus F508del+/+ and F508del/PTC pwCF. CFTR activity in PTC/PTC pwCF's HNE cells ranged between 0% to 3% of the wild-type level. Nonsense mutations decrease the survival and accelerate the course of respiratory disease in children and adolescents with Cystic Fibrosis. [ABSTRACT FROM AUTHOR]

Purpose: The effects of air pollution on human health have long been a hot topic of research. For respiratory diseases, a large number of studies have proved that air pollution is one of the main causes. The purpose of this study was to investigate the risk of hospitalization of children with respiratory system diseases (CRSD) caused by six pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) in Hefei City, and further calculate the disease burden. Method: In the first stage, the generalized additive models were combined with the distributed lag non-linear models to evaluate the impact of air pollution on the inpatients for CRSD in Hefei. In the second stage, this study used the cost-of-illness approach to calculate the attributable number of hospitalizations and the extra disease burden. Result: Overall, all the six kinds of pollutants had the strongest effects on CRSD inpatients within lag10 days. SO2 and CO caused the highest and lowest harm, respectively, and the RR values were SO2 (lag0-5): 1.1 20 (1.053, 1.191), and CO (lag0-6): 1.002 (1.001, 1.003). During the study period (January 1, 2014 to December 30, 2020), the 7-year cumulative burden of disease was 36.19 million CNY under the WHO air pollution standards. Conclusion: In general, we found that six air pollutants were risk factors for CRSD in Hefei City, and create a huge burden of disease. [ABSTRACT FROM AUTHOR]

Objective: Allergic rhinitis and allergic asthma are common respiratory diseases in children. Skin prick tests (SPT) and allergen-specific immunoglobulin E (SpIgE) measurements play a crucial role in their diagnosis. In recent years, the use of rapid diagnostic kits has increased. This study aimed to investigate the diagnostic performance of multiheaded applicator and allergen SpIgE compared to the gold standard lanset. Materials and Methods: Skin prick tests were conducted on the same patients using both a multi-headed applicator and lancet with the same allergen solutions. Additionally, allergen SpIgE levels were measured for each patient. The diagnostic performances of multi-headed applicator and allergen SpIgE were statistically compared to those of lancet. Results: A total of 2100 SPTs were performed on 105 patients, from whom allergen SpIgE levels were also obtained. Allergen sensitivities were detected in order of prevalence as house dust mites, pollens, and molds. Sensitization rates were found to be 73.3% for multi-headed applicators, 82.9% for lanset, and 81% for SpIgE. The diagnostic sensitivity of the multiheaded applicator ranged from 0% to 52%, and its correlations with lanset were weak. Conclusion: Rapid-result tests aimed at allergen sensitivity assessment showed limited effectiveness. The use of accurate and reliable diagnostic methods such as lancet-based SPT and SpIgE measurements is crucial. This study holds the distinction of being the first to evaluate different SPT methods using allergen solutions, providing important insights for accurate diagnosis and treatment of allergic diseases. [ABSTRACT FROM AUTHOR]

The aim of the study was to analyze the relationship between air temperature data against hospital admissions due to respiratory diseases of children (under five years of age) and the elderly (over 65) in subtropical Porto Alegre, Brazil, comparing outcomes for 3 sequential years, 2018–2020, pre- and post-COVID 19 pandemic. Meteorological and hospital admission (HA) data for Porto Alegre, marked by a Koeppen-Geiger's Cfa climate type with well-defined seasons, were used in the analyses. HA was obtained for respiratory diseases (J00–99, according to the International Classification of Diseases, ICD-10) from the Brazilian DATASUS (Unified Health System database). We performed correlation analysis between variables (HA versus air temperature and heat stress) in order to identify existing relationships and lag effects (between meteorological condition and morbidity). Relative risk (RR) was also obtained for the two age groups during the three years. Results showed that the pandemic year disrupted observed patterns of association between analyzed variables, with either very low or non-existent correlations. [ABSTRACT FROM AUTHOR]

Objective: To find out the types and outcome of respiratory illnesses at a tertiary healthcare facility. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: January 2022 to July 2022. Material & Methods: Admitted children of both genders aged between 1 month to 12 years were analyzed. At the time of admission, characteristics like gender, age, body weight, vaccination status and types of respiratory illness were noted. Duration of hospitalization along with outcome was recorded. Results: During the study period, a total 851 children were admitted. Out of these 851 children, 266 (31.3%) children had some kinds of respiratory illnesses and were further analyzed. There were 148 (55.6%) male children while overall mean age was 3.9±2.6 years. Pneumonia was the commonest respiratory illness noted in 92 (34.5%) children while bronchiolitis was the 2nd most common respiratory illness observed in 56 (21.1%). A total of 241 (90.6%) children were discharged, 11 (4.1%) referred to other departments, 7 (2.6%) LAMA while deaths were noted in 7 (2.6%). Vaccination status was found to have significant association with the outcome (n=0.0096). Conclusion: Respiratory illnesses contribute significantly to children admitted to resource limited healthcare facilities. Poor immunization status has significant association with mortality among children with respiratory illnesses. [ABSTRACT FROM AUTHOR]

TET1 contributes to allergic airway inflammation and regulates interferon and aryl hydrocarbon receptor signaling pathways in bronchial epithelial cells. The interplay between oxidative stress and the epigenome-modifying enzymes in the pathogenesis of asthma and other lung diseases represents an intriguing area of investigation. Together, these data strongly suggest a critical, protective role of Tet1 in regulating genes and pathways responsive to allergen-induced oxidative stress in airway epithelial cells. Although therapeutic strategies to target oxidative stress in a recent nonhuman primate model of Th2-low asthma showed some promising effects on ozone-induced airway inflammation [9], other approaches using nutritional, pharmacologic, and environmental interventions have had mixed results [10]. [Extracted from the article]

Respiratory syncytial virus (RSV) is the leading cause of hospitalization among U.S. infants. In July 2023, the Food and Drug Administration approved nirsevimab, a long-acting monoclonal antibody, for passive immunization to prevent RSV-associated lower respiratory tract infection among infants and young children. Since October 2021, the Advisory Committee on Immunization Practices (ACIP) Maternal and Pediatric RSV Work Group has reviewed evidence on the safety and efficacy of nirsevimab among infants and young children. On August 3, 2023, ACIP recommended nirsevimab for all infants aged <8 months who are born during or entering their first RSV season and for infants and children aged 8-19 months who are at increased risk for severe RSV disease and are entering their second RSV season. On the basis of pre-COVID-19 pandemic patterns, nirsevimab could be administered in most of the continental United States from October through the end of March. Nirsevimab can prevent severe RSV disease among infants and young children at increased risk for severe RSV disease. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) infections are among the primary causes of death for children under 5 years of age worldwide. A notable challenge with many of the upcoming prophylactic interventions against RSV is their short duration of protection, making the age profile of key interest to the design of prevention strategies. Methods and findings: We leverage the RSV data collected on cases, hospitalizations, and deaths in a systematic review in combination with flexible generalized additive mixed models (GAMMs) to characterize the age burden of RSV incidence, hospitalization, and hospital-based case fatality rate (hCFR). Due to the flexible nature of GAMMs, we estimate the peak, median, and mean incidence of infection to inform discussions on the ideal "window of protection" of prophylactic interventions. In a secondary analysis, we reestimate the burden of RSV in all low- and middle-income countries. The peak age of community-based incidence is 4.8 months, and the mean and median age of infection is 18.9 and 14.7 months, respectively. Estimating the age profile using the incidence coming from hospital-based studies yields a slightly younger age profile, in which the peak age of infection is 2.6 months and the mean and median age of infection are 15.8 and 11.6 months, respectively. More severe outcomes, such as hospitalization and in-hospital death have a younger age profile. Children under 6 months of age constitute 10% of the population under 5 years of age but bear 20% to 29% of cases, 28% to 39% of hospitalizations, and 38% to 50% of deaths. On an average year, we estimate 28.23 to 31.34 million cases of RSV, between 2.95 to 3.35 million hospitalizations, and 16,835 to 19,909 in-hospital deaths in low, lower- and upper middle-income countries. In addition, we estimate 17,254 to 23,875 deaths in the community, for a total of 34,114 to 46,485 deaths. Globally, evidence shows that community-based incidence may differ by World Bank Income Group, but not hospital-based incidence, probability of hospitalization, or the probability of in-hospital death (p ≤ 0.01, p = 1, p = 0.86, 0.63, respectively). Our study is limited mainly due to the sparsity of the data, especially for low-income countries (LICs). The lack of information for some populations makes detecting heterogeneity between income groups difficult, and differences in access to care may impact the reported burden. Conclusions: We have demonstrated an approach to synthesize information on RSV outcomes in a statistically principled manner, and we estimate that the age profile of RSV burden depends on whether information on incidence is collected in hospitals or in the community. Our results suggest that the ideal prophylactic strategy may require multiple products to avert the risk among preschool children. Marina Antillon and colleagues use updated statistical models to estimate the burden of RSV in low- and middle-income countries with the aim of improved targeted prevention strategies. Author summary: Why was this study done?: Respiratory syncytial virus (RSV) is the most common cause of acute pulmonary infections in children. The RSV disease burden is high, especially in the nearly 600 million children under 5 living in 121 low-income (LIC) and middle-income countries (MICs) on which this study focuses. Evidence on the age distribution of RSV infections in these countries is based on sparse data using age breakdowns that are not always comparable. Different pharmaceutical products are becoming available that can reduce the RSV burden. Given that the immunity these products confer differs and wanes over time, it is essential to understand well at which months of age RSV infections drive the RSV disease burden. This study uses improved statistical models to estimate in depth the age profile of RSV cases, hospitalizations, and in-hospital deaths in young children. What did the researchers do and find?: We calculated the distributions of the age of infection, hospitalization, and in-hospital deaths. Depending on whether we use hospital-based or community-based incidence studies to inform our methods, we estimate the peak age of infection at 2.6 to 4.8 months, the mean age at 15.8 to 18.9, and the median age at 11.6 to 14.7 months. We estimate that on an average year, there are 28.23 to 31.34 million cases of RSV, 2.95 to 3.35 million hospitalizations, and 34,114 to 46,485 deaths in children under 5 in LICs and MICs. About half the deaths occur in the community, outside of hospital settings. More severe outcomes, such as hospitalizations and in-hospital deaths have a younger age profile. Children under 6 months of age constitute 10% of the population under 5 years of age but bear 20% to 29% of cases, 28% to 39% of hospitalizations, and 38% to 50% of deaths. What do these findings mean?: Our results support strategies using passive immunity products, such as maternal vaccines and monoclonal antibodies, to protect infants and active vaccination strategies for children over one, who also bear a large proportion of the burden. These results improve the choice of strategies offering the best value for money from a given budget. This study may enable modelers to make improved estimates thus allowing policymakers to gain a better understanding of the potential impact that new pharmaceutical products could have. [ABSTRACT FROM AUTHOR]

Background: Joubert syndrome is a rare genetic condition with a prevalence of 1:80,000--1:100,000. In most cases, it shows an autosomal autosomal recessive hereditary pattern, although X-linked and autosomal dominant cases have been described. The distinctive characteristic of this syndrome is the malformation at cerebral and cerebellar levels, known as the "molar tooth sign," hypotonia, and delayed neurodevelopment. Case report: We describe the case of a newborn with transient tachypnea. However, during hospital stay, he showed other clinical signs not corresponding to the admission diagnosis, such as bradycardia, apneas, hypotonia, and alteration in swallowing mechanics. To rule out etiologies of central origin, we conducted a magnetic resonance of the brain and identified the "molar tooth sign," where the pathognomonic sign of Joubert syndrome. Conclusions: Rare genetic diseases may manifest as early as the neonatal period with non-specific signs. The early diagnosis of Joubert syndrome is reflected in better pediatric follow-up, which impacts its prognosis and the possibility of improving the patient's quality of life with a multidisciplinary management and genetic counseling. [ABSTRACT FROM AUTHOR]

In the period 2020-2022 as a result of epidemiological measures specific to the COVID-19 pandemic (protective mask, online teaching activity, social distancing) we witnessed a considerable decrease in the number of cases of respiratory viroids in children. With the lifting of prophylactic measures that coincided with the start of physical teaching activities and the onset of the cold season, we have been confronted in pediatric wards with an increase in the incidence of virological infections in the pediatric population. In this article we aim to analyze the particularities of respiratory virological diseases in children in the season 2022 - 2023 both from the etiological and epidemiological point of view and the characteristic clinical forms of the disease. We conducted a retrospective clinical study of cases admitted to the Clinical Departments of Infectious DiseasesPediatrics of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” in the period October 2022 - March 2023. During this period, we recorded 3.012 cases of respiratory virology in children, which represents the majority of pediatric pathology admitted (72,9 %). The peak incidence of respiratory virology occurred in December (688 cases). From the etiological point of view, most cases were SARS-CoV-2 infections, followed by influenza (predominantly type A), then a smaller number of infections with respiratory syncytial virus (RSV), rhinovirus, adenovirus, metapneumovirus. The most common clinical form of the disease was moderate (66.9%), with severe forms accounting for 10.5%. All pediatric cases of respiratory virology admitted to our wards have evolved favorably, with no deaths. [ABSTRACT FROM AUTHOR]

Not much attention has been paid to the identification of morphological changes in the face-jaw area in children with chronic diseases of the respiratory system. Orthodontic dentist, ENT, pediatric specialists did not work together. In order to eliminate anomalies and deformations of the tooth-jaw system, orthodontic dentists carried out treatment measures without paying attention to their etiology. Today, attention has been paid to the treatment of changes in the face-jaw area in children with chronic diseases of the respiratory system, anomalies and deformations of the tooth-jaw system. Analysis of morphological changes in the upper jaw in mouth-breathing children, clinical examinations, anthropometric analysis of control diagnostic models separately for each patient, as well as analysis of X-ray data (orthopantomography and teleroentgenography). Evaluating the economic and medical effectiveness of our research. [ABSTRACT FROM AUTHOR]

In order to limit the spread of the novel betacoronavirus (SARS-CoV-2), it is necessary to detect positive cases as soon as possible and isolate them. For this purpose, machine-learning algorithms, as a field of artificial intelligence, have been recognized as a promising tool. The aim of this study was to assess the utility of the most common machine-learning algorithms in the rapid triage of children with suspected COVID-19 using easily accessible and inexpensive laboratory parameters. A cross-sectional study was conducted on 566 children treated for respiratory diseases: 280 children with PCR-confirmed SARS-CoV-2 infection and 286 children with respiratory symptoms who were SARS-CoV-2 PCR-negative (control group). Six machine-learning algorithms, based on the blood laboratory data, were tested: random forest, support vector machine, linear discriminant analysis, artificial neural network, k-nearest neighbors, and decision tree. The training set was validated through stratified cross-validation, while the performance of each algorithm was confirmed by an independent test set. Random forest and support vector machine models demonstrated the highest accuracy of 85% and 82.1%, respectively. The models demonstrated better sensitivity than specificity and better negative predictive value than positive predictive value. The F1 score was higher for the random forest than for the support vector machine model, 85.2% and 82.3%, respectively. This study might have significant clinical applications, helping healthcare providers identify children with COVID-19 in the early stage, prior to PCR and/or antigen testing. Additionally, machine-learning algorithms could improve overall testing efficiency with no extra costs for the healthcare facility. [ABSTRACT FROM AUTHOR]

Parainfluenza virus type 3 (PIV-3) is one of the common pathogens for respiratory infections in children. Whether viral load of PIV-3 is associated with severity of respiratory diseases in children is not yet known. Our aim was to determine significance of PIV-3 viral load among infected children. We conducted a single-center, retrospective study at Tokyo Metropolitan. Children's Medical Center, Japan, from June to August 2021. Hospitalized children were screened with a posterior nasal swab for multiplex PCR, and viral load was subsequently measured from remained samples by real-time PCR. Demographic data were collected from digital charts. PIV-3 positive patients were categorized into mild group with no oxygen demand, moderate group with low-flow oxygen demand and severe group with high-flow nasal cannula oxygen or non-invasive positive pressure ventilation or mechanical ventilation. Viral loads were compared among mild, moderate and severe groups. 151 patients were positive for PIV-3. We found no statistically significant association among PIV-3 viral load and severity of respiratory diseases (p = 0.35), and no statistically significant association between severity of illness and co-detection of other viruses. In each severity group, relatively high viral load per posterior nasal swab was observed at the time of testing. Among PIV-3 patients, we could not find statistically significant between viral load and their severity, therefore we could not conclude that viral load is a good surrogate marker for clinical severity of PIV-3. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic respiratory disease in children. The neutrophil-to-lymphocyte ratio (NLR) is a marker of a chronic inflammatory state; however, data on the association of NLR with acute asthma exacerbations in children is lacking. In this cross-sectional study, between 2016 and 2021, children aged 2–18 years who were referred to the emergency department (ED) due to asthma exacerbation, were included. NLR, calculated from complete blood count upon arrival, was assessed as a continuous variable and was classified into four groups according to quartiles. The association between severity parameters and NLR quartiles was examined. A total of 831 ED visits for asthma exacerbation were included in the study. The median NLR was 1.6, 3.8, 6.7, and 12.9 in quartiles 1–4, respectively (p < 0.001). Demographic parameters, background diseases, and chronic medications were similar between the quartiles. Higher heart rate, body temperature, systolic blood pressure, and respiratory rate were observed in the higher NLR quartiles, as well as lower oxygen saturation. Higher urgency scale and higher rates of intravenous magnesium sulfate were observed in the higher NLR quartiles, with higher admission rates and prolonged hospitalizations. In summary, NLR upon admission is associated with the severity of asthma exacerbation and higher chances of hospitalization among children in the ED. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in children, causing approximately 3.6 million hospitalizations per year, and has been associated with long-term pulmonary sequelae for up to 30 years after infection, yet preventative strategies and active treatment options remain elusive. The associated morbidity and healthcare related costs could be decreased substantially with the development of these much-needed medications. After an initial false start in the development of an RSV vaccine, gradual progress is now being made with the development of multiple vaccine candidates using numerous different mechanisms of action. Furthermore, nirsevimab, a new monoclonal antibody for the prevention of RSV, has recently been registered in the European Union. New novel treatments for RSV infection are also in the pipeline, which would provide the clinician with much needed ammunition in the management of the acute disease. The next few years have the potential to change the landscape of LRTI forever through the prevention and management of RSV LRTI and thereby decrease the mortality and morbidity associated with it. In this review, we discuss these new approaches, current research, and clinical trials in monoclonal antibody and vaccine development against RSV. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) causes a substantial burden of acute lower respiratory infection in children under 5 years, particularly in low- and middle-income countries (LMICs). Maternal vaccine (MV) and next-generation monoclonal antibody (mAb) candidates have been shown to reduce RSV disease in infants in phase 3 clinical trials. The cost-effectiveness of these biologics has been estimated using disease burden data from global meta-analyses, but these are sensitive to the detailed age breakdown of paediatric RSV disease, for which there have previously been limited data. Methods: We use original hospital-based incidence data from South Africa (ZAF) and Kenya (KEN) collected between 2010 and 2018 of RSV-associated acute respiratory infection (ARI), influenza-like illness (ILI), and severe acute respiratory infection (SARI) as well as deaths with monthly age-stratification, supplemented with data on healthcare-seeking behaviour and costs to the healthcare system and households. We estimated the incremental cost per DALY averted (incremental cost-effectiveness ratio or ICER) of public health interventions by MV or mAb for a plausible range of prices (5–50 USD for MV, 10–125 USD for mAb), using an adjusted version of a previously published health economic model of RSV immunisation. Results: Our data show higher disease incidence for infants younger than 6 months of age in the case of Kenya and South Africa than suggested by earlier projections from community incidence-based meta-analyses of LMIC data. Since MV and mAb provide protection for these youngest age groups, this leads to a substantially larger reduction of disease burden and, therefore, more favourable cost-effectiveness of both interventions in both countries. Using the latest efficacy data and inferred coverage levels based on antenatal care (ANC-3) coverage (KEN: 61.7%, ZAF: 75.2%), our median estimate of the reduction in RSV-associated deaths in children under 5 years in Kenya is 10.5% (95% CI: 7.9, 13.3) for MV and 13.5% (10.7, 16.4) for mAb, while in South Africa, it is 27.4% (21.6, 32.3) and 37.9% (32.3, 43.0), respectively. Starting from a dose price of 5 USD, in Kenya, net cost (for the healthcare system) per (undiscounted) DALY averted for MV is 179 (126, 267) USD, rising to 1512 (1166, 2070) USD at 30 USD per dose; for mAb, it is 684 (543, 895) USD at 20 USD per dose and 1496 (1203, 1934) USD at 40 USD per dose. In South Africa, a MV at 5 USD per dose would be net cost-saving for the healthcare system and net cost per DALY averted is still below the ZAF's GDP per capita at 40 USD dose price (median: 2350, 95% CI: 1720, 3346). For mAb in ZAF, net cost per DALY averted is 247 (46, 510) USD at 20 USD per dose, rising to 2028 (1565, 2638) USD at 50 USD per dose and to 6481 (5364, 7959) USD at 125 USD per dose. Conclusions: Incorporation of new data indicating the disease burden is highly concentrated in the first 6 months of life in two African settings suggests that interventions against RSV disease may be more cost-effective than previously estimated. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) causes severe lower respiratory tract disease in children and the elderly. However, there are no effective antiviral drugs or licensed vaccines available for RSV infection. Here, RSV virus-like particle (VLP) vaccines expressing Pre-F, G, or Pre-F and G proteins on the surface of influenza virus matrix protein 1 (M1) were produced using the baculovirus expression system, and their protective efficacy was evaluated in mice. The morphology and successful assembly of VLPs were confirmed by transmission electron microscope (TEM) and Western blot. High levels of serum IgG antibody response were detected in VLP-immunized mice, and significantly higher levels of IgG2a and IgG2b were found in the Pre-F+G VLP immunization group compared to the unimmunized control. Serum-neutralizing activity was higher in the VLP immunization groups compared to the naïve group, with Pre-F+G VLPs demonstrating superior neutralizing activity to the single antigen-expressing VLP groups. Pulmonary IgA and IgG responses were generally comparable across the immunization groups, with VLPs expressing the Pre-F antigen eliciting higher IFN-γ in spleens. The frequencies of eosinophils and IL-4-producing CD4+ T cell populations were substantially lower in the lungs of VLP-immunized mice, with the PreF+G vaccine inducing a significant increase in CD4+ and CD8+ T cells. VLP immunization significantly decreased the viral titer and inflammation in the lungs of mice, with Pre-F+G VLPs conferring the best protection. In conclusion, our present study suggests that the Pre-F+G VLPs could be a potential vaccine candidate against RSV infection. [ABSTRACT FROM AUTHOR]

The purpose of this study is to describe the prevalence and severity of respiratory symptoms in children born very preterm and to assess their association with parents' health-related quality of life (HRQoL) and family functioning. We conducted a cross-sectional study and recruited children born less than 32 weeks' gestation between January 2006 and December 2019, in the greater Zurich area, Switzerland. Between May and December 2021, parents were invited to complete an online survey for their preterm child and for a control term born (≥ 37 weeks' gestation) sibling aged 1 to 18 years. We used a validated questionnaire to assess respiratory symptoms and the Pediatrics Quality of Life Family Impact Module (PedsQL FIM) to assess parents' HRQoL and family functioning. The survey was completed for 616 very preterm children (99 with bronchopulmonary dysplasia (BPD)) and 180 controls. Girls made up 45% (46% in controls) of the sample, and 63% (60% in controls) of participants were aged 6 to 18 years (school-age). Very preterm children reported a higher risk of respiratory symptoms than controls, especially preschoolers and those with moderate-to-severe BPD. Parents of children with "mild" and "moderate-severe" respiratory symptoms had on average −3.9 (95%CI: −6.6 to −1.1) and −8.2 (−11.2 to −5.2) lower PedsQL FIM total score, respectively, than parents of children with no symptoms. The same pattern was observed after stratifying by age categories. Conclusions: Our study suggests that respiratory morbidity in very preterm children has a negative impact on parents' HRQoL and family functioning, even beyond the first years of life. What is Known: • The burden of respiratory morbidity associated with very premature birth is high and last far beyond the neonatal period. • Respiratory morbidity contributes to lower health-related quality of life (HRQoL) in parents of very preterm children in early infancy. What is New: • Respiratory morbidity in very preterm children has a negative impact on parents' HRQoL and family functioning beyond the first years of life. • Parents of very preterm children with moderate and severe respiratory symptoms are the ones who report lower scores, both for preschool and school-age children. [ABSTRACT FROM AUTHOR]

As functional respiratory impairment following COVID‐19 infection (COVID‐19) is increasingly reported in adult, data regarding children especially with pre‐existing chronic respiratory disease (PCRD) remain scarce. We retrospectively assessed clinical presentation, duration of symptoms related to COVID‐19 from paediatric patients with PCRD and compared their pre/post COVID‐19‐I spirometry values. Data from 12 patients were analysed. Timing between COVID‐19 diagnosis and subsequent functional evaluation ranged from 26 to 209 days (mean 77). The PCRD in these patients included asthma, cystic fibrosis, bronchiolitis obliterans and bronchomalacia. During COVID‐19, all clinical presentations were mild. One patient displayed persistent post‐COVID‐19 symptoms for 8 weeks after infection. Two patients presented significant deterioration of post‐COVID‐19 spirometric values with a return to pre‐COVID‐19 values in subsequent measures. We concluded that children with PCRD are not at increased risk for severe COVID disease and that most of them have no or only transient pulmonary functional impairment 1 to 7 months after COVID‐19. [ABSTRACT FROM AUTHOR]

Objective: To identify factors influencing mycoplasma pneumonia and respiratory diseases as a function of yearly seasons. Methods: Records of respiratory disease cases, as obtained from the respiratory laboratory of the First Affiliated Hospital of China Medical University over the period from November 2013 to October 2018, were retrospectively analyzed. Susceptible factors, as related to the general data from mycoplasma pneumonia cases, included season of the year along with the age and gender of the patients. Results: Statistically significant differences in mycoplasma pneumonia were obtained among the different seasons (2 = 496.24, P <0.05), ages (P < 0.05) and gender (2 = 300.10, P < 0.05). The rate and number of mycoplasma pneumonia cases were highest in the winter and lowest in the summer, with the difference between these two seasons being statistically significant (P < 0.05). Among confirmed positive cases, infection rates of mycoplasma pneumonia in young and middle-aged patients were significantly greater than that in the elderly (P < 0.05) and the incidence in women was significantly greater than that in men (2 = 300.10, P < 0.05). Among the total of all lung diseases sampled, the largest numbers were observed in pediatric cases and the peak period of disease occurrence was over the period from October to January. Conclusion: The incidence of pneumonia shows significant differences as a function of the season of the year, effects which are observed in all ages. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) is the single largest infectious cause of hospitalization and death in children worldwide. With improved immunizations, the incidence of bacterial pneumonia and the number of colonized bacteria have decreased. However, respiratory viruses are still an important cause of CAP, especially as new infectious agents such severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerge. The SARS-CoV-2 virus emerged in 2019 and caused the current coronavirus disease 2019 pandemic. Therefore, it is necessary to elucidate the epidemiology and causative pathogens of CAP. Recently, the Pneumonia and Respiratory Disease Study Group, affiliated with the Korean Academy of Pediatric Allergy and Respiratory Disease, investigated the causative pathogens of respiratory infections in children hospitalized with CAP, the serotype of Streptococcus pneumoniae, and the prevalence of Mycoplasma pneumoniae with gene mutations. Antibiotic resistance and serotype test results can determine the use of empirical antibiotics. Moreover, it is possible to help develop future vaccines by comparing bacterial culture results with vaccine serotype and identifying the changes and prevalence of each serotype. Therefore, we will perform continuous national surveillance and monitor the epidemiology of respiratory pathogens in Korea and worldwide. The surveillance of these respiratory infections can play a role in monitoring the emergence of new infectious diseases such as SARS-CoV-2. [ABSTRACT FROM AUTHOR]

To compare the incidence of respiratory symptoms and short-term consequences between children with Down syndrome and children from the general population, we conducted a prospective parent-reported observational study. Children with Down syndrome (≤ 18 years) were included between March 2012 and June 2014. Caregivers received a baseline questionnaire with follow-up 1–2 years after inclusion. Caregivers received a weekly questionnaire about respiratory symptoms, fever, antibiotic prescriptions, doctor's visits, and consequences for school and work attendance. Children with Down syndrome were compared to a cohort of the general population ("Kind en Ziek" study) with similar weekly questionnaires. A total of 9,011 childweeks were reported for 116 participants with Down syndrome (75% response rate). The frequency of respiratory symptoms was higher in children with Down syndrome than in children from the general population (30% vs 15.2%). In addition, symptoms subsided later (around 8 vs 5 years of age). The seasonal influence was limited, both in children with Down syndrome and children from the general population. Consequences of respiratory disease were significant in children with Down syndrome compared to children from the general population, with a higher rate of doctor's visits (21.3% vs 11.8%), antibiotic prescriptions (47.8% vs 26.3%), and absenteeism from school (55.5% vs 25.4%) and work (parents, 9.4% vs 8.1%). Conclusion: Children with Down syndrome have a higher frequency of respiratory symptoms and symptoms last until a later age, confirming the impression of professionals and caregivers. Individualized treatment plans might prevent unfavorable consequences of chronic recurrent respiratory disease in children with Down syndrome. What is Known: • Children with Down syndrome have an altered immune system and are prone to a more severe course of respiratory tract infections. • The overall conception is that patients with Down syndrome suffer from respiratory tract infections more often. What is New: • Children with Down syndrome suffer from respiratory symptoms more frequently than children from the general population. • The respiratory symptoms in children with Down syndrome subside at a later age compared to children from the general population. [ABSTRACT FROM AUTHOR]

• Our results suggest that nonpharmaceutical interventions (NPIs) reduce children's respiratory admissions significantly. • The effect of NPIs is most drastic for pneumonia among children of all ages. • The effect is most drastic for children aged 4-6 and 7-12 years. • NPIs may be used to further prevent admissions for children's respiratory infections. To estimate the impact of nonpharmaceutical interventions (NPIs) targeted at the COVID-19 pandemic on the admission number of respiratory diseases, including pneumonia, acute bronchitis & bronchiolitis, and acute upper respiratory infections (AURIs) for children in China. Continuous hospitalization records aged 0-18 years from January 1, 2016, to December 31, 2020, were collected from 26 tertiary children's hospitals. Interrupted time series analysis with a quasi-Poisson model was conducted with the start time of the COVID-19 pandemic as the interrupted timepoint and the weekly admission numbers of all-cause respiratory disease, pneumonia, acute bronchitis & bronchiolitis, and AURI as the outcome measures. Hospitalizations of childhood neoplasms were analyzed as the reference group. The reduction in admission numbers following NPIs was -55.0% (-57.9 to -51.9%) for all-cause respiratory diseases, -62.7% (-65.7 to -59.5%) for pneumonia, -48.1% (-53.3 to -42.3%) for bronchitis & bronchiolitis, and -24.3% (-28.6 to -19.8%) for AURI. The effect estimates of NPIs on childhood neoplasms was -29.1% (-33.6 to -24.4%). Stratification analysis showed the reduction was most drastic for children at 4-6 and 7-12 years. The admission number for respiratory diseases among children in China decreased drastically after the implementation of NPIs. NPIs with low socio-economic burdens should be suggested even outside the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Patterns of aeroallergen sensitization vary by countries. Testing with the minimum number of allergens is important to identify sensitized patients for a cost-effective approach. We aimed to assess the minimal skin prick test (SPT) panel to identify sensitized children with allergic respiratory diseases. Methods: The SPT results from January 2020 to December 2021 in children aged 2–18 years with symptoms of asthma or allergic rhinitis or both were retrospectively reviewed. All children received 11 allergen extracts (Dermatophagoides pteronyssinus [Der p], Dermatophagoides farinae [Der f], American cockroach, German cockroach, cat, dog, Bermuda grass, careless weed, Timothy, Acacia, and molds). The conditional approach was used to determine the allergen selection for the SPT panel. Results: A total of 688 children were enrolled (mean age = 8.14 ± 3.91 years). The sensitization results were Der p (57.85%), Der f (55.09%), German cockroach (18.02%), American cockroach (17.01%), cat (11.77%), Acacia (3.49%), Bermuda grass (3.34%), molds (3.05%), Timothy (2.33%), dog (1.89%), and careless weed (1.60%). Der p, Der f, and German cockroach were required to detect at least 95% of sensitized children. If the SPT panel added Acacia, cat, American cockroach, Bermuda grass, and careless weed, sensitization was detected in 99–100% of cases. Conclusions: Indoor allergens (Der p, cockroach, and cat) were common causes of sensitization in Thai children with allergic respiratory diseases. Eight allergens were sufficient for sensitization identification in Thai children with asthma or allergic rhinitis or both in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Objectives. Acute bronchiolitis is a common respiratory disease in children. C-reactive protein (CRP) is an indicator of bacterial coinfection. This study is aimed at assessing the frequency of elevated CRP in children with acute bronchiolitis and at comparing the clinical characteristics, laboratory and radiological findings, antibiotics use, and outcome according to CRP levels. Material and Methods. We retrospectively reviewed medical records of children with acute bronchiolitis admitted to Pediatric Department, Salmaniya Medical Complex, Bahrain, in 2019-2020. Demographic, clinical, laboratory and radiological data, and outcomes were collected. Patients with high CRP were compared with those with normal levels. Results. Of 287 patients, 229 (79.2%) were included. 132 (57.6%) were males. Median presentation age was 3.7 (interquartile range (IQR), 1.27-12.33) months. Median CRP level was 10.4 (IQR, 2.8-35.1) mg/L. CRP was high in 167 (72.9%) patients. 17.6% (33/187 patients) had confirmed bacterial coinfection. Respiratory syncytial virus (RSV) was detected in 84 (36.7%) patients. Mean CRP level was higher in RSV-negative compared to RSV-positive patients, 31.3 ± 44.3 versus 21.5 ± 27.7 mg / L , respectively (P = 0.042). Respiratory viral serology profile was positive in 34.7% (17/49 patients). 66.9% (107/160 patients) had positive chest X-ray. Antibiotics were used in 78.1% (179/227 patients). Thirteen (5.7%) patients required intensive care, five (2.2%) had surgical intervention, four (1.8%) required endotracheal intubation, and four (1.8%) died. Patients with high CRP were older at presentation (P < 0.0001) and had more fever (P < 0.0001) and cough (P = 0.002), but lower hemoglobin level (P < 0.0001) compared to those with normal CRP. Fever (P = 0.016) and hemoglobin level (P = 0.002) were independent factors. Conclusion. Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection. This study also showed a high overall rate of antibiotic prescriptions in mostly viral disease. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract disease of children, the elderly, and immunocompromised individuals. Currently, there are no FDA-approved RSV vaccines. The RSV G glycoprotein is used for viral attachment to host cells and impairment of host immunity by interacting with the human chemokine receptor CX3CR1. Antibodies that disrupt this interaction are protective against infection and disease. Nevertheless, development of an RSV G vaccine antigen has been hindered by its low immunogenicity and safety concerns. A previous study described three engineered RSV G proteins containing single-point mutations that induce higher levels of IgG antibodies and have improved safety profiles compared to wild-type RSV G (H. C. Bergeron, J. Murray, A. M. Nuñez Castrejon, et al., Viruses 13:352, 2021, https://doi.org/10.3390/v13020352). However, it is unclear if the mutations affect RSV G protein folding and display of its conformational epitopes. In this study, we show that the RSV G S177Q protein retains high-affinity binding to protective human and mouse monoclonal antibodies and has equal reactivity as wild-type RSV G protein to human reference immunoglobulin to RSV. Additionally, we determined the high-resolution crystal structure of RSV G S177Q protein in complex with the anti-RSV G antibody 3G12, further validating its antigenic structure. These studies show for the first time that an engineered RSV G protein with increased immunogenicity and safety retains conformational epitopes to high-affinity protective antibodies, supporting its further development as an RSV vaccine immunogen. IMPORTANCE Respiratory syncytial virus (RSV) causes severe lower respiratory diseases of children, the elderly, and immunocompromised populations. There currently are no FDA-approved RSV vaccines. Most vaccine development efforts have focused on the RSV F protein, and the field has generally overlooked the receptor-binding antigen RSV G due to its poor immunogenicity and safety concerns. However, single-point mutant RSV G proteins have been previously identified that have increased immunogenicity and safety. In this study, we investigate the antibody reactivities of three known RSV G mutant proteins. We show that one mutant RSV G protein retains high-affinity binding to protective monoclonal antibodies, is equally recognized by anti-RSV antibodies in human sera, and forms the same three-dimensional structure as the wild-type RSV G protein. Our study validates the structure-guided design of the RSV G protein as an RSV vaccine antigen. [ABSTRACT FROM AUTHOR]

The diagnosis of asthma depends on the unprejudiced proof of the varying airflow obstruction. The pulmonary function tests are carried out to evaluate the clinical value of different types of respiratory diseases in children or infants. This study is focused on the clinical evaluation of the pulmonary function tests in the diagnosis of pediatric asthma and cough variant asthma. A differential diagnosis method for chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap with complementary diagnostic value is proposed. For the pulmonary function tests, the COPD gene dataset was selected and feature selection was performed using the DBN-SVM scoring method. For analysis and comparison, the differential diagnosis models were built using ROC curves for the accuracy of the deep belief network model and the support vector machine model. The sensitive features associated with COPD and ACO classification using the deep belief network model were found to be in good agreement with known clinical diagnostic strategies. The clinical diagnosis tests for pulmonary pediatric asthma and cough variant asthma were conducted on two groups of children, with both groups containing a basis of comparison. 80 cases of pediatric asthma and cough variant asthma were admitted from 2013 to 2014 and 80 cases of children with a healthy physical examination. The results of the two groups were compared. The results showed that the levels of FEV1, PEF, and FVC were significantly lower (P < 0.05), in healthy children, and FEV1/FVC%, RV, and RV/TCL% were significantly higher (P < 0.05) in children with asthma and cough variant asthma during acute exacerbation and chronic persistence. There were no statistically significant differences in the duration of clinical remission (P > 0.05). Thus, the study suggests that confirmed cases of the diagnosis of pediatric asthma and cough variant asthma by pulmonary function tests were significantly higher than those of conventional tests (P < 0.05). From this study, we can conclude that pulmonary function tests can accurately diagnose pediatric asthma and cough variant asthma, and also accurately reflect the development of the child's disease, which is of high clinical value. [ABSTRACT FROM AUTHOR]

Wheezing diseases are one of the major chronic respiratory diseases in children. To explore the effects of meteorological and environmental factors on the prevalence of children wheezing diseases, clinical data of children hospitalized with wheezing diseases in Suzhou, China from 2013 to 2017 were collected. Meteorological and environmental factors from 2013 to 2017 were obtained from the local Meteorological Bureau and Environmental Protection Bureau. Relationships between wheezing diseases and meteorological and environmental factors were evaluated using Pearson's correlation and multivariate regression analysis. An autoregressive integrated moving average (ARIMA) model was used to estimate the effects of meteorological and environmental variables on children wheezing diseases. Children wheezing diseases were frequently presented in infants less than 12 months old (1897/2655, 58.28%), and the hospitalization rate was highest in winter (1024/3255, 31.46%). In pathogen-positive specimens, the top three pathogens were respiratory syncytial virus (21.35%), human rhinovirus (16.28%) and mycoplasma pneumoniae (10.47%). The seasonality of wheezing children number showed a distinctive winter peak. Children wheezing diseases were negatively correlated with average temperature (P < 0.001, r = − 0.598). The ARIMA (1,0,0)(0,0,0)12 model could be used to predict temperature changes associated wheezing diseases. Meteorological and environmental factors were associated with the number of hospitalized children with wheezing diseases and can be used as early warning indicators for the occurrence of wheezing diseases and prevalence of virus. [ABSTRACT FROM AUTHOR]

Exposure to maternal diabetes is increasingly recognized as a risk factor for chronic respiratory disease in children. It is currently unclear; however, whether maternal diabetes affects the lung health of male and female offspring equally. This study characterizes the sex-specific impact of a murine model of diet-induced gestational diabetes (GDM) on offspring lung function and airway inflammation. Female adult mice are fed a high-fat (45% kcal) diet for 6 wk prior to mating. Control offspring are from mothers fed a low-fat (10% kcal) diet. Offspring were weaned and fed a chow diet until 10 wk of age, at which point lung function was measured and lung lavage was collected. Male, but not female, offspring exposed to GDM had increased lung compliance and reduced lung resistance at baseline. Female offspring exposed to GDM displayed increased methacholine reactivity and elevated levels of proinflammatory cytokines [e.g., interleukin (IL)-1β, IL-5, and CXCL1] in lung lavage. Female GDM offspring also displayed elevated abundance of matrix metalloproteinases (MMP) within their airways, namely, MMP-3 and MMP-8. These results indicate disparate effects of maternal diabetes on lung health and airway inflammation of male and female offspring exposed to GDM. Female mice may be at greater risk of inflammatory lung conditions, such as asthma, whereas male offspring display changes that more closely align with models of chronic obstructive pulmonary disease. In conclusion, there are important sex-based differences in the impact of maternal diabetes on offspring lung health that could signal differences in future disease risk. [ABSTRACT FROM AUTHOR]

• Induced sputum (IS) is used in children to study chronic respiratory diseases. • A respiratory pathogen in IS was identified in 72.1% children with pneumonia. • IS is an adequate and feasible sample to determine the etiology of pneumonia. • IS is safe, well tolerated, and has higher diagnostic yield compared with other samples. This study aimed to evaluate the utility of induced sputum (IS) for the diagnosis of community-acquired pneumonia (CAP) in pediatric population. This cross-sectional study included pediatric population aged between 1 month and 17 years who were hospitalized with a diagnosis of CAP in 13 hospitals in Colombia, in whom an IS sample was obtained. Gram staining, aerobic bacterial and mycobacterial culture tests, and polymerase chain reaction (PCR) for 6 atypical bacteria and 15 respiratory viruses were performed. We evaluated the quality of IS samples. IS samples were collected in 516 of 525 children included in this study. The median age was 32 months, 38.6% were younger than 2 years, and 40.9% were between 2 and 5 years. Two patients had transient hypoxemia during the procedure. The quality of the IS obtained was good in 48.4% and intermediate in 24.5%. Identification of a respiratory pathogen was achieved with an IS sample (with Gram staining, culture test, and PCR) in 372 of 516 children with CAP. Our study shows that IS is an adequate sample for the diagnosis of CAP in pediatric population that required hospitalization. The procedure was safe, well tolerated, and with better diagnostic yields compared with the rest of the samples obtained. [ABSTRACT FROM AUTHOR]

Severe pneumonia is a common acute respiratory disease in children, and it has a rapid onset and violent onset, which often affects the whole body. Moreover, typical clinical manifestations and signs often cannot be taken seriously or covered up in clinical work. Due to the short time for treatment, it is easy to cause improper diagnosis and treatment, aggravate the disease and further deteriorate, and even threaten the life of the child. In order to achieve early intervention and treatment of severe Mycoplasma pneumoniae pneumonia in children, reduce or shorten the course of the disease, and improve the cure rate, this paper combines the imaging diagnosis to study the analysis of clinical related factors of severe Mycoplasma pneumoniae pneumonia in children. In addition, this paper analyzes the experimental data with hospital case samples, conducts statistical research on the analysis of clinical related factors of severe Mycoplasma pneumoniae pneumonia in children, and proposes effective coping strategies. [ABSTRACT FROM AUTHOR]

Respiratory disease and its complication are the cause of children deaths worldwide every year. Several epidemiological studies pointed out an association between quality of residential in inner city and risk of children health. However, few studies had been focused in high-polluted urban area in low to middle income countries. A cross-sectional study was conducted to investigate the association between residential environments and respiratory symptoms including asthma among 658 primary school children living in urban area of Bangkok Thailand. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was modified to access symptoms during the past 12 months. Binary logistic regression model was performed. Living near garment and clothing shop is associated with shortness of breath (AOR = 1.846; 95% CI 1.034, 3.297). Vectors in home is related to dry cough at night (AOR = 1.505; 95% CI 1.052, 2.153) and phlegm (AOR = 1.414; 95% CI 1.014, 1.973). Wall dampness is increased odd of having wheezing or whistling (asthma) in the chest (AOR = 1.921; 95% CI 1.141, 3.235). Children age, gender, and a family history of asthma were modified the associations. Our finding may provide strategies focusing on living environment improvement with a specific group of children to address respiratory disease prevention. [ABSTRACT FROM AUTHOR]

Between 2007 and 2012, hospitalization rate related to respiratory system diseases in children ≤1–year‐old was near 7 times higher in Nunavik compared with the whole province of Quebec. To assess the impact of poor indoor air quality (IAQ) in residential environments on children's respiratory health, the Nunavik's intervention study investigated the impact of the optimization of ventilation systems on the incidence rates of respiratory infections in children in Nunavik. Children under 10 years were recruited and categorized according to the type of ventilation system in their home: energy recovery ventilator (ERV), heat recovery ventilator (HRV), no HRV or ERV, and control groups. Children's' medical records were analyzed over a period of 50 weeks pre‐ and post‐intervention. Clinical diagnoses were classified into 4 categories: upper respiratory infections, lower respiratory infections, otitis media, and asthma. A decrease in respiratory infections episodes was observed in all groups following intervention with the highest impact observed for HRV systems (−53.0%). Decreases in the ERV group were not significant (−21,7%) possibly due to the presence of some volatile organic compound (such as propylene glycol) and inerrant experimental bias. Nevertheless, no significant association was found between health episodes incidence and household's behaviors or IAQ. [ABSTRACT FROM AUTHOR]

Imaging speed, spatial resolution and availability have made CT the favored cross-sectional imaging modality for evaluating various respiratory diseases of children — but only for the price of a radiation exposure. MRI is increasingly being appreciated as an alternative to CT, not only for offering three-dimensional (3-D) imaging without radiation exposure at only slightly inferior spatial resolution, but also for its superior soft-tissue contrast and exclusive morpho-functional imaging capacities beyond the scope of CT. Continuing technical improvements and experience with this so far under-utilized modality contribute to a growing acceptance of MRI for an increasing number of indications, in particular for pediatric patients. This review article provides the reader with practical easy-to-use protocols for common clinical indications in children. This is intended to encourage pediatric radiologists to appreciate the new horizons for applications of this rapidly evolving technique in the field of pediatric respiratory diseases. [ABSTRACT FROM AUTHOR]

Haemophilus influenzae (Hi) infections are associated with recurring acute exacerbations of chronic respiratory diseases in children and adults including otitis media, pneumonia, chronic obstructive pulmonary disease and asthma. Here, we show that persistence and recurrence of Hi infections are closely linked to Hi metabolic properties, where preferred growth substrates are aligned to the metabolome of human airway epithelial surfaces and include lactate, pentoses, and nucleosides, but not glucose that is typically used for studies of Hi growth in vitro. Enzymatic and physiological investigations revealed that utilization of lactate, the preferred Hi carbon source, required the LldD L-lactate dehydrogenase (conservation: 98.8% of strains), but not the two redox-balancing D-lactate dehydrogenases Dld and LdhA. Utilization of preferred substrates was directly linked to Hi infection and persistence. When unable to utilize L-lactate or forced to rely on salvaged guanine, Hi showed reduced extra- and intra-cellular persistence in a murine model of lung infection and in primary normal human nasal epithelia, with up to 3000-fold attenuation observed in competitive infections. In contrast, D-lactate dehydrogenase mutants only showed a very slight reduction compared to the wild-type strain. Interestingly, acetate, the major Hi metabolic end-product, had anti-inflammatory effects on cultured human tissue cells in the presence of live but not heat-killed Hi, suggesting that metabolic endproducts also influence HI-host interactions. Our work provides significant new insights into the critical role of metabolism for Hi persistence in contact with host cells and reveals for the first time the immunomodulatory potential of Hi metabolites. Author summary: The ability to access suitable growth substrates and use them for energy generation is essential for the survival of bacterial pathogens in their host but is often not well understood. This includes the highly prevalent respiratory pathogen Haemophilus influenzae (Hi), which causes pneumonia and otitis media, and worsens several common chronic respiratory infections such as asthma, bronchiectasis, and chronic obstructive pulmonary disease. Here we have shown that Hi metabolism is specifically adapted to the human respiratory tract, and access to preferred growth substrates, which included L-lactate, is required for Hi long-term persistence in primary human epithelia, including intracellular colonization of the host cells. The role of metabolism for host interactions was not limited to growth substrates but extended to Hi metabolic endproducts where we were able to link the immunometabolite acetate to a reduction of the host immune response to Hi infection. This is the first time that a specific link between metabolism and Hi persistence in the host has been established. [ABSTRACT FROM AUTHOR]

Human metapneumovirus (HMPV) causes severe respiratory diseases in young children. The HMPV RNA genome is encapsidated by the viral nucleoprotein (N), forming an RNA-N complex (NNuc), which serves as the template for genome replication and mRNA transcription by the RNA-dependent RNA polymerase (RdRp). The RdRp is formed by the association of the large polymerase subunit (L), which has RNA polymerase, capping, and methyltransferase activities, and the tetrameric phosphoprotein (P). P plays a central role in the RdRp complex by binding to NNuc and L, allowing the attachment of the L polymerase to the NNuc template. During infection these proteins concentrate in cytoplasmic inclusion bodies (IBs) where viral RNA synthesis occurs. By analogy to the closely related pneumovirus respiratory syncytial virus (RSV), it is likely that the formation of IBs depends on the interaction between HMPV P and NNuc, which has not been demonstrated yet. Here, we finely characterized the binding P-NNuc interaction domains by using recombinant proteins, combined with a functional assay for the polymerase complex activity, and the study of the recruitment of these proteins to IBs by immunofluorescence. We show that the last 6 C-terminal residues of HMPV P are necessary and sufficient for binding to NNuc and that P binds to the N-terminal domain of N (NNTD), and we identified conserved N residues critical for the interaction. Our results allowed us to propose a structural model for the HMPV P-NNuc interaction. [ABSTRACT FROM AUTHOR]

Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil), a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting ß2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population. [ABSTRACT FROM AUTHOR]

Herbal medicine is a mild and well-tolerated alternative treatment method that could be used to treat pediatric respiratory ailments. Medicinal plants such as captalan, geranium, turmeric or echinacea have been shown in numerous studies to have the ability to significantly improve the respiratory function of pediatric patients and may thus be a viable alternative to conventional treatments in acute and chronic respiratory diseases. [ABSTRACT FROM AUTHOR]

Asthma, bronchiolitis, coronavirus disease 2019, influenza, pneumonia, respiratory disease, pediatric intensive care unit, respiratory syncytial virus Keywords: asthma; bronchiolitis; coronavirus disease 2019; influenza; pediatric intensive care unit; pneumonia; respiratory disease; respiratory syncytial virus EN asthma bronchiolitis coronavirus disease 2019 influenza pediatric intensive care unit pneumonia respiratory disease respiratory syncytial virus 2137 2140 4 11/19/21 20211201 NES 211201 As health systems which care for adult patients became overwhelmed with cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during winter and early spring of 2020, pediatric units in general hospitals and pediatric hospitals and institutions did not. Respiratory syncytial virus (RSV) was virtually nonexistent from in the United States during the natural experiment, described by Maddux et al ([9]). Despite influenza vaccination recommendation for all children 6 months old and older, there continues excessive, severe disease from influenza, whether it is acquired during a "pandemic" or during seasonal influenza periods ([13]). [Extracted from the article]

In 2014, enterovirus D68 (EV-D68) emerged causing outbreaks of severe respiratory disease in children worldwide. In a subset of patients, EV-D68 infection was associated with the development of central nervous system (CNS) complications, including acute flaccid myelitis (AFM). Since then, the number of reported outbreaks has risen biennially, which emphasizes the need to unravel the systemic pathogenesis in humans. We present here a comprehensive review on the different stages of the pathogenesis of EV-D68 infection – infection in the respiratory tract, systemic dissemination and infection of the CNS – based on observations in humans as well as experimental in vitro and in vivo studies. This review highlights the knowledge gaps on the mechanisms of systemic dissemination, routes of entry into the CNS and mechanisms to induce AFM or other CNS complications, as well as the role of virus and host factors in the pathogenesis of EV-D68. [ABSTRACT FROM AUTHOR]

Background: Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children's exposure to second-hand smoke (SHS) before and after the ban, its effect on children's health and prevalence of active smoking in adults.Methods: Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children's intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking.Results: The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI95% 1.01-1.35), 1.65 (CI95% 1.39-1.95), 2.85 (CI95% 2.32-3.51), 2.24 (CI95% 1.84-2.72) and 3.66 (CI95% 2.89-4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI95% 1.03-1.24)) and S8 (OR = 1.24 (CI95% 1.13-1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI95% 1.06-1.40) for S2 and 1.57 (CI95% 1.33-1.86) for S8 compared to S1. Adverse health effects related to children's exposure to SHS are significantly less in S8 compared to S1.Conclusion: After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing. [ABSTRACT FROM AUTHOR]