Acute viral lower respiratory infections in children in a rural community in Thailand.

The present study was conducted as a population based cohort in a rural community of Amphoe Takhli, Nakhon Sawan province for the determination of the prevalence of acute viral lower respiratory infection (ALRI) in pediatric cases under 5 years of age from November 1998 to February 2001. There were 472 ALRI episodes during the study period; and there were 5 cases who contracted ALRI twice. The etiologic agents were determined by indirect immunofluorescence (IIF) test using specific monoclonal antibodies for the staining of exfoliated cells in nasopharyngeal aspirate (NPA) samples. The slides of fixed cells were prepared by Takhli Hospital and posted in ambient temperature to the Virology Laboratory, Siriraj Hospital where they were stained and examined. Among 472 episodes of ALRI, 170 (36.0%) viral agents were found. Viral agents were associated with 41.4 per cent of all pneumonic cases. Respiratory syncytial virus (RSV) was the most common virus observed in the present study; and it was also the most common virus associated with pneumonia and bronchitis. RSV subgrouping was performed directly in NPA samples by IIF test using a panel of subgroup specific monoclonal antibodies. RSV subgroup B predominated over subgroup A in the first study year, and it was vice versa in the second year. Overall, more cases of subgroup B were found which was in contrast to what the authors had reported in the previous study. Prevalence of RSV was seasonal dependent, the epidemic was seen during the rainy season with peaks in August or September of each year. As the method of viral identification was limited to IIF only, therefore, fewer viruses were detected. Parainfluenza viruses were detected as the second most common viral agent, the viruses spread during early summer with peaks in February or March of each year. However, its association with croup could not be demonstrated which may be due to the insensitivity of IIF in the diagnosis of non-RSV infection. Nevertheless, in terms of feasibility to investigate the disease in a rural area, IIF is economic, convenient and rapid; and gives enough information for the nationwide plan of a health care development system.

Wheezing--associated lower respiratory infections in under 5-year-old children: study in Takhli District Hospital.

Wheezing was detected in 251 of the 421 (59.6%) children under 5 years old suffering from acute lower respiratory infections (LRI) treated at the Takhli Hospital, Nakhon Sawan Province from November 1998 to October 2000. Bronchitis and pneumonia accounted for 55.0 per cent and 40.6 per cent of LRI with wheezing. Most of the patients, 162 of 251 (64.5%) cases were children under 2 years old. The wheezing symptom declined significantly in children older than 4 years of age. In this study, LRI with wheezing was found all year round but was more frequent in the rainy season similar to other respiratory infections. As the respiratory syncytial virus (RSV) infections were mainly found during the rainy season (July-October), the association of wheezing and RSV infections in the rainy season was evaluated. RSV causing LRI with wheezing in the rainy season revealed 54.7 per cent and 39.4 per cent in the first and second studied year, respectively. The two-year follow-up of 121 cases of LRI with wheezing showed that 37 cases (30.5%) had repeated episodes of wheezing. In conclusion, LRI with wheezing caused by RSV was commonly found in children under 2 years old. The occurrence was all the year round but predominantly in the rainy season.

Respiratory syncytial virus-associated lower respiratory tract infection in under-5-year-old children in a rural community of central Thailand, a population-based study.

The population-based cohort study on the epidemiology of respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRI) (RSV-LRI) was conducted in Takhli district from November 1998 to February 2001. The incidence of RSV-LRI was 12.6/1,000 child-year and 5.8/ 1,000 child-year during the first and second year, respectively. RSV accounted for 35.8 per cent of all LRI cases during the first year and significantly decreased to 17.5 per cent during the second year. Three-quarters of RSV-LRI occurred among children under 2 years old (76.6% during the first year and 62.2% during the second year). Most of RSV-LRI in both years occurred from July to October. Risk factor for morbidity of RSV infections were age less than or equal to 2 years (OR = 2.38, 95% CI = 1.22-4.67 p = 0.009) and sleeping with more than 3 persons in the patient's bedroom (OR = 2.92,95% CI = 1.42-6.00, p = 0.002). Most RSV-LRI (63.9%) were clinically diagnosed as having pneumonia. No RSV-LRI deaths were detected. During the first year, RSV subtype B was predominate, in contrast to the second year when subtype A was more predominate. Further research to determine the annual change in subtype of RSV-LRI and correlation of severity of disease with specific subtypes needs to conducted in order to prepare for the future introduction of a vaccine.

Economic burden in management of acute lower respiratory infection, patients' perspective: a case study of Takhli District Hospital.

A cross-sectional descriptive study to determine the economic burden in management of acute lower respiratory infection from the patient's perspective was conducted at Takhli District Hospital from March 2000 to February 2001. Information obtained from interviewing caretakers of 165 children with LRI and data collected from medical records revealed the cost per case ranged from 140 to 6,471 baht with an average total cost per case of 1248 baht. The main determinants of the average total cost per case included the diagnosis of diseases, type of patient (outpatient or inpatient), wheezing association and respiratory syncytial virus positivity. Children with severe pneumonia accounted for the highest in the average total cost per case (2,348 baht) while those with bronchitis accounted for the lowest (924 baht). The average total cost per case of inpatients was 3.5 times higher than that of outpatients. Health policy efforts to improve the effectiveness of care in an ambulatory setting may reduce the financial cost of the illness.