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Published on: December 10, 2013
A household-based study of acute viral respiratory illnesses in Andean children
Philip J Budge1, Marie R Griffin, Kathryn M Edwards
1From the *Division of Infectious Diseases, Department of Internal Medicine; †Department of Preventive Medicine; ‡Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics; §Department of Pediatrics; ¶Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN; ‖Instituto de Investigacion Nutricional, Lima, Peru; **Swiss Tropical and Public Health Institute, Basel, Switzerland; and ††Department of Biostatistics, Vanderbilt University, Nashville, TN.
Insights
Acute respiratory illness (ARI) is common and often severe in young children living in remote, high-altitude areas. Various respiratory viruses cause these infections, necessitating targeted prevention and control strategies.
Area of Science:
- Pediatric infectious diseases
- High-altitude medicine
- Epidemiology
Background:
- Limited data exist on acute respiratory illness (ARI) incidence, severity, and causes in children in remote, high-altitude rural settings.
- Understanding these factors is crucial for public health interventions.
Purpose of the Study:
- To measure the incidence, severity, and viral etiology of ARI in children under three years old in rural highland Peru.
- To inform the development of effective prevention and control strategies.
Main Methods:
- Active, household-based surveillance for ARI in children <3 years in rural Peru (May 2009-Sept 2011).
- ARI defined by fever or cough; lower respiratory tract infections identified by clinical signs.
- Nasal swabs tested for respiratory viruses using real-time RT-PCR; incidence calculated via Poisson regression.
Main Results:
- An adjusted ARI incidence of 6.2 episodes per child-year was observed among 892 children.
- Respiratory viruses were detected in 67% of samples, with rhinovirus, adenovirus, and parainfluenza virus being most common.
- Respiratory syncytial virus, metapneumovirus, and parainfluenza viruses were disproportionately associated with lower respiratory tract infections.
Conclusions:
- ARI is highly prevalent and frequently severe in young children in this high-altitude rural population.
- Multiple respiratory viruses contribute to the burden of ARI, particularly lower respiratory tract infections.
- There is a critical need for effective prevention and control measures for ARI in this vulnerable population.
Background:
Few community studies have measured the incidence, severity and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings.
Methods:
We conducted active, household-based ARI surveillance among children aged <3 years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections if tachypnea, wheezing, grunting, stridor or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time, reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression.
Results:
During 755.1 child-years of observation among 892 children in 58 communities, 4475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% confidence interval: 5.9-6.5). Families sought medical care for 24% of ARI, 4% were classified as lower respiratory tract infections and 1% led to hospitalization. Of 5 deaths among cohort children, 2 were attributed to ARI. One or more respiratory viruses were detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30 and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus and parainfluenza virus 1-3 comprised a disproportionate share of lower respiratory tract infections compared with other etiologies.
Conclusions:
In this high-altitude rural setting with low-population density, ARI in young children were common, frequently severe and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed.
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