Real-time investigation of an influenza A(H3N2) virus outbreak in a refugee community, November 2022.

OBJECTIVES: To report epidemiological and virological results of an outbreak investigation of influenza-like illness (ILI) among refugees in Northern Italy. STUDY DESIGN: Outbreak investigation of ILI cases observed among nearly 100 refugees in Northern Italy unvaccinated for influenza. METHODS: An epidemiological investigation matched with a differential diagnosis was carried out for each sample collected from ILI cases to identify 10 viral pathogens (SARS-CoV-2, influenza virus type A and B, respiratory syncytial virus, metapneumovirus, parainfluenza viruses, rhinovirus, enterovirus, parechovirus, and adenovirus) by using specific real-time PCR assays according to the Centers for Disease Control and Prevention (CDC) protocols. In cases where the influenza virus type was identified, complete hemagglutinin (HA) gene sequencing and the related phylogenetic analysis were conducted. RESULTS: The outbreak was caused by influenza A(H3N2): the attack rate was 83.3% in children aged 9-14 years, 84.6% in those aged 15-24 years, and 28.6% in adults ≥25 years. Phylogenetic analyses uncovered that A(H3N2) strains were closely related since they segregated in the same cluster, showing both a high mean nucleotide identity (100%), all belonging to the genetic sub-group 3C.2a1b.2a.2, as those mainly circulating into the general population in the same period. CONCLUSIONS: The fact that influenza outbreak strains as well as the community strains were genetically related to the seasonal vaccine strain suggests that if an influenza prevention by vaccination strategy had been implemented, a lower attack rate of A(H3N2) and ILI cases might have been achieved.

Household heating fuels impact on Acute Respiratory Infection (ARI) symptoms among children in Punjab, Pakistan.

Exposure to household air pollution (HAP) accounted for the loss of 86 million healthy lives in 2019, with almost half of all deaths due to lower respiratory infection among children under 5 years of age. Similarly, the situation in Punjab - Pakistan's largest province - is also not promising. This study was conducted to examine household energy consumption and respiratory symptoms among children under the age of five in rural and urban areas of Punjab. Using data from the Multiple Indicator Cluster Survey (MICS) 2017-18, logistic regression models were applied to the data of a sample of 35,000 children under the age of five living in households with polluting heating fuels. A hypothesis was formulated to investigate the relationship between polluting heating activities and respiratory infections among children under five. Those Children who live in households having traditional space heaters without chimneys are 50% more likely to have symptoms of Acute Respiratory Infection (ARI) compared to those whose households have chimneys with traditional space heaters. When households utilize polluting heating fuel, the likelihood of children experiencing rapid, shortness of breath increases by 49%, and the likelihood of children displaying ARI symptoms characterized by coughing rises by approximately 30%. This study proposed a complete banning of polluting heating activities and replacing it with cleaner ones using financial incentives. It is pertinent to raise awareness campaigns majorly focusing on the guidelines to adopt better heat output with less harmful emissions.

Corrigendum: Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh.

[This corrects the article DOI: 10.3389/fpubh.2022.985445.].

Used paper tissues for pathogen identification in acute respiratory infection.

During the Belgian winter and spring season 2022-2023, we investigated the potential of used paper tissue (UPT) as a noninvasive sampling method for the diagnosis of acute respiratory infections. Screening for respiratory pathogens was done using an in-house developed respiratory panel for simultaneous detection of 22 respiratory viruses and seven nonviral pathogens. The method allowed the identification and typing of respiratory pathogens in symptomatic individuals, as well as in collective samples taken at a community level. Pathogens that were identified in nasal swabs could also be detected in concurrent UPT from the same patient. In all cases that tested positive on an antigen-detection rapid diagnostic test, the corresponding virus could be detected in UPT. The collection of UPT could be useful in epidemiological surveillance of severe acute respiratory syndrome coronavirus 2 and other coronaviruses, as well as other respiratory pathogens such as influenzavirus, respiratory syncytial virus, entero/rhinoviruses including EV-D68, parainfluenzaviruses, and Streptococcus pneumoniae. Multiple respiratory pathogens could be detected in UPTs of collectivities, confirming its applicability for community testing. This is especially interesting for screening in nursing homes, centers for the disabled, schools or other settings were taking nasal or nasopharyngeal samples is cumbersome.

Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh.

In developing countries, acute respiratory infections (ARIs) cause a significant number of deaths among children. According to Bangladesh Demographic and Health Survey (BDHS), about 25% of the deaths in children under-five years are caused by ARI in Bangladesh every year. Low-income families frequently rely on wood, coal, and animal excrement for cooking. However, it is unclear whether using alternative fuels offers a health benefit over solid fuels. To clear this doubt, we conducted a study to investigate the effects of fuel usage on ARI in children. In this study, we used the latest BDHS 2017-18 survey data collected by the Government of Bangladesh (GoB) and estimated the effects of fuel use on ARI by constructing multivariable logistic regression models. From the analysis, we found that the crude (the only type of fuel in the model) odds ratio (OR) for ARI is 1.69 [95% confidence interval (CI): 1.06-2.71]. This suggests that children in families using contaminated fuels are 69.3% more likely to experience an ARI episode than children in households using clean fuels. After adjusting for cooking fuel, type of roof material, child's age (months), and sex of the child-the effect of solid fuels is similar to the adjusted odds ratio (AOR) for ARI (OR: 1.69, 95% CI: 1.05-2.72). This implies that an ARI occurrence is 69.2% more likely when compared to the effect of clean fuel. This study found a statistically significant association between solid fuel consumption and the occurrence of ARI in children in households. The correlation between indoor air pollution and clinical parameters of ARI requires further investigation. Our findings will also help other researchers and policymakers to take comprehensive actions by considering fuel type as a risk factor as well as taking proper steps to solve this issue.

Factors associated with healthcare-seeking behavior for symptomatic acute respiratory infection among children in East Africa: a cross-sectional study.

BACKGROUND: Although there has been promising progress in the reduction of child mortality from ARI, the magnitude is high yet, especially in East Africa. Since mothers/guardians decide upon the type and frequency of healthcare services for children, their good healthcare-seeking behavior could prevent acute respiratory infections (ARI) related mortality and morbidity. This study aimed to investigate the pooled prevalence and factors associated with healthcare-seeking behavior of children younger than five years with ARI symptoms by using data from nationally representative surveys of East Africa. METHODS: We analyzed secondary data based on the eleven East African Demographic and Health Survey data. Both Individual and community level variables were considered for this study and a multilevel binary logistic regression model was fitted to identify associated factors of children's healthcare-seeking behavior for ARI symptoms. STATA V.14 software was used to clean, recode and analyze the data. All variables with a p-value = 0.2 in the bi-variable analysis were considered for the multivariable multilevel analysis. Adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors in the multivariable multilevel analysis. RESULT: The overall prevalence of healthcare-seeking behavior of under-five children for ARI symptoms was 64.4% in East Africa. In the multilevel analysis, the following characteristics were found to be the most important factors of children healthcare seeking behavior for ARI symptoms (P < 0.05): Rural residence [AOR = 0.51, 95% CI (0.37-0.65)], high community level media usage [AOR = 1.63, 95% CI (1.49-1.79)], high community level women education [AOR = 1.51, 95% CI (1.39-1.66)], primary education [AOR = 1.62, 95% CI (1.45-1.82)], secondary education and above [AOR = 1.99, 95% CI (1.71-2.32)], working mother [AOR = 1.33, 95% CI (1.20-1.48)], unmarried women [AOR = 1.15, 95% CI (1.04-1.27)], media access [AOR = 1.43, 95% CI (1.20-1.58)], richest [AOR = 1.39, 95% CI (1.29-1.51)], distance to health facility not a big problem [AOR = 1.11, 95% CI (1.02-1.21)], Place of delivery at health facilities [AOR = 1.77, 95% CI (1.60-1.95)], age of child 7-23 months [AOR = 1.59, 95% CI (1.39-1.82)], age of child 24-59 months [AOR = 1.24, 95% CI (1.09-1.41)] in comparison with children aged 0-6 months, family size > 10 [AOR = 1.53, 95% CI (1.22-1.92)]. CONCLUSIONS AND RECOMMENDATIONS: The overall prevalence of children's healthcare-seeking behavior for ARI symptoms was found relatively low in East Africa, ARI symptoms were determined by individual-level variables and community-level factors. Targeted interventions are needed to improve socioeconomic and health systems to overcome the problem of acute respiratory infection in children. Special attention is required to empower local health staff and health facilities to provide proper diagnosis and management of ARI cases in East Africa.

Pre COVID-19 molecular epidemiology of respiratory syncytial virus (RSV) among children in Bangladesh.

Epidemiological data of specific respiratory pathogens from the pre-COVID-19 period are essential to determine the effects of the COVID-19 pandemic on other respiratory infections. In this study, we revealed the pre-COVID-19 molecular epidemiology of respiratory syncytial virus (RSV) among children in Bangladesh. We tested 3170 samples collected from 2008 to 2012 for a panel of respiratory viruses; RSV, human metapneumovirus (hMPV), human parainfluenza viruses (hPIV) 1, 2, 3, and adenovirus. Five hundred fifty-five samples (17.5 %) were positive for RSV, including 2.5% having co-infections with other viruses. Genotypic characterization of RSV showed that RSV-A (82%) contributed more acute respiratory infections than RSV-B (18%). Clinical features were similar with RSV-A and RSV-B infections. However, children with RSV-B were more likely to have upper respiratory infections (URI) (10% vs. 29%, p = 0.03). Among RSV-A cases, hospitalization was higher for ON1 cases (25%, ON1 vs. 8%, NA1, p = 0.04), whereas the recovery without a disability was higher among the NA1 cases (56%, ON1 vs. 88%, NA1, p = 0.02). The time to the most recent common ancestor (TMRCA) for RSV in Bangladesh was 1949 for RSV-A and 1944 for RSV-B. This study revealed the genotypic diversity and evolutionary relatedness of RSV strains in Bangladesh and provided pre-COVID molecular epidemiology data to understand better the COVID-19 impact on upcoming RSV epidemiology in Bangladesh.

The role of exclusive breastfeeding on sIgA and lactoferrin levels in toddlers suffering from Acute Respiratory Infection: A cross-sectional study.

Secretion of Immunoglobulin A (sIgA) and lactoferrin is a nutrient content in breast milk that can increase immunity in preventing infectious diseases such as Acute Respiratory Infection (ARI). This research aims to determine the role of exclusive breastfeeding (EBF) on sIgA and Lactoferrin levels in toddlers suffering from ARI. A cross-sectional study was conducted on 124 toddlers under five from January-July 2021. Toddlers were selected using a purposive technique sampling from three Community Health Centers in Central Jakarta. Data were analyzed using t-test and ANOVA. The history of immunization, EBF, and frequency of ARI was significantly associated with levels of sIgA and lactoferrin. Parity only correlated with sIgA but not with lactoferrin levels. Maternal and toddlers' age, gender, and nutritional status were not significantly related to sIgA and lactoferrin levels. There is a significant (p-value <0.001) difference in the mean protein sIgA and lactoferrin levels in toddlers who were given EBF with ARI frequency <2 times and toddlers who were given EBF with ARI frequency ≥2 times. Toddlers who were exclusively breastfed with ARI frequency <2 times had higher levels of sIgA and lactoferrin (188901.77 pg/ml and 262.32 ng/ml, respectively) compared to infants given EBF with ARI frequency ≥2 times (136683.47 pg/ml and 181.49 ng/ml, respectively). History of immunization was also significantly (p-value <0.05) associated with levels of sIgA and lactoferrin in infants with ARI. The content of sIgA and lactoferrin in breast milk and immunization can increase the body's immune system in toddlers suffering from ARI.

Association between early initiation of breastfeeding and reduced risk of respiratory infection: Implications for nonseparation of infant and mother in the COVID-19 context.

Early initiation of breastfeeding, within 1 h of birth, is vital for the health of newborns and reduces morbidity and mortality. Secondary analysis of the 2016 Nepal Demographic and Health Survey (DHS) showed that early initiation of breastfeeding significantly reduced the risk of acute respiratory infection (ARI) in children under 2 years. Early initiation of breastfeeding requires maternal proximity. Separation of infant and mother inhibits early initiation of breastfeeding and increases the risk that infants will suffer from ARIs. However, during the COVID-19 pandemic, guidance varied, with some recommending that infants and mothers with SARS-CoV-2 be isolated from one another. Nepal's Ministry of Health and Population recommended nonseparation, but the adherence to this guidance was inconsistent. Maternal proximity, nonseparation and early initiation of breastfeeding should be promoted in all birthing facilities.

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys.

BACKGROUND: Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana. METHODS: In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics. RESULTS: Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 - 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 - 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 - 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 - 3.243), richer (RRR = 1.908, 95 % CI 1.145 - 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 - 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 - 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 - 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 - 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 - 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 - 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 - 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions. CONCLUSIONS: Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

A global analysis of the regional variation in the symptoms of acute respiratory infection during childhood: Epidemics and their association with environmental vulnerability.

Using Demographic and Health Surveys from 48 low-income and middle-income countries (N = 432,860), we investigated whether or not the presence of symptoms of acute respiratory infection (ARI) are contingent on environmental vulnerabilities such as the region, the level of ambient air pollution, community orphanhood status, and household poverty among young children under five. In addition, we also examined whether such an effect may be a consequence of socioeconomic development and/or lifestyle. Using multilevel logistic regression models, environmental vulnerability was found to be significantly associated with the likelihood of childhood ARI symptoms and this association seemed to be related to the level of ambient air pollution. Our findings suggest that important roles are played by both geographic region and ambient air pollution, and that these factors may disproportionately shape a child's risk of ARI symptoms in a global context.

Ventilation and laboratory confirmed acute respiratory infection (ARI) rates in college residence halls in College Park, Maryland.

Strategies to protect building occupants from the risk of acute respiratory infection (ARI) need to consider ventilation for its ability to dilute and remove indoor bioaerosols. Prior studies have described an association of increased self-reported colds and influenza-like symptoms with low ventilation but have not combined rigorous characterization of ventilation with assessment of laboratory confirmed infections. We report a study designed to fill this gap. We followed laboratory confirmed ARI rates and measured CO2 concentrations for four months during the winter-spring of 2018 in two campus residence halls: (1) a high ventilation building (HVB) with a dedicated outdoor air system that supplies 100% of outside air to each dormitory room, and (2) a low ventilation building (LVB) that relies on infiltration as ventilation. We enrolled 11 volunteers for a total of 522 person-days in the HVB and 109 volunteers for 6069 person-days in the LVB, and tested upper-respiratory swabs from symptomatic cases and their close contacts for the presence of 44 pathogens using a molecular assay. We observed one ARI case in the HVB (0.70/person-year) and 47 in the LVB (2.83/person-year). Simultaneously, 154 CO2 sensors distributed primarily in the dormitory rooms collected 668,390 useful data points from over 1 million recorded data points. Average and standard deviation of CO2 concentrations were 1230 ppm and 408 ppm in the HVB, and 1492 ppm and 837 ppm in the LVB, respectively. Importantly, this study developed and calibrated multi-zone models for the HVB with 229 zones and 983 airflow paths, and for the LVB with 529 zones and 1836 airflow paths by using a subset of CO2 data for model calibration. The models were used to calculate ventilation rates in the two buildings and potential for viral aerosol migration between rooms in the LVB. With doors and windows closed, the average ventilation rate was 12 L/s in the HVB dormitory rooms and 4 L/s in the LVB dormitory rooms. As a result, residents had on average 6.6 L/(s person) of outside air in the HVB and 2.3 L/(s person) in the LVB. LVB rooms located at the leeward side of the building had smaller average ventilation rates, as well as a somewhat higher ARI incidence rate and average CO2 concentrations when compared to those values in the rooms located at the windward side of the building. Average ventilation rates in twenty LVB dormitory rooms increased from 2.3 L/s to 7.5 L/s by opening windows, 3.6 L/s by opening doors, and 8.8 L/s by opening both windows and doors. Therefore, opening both windows and doors in the LVB dormitory rooms can increase ventilation rates to the levels comparable to those in the HVB. But it can also have a negative effect on thermal comfort due to low outdoor temperatures. Simulation results identified an aerobiologic pathway from a room occupied by an index case of influenza A to a room occupied by a possible secondary case.

Do fuel type and place of cooking matter for acute respiratory infection among Afghan children? Evidence from the Afghanistan DHS 2015.

In Afghanistan, acute respiratory infection (ARI) is a leading cause of under-five mortality. Previous studies on the effects of cooking fuel on ARI have only looked at the types of cooking fuel, and not the effects of the location of the cooking place. The present study aimed to assess the effects of fuel type and place of cooking on the prevalence of ARI among under-five children in Afghanistan. Descriptive statistics and multilevel logistic regression analysis were performed for 31,063 children using data from the first round of the Afghanistan Demographic and Health Survey conducted in 2015. Overall, 13% of the children suffered from ARI symptoms in the 2 weeks before the survey, but this varied widely across the country. The multilevel analysis showed that, compared with households using clean cooking fuel in a separate building or outside, households using clean cooking fuel within the house and without a separate kitchen had a 32% lower risk [95% confidence interval (CI)=0.51-0.91] of having under-five children with ARI, and those using clean fuel in a separate kitchen in the house had a 17% lower risk (95% CI=0.67-1.03). On the other hand, households using polluting cooking fuel in the house without a kitchen had a 14% (95% CI=0.91-1.44) higher risk of having under-five children with ARI, and those using polluting cooking fuel in the house with a separate kitchen had a 5% (95% CI=0.85-1.30) higher risk, after adjusting for other covariates. The findings indicate that type of cooking fuel is not the only issue affecting ARI in children. Place of cooking (in a house with or without a separate kitchen versus outside) also affects the risk of ARI among under-five children. The study also found that mother's education and occupational status, community poverty and ethnicity are other important factors affecting the prevalence of ARI in under-five children in Afghanistan.

Geographically Weighted Regression Analysis: A Statistical Method to Account for Spatial Heterogeneity.

Ordinary linear regression (OLR) is one of the most common statistical techniques used in determining the association between the outcome variable and its related factors. This method determines the association that is assumed to be true for the whole study area - a global association. In the field of public health and social sciences, this assumption is not always true, especially when it is known that the relationship between variables varies across the study area. Therefore, in such a scenario, an OLR should be calibrated in a way to account for this spatial variability. In this paper, we demonstrate use of the geographically weighted regression (GWR) method to account for spatial heterogeneity. In GWR, local models are reported in which association varies according to the location accounting for the local variation in variables. This technique utilizes geographical weights in determining association between the outcome variable and its related factors. These geographical weights are relatively large (i.e. close to 1) for observations located near regression point than for the observations located farther from the regression point. In this paper, we demonstrated the application of GWR and its comparison with OLR using demographic and health survey (DHS) data from Tanzania. Here we have focused on determining the association between percentages of acute respiratory infection (ARI) in children with its related factors. From OLR, we found that the percentage of female with higher education had the largest significant association with ARI (P = 0.027). On the other hand, result from the GWR returned coefficients varying from -0.15 to -0.01 (P < 0.001) over the study area in contrast to the global coefficient from OLR model. We advocate that identifying significant spatially-varying association will help policymaker to recognize the local areas of interest and design targeted interventions.

Longitudinal Epidemiology of Viral Infectious Diseases Combining Virus Isolation, Antigenic Analysis, and Phylogenetic Analysis as Well as Seroepidemiology in Yamagata, Japan, between 1999 and 2018.

We introduced a microplate method for virus isolation in the Department of Microbiology, Yamagata Prefectural Institute of Public Health (YPIPH) in 1999 in Yamagata, Japan. We have since carried out longitudinal epidemiological studies on viral infectious diseases, particularly respiratory viruses, combining traditional technologies such as virus isolation and serological techniques and newly developed molecular methods. Here, we provide an overview of our activities at YPIPH between 1999 and 2018. During the study period, we observed emerging and re-merging diseases such as those caused by echovirus type 13, enterovirus D68, parechovirus-A3 (PeV-A3), and Saffold virus. With regard to PeV-A3, we proposed a new disease concept, "PeV-A3-associated myalgia/myositis." We also revealed the longitudinal epidemiologies of several viruses such as enterovirus A71 and coxsackievirus A16. To perform longitudinal epidemiological studies at any time in Yamagata, we established a system for stocking clinical specimens, viral isolates, complementary DNAs, and serum specimens. We have also pursued collaboration works with virology laboratories across Japan. We hope our experiences, findings, and research materials will further contribute to the development of countermeasures against viral infectious diseases and improvement in public health strategies in Yamagata, Japan, Asia, and around the world.

Liver involvement in the process of acute respiratory infections in pediatric patients.

INTRODUCTION: We aimed to investigate the prevalence of liver involvement in pediatric patients with ARI using both routine tests of hepatic panel, and ornithine carbamoyltransferase (OCT) to identify the most sensitive indicators of early hepatic injury. METHODOLOGY: A prospective cohort study of 84 armenian children with ARI was conducted to evaluate the associated liver involvement. The diagnostic variables of interest were the signs of clinical disease severity, and enzymatic profile of the patients. RESULTS: Serum levels of OCT were increased in 94% of patients versus routine tests of hepatic panel (AST in 41.7%, ALT in 15.5%, etc). Variance analysis by severity groups showed the serum levels of OCT (p < 0.001), ammonia (p < 0.001), phospholipides (p = 0.05), glucose (p = 0.01), TNF-α (p = 0.01), IL-8 (p < 0.001), AST (p < 0.001), and ALP (p < 0.001) were associated with the severity of underlying disease. Moreover, regression analysis revealed the serum activity of OCT (p value < 0.001, OR = 1.27) and ammonia (p value 0.002, OR = 1.1) significantly predict the severity of the disease. CONCLUSIONS: Using more sensitive marker of liver damage can detect more cases of ARI with hepatic manifestations. For evaluation of the liver involvement we are suggesting the testing of serum OCT levels as a more sensitive and specific marker. Pediatric patients with ARI and with higher serum OCT levels have 27% more chance to experience increased disease severity, which can affect on liver state and prolong hospitalization time and cost.

Acute Respiratory Infection and Use of Nonsteroidal Anti-Inflammatory Drugs on Risk of Acute Myocardial Infarction: A Nationwide Case-Crossover Study.

Background: Previous studies have suggested that acute respiratory infection (ARI) and nonsteroidal anti-inflammatory drugs (NSAIDs) use could trigger acute myocardial infarction (AMI). In some countries, physicians prescribe NSAIDs for patients with ARI for symptom relief. However, there is no research evaluating whether NSAIDs use during ARI episodes may increase the risk of AMI. Methods: We identified 9793 patients with an incident hospitalization of AMI (index date) between 2007 and 2011. Using case-crossover design, we compared the following exposure status between the case (1-7-day before index date) and matched control period (366-372-day before index date): NSAIDs use during ARI episodes, ARI episodes without NSAIDs use, NSAIDs use only, or no exposure. Multivariable conditional logistic regression models were used to estimate odds ratios adjusted for potential confounders. Results: Nonsteroidal anti-inflammatory drugs use during ARI was associated with a 3.4-fold increased risk of AMI (adjusted odds ratio [aOR] = 3.41; 95% confidence interval [CI] = 2.80-4.16), ARI without NSAIDs use was associated with a 2.7-fold increased risk (aOR = 2.65; 95% CI = 2.29-3.06), and NSAIDs use only was associated with a 1.5-fold increased risk (aOR = 1.47; 95% CI = 1.33-1.62). Moreover, parenteral NSAIDs were associated with much higher risk in ARI patients (aOR = 7.22; 95% CI = 4.07-12.81). Conclusions: Nonsteroidal anti-inflammatory drugs use during ARI episodes, especially parenteral NSAIDs, was associated with a further increased risk of AMI.

A multilevel analysis of lifestyle variations in symptoms of acute respiratory infection among young children under five in Nigeria.

BACKGROUND: Nigeria has the second highest estimated number of deaths due to acute respiratory infection (ARI) among children under five in the world. A common hypothesis is that the inequitable distribution of socioeconomic resources shapes individual lifestyles and health behaviors, which leads to poorer health, including symptoms of ARI. This study examined whether lifestyle factors are associated with ARI risk among Nigerian children aged less than 5 years, taking individual-level and contextual-level risk factors into consideration. METHODS: Data were obtained from the nationally representative 2013 Nigeria Demographic and Health Survey. A total of 28,596 surviving children aged 5 years or younger living in 896 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between lifestyle factors and ARI symptoms. RESULTS: The multivariate results from multilevel regressions indicated that the odds of having ARI symptoms were increased by a number of lifestyle factors such as in-house biomass cooking (OR = 2.30; p < 0.01) and no hand-washing (OR = 1.66; p < 0.001). An increased risk of ARI symptoms was also significantly associated with living in the North West region and the community with a high proportion of orphaned/vulnerable children (OR = 1.74; p < 0.001). CONCLUSIONS: Our findings underscore the importance of Nigerian children's lifestyle within the neighborhoods where they reside above their individual characteristics. Program-based strategies that are aimed at reducing ARI symptoms should consider policies that embrace making available basic housing standards, providing improved cooking stoves and enhancing healthy behaviors.

Prevalence of neutralizing antibodies to common respiratory viruses in intravenous immunoglobulin and in healthy donors in southern China.

BACKGROUND: Acute respiratory infections (ARIs) are a leading cause of death among children under the age of 5. However, there are no effective drugs for most of these severe viral infections. Passive immunotherapy with convalescent plasma or hyperimmune intravenous immunoglobulin (H-IVIG) is a potential therapeutic option for serious viral infections. It is important to find a suitable source of convalescent plasma and of H-IVIG containing high titer neutralizing antibodies (NAbs). METHODS: Sera from 96 healthy adult donors in southern China and commercially available IVIG were analyzed for the titers of NAb to several most common respiratory viruses including respiratory syncytial virus (RSV), seasonal influenza A (InfA), enterovirus 71 (EV71), coxsackievirus A16 (CA16), adenovirus type 3 (Ad3) and a recent epidemic adenovirus type 55 (Ad55) by microneutralization test. RESULTS: A high proportion of samples from healthy adult donors were positive for NAbs (>16) to all the viruses except Ad55. A different proportion of these samples had high NAb titers (>512) for InfA (25%), Ad3 (17.71%), RSV (9.38%), EV71 (1.04%), CA16 (3.13%), and Ad55 (4.17%). Commercially available IVIG had high NAb titers to InfA and Ad3 (>1,000) and lower NAb titers to RSV [320], EV71 [160], and CA16 [160]. Strikingly, IVIG also had a high NAb titer to Ad55 (>1,000). CONCLUSIONS: Convalescent plasma could be screened from healthy blood volunteers to establish blood banks and to prepare specific H-IVIG for treating severe ARIs caused by common respiratory viruses.