Neumonías graves bacterianas en niños menores de 1 año / Severe bacterial pneumonia in children under 1 year of age / Pneumonias bacterianas graves em crianças menores de 1 ano

RESUMEN La neumonía es una infección común y potencialmente grave que tiene una prevalencia importante en la infancia y causa más muerte que cualquier otra enfermedad en el mundo en niños menores de 5 años. Con el objetivo de caracterizar el comportamiento de neumonía grave bacteriana en los menores de 1 año, ingresados en la unidad de cuidados intensivos pediátrico, en el 2do semestre del año 2019.Se realizó un estudio descriptivo, observacional y retrospectivo en este año. El universo estuvo constituido por 37 pacientes a los que se les diagnosticó neumonía que requirió ingreso hospitalario y la muestra quedó representada por 32 pacientes que cumplieron con los criterios de inclusión y exclusión. El grupo de 0-4 meses(50%), el sexo masculino (68.8 %), la zona rural (71.9%), la vía de ingreso por cuerpo de guardia (56.3 %), la estadía hospitalaria menor de 72 horas en UTIP (68.8 %) y las acciones de enfermería independientes (46.8%), fueron los hallazgos más significativos encontrados. El grupo de edad entre 0-4 meses, del sexo masculino y de procedencia rural predominó en el estudio. El cuerpo de guardia fue la vía de ingreso que más se utilizó. Los pacientes tuvieron una estadía hospitalaria menor de 3 días y las acciones de enfermería independientes en la neumonía grave bacteriana fueron las que más se utilizaron.

ABSTRACT Pneumonia is a common and potentially serious infection that has a significant prevalence in childhood and causes more death than any other disease in the world in children under the age of 5. With the aim of characterizing the behavior of severe bacterial pneumonia in children under 1 year, admitted to the pediatric intensive care unit, in the 2nd semester of 2019. A descriptive, observational and retrospective study was conducted this year. The universe consisted of 37 patients who were diagnosed with pneumonia that required hospital admission and the sample was represented by 32 patients who met the inclusion and exclusion criteria. The group of 0-4 months (50%), the male sex (68.8%), the rural area (71.9%), the route of admission by guard corps (56.3%), the hospital stay less than 72 hours in PICU (68.8%) and the independent nursing actions (46.8%), were the most significant findings found.The age group between 0-4 months, male and rural origin predominated in the study. The guard corps was the most widely used route of entry. Patients had a hospital stay of less than 3 days and independent nursing actions in severe bacterial pneumonia were the most widely used.

RESUMO A pneumonia é uma infecção comum e potencialmente grave que tem uma prevalência significativa na infância e causa mais morte do que qualquer outra doença no mundo em crianças menores de 5 anos. Como objetivo de caracterizar o comportamento de pneumonia bacteriana grave em crianças menores de 1 ano, internado na unidade de terapia intensiva pediátrica, no 2º semestre de 2019. Este ano, foi realizado um estudo descritivo, observacional e retrospectivo. O universo era composto por 37 pacientes diagnosticados com pneumonia que necessitavam de internação hospitalar e a amostra foi representada por 32 pacientes que atenderam aos critérios de inclusão e exclusão. O grupo de 0-4 meses (50%), o sexo masculino (68,8%), a área rural (71,9%), a rota de internação por corpo de guarda (56,3%), a internação hospitalar inferior a 72 horas no PICU (68,8%) e as ações independentes de enfermagem (46,8%), foram os achados mais significativos encontrados. A faixa etária entre 0-4 meses, de origem masculina e rural, predominou no estudo. O corpo de guarda foi a rota de entrada mais utilizada. Os pacientes tiveram uma internação hospitalar de menos de 3 dias e as ações independentes de enfermagem em pneumonia bacteriana grave foram as mais utilizadas.

Impact of morbidity among under-five children: A meta-analysis

The burden of morbidity and mortality among infants is the highest in developing countries. The future economic growth of a country depends upon the well-being of the infants of today; hence, infants need the utmost attention of society through organized medical care and social activities. Feeding infants and young children properly are essential for their growth, development, nutritional status, health, and survival. Improper feeding practices may lead to irreversible outcomes like malnutrition, infectious diseases, attention deficit, memory failure, lower IQ, and lifelong poor cognitive and behavioral development. This review was taken to assess the cause, prevalence, and impact of various morbidities during infancies. The literature search covered both conceptual and specific literature. The specific literature search was on the assessment of morbidities among infants. Morbidities were further classified into diarrhea, acute respiratory infections (ARIs), and fever. Factors affecting each morbidity during the first year of life were classified as International and Indian studies. The studies were further categorized based on methodology as cross-sectional, prospective studies, systematic reviews, and meta-analysis. We conclude that the incidence of morbidities specifically ARIs, diarrhea, and fever have a debilitating effect on the growth and development of infants. Further research is required to assess the impact of morbidity on growth and development in children.

Revisión rápida: evidencia de transmisión por Covid-19 e infecciones respiratorias agudas similares en espacios públicos abiertos / Rapid review: evidence of Covid-19 transmission and similar acute respiratory infections in open public spaces

Resumen: Objetivo: Describir la evidencia disponible sobre la transmisión por Covid-19 e infecciones respiratorias agudas similares al Covid-19 en espacios públicos abiertos. Material y métodos: La búsqueda incluyó 4 926 artículos en inglés de los años 2000 a 2020. Seis investigadores revisaron el título y el resumen de los artículos de Embase y PubMed; dos investigadores revisaron los de medRxiv. Todos los investigadores revisaron textos completos y otros resolvieron las discrepancias. Resultados: De los 21 artículos seleccionados, se observó que la presencia de virus en superficies públicas, aguas residuales y áreas exteriores no fue indicativa de transmisión. No obstante, se observó que el uso de cubrebocas, el lavado de manos, el distanciamiento social, no asistir a eventos masivos y la movilidad individual a espacios públicos podría ayudar a reducir el riesgo de transmisión. Conclusión: Esta información podría coadyuvar a generar recomendaciones en salud pública, sin embargo, es recomendable actualizar esta revisión conforme avance la evidencia científica.

Abstract: Objective: To describe the available evidence on the transmission of Covid-19 or similar acute respiratory infections in open, public spaces. Materials and methods: Our search included 4 926 articles in English from 2000 to 2020. Six researchers reviewed the title and abstracts from Embase and PubMed databases, and two researchers reviewed medRxiv database. All reviewed full texts and others resolved the discrepancies. Results: A total of 21 articles were selected. The presence of the SARS-CoV-2 virus on public surfaces, sewage, and outdoor areas was not indicative of transmission. Nevertheless, we observed that applying preventive measures such as the use of face masks, hand washing, social distancing, restricting attendance to massive events, and reducing people's mobility to public spaces may reduce the risk of transmission. Conclusions: This information could help to generate public health recommendations. However, we advise updating this review as new evidence is generated.

Characteristics and outcomes of pregnant women with SARS-CoV-2 infection and other severe acute respiratory infections (SARI) in Brazil from January to November 2020

ABSTRACT Background: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging. Aim: To analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil. Methods: National surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) was used to describe currently and recently pregnant women aged 10-49 years hospitalized for SARI from January through November, 2020. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. Binomial proportion and 95% confidence intervals (95% CI) for outcomes were obtained using the Clopper-Pearson method. Results: Of 945,460 SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7964) or recently pregnant (3110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95%CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients. Conclusion: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high.

Nivel de conocimiento sobre signos de alarma de infecciones respiratorias agudas en madres de niños menores de cinco años: servicio desconcentrado Hospital Universitario Pediátrico Dr. Agustín Zubillaga / Level of knowledge about warning signs of acute respiratory infections in mothers of children under five years of age: deconcentrated service Dr. Agustín Zubillaga Pediatric University Hospital

Con el objetivo de determinar el nivel de conocimiento que poseen las madres sobre los signos de alarma de las infecciones respiratorias agudas (IRA) en niños menores de 5 años que asistieron al Servicio Desconcentrado Hospital Universitario Pediátrico Dr. Agustín Zubillaga durante el mes de noviembre 2019, se realizó un estudio descriptivo transversal con 37 madres las cuales se caracterizaron por un promedio de edad de 29,2 ± 7,3 años, solteras (43,2%), con secundaria completa (27%) y empleadas (40,5%). El promedio de edad de los pacientes fue de 15,3 ± 6,2 meses, con predominio del sexo masculino (54%); durante el último año, 45,9% registraron entre 2-3 episodios de IRA. Sobre el nivel de conocimiento global de las madres en relación a los signos de alarma de las IRA se evidenció que en el 56,7% de las madres el nivel era regular. El nivel de conocimiento para las causas de las IRA fue insuficiente en el 48,6% de los casos. En relación a los signos de alarma de IRA identificadas por parte de las madres fueron, en orden de frecuencia, dificultad para respirar (91,8%), fiebre (81%), rechazo al alimento (78,3%) y respiración ruidosa (75,6%). En conclusión, es evidente que la mayoría de las madres conoce los principales signos de alarma de las IRA sin embargo se deben establecer estrategias de intervención destinadas a mejorar su conocimiento con el fin de que las madres reconozcan tempranamente los signos de alarma y por ende busquen atención en el momento oportuno(AU)

With the objective of determining the level of knowledge that mothers have about warning signs of acute respiratory infections (ARI) in children under 5 years of age who attended the Servicio Desconcentrado Hospital Universitario Pediátrico Dr. Agustín Zubillaga (November, 2019), a cross-sectional descriptive study was carried out with 37 mothers with an average age of 29.2 ± 7.3 years, 43.2% were single, with completed secondary school (27%) and employed (40.5%). Average age of patients was 15.3 ± 6.2 months with male predominance (54%); during the previous year, 45.9% had between 2-3 episodes of ARI. Level of knowledge of mothers about global warning signs of ARI was regular in 56.76% of cases. Regarding causes of ARI, level of knowledge was insufficient in 48.6% of mothers. Warning signs of ARI identified by the mothers were, in order of frequency, difficulty in breathing (91.8%), fever (81%), food rejection (78.3%) and loud breathing loud (75.6%). In conclusion, it is clear that most mothers know the main warning signs of ARI however intervention strategies should be established to improve knowledge in order for mothers to recognize early warning signs and therefore seek attention in a timely manner(AU)

Respiratory infections and coinfections: geographical and population patterns / Infecciones y coinfecciones respiratorias: patrón geográfico y de circulación poblacional

Abstract Introduction: Acute respiratory infections are the second cause of mortality in children younger than five years, with 150.7 million episodes per year. Human orthopneumovirus (hOPV) and metapneumovirus (hMPV) are the first and second causes of bronchiolitis; type 2 human orthorubulavirus (hORUV) has been associated with pneumonia in immunocompromised patients. Objective: To define hOPV, hMPV and hORUV geographical distribution and circulation patterns. Method: An observational, prospective cross-sectional pilot study was carried out. Two-hundred viral strains obtained from pediatric patients were genotyped by endpoint reverse transcription polymerase chain reaction (RT-PCR). Results: One-hundred and eighty-six positive samples were typed: 84 hOPV, 43 hMPV, two hORUV and 57 co-infection specimens. Geographical distribution was plotted. hMPV, hOPV, and hORUV cumulative incidences were 0.215, 0.42, and 0.01, respectively. Cumulative incidence of hMPV-hORUV and hMPV-hOPV coinfection was 0.015 and 0.23; for hOPV-hMPV-hORUV, 0.035; and for hORUV-hOPV, 0.005. The largest number of positive cases of circulating or co-circulating viruses occurred between January and March. Conclusions: This study successfully identified circulation and geographical distribution patterns of the different viruses, as well as of viral co-infections.

Resumen Introducción: Las infecciones respiratorias agudas constituyen la segunda causa de mortalidad en los niños menores de cinco años, con 150.7 millones de episodios anuales. Entre los principales agentes etiológicos están Orthopneumovirus (hOPV) y metapneumovirus (hMPV) humanos como primera y segunda causa de bronquiolitis, respectivamente; Orthorubulavirus humano tipo 2 (hORUV) se ha asociado a neumonía en pacientes inmunocomprometidos. Objetivo: Definir patrones de distribución geográfica y de circulación de hOPV, hMPV y hORUV. Método: Se llevó a cabo un estudio piloto transversal prospectivo observacional. Se genotipificaron 200 aislamientos virales de pacientes pediátricos mediante transcripción inversa seguida de reacción en cadena de la polimerasa en punto final (RT-PCR). Resultados: Se tipificaron 186 muestras positivas: 84 de hOPV, 43 de hMPV, dos de hORUV y 57 de coinfecciones. Se trazó la distribución geográfica. Las incidencias acumuladas de hMPV, hOPV y hORUV fueron de 0.215, 0.42 y 0.01, respectivamente. Las incidencias acumuladas de la coinfección de hMPV-hORUV y hMPV-hOPV fueron de 0.015 y 0.23; de hOPV-hMPV-hORUV, de 0.035; y de hORUV-hOPV, de 0.005. El mayor número de casos positivos de virus circulantes o cocirculantes se presentó entre enero y marzo. Conclusiones: Fue posible identificar patrones de circulación y distribución geográfica de los diferentes virus, así como de las coinfecciones virales.

Caracterización clínico epidemiológica de lactantes con bronquiolitis aguda grave / Clinical epidemiological characterization of infants with severe acute bronchiolitis / Caracterização epidemiológica clínica de lactentes com bronquiolite aguda grave

RESUMEN La bronquiolitis se considera como el primer episodio agudo de sibilancias en el contexto de un cuadro respiratorio de origen viral que afecta a niños menores de 24 meses que se acompaña de dificultad respiratoria de diversos grados. Este trabajo tiene como objetivo caracterizar a los pacientes con bronquiolitis aguda grave en la unidad de cuidados intensivos del Hospital Pediátrico Provincial Hermanos Cordové durante el periodo enero del 2014 a diciembre del 2018. Para lograr el objetivo planteado se realizó un estudio retrospectivo observacional descriptivo transversal con fases analíticas. El universo estuvo constituido por 72 pacientes, recolectando la información a partir de las historias clínicas y registro de control hospitalario. Se procesó la información utilizándose medidas expresadas en números absolutos, desviación estándar, media aritmética, porcentajes y tasas. Se demostró que la edad de aparición de la bronquiolitis aguda grave se presenta en menores de 6 meses de edad, resultando la estadía predominante de más de 48 horas. Se relaciona directamente la enfermedad con factores de riesgo como la no lactancia materna exclusiva y la malnutrición proteico-energética, requiriendo estos pacientes, al ingreso, oxígeno suplementario y aspiración de secreciones como terapéutica fundamental. Se presentaron complicaciones frecuentes como la neumonía e insuficiencia respiratoria aguda. Podemos concluir diciendo que se necesitan políticas bien definidas y protocolos de actuación actualizados para el manejo integral del lactante con bronquiolitis aguda grave, evitando así la aparición de complicaciones que pudieran llevar a la muerte del paciente.

ABSTRACT Bronchiolitis is considered to be the first acute episode of wheezing in the context of a respiratory picture of viral origin that affects children younger than 24 months accompanied by respiratory distress of various degrees. This study aims to characterize patients with severe acute bronchiolitis in the intensive care unit of the Hermanos Cordové Provincial Pediatric Hospital during the period from January 2014 to December 2018. To achieve the stated objective, a retrospective observational descriptive cross-sectional study was conducted with analytical phases. The universe consisted of 72 patients, collecting the information from the medical records and the hospital control registry. The information was processed using measures expressed in absolute numbers, standard deviation, arithmetic mean, percentages and rates. It was demonstrated that the age of onset of severe acute bronchiolitis occurs in children under 6 months of age, resulting in the predominant stay of more than 48 hours. The disease is directly related to risk factors such as exclusive non-breastfeeding and protein-energy malnutrition, requiring these patients, upon admission, supplemental oxygen and secretion aspiration as fundamental therapy. Frequent complications such as pneumonia and acute respiratory failure occurred. We can conclude by saying that well-defined policies and updated action protocols are needed for the comprehensive management of the infant with severe acute bronchiolitis, thus avoiding the appearance of complications that could lead to the death of the patient.

RESUMO A bronquiolite é considerada o primeiro episódio agudo de sibilância no contexto de um quadro respiratório de origem viral que afeta crianças menores de 24 meses acompanhadas de dificuldade respiratória de vários graus. Este estudo tem como objetivo caracterizar pacientes com bronquiolite aguda grave na unidade de terapia intensiva do Hospital Pediátrico Provincial de Hermanos Cordové, no período de janeiro de 2014 a dezembro de 2018. Para atingir o objetivo declarado, foi realizado um estudo transversal observacional descritivo retrospectivo com fases analíticas. O universo foi constituído por 72 pacientes, coletando as informações dos prontuários e do registro de controle hospitalar. As informações foram processadas utilizando medidas expressas em números absolutos, desvio padrão, média aritmética, porcentagens e taxas. Foi demonstrado que a idade de início da bronquiolite aguda grave ocorre em crianças menores de 6 meses de idade, resultando em permanência predominante de mais de 48 horas. A doença está diretamente relacionada a fatores de risco, como a não amamentação exclusiva e a desnutrição energético-protéica, exigindo desses pacientes, na admissão, oxigênio suplementar e aspiração de secreção como terapia fundamental. Ocorreram complicações frequentes, como pneumonia e insuficiência respiratória aguda. Podemos concluir dizendo que são necessárias políticas bem definidas e protocolos de ação atualizados para o manejo abrangente da criança com bronquiolite aguda grave, evitando o aparecimento de complicações que podem levar à morte do paciente.

Revisión rápida del uso de cubrebocas quirúrgicos en ámbito comunitario e infecciones respiratorias agudas / Rapid review of the community-wide use of surgical masks and acute respiratory infections

Resumen: Objetivo: Evaluar la efectividad del uso de cubrebocas quirúrgico en ámbitos comunitarios para reducir la probabilidad de contagio por SARS-CoV-2 u otra infección respiratoria aguda viral, en comparación con no usar cubrebocas. Material y métodos: Se utilizó la metodología de revisiones rápidas de Cochrane. La estrategia de búsqueda abarcó una base de datos académica y pre-prints hasta el 1 de abril de 2020. Los títulos y resúmenes fueron revisados por un investigador. La revisión de textos completos fue dividida entre tres investigadores. Los resultados fueron sintetizados de forma narrativa. Resultados: Se identificaron 713 manuscritos, de los cuales 21 cumplieron los criterios de inclusión. De seis revisiones sistemáticas, cuatro no encontraron reducciones en la probabilidad de contagio y seis estudios experimentales en hogares no encontraron diferencias en la probabilidad de contagio asociado con el uso de cubrebocas. Únicamente un estudio de modelaje estimó una reducción de 20% en la incidencia de enfermedad respiratoria, asumiendo que 10 a 50% de la población hace uso correcto de cubrebocas quirúrgicos. Conclusiones: La evidencia científica no es concluyente para recomendar o desalentar el uso de cubrebocas a nivel poblacional. Considerando los potenciales efectos negativos, las recomendaciones gubernamentales deberían esperar a los resultados de los experimentos naturales en países que han recomendado la utilización poblacional de cubrebocas.

Abstract: Objective: To assess the effectiveness of using surgical masks in community settings to reduce the probability of infection by SARS-CoV-2 or other acute viral respiratory infection, compared to not using surgical masks. Materials and methods: We followed the Cochrane rapid review methodology. The search strategy encompasses one academic database and pre-prints until April 1, 2020. Titles and abstracts were reviewed by one investigator. The full text review was divided among three researchers. The results were synthesized in a narrative way. Result: 713 manuscripts were identified, of which 21 met the inclusion criteria. Of six systematic reviews, four found no reduction in the probability of transmission. Experimental home studies found no differences in the probability of contagion associated with the use of mouth masks. Only one modeling study estimated a 20% reduction in the incidence of acute respiratory disease, assuming that 10 to 50% of the population use the surgical masks correctly. Conclusions: The scientific evidence is inconclusive to recommend or discourage the use of surgical masks at the population level. Considering the potential negative effects, official recommendations should await for the results of natural experiments currently occurring in countries that have recommended the use of face masks at the population level.

Management of Acute Respiratory Infections in Children under Five by Self-medication and Prescription of Antibiotics in Bukavu

Acute respiratory infections (ARI) are one of the top 10 killer diseases in children. In developing countries, the treatment is often initiated by self-medication (SM) before going to the hospital in case of a complication. This study assessed the level ofself-medication and the adequacy of hospital prescribing patterns of antibiotics for the management of acute respiratory infections in children under five. It was a cross-sectional survey conducted in 2018, including a face-to-face interview with 227 children’s mothers for self-medication and a review of 1162 medical files available at the pediatrics wards of Panzi General Hospital and University Clinic in Bukavu. Of 227 mothers interviewed, 168(74%) self-medicated children with six antibiotics, mainly amoxicillin (67%), and Cotrimoxazole (60%), principally to avoid medical consultation fees and to mitigate the early signs of the disease. However, among them, 49.8% rushed to the hospital after a complication. Of the 1162 medical files reviewed, 248(21.34%)are ARI cases of which 53% males and 47% females. Under 2 years constitute 85%. Dominant ARIs were acute pharyngitis (19.1%), acute otitis media (15.3%), bronchial superinfection (23.3%), and pneumonia (16.3%). The mortality rate attributable to ARIs was 17.5% (14/80). The antibiotics used in hospital include gentamicin (67%) in combination with cefotaxime, ampicillin, and azithromycin. The unprofessional dispensing of antibiotics in community pharmacies encouraged the high level of self-medication.

Modelo computacional interactivo, semi-automatizado y de código abierto aplicado a la vigilancia de virus respiratorios / Interactive, semi-automatized and open source computational model applied to respiratory viruses surveillance

Resumen Las infecciones respiratorias agudas (IRA) causadas por virus son una importante causa de morbilidad y mortalidad en el mundo, afectando principalmente a niños y adultos mayores. Se asocian a un alto número de consultas y hospitalizaciones, a una significativa sobrecarga del sistema de salud y a un alto costo económico. La vigilancia de virus respiratorios tiene el potencial de ayudar a optimizar la respuesta sanitaria, garantizar la disponibilidad de recursos humanos, racionalizar los recursos y disminuir los costos asociados a la atención en salud. Con el objetivo de optimizar la recolección y visualización de los datos de nuestro actual sistema de vigilancia de virus respiratorios, se diseñó una plataforma basada en R y sus paquetes Shiny, que permite la creación de una interfase web interactiva y amigable para la recolección, análisis y publicación de los datos. Se ingresaron a esta plataforma los datos de la red de vigilancia metropolitana de virus respiratorios disponibles desde 2006. En esta plataforma, el investigador demora menos de un minuto en registrar los datos. El análisis y publicación es inmediato, llegando a cualquier usuario con un dispositivo conectado a Internet, quien puede elegir las variables a consultar. Con un costo muy bajo, en poco tiempo y utilizando el lenguaje de programación R, se logró crear un sistema simple e interactivo, disminuyendo el tiempo de carga y análisis de datos de forma considerable, posiblemente aumentando el impacto y la disponibilidad de esta vigilancia.

Abstract Acute respiratory infections (ARI) are an important cause of morbidity and mortality worldwide, affecting mainly children and the elderly. They are associated with a high economic burden, increased number of medical visits and hospitalizations. The surveillance of the circulation of respiratory viruses can reduce the health care associated costs, and to optimize the health response. A platform based on R and its package Shiny was designed, to create an interactive and friendly web interface for gathering, analysis and publication of the data. The data from the Chilean metropolitan respiratory viruses surveillance network, available since 2006, was uploaded into the platform. Using this platform, the researcher spends less than 1 minute to upload the data, and the analysis and publication is immediate, available to be seen by any user with a device connected to Internet, who can choose the variables to be displayed. With a very low cost, in a short time, and using the R programming language, it was possible to create a simple, and interactive platform, considerably decreasing the upload and analysis time, and increasing the impact and availability of this surveillance.

Prevalence of acute respiratory infections among under five children in a rural area of Kozhikode district, Kerala

Background: Although childhood acute respiratory infections (ARI) is a significant public health problem in India, robust epidemiological data on its prevalence is not available. This study was done to estimate the prevalence of ARI in under five children and study the factors responsible for the same in a rural area of Kozhikode District.Methods: This cross sectional study was conducted in 386 under-5 children in Kunnamangalam panchayat of Kozhikode district from June 2015 to June 2016. Employing cluster sampling technique, data regarding socio demographic factors, prevalence of ARI and selected factors were collected using a pre tested semi structured questionnaire.Results: The overall prevalence of ARI in children was 31.9 %. Prevalence was slightly higher in boys (32.7%) than in girls (31.1%). The prevalence of ARI was more in lower social class children (36.1%), compared to those from upper social class (26.3%). ARI was higher in children living in overcrowded houses (40.2%), poorly ventilated houses (37.8%), houses in which there were no smoke outlets (43.1%), houses having pets (58.6%). Underweight children were also found to have higher rates of ARI (46.5%). Binary logistic regression revealed that after adjusting for all other factors, age less than 1 year (OR 0.48, p=0.02) and nuclear family (OR 0.10, p=0.01) are significant independent protective factors for ARI.Conclusions: Among under-5 children, younger age and membership in a nuclear family are significant protective factors for ARI

Genetic diversity of human respiratory syncytial virus in children with acute respiratory infections in Chennai, South India

Introduction: Human respiratory syncytial virus (HRSV) an RNA virus belonging to Pneumoviridae family, is an important cause of acute respiratory infections (ARIs) in young children. HRSV circulates as two subgroups A and B, which are further categorised into several genotypes. New genotypes may replace existing ones over successive epidemic seasons and multiple genotypes may cocirculate in the same community rendering it important to monitor them at the molecular level. The present study assessed the circulating genotypes of HRSV in Chennai. Materials and Methods: Two hundred and sixty-seven children with ARI were recruited during the study from April 2016 to March 2018 for detecting HRSV A and B by real-time reverse transcription-polymerase chain reaction. Phylogeny and selection pressure analysis were done. Results: Fifty-seven of the 267 samples (21.3%) were positive for HRSV, of which 7.1% and 14.2% were HRSV A and B, respectively, indicating that HRSV B was the major subgroup circulating in Chennai. Peak activity of HRSV was observed during the monsoon and winter months. Phylogenetic analysis of 2nd hypervariable region (HVR) of attachment glycoprotein gene (G gene) revealed that the HRSV A strains belonged to ON1 and HRSV B strains belonged to BA9 genotypes. Several unique amino acid substitutions were observed among the study strains. The Shannon entropy plot revealed that the HRSV A strains from our study have a high potential for amino acid substitutions in the 2nd HVR of G gene. Conclusion: This study underlines the genetic diversity of HRSV and emphasises the need for continued molecular surveillance for infection management and prevention strategies.

Etiologic and epidemiologic features of acute respiratory infections in adults from Shanghai, during 2015-2017 / 中华流行病学杂志

Objective@#To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017.@*Methods@#Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens.@*Results@#A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001).@*Conclusions@#In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.

Detección y caracterización molecular de virus respiratorios causantes de infección respiratoria aguda en población adulta / Detection and molecular characterization of respiratory viruses that cause acute respiratory infection in the adult population

Resumen Introducción: Las infecciones respiratorias agudas son una de las principales causas de morbimortalidad en adultos mayores y pacientes con enfermedades crónicas. Dentro de los agentes etiológicos responsables se encuentran los virus respiratorios humanos, tales como: virus sincitial respiratorio, virus parainfluenza y metapneumovirus. Objetivo: Realizar un estudio de diagnóstico diferencial de virus respiratorios que circulan y cocirculan en una población adulta. Método: Se realizó un estudio tipo piloto en pacientes mayores de 18 años, que presentaron signos y síntomas sugestivos de infección respiratoria aguda y cuyo cuadro clínico no sobrepasara los 15 días de evolución; se realizaron ensayos de reacción en cadena de la polimerasa de punto final con el uso de oligonucleótidos específicos para el diagnóstico molecular. Resultados: Se tipificaron 72 especímenes de pacientes con una edad de 51.33 ± 19.33 años, con predominio del sexo femenino (4.5:1); originarios en su totalidad de la Ciudad de México; solo 22 fueron positivos para virus respiratorios, siendo en su mayoría infecciones por metapneumovirus. Conclusiones: El conocimiento de las cepas virales circulantes en la población permitirá determinar cambios que puedan declarar una alerta epidemiológica llevando a la mejor toma de decisiones en beneficio de los pacientes.

Abstract Introduction: Acute respiratory infections are one of the main causes of morbidity and mortality in older adults and patients with chronic diseases. Among the responsible etiological agents are human respiratory viruses, such as: respiratory syncytial virus, parainfluenza virus and metapneumovirus. Objective: To carry out a differential diagnostic study of respiratory viruses circulating and co-circulating in an adult population. Methods: A pilot study was conducted in patients older than 18 years, who presented signs and symptoms suggestive of acute respiratory infection and whose clinical picture did not exceed 15 days of evolution; end-point polymerase chain reaction assays were performed with the use of specific oligonucleotides for molecular diagnosis. Results: 72 specimens of patients with an age of 51.33 ± 19.33 years, with a predominance of females (4.5:1); original inhabitants of Mexico City; only 22 were positive for respiratory viruses, being mostly metapneumovirus infections. Conclusions: The knowledge of the circulating viral strains in the population will allow to determine changes that can declare an epidemiological alert leading to the best decision making for the benefit of the patients.

Viral etiology of acute respiratory infections in children in Southern Iran

Abstract INTRODUCTION: Prevalence of influenza A virus (Flu-A), respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) was assessed in children with acute respiratory infections (ARIs). METHODS: Nasopharyngeal aspirates and throat swabs were subjected to real-time polymerase chain reaction (PCR) to detect RSV and Flu-A and to conventional PCR to detect hMPV. RESULTS: Of the 156 children assessed, 93 (59.6%) carried at least one virus, with 35.9% positive for RSV, 14.1% for hMPV, and 9.6% for Flu-A. The prevalence of co-infections was 2.6%. CONCLUSIONS: The high detection rate may reflect increased sensitivity of real-time PCR compared to traditional PCR and viral culture.

Introducción de nuevos ensayos de reacción en cadena de la polimerasa en tiempo real para el diagnóstico y vigilancia de virus respiratorios / Introduction of new assays of real time polymerase's chain reaction for the diagnosis and surveillance of respiratory viruses

Las infecciones respiratorias agudas constituyen la causa fundamental de mortalidad y morbilidad en el ámbito mundial. Los principales agentes causales de estas infecciones son los virus. La detección rápida y eficaz de estos patógenos es determinante en el tratamiento y la prevención de las enfermedades que estos agentes virales pueden ocasionar. En la actualidad, los métodos moleculares para el diagnóstico virológico son muy útiles por su elevada sensibilidad, especificidad y rapidez en la obtención de los resultados. El objetivo es introducir cuatro ensayos múltiples de transcripción reversa de reacción en cadena de la polimerasa en tiempo real para el diagnóstico y vigilancia de 15 virus respiratorios. Se procesaron 2 441 muestras clínicas respiratorias recibidas en el Laboratorio Nacional de Referencia de Virus Influenza y otros Virus Respiratorios en el período comprendido entre septiembre de 2013 y abril de 2014. Se analizaron 2 352 exudados nasofaríngeos, 77 aspirados bronquiales y 12 muestras de necropsia. A estas se les realizó el diagnóstico molecular por los sistemas múltiples de transcripción reversa de reacción en cadena de la polimerasa en tiempo real mediante el empleo de cebadores y sondas TaqMan. De las 2 441 muestras clínicas estudiadas, 1 290 fueron positivas para alguno de los virus respiratorios (52,85 por ciento). El virus sincitial respiratorio humano se detectó con mayor frecuencia (47,83 por ciento), seguido de los virus influenza (19 por ciento) y los rinovirus humanos (14,73 por ciento). Se concluye que la introducción de los cuatro ensayos de transcripción reversa de reacción en cadena de la polimerasa en tiempo real posibilita la actualización del algoritmo diagnóstico en el Laboratorio Nacional de Referencia de Virus Influenza y otros Virus Respiratorios para la vigilancia de estos agentes en Cuba, lo que contribuye al mejoramiento del Programa Nacional de Prevención y Control de las Infecciones Respiratorias Agudas(AU)

Acute respiratory infections are the major cause of mortality and morbidity worldwide. Respiratory viruses are the main causative agents of acute respiratory infections. Rapid and accurate detection of these pathogens is critical for the treatment and prevention of the diseases these viral agents can cause. Currently, molecular diagnostic methods are useful tools for the virological detection of respiratory viruses due to its high sensitivity, specificity and their speed in obtaining results. The objective of this study was to introduce four multiplex real-time TR-RCP assays for the diagnosis and surveillance of fifteen virus causing acute respiratory infections. 2 441 clinical respiratory samples were processed in the period between September 2013 and April 2014 in the National Laboratory of Reference for Influenza Virus and other Respiratory Viruses. There were analyzed 2 352 nasopharyngeal exudates, 77 bronchial aspirations and 12 necropsy samples. Multiplex real-time TR-RCP was performed using TaqMan primers and probes previously published. From the 2 441 clinical samples studied, 1 290 were positive for some of the respiratory viruses, which represent 52.85 percent Syncytial respiratory virus was the most frequently detected virus (47.83 percent), then influenza viruses (19 percent) and human rhinovirus (14.73 percent). The introduction at the National Reference Laboratory of the four multiplex real-time TR-RCP assays allows updating the algorithm for the diagnosis and surveillance of respiratory viruses in Cuba, as a contribution to the National Program for the Prevention and Control of Acute Respiratory Infection(AU)

La atención primaria de salud y la salud materno infantil

The Primary Health Care strategy introduced concepts which sought to revolutionize the way how to achieve Health for All at the global level. The Declaration of Alma Ata was a prelude to initiatives and global plans that sought compromise to States and society in achieving access to health equity. The Summit of Action for Children and the Meeting of the Millennium, which agreed health targets to achieve by year 2015 were inspired by the concepts included in Primary Health Care. While it is true that the purposes lying below the postulates in Alma Ata were not reached, there was remarkable progress in aspects related to the Mother and Child Health. The Selective Primary Healthcare inspired the so-called "Revolution for the Child Survival", which identified the main causes of the 15 million deaths in children recorded at the global level at the beginning of the Decade of the eighties of the last century, as well as the simple, low-cost interventions based on the evidence shown to be effective in the prevention of this "silent emergency" represented by the avoidable child deaths. Product of these interventions related to children health and the subsequent inclusion of interventions for the prevention of the 500 000 preventable maternal deaths recorded worldwide at the beginning of this century, has achieved remarkable progress at global level. Peru was one of the countries of the Americas that showed greater progress in reducing maternal and infant mortality. This article seeks to find an explanation of procedures and processes that allowed these achievements at the global level and in Peru, inspired by the principles proposed by the Primary Health Care strategy.

La estrategia Atención Primaria de la Salud introdujo conceptos que buscaron revolucionar la forma como se aspiraba lograr la Salud para Todos a nivel global. La declaración de Alma Ata fue un preludio de iniciativas y planes globales que buscaron comprometer a los Estados y a la sociedad en alcanzar el acceso a la salud con equidad. La Cumbre de Acción por la Infancia y la Reunión del Milenio, en la que se acordó las metas de salud a lograr el año 2015, estuvieron inspiradas en los conceptos incluidos en la Atención Primaria de la Salud. Si bien es cierto, los propósitos que subyacían a los postulados recogidos en Alma Ata no fueron alcanzados, sí hubo notables progresos en aspectos relacionados con la salud Materno Infantil. La Atención Primaria Selectiva de la Salud, inspiró la llamada ‘Revolución por la Supervivencia Infantil, que identificó las principales causas de las 15 millones muertes en niños, que se registraban a nivel global a inicios de la década de los años 80 del siglo pasado, así como las intervenciones sencillas, de bajo costo y basadas en la evidencia que habían mostrado ser efectivas en la prevención de esta ‘emergencia silenciosa que representaban las muertes infantiles evitables. Producto de estas intervenciones relacionadas con la salud infantil y la posterior inclusión de intervenciones para la prevención de las 500 000 muertes maternas evitables que registraba el mundo a inicios del presente siglo, se ha logrado notables progresos a nivel global en estos propósitos. El Perú fue uno de los países de las Américas que mostró mayores progresos en la reducción de la mortalidad materna y en la niñez. El presente artículo busca encontrar una explicación de las intervenciones y procesos que permitieron estos logros a nivel global y en el Perú, inspirados en los postulados propuestos por la estrategia de la Atención Primaria de la Salud.

Infecciones respiratorias agudas bajas en niños menores de 2 años: hospitalizaciones durante el invierno del año 2014 / Low acute respiratory infections in children under 2 years: 2014 winter hospitalizations / Infecções agudas das vias respiratórias inferiores em crianças menores de 2 anos: hospitalizações em 2014

Durante el invierno las infecciones respiratorias agudas bajas (IRAB) determinan un incremento en la demanda asistencial, afectando sobre todo a los niños más pequeños. El objetivo de la investigación fue describir las características clínicas, modalidades de tratamiento y evolución de los menores de 2 años hospitalizados en el Hospital Pediátrico-Centro Hospitalario Pereira Rossell por IRAB de etiología viral durante el invierno de 2014. Se realizó un estudio descriptivo, retrospectivo, describiendo las características de los menores de 2 años hospitalizados del 9/6 al 21/9/2014 por IRAB de probable etiología viral. Se describieron las características epidemiológicas y clínicas, el tratamiento realizado y la evolución de los pacientes. En el período evaluado egresaron 742 niños (34% de los egresos de la institución). Tenían una mediana de edad de 4 meses; 18% presentaba al menos un factor de riesgo de IRAB grave. Se identificó al virus respiratorio sincicial en 59,6%. La estadía hospitalaria tuvo una mediana de 4 días. En las salas de cuidados moderados se aplicó ventilación no invasiva a 46 niños, y oxigenación de alto flujo a 129 niños, logrando una mejoría clínica en el 87,0% y el 87,6% respectivamente. Ingresaron a unidades de cuidados intensivos 217 niños, 54% requirió asistencia ventilatoria mecánica. Dos pacientes fallecieron. En el período evaluado los niños pequeños con IRAB representaron una importante proporción de los egresos, con importante carga asistencial. La mayoría eran niños sin factores de riesgo. La aplicación de las técnicas de tratamiento en cuidados moderados fue efectiva, permitiendo disminuir la demanda de camas de cuidados intensivos.

During the winter, low acute respiratory infections (LARI) determine an increase in care demand, especially affecting younger children. The objective of the research was to describe the clinical characteristics, treatment modalities and evolution of children under 2 years of age hospitalized at the Hospital Pediátrico-Centro Hospitalario Pereira Rossell for viral etiology LARI during the 2014 winter. A descriptive, retrospective study was conducted, describing the characteristics of children under 2 years hospitalized between 9/6 and 9/21/2014 for LARI of probable viral etiology. The following features were described: epidemiological and clinical characteristics, treatment performed and patient's evolution. During the period evaluated, 742 children were discharged (34% of the institution's admissions). They had a median age of 4 months; 18% had at least one risk factor for severe LARI. Respiratory syncytial virus was identified in 59.6%. The hospital stay had a median of 4 days. In moderate care rooms noninvasive ventilation was applied to 46 children, and high flow oxygenation to 129 children, achieving clinical improvement in 87.0% and 87.6%, respectively. Two hundred and seventeen children were admitted 54% required mechanical ventilation. Two patients died. In the evaluated period small children with LARI represented a significant proportion of the discharges, with an important burden of care. The majority were children without risk factors. The application of treatment techniques in moderate care was effective, allowed a decrease in the demand for intensive care beds.

Durante o inverno, as infecções respiratórias agudas baixas (IRAB) determinam o aumento da demanda de cuidados, afetando especialmente as crianças menores. O objetivo da pesquisa foi descrever as características clínicas, as modalidades de tratamento e a evolução de crianças menores de dois anos hospitalizados no Hospital Pediátrico-Centro Hospitalario Pereira Rossell devido a IRAB de etiologia viral, durante o inverno de 2014. Foi realizado um estudo descritivo e retrospectivo, descrevendo as características das crianças menores de 2 anos hospitalizadas entre 9/6 e 21/9/2014 devido a IRAB de provável etiologia viral. Descreveram-se: características epidemiológicas e clínicas, tratamento realizado e evolução dos pacientes. Durante o período avaliado, 742 crianças foram hospitalizadas (34% dos ingressos da instituição). Tinham uma idade média de 4 meses; 18% tinham pelo menos um fator de risco para IRAB severa. O vírus sincicial respiratório foi identificado em 59,6%. A estadia hospitalaria teve uma mediana de 4 dias. Em salas de cuidados moderados, a ventilação não invasiva foi aplicada a 46 crianças e a oxigenação de alto fluxo a 129 crianças, atingindo melhora clínica em 87,0% e 87,6%, respectivamente. Foram internadas em unidades de terapia intensiva 217 crianças, 54% necessitaram de ventilação mecânica. Dois pacientes faleceram. No período avaliado, as crianças pequenas com IRAB representaram uma proporção significativa das despesas, com um carga importante de atendimento. A maioria carecia de fatores de risco. A aplicação de técnicas de tratamento em cuidados moderados foi eficaz, permitindo uma diminuição da demanda por leitos de terapia intensiva.

Riesgo de neumonía grave en niños menores de 5 años / Risk of severe pneumonia in children under 5 years of age

Introducción: Las infecciones respiratorias agudas se encuentran entre las principales causas de muerte en la primera infancia; se destaca la neumonía adquirida en la comunidad como una de las más importantes. Objetivo: Determinar los factores asociados a la Neumonía Grave Adquirida en la Comunidad en niños menores de 5 años. Material y Método: Se realizó una investigación analítica, prospectiva, tipo caso-control no pareada, en niños con Neumonía Adquirida en la Comunidad ingresados en el Hospital Materno Infantil Dr Ángel Arturo Aballí, en La Habana. Fueron evaluados 255 casos. Se realizó el análisis univariado y de regresión logística multivariado; se calculó el OR simple y ajustado para el resto de las variables. Resultados: Las variables con valores de OR simple que muestran asociación significativa con la Neumonía Grave Adquirida en la Comunidad fueron: edad, desnutrición, lactancia materna no efectiva, antecedentes de infecciones respiratorias a repetición, fumadores pasivos, quejido, tiraje, taquipnea, taquicardia, complicaciones, empleo de antibiótico previo y localización izquierda de la neumonía. De igual forma ocurrió con el conteo de leucocitos, la velocidad de sedimentación globular, la hemoglobina, la albúmina sérica, la proteína C reactiva y la mayor estadía hospitalaria. Conclusiones: La edad, la lactancia materna no efectiva, el fumador pasivo, las complicaciones y la estadía fue el conjunto de factores que integró la función de variables asociadas con riesgo independiente a la Neumonía Grave Adquirida en la Comunidad(AU)

Introduction: Acute respiratory infections are among the main leading causes of death in early childhood, highlighting community-acquired pneumonia as one of the most important. Objective: To determine the factors associated with Severe Community-Acquired Pneumonia in children under five years of age. Material and Method: An analytical prospective non-paired case-control study was conducted in children with Severe Community-Acquired Pneumonia admitted to Dr Ángel Arturo Aballí Maternal and Child Health Hospital in Havana. A total of 255 cases were evaluated. Univariate and multivariate logistic regression analyses were carried out, calculating the simple OR and adjusted for the rest of the variables. Results: The variables with simple OR values that show significant association with the Severe Community-Acquired Pneumonia were: age, malnutrition, non-effective breastfeeding, history of repeated respiratory infections, passive smoking, moan, retraction, tachypnea, tachycardia, complications, use of prior antibiotic, and left location of pneumonia. Likewise, it occurred with white blood cell count, erythrocyte sedimentation rate, hemoglobin, serum albumin, C-reactive protein, and the highest hospital stay. Conclusions: Age, ineffective breastfeeding, passive smoking, complications, and stay were the group of factors that integrated the function of variables associated with independent risk of Severe Community-Acquired Pneumonia(AU)

Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years / Impacto e sazonalidade da infecção por rinovírus humano em pacientes internados por dois anos consecutivos

Abstract Objectives: To report epidemiological features, clinical characteristics, and outcomes of human rhinovirus (HRV) infections in comparison with other community acquired respiratory virus (CRV) infections in patients hospitalized for two consecutive years. Methods: This was a cross-sectional study. Clinical, epidemiological, and laboratory data of patients hospitalized with acute respiratory syndrome in a tertiary care hospital from 2012 to 2013 were reviewed. Results: HRV was the most common CRV observed (36%, 162/444) and was present in the majority of viral co-detections (69%, 88/128), mainly in association with human enterovirus (45%). Most HRV-infected patients were younger than 2 years (57%). Overall, patients infected with HRV had a lower frequency of severe acute respiratory infection than those infected with other CRVs (60% and 84%, respectively, p = 0.006), but had more comorbidities (40% and 27%, respectively; p = 0.043). However, in the adjusted analysis this association was not significant. The mortality rate within the HRV group was 3%. Detection of HRV was more prevalent during autumn and winter, with a moderately negative correlation between viral infection frequency and temperature (r = −0.636, p < 0.001) but no correlation with rainfall (r = −0.036, p = 0.866). Conclusion: HRV is usually detected in hospitalized children with respiratory infections and is often present in viral co-detections. Comorbidities are closely associated with HRV infections. These infections show seasonal variation, with predominance during colder seasons.

Resumo Objetivos: Relatar as características epidemiológicas, as características clínicas e os resultados das infecções por rinovírus humano (RVH) em comparação a outras infecções por vírus respiratórios adquiridos na comunidade (VRCs) em pacientes internados por dois anos consecutivos. Métodos: Este foi um estudo transversal. Foram revisados os dados clínicos, epidemiológicos e laboratoriais de pacientes internados com síndrome respiratória aguda em um hospital terciário de 2012 a 2013. Resultados: O RVH foi o VRC mais comum observado (36%, 162/444) e esteve presente na maior parte das codetecções virais (69%, 88/128), principalmente em associação ao enterovírus humano (45%). A maioria dos pacientes infectados por RVH possuía menos de 2 anos (57%). De modo geral, os pacientes com RVH apresentaram uma menor frequência de infecção respiratória aguda grave que os pacientes infectados por outros VRCs (60% e 84%, respectivamente, p = 0,006), porém mais comorbidades (40% e 27%, respectivamente; p = 0,043). Contudo, em uma análise ajustada, essa associação não foi significativa. A taxa de mortalidade no grupo RVH foi 3%. A detecção de RVH foi mais prevalente durante o outono e inverno, com uma correlação negativa moderada entre a frequência de infecção viral e a temperatura (r = -0,636, p < 0,001), porém nenhuma correlação com a precipitação (r = −0,036, p = 0,866). Conclusão: O RVH é normalmente detectado em crianças internadas com infecções respiratórias e normalmente está presente em codetecções virais. As comorbidades estão estreitamente associadas a infecções por RVH. Essas infecçõesmostram variação sazonal, com predominância durante as estações mais frias.