Enterovirus 68 among Children with Severe Acute Respiratory Infection, the Philippines

TOC summary: Enterovirus 68 was found in 21 children with severe pneumonia

Influenza and other respiratory viruses detected by influenza-like illness surveillance in Leyte Island, the Philippines, 2010-2013.

This study aimed to determine the role of influenza-like illness (ILI) surveillance conducted on Leyte Island, the Philippines, including involvement of other respiratory viruses, from 2010 to 2013. ILI surveillance was conducted from January 2010 to March 2013 with 3 sentinel sites located in Tacloban city, Palo and Tanauan of Leyte Island. ILI was defined as fever ≥38°C or feverish feeling and either cough or running nose in a patient of any age. Influenza virus and other 5 respiratory viruses were searched. A total of 5,550 ILI cases visited the 3 sites and specimens were collected from 2,031 (36.6%) cases. Among the cases sampled, 1,637 (75.6%) were children aged <5 years. 874 (43.0%) cases were positive for at least one of the respiratory viruses tested. Influenza virus and respiratory syncytial virus (RSV) were predominantly detected (both were 25.7%) followed by human rhinovirus (HRV) (17.5%). The age distributions were significantly different between those who were positive for influenza, HRV, and RSV. ILI cases were reported throughout the year and influenza virus was co-detected with those viruses on approximately half of the weeks of study period (RSV in 60.5% and HRV 47.4%). In terms of clinical manifestations, only the rates of headache and sore throat were significantly higher in influenza positive cases than cases positive to other viruses. In conclusion, syndromic ILI surveillance in this area is difficult to detect the start of influenza epidemic without laboratory confirmation which requires huge resources. Age was an important factor that affected positive rates of influenza and other respiratory viruses. Involvement of older age children may be useful to detect influenza more effectively

Viral etiology for influenza-like illness (ILI) cases from 2010 to 2013.

<p>* In 2013, samples were collected until March.</p><p>Abbreviations: RSV, respiratory syncytial virus; HRV, human rhinovirus; hMPV, human metapneumovirus.</p><p>Viral etiology for influenza-like illness (ILI) cases from 2010 to 2013.</p

Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines—A Community-Based Study

<div><p>Pneumonia is a leading cause of deaths in infants and young children in developing countries, including the Philippines. However, data at the community level remains limited. Our study aimed to estimate incidence and mortality rates and to evaluate risk factors and health-seeking behavior for childhood pneumonia. A household level interview survey was conducted in Biliran Island, the Philippines. Caregivers were interviewed using a semi-structured questionnaire to check if children had symptoms suggesting pneumonia-like episodes from June 2011 to May 2012. Of 3,327 households visited in total, 3,302 (99.2%) agreed to participate, and 5,249 children less than 5 years of age were included in the study. Incidence rates of pneumonia-like episodes, severe pneumonia-like episodes, and pneumonia-associated mortality were 105, 61, and 0.9 per 1,000 person-years, respectively. History of asthma [hazard ratio (HR): 5.85, 95% confidence interval (CI): 4.83–7.08], low socioeconomic status (SES) (HR: 1.11, 95% CI: 1.02–1.20), and long travel time to the healthcare facility estimated by cost distance analysis (HR: 1.32, 95% CI: 1.09–1.61) were significantly associated with the occurrence of pneumonia-like episodes by the Cox proportional hazards model. For severe pneumonia-like episodes, a history of asthma (HR: 8.39, 95% CI: 6.54–10.77) and low SES (HR: 1.30, 95% CI: 1.17–1.45) were significant risk factors. Children who had a long travel time to the hospital were less likely to seek hospital care (Odds ratio: 0.32, 95% CI: 0.19–0.54) when they experienced severe pneumonia-like episodes. Incidence of pediatric pneumonia-like episodes was associated with a history of asthma, SES, and the travel time to healthcare facilities. Travel time was also identified as a strong indicator for health-seeking behavior. Improved access to healthcare facilities is important for early and effective management. Further studies are warranted to understand the causal relationship between asthma and pneumonia.</p></div

A–C Weekly number of influenza-like illness (ILI) (A), and weekly proportions of influenza positives (B), and virus positives other than influenza (C) from 2010 to 2013.

<p>Abbreviations: RSV, respiratory syncytial virus; HRV, human rhinovirus; hMPV, human metapneumovirus</p

Frequencies of clinical manifestations presented among cases aged up to 15 years.

<p>Abbreviations: RN, runny nose; ST, sore throat; DB, difficulty in breathing; CI, chest indrawing, hMPV, human metapneumovirus; HRV, human rhinovirus; RSV, respiratory syncytial virus.</p

Locations of the 3 sentinel sites in the Eastern Visayas region, the Philippines.

<p>Map source; DIVA-GIS website (<a href="http://www.diva-gis.org/gdata" target="_blank">http://www.diva-gis.org/gdata</a>).</p

Healthcare-seeking behavior of children who experienced pneumonia-like episodes sought a primary healthcare facility or a hospital (A) and severe pneumonia-like episodes sought Biliran Provincial Hospital (B) by a household plot overlaid on the map of the travel time to healthcare facilities.

<p>The color scale shows the travel time (in hours) from each point of the map to the closest public healthcare facility (A) and to Biliran Provincial Hospital (B) estimated by the cost distance analysis.</p

Study sites: Biliran Province, the Eastern Visayas Region (Region VIII), the Philippines.

<p>RHU: Rural health unit, Hospital: Biliran Provincial Hospital. Maripipi, municipality in a small island, is not included in the map.</p