Incidence of viral respiratory infections in a prospective cohort of outpatient and hospitalized children aged ≤5 years and its associated cost in Buenos Aires, Argentina

Background: Although information about the incidence of viral respiratory illnesses and their associated cost can help health officials explore the value of interventions, data are limited from middle-income countries. Methods: During 2008-2010, we conducted a prospective cohort study and followed ~1,800 Argentinian children aged ≤5years to identify those children who were hospitalized or who sought care at an emergency room with any acute respiratory infection sign or symptom (e.g., rhinorrhea, cough, wheezing, tachypnea, retractions, or cyanosis). Respiratory samples were obtained for respiratory syncytial virus, influenza, parainfluenza, adenovirus, and metapneumovirus testing by immunofluorescence and for rhinovirus by real-time reverse transcription polymerase chain reaction. Results: The incidence of respiratory syncytial virus (24/1000 children-years), human metapneumovirus (8/1000 children-years), and influenza (8/1000 children-years) illnesses was highest among hospitalized children aged <6months and decreased among older children. In contrast, the incidence of rhinovirus was highest (12/1000 children-years) among those aged 6-23 months. In the emergency room, the incidence of rhinovirus was 459; respiratory syncytial virus 352; influenza 185; parainfluenza 177; metapneumovirus 130; and adenovirus 73/1,000 children-years. The total cost of hospitalization was a median of US$529 (Interquartile range, US$362-789). Conclusions: Our findings indicate that respiratory viruses, in particular rhinovirus, respiratory syncytial virus, metapneumovirus, and influenza may be associated with severe illness causing substantial economic burden.Fil: Marcone, Débora Natalia. Centro de Educaciones Médicas e Investigación Clínica ; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Durand, Lizette O.. Centers for Disease Control and Prevention; Estados UnidosFil: Azziz Baumgartner, Eduardo. Centers for Disease Control and Prevention; Estados UnidosFil: Vidaurreta, Santiago Manuel. Centro de Educaciones Médicas e Investigación Clínica ; ArgentinaFil: Ekstrom, Jorge. Centro de Educaciones Médicas e Investigación Clínica ; ArgentinaFil: Carballal, Guadalupe. Centro de Educaciones Médicas e Investigación Clínica ; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Echavarría, Marcela Silvia. Centro de Educaciones Médicas e Investigación Clínica ; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Household-level risk factors for secondary influenza-like illness in a rural area of Bangladesh

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Objective To describe household‐level risk factors for secondary influenza‐like illness (ILI), an important public health concern in the low‐income population of Bangladesh. Methods Secondary analysis of control participants in a randomised controlled trial evaluating the effect of handwashing to prevent household ILI transmission. We recruited index‐case patients with ILI – fever (<5 years); fever, cough or sore throat (≥5 years) – from health facilities, collected information on household factors and conducted syndromic surveillance among household contacts for 10 days after resolution of index‐case patients’ symptoms. We evaluated the associations between household factors at baseline and secondary ILI among household contacts using negative binomial regression, accounting for clustering by household. Results Our sample was 1491 household contacts of 184 index‐case patients. Seventy‐one percentage reported that smoking occurred in their home, 27% shared a latrine with one other household and 36% shared a latrine with >1 other household. A total of 114 household contacts (7.6%) had symptoms of ILI during follow‐up. Smoking in the home (RRadj 1.9, 95% CI: 1.2, 3.0) and sharing a latrine with one household (RRadj 2.1, 95% CI: 1.2, 3.6) or >1 household (RRadj 3.1, 95% CI: 1.8–5.2) were independently associated with increased risk of secondary ILI. Conclusion Tobacco use in homes could increase respiratory illness in Bangladesh. The mechanism between use of shared latrines and household ILI transmission is not clear. It is possible that respiratory pathogens could be transmitted through faecal contact or contaminated fomites in shared latrines

Role of Temperature, Humidity and Rainfall on Influenza Transmission in Guatemala, El Salvador and Panama

Worldwide, seasonal influenza causes about 500,000 deaths and 5 million severe illnesses per year. The environmental drivers of influenza transmission are poorly understood especially in the tropics. We aimed to identify meteorological factors for influenza transmission in tropical Central America. We gathered laboratory-confirmed influenza case-counts by week from Guatemala City, San Salvador Department (El Salvador) and Panama Province from 2006 to 2010. The average total cases per year were: 390 (Guatemala), 99 (San Salvador) and 129 (Panama). Meteorological factors including daily air temperature, rainfall, relative and absolute humidity (RH, AH) were obtained from ground stations, NASA satellites and land models. For these factors, we computed weekly averages and their deviation from the 5-yr means. We assessed the relationship between the number of influenza case-counts and the meteorological factors, including effects lagged by 1 to 4 weeks, using Poisson regression for each site. Our results showed influenza in San Salvador would increase by 1 case within a week of every 1 day with RH>75% (Relative Risk (RR)= 1.32, p=.001) and every 1C increase in minimum temperature (RR=1.29, p=.007) but it would decrease by 1 case for every 1mm-above mean weekly rainfall (RR=0.93,p<.001) (model pseudo-R2=0.55). Within 2 weeks, influenza in Panama was increased by 1 case for every 1% increase in RH (RR=1.04, p=.003), and it was increased by 2 cases for every 1C increase of minimum temperature (RR=2.01, p<.001) (model pseudo-R2=0.4). Influenza counts in Guatemala had 1 case increase for every 1C increase in minimum temperature in the previous week (RR=1.21, p<.001), and for every 1mm/day-above normal increase of rainfall rate (RR=1.03, p=.03) (model pseudo-R2=0.54). Our findings that cases increase with temperature and humidity differ from some temperate-zone studies. But they indicate that climate parameters such as humidity and temperature could be predictive of influenza activity and should be incorporated into country-specific influenza transmission model

Where backyard poultry raisers seek care for sick poultry: implications for avian influenza prevention in Bangladesh

Abstract Background In Bangladesh, backyard poultry raisers lack awareness of avian influenza and infrequently follow government recommendations for its prevention. Identifying where poultry raisers seek care for their ill poultry might help the government better plan how to disseminate avian influenza prevention and control recommendations. Methods In order to identify where backyard poultry raisers seek care for their ill poultry, we conducted in-depth and informal interviews: 70 with backyard poultry raisers and six with local poultry healthcare providers in two villages, and five with government veterinary professionals at the sub-district and union levels in two districts during June–August 2009. Results Most (86% [60/70]) raisers sought care for their backyard poultry locally, 14% used home remedies only and none sought care from government veterinary professionals. The local poultry care providers provided advice and medications (n = 6). Four local care providers had shops in the village market where raisers sought healthcare for their poultry and the remaining two visited rural households to provide poultry healthcare services. Five of the six local care providers did not have formal training in veterinary medicine. Local care providers either did not know about avian influenza or considered avian influenza to be a disease common among commercial but not backyard poultry. The government professionals had degrees in veterinary medicine and experience with avian influenza and its prevention. They had their offices at the sub-district or union level and lacked staffing to reach the backyard raisers at the village level. Conclusions The local poultry care providers provided front line healthcare to backyard poultry in villages and were a potential source of information for the rural raisers. Integration of these local poultry care providers in the government’s avian influenza control programs is a potentially useful approach to increase poultry raisers’ and local poultry care providers’ awareness about avian influenza

Evaluating Hospital-Based Surveillance for Outbreak Detection in Bangladesh: Analysis of Healthcare Utilization Data.

BACKGROUND: The International Health Regulations outline core requirements to ensure the detection of public health threats of international concern. Assessing the capacity of surveillance systems to detect these threats is crucial for evaluating a country's ability to meet these requirements. METHODS AND FINDINGS: We propose a framework to evaluate the sensitivity and representativeness of hospital-based surveillance and apply it to severe neurological infectious diseases and fatal respiratory infectious diseases in Bangladesh. We identified cases in selected communities within surveillance hospital catchment areas using key informant and house-to-house surveys and ascertained where cases had sought care. We estimated the probability of surveillance detecting different sized outbreaks by distance from the surveillance hospital and compared characteristics of cases identified in the community and cases attending surveillance hospitals. We estimated that surveillance detected 26% (95% CI 18%-33%) of severe neurological disease cases and 18% (95% CI 16%-21%) of fatal respiratory disease cases residing at 10 km distance from a surveillance hospital. Detection probabilities decreased markedly with distance. The probability of detecting small outbreaks (three cases) dropped below 50% at distances greater than 26 km for severe neurological disease and at distances greater than 7 km for fatal respiratory disease. Characteristics of cases attending surveillance hospitals were largely representative of all cases; however, neurological disease cases aged <5 y or from the lowest socioeconomic group and fatal respiratory disease cases aged ≥60 y were underrepresented. Our estimates of outbreak detection rely on suspected cases that attend a surveillance hospital receiving laboratory confirmation of disease and being reported to the surveillance system. The extent to which this occurs will depend on disease characteristics (e.g., severity and symptom specificity) and surveillance resources. CONCLUSION: We present a new approach to evaluating the sensitivity and representativeness of hospital-based surveillance, making it possible to predict its ability to detect emerging threats

Case–Control Study of an Acute Aflatoxicosis Outbreak, Kenya, 2004

Objectives: During January–June 2004, an aflatoxicosis outbreak in eastern Kenya resulted in 317 cases and 125 deaths. We conducted a case–control study to identify risk factors for contamination of implicated maize and, for the first time, quantitated biomarkers associated with acute aflatoxicosis. Design: We administered questionnaires regarding maize storage and consumption and obtained maize and blood samples from participants. Participants: We recruited 40 case-patients with aflatoxicosis and 80 randomly selected controls to participate in this study. Evaluations/Measurements: We analyzed maize for total aflatoxins and serum for aflatoxin B(1)–lysine albumin adducts and hepatitis B surface antigen. We used regression and survival analyses to explore the relationship between aflatoxins, maize consumption, hepatitis B surface antigen, and case status. Results: Homegrown (not commercial) maize kernels from case households had higher concentrations of aflatoxins than did kernels from control households [geometric mean (GM) = 354.53 ppb vs. 44.14 ppb; p = 0.04]. Serum adduct concentrations were associated with time from jaundice to death [adjusted hazard ratio = 1.3; 95% confidence interval (CI), 1.04–1.6]. Case patients had positive hepatitis B titers [odds ratio (OR) = 9.8; 95% CI, 1.5–63.1] more often than controls. Case patients stored wet maize (OR = 3.5; 95% CI, 1.2–10.3) inside their homes (OR = 12.0; 95% CI, 1.5–95.7) rather than in granaries more often than did controls. Conclusion: Aflatoxin concentrations in maize, serum aflatoxin B(1)–lysine adduct concentrations, and positive hepatitis B surface antigen titers were all associated with case status. Relevance: The novel methods and risk factors described may help health officials prevent future outbreaks of aflatoxicosis

Timing of respiratory syncytial virus and influenza epidemic activity in five regions of Argentina, 2007-2016

Fil: Baumeister, Elsa. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología. Servicio de Virosis Respiratoria; Argentina.Fil: Duque, Jazmin. Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Fil: Varela, Teresa. Sistema Nacional de Vigilancia por Laboratorio, Sistema Nacional de Vigilancia de la Salud, Ministerio de Salud de la Nación, Buenos Aires; Argentina.Fil: Palekar, Rakhee. Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Fil: Couto, Paula. Pan American Health Organization, Washington, District of Columbia; Estados Unidos.Fil: Savy, Vilma L. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología. Servicio de Virosis Respiratoria; Argentina.Fil: Giovacchini, Carlos. Pan American Health Organization, Washington, District of Columbia; Estados Unidos.Fil: Haynes, Amber K. Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Fil: Rha, Brian. Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Fil: Arriola, Carmen S. Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Fil: Gerber, Susan I. Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Fil: Azziz-Baumgartner, Eduardo. Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Estados Unidos.Within-country differences in the timing of RSV and influenza epidemics have not been assessed in Argentina, the eighth largest country in the world by area

Influenza in Outpatient ILI Case-Patients in National Hospital-Based Surveillance, Bangladesh, 2007–2008

Recent population-based estimates in a Dhaka low-income community suggest that influenza was prevalent among children. To explore the epidemiology and seasonality of influenza throughout the country and among all age groups, we established nationally representative hospital-based surveillance necessary to guide influenza prevention and control efforts.We conducted influenza-like illness and severe acute respiratory illness sentinel surveillance in 12 hospitals across Bangladesh during May 2007–December 2008. We collected specimens from 3,699 patients, 385 (10%) which were influenza positive by real time RT-PCR. Among the sample-positive patients, 192 (51%) were type A and 188 (49%) were type B. Hemagglutinin subtyping of type A viruses detected 137 (71%) A/H1 and 55 (29%) A/H3, but no A/H5 or other novel influenza strains. The frequency of influenza cases was highest among children aged under 5 years (44%), while the proportions of laboratory confirmed cases was highest among participants aged 11–15 (18%). We applied kriging, a geo-statistical technique, to explore the spatial and temporal spread of influenza and found that, during 2008, influenza was first identified in large port cities and then gradually spread to other parts of the country. We identified a distinct influenza peak during the rainy season (May–September).Our surveillance data confirms that influenza is prevalent throughout Bangladesh, affecting a wide range of ages and causing considerable morbidity and hospital care. A unimodal influenza seasonality may allow Bangladesh to time annual influenza prevention messages and vaccination campaigns to reduce the national influenza burden. To scale-up such national interventions, we need to quantify the national rates of influenza and the economic burden associated with this disease through further studies