ABSTRACT
Background: Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal. Methods: Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression. Results: Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3-286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52-4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01-1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December-February) and 1 autumn (September-November). Conclusions: HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.
Subject(s)
Coronavirus Infections/epidemiology , Cost of Illness , Respiratory Tract Infections/epidemiology , Rural Population , Adult , Child, Preschool , Coinfection/epidemiology , Coinfection/virology , Coronavirus/genetics , Coronavirus/isolation & purification , Epidemiological Monitoring , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Nepal/epidemiology , Pregnancy , Pregnant Women , Prospective Studies , Regression Analysis , Respiratory Tract Infections/virology , Risk Factors , Seasons , Young AdultABSTRACT
BACKGROUND: We developed a systematic method of cleaning and calibration-checking for the pneumotachometer tube of the SpiroPro portable spirometer; this method maximized spirometry accuracy in a population-based study in a remote area of Nepal. METHODS: We tested 10 factory-calibrated pneumotachometer tubes. Each use consisted of a full set of spirometry maneuvers, per the American Thoracic Society (ATS) spirometry criteria. RESULTS: The pneumotachometers remained accurate, per the ATS criteria, for 5-9 disinfections, but began to drift toward inaccuracy after the first disinfection. All the pneumotachometers had become inaccurate, per the ATS criteria, after 10 disinfections. CONCLUSIONS: In a remote field setting the SpiroPro pneumotachometer tube can be cleaned and reused 5-9 times before it becomes inaccurate per the ATS criteria. Rigorous rinsing in distilled water and repeated calibration checks, at various flows up to 12 L/s, are essential for precise and accurate spirometry with the SpiroPro. Reusing the SpiroPro pneumotachometer in a remote setting may impose measurement bias. Single use of SpiroPro pneumotachometers, albeit more costly, will provide better data.
Subject(s)
Calibration , Disinfection/methods , Lung Diseases, Obstructive/diagnosis , Point-of-Care Systems , Rural Health Services , Spirometry/instrumentation , Adolescent , Child , Cohort Studies , Equipment Design , Equipment Failure Analysis , Equipment Reuse , Humans , Reproducibility of Results , Young AdultABSTRACT
OBJECTIVE: A high proportion of deaths during the neonatal period are attributed to infections. Neonatal skin plays an important role in protecting the newborn from invasive pathogens. In preparation for a study of newborn skin cleansing with chlorhexidine in Nepal, we evaluated the feasibility, acceptability, and safety of the newborn cleansing procedure. STUDY DESIGN/SETTING: Observational pilot study of full-body cleansing of newborns in rural Nepal. METHODS: Thirty two newborn infants were wiped with commercially available non-antiseptic baby wipes. Pre and post-procedure axillary temperatures were recorded to estimate the impact of cleansing on body temperature. Skin aggravation, residual moisture, removal of vernix, and maternal satisfaction were assessed qualitatively. RESULTS: Body temperature of newborns decreased an average of 0.40 C (95% CI: 0.31 to 0.49 C, p < 0.0001) during the procedure. There was no evidence of skin aggravation, injury or removal of vernix, and mothers expressed satisfaction with the procedure. The procedure was simple and project workers were easily trained. CONCLUSION: Care must be taken to promptly wrap infants after skin cleansing procedures as slight temperature decrease was noted after the procedure. These pilot data indicate, however, that gentle cleansing of newborn skin poses minimal risk to infants. This procedure is safe and appropriate precautions can be taken to deliver safe skin antisepsis with chlorhexidine to infants in the community.
