The Underrecognized Burden of Influenza in Young Children Poehling, Katherine A; Edwards, Kathryn M; Weinberg, Geoffrey A ...
New England journal of medicine/The New England journal of medicine,
07/2006, Letnik:
355, Številka:
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Journal Article
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In this report, investigators from the New Vaccine Surveillance Network, sponsored by the Centers for Disease Control and Prevention, prospectively assessed the pediatric burden of undiagnosed ...influenza infection in inpatient and outpatient settings. In children presenting with fever or an acute respiratory tract infection, influenza was clinically diagnosed only 28 percent of the time in the inpatient setting and 13 percent of the time in the outpatient setting.
In children presenting with fever or an acute respiratory tract infection, influenza was clinically diagnosed only 28 percent of the time in the inpatient setting and 13 percent of the time in the outpatient setting.
Influenza virus is an important cause of respiratory illness among children. Modeling studies suggest that children younger than two years of age have high rates of hospitalization attributable to influenza; these rates are similar to rates of hospitalization attributable to influenza among older adults.
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However, rates of hospitalization and outpatient visits attributable to laboratory-confirmed influenza infections are not well described.
In 1999, the New Vaccine Surveillance Network (NVSN), sponsored by the Centers for Disease Control and Prevention (CDC), began prospective surveillance to determine population-based rates of laboratory-confirmed influenza and to assess the effects of recommendations regarding vaccination.
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Before 2002, . . .
To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months.
Population-based surveillance ...for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed.
The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza.
Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.
The cause of warming in the Southern Hemisphere during the most recent deglaciation remains a matter of debate. Hypotheses for a Northern Hemisphere trigger, through oceanic redistributions of heat, ...are based in part on the abrupt onset of warming seen in East Antarctic ice cores and dated to 18,000 years ago, which is several thousand years after high-latitude Northern Hemisphere summer insolation intensity began increasing from its minimum, approximately 24,000 years ago. An alternative explanation is that local solar insolation changes cause the Southern Hemisphere to warm independently. Here we present results from a new, annually resolved ice-core record from West Antarctica that reconciles these two views. The records show that 18,000 years ago snow accumulation in West Antarctica began increasing, coincident with increasing carbon dioxide concentrations, warming in East Antarctica and cooling in the Northern Hemisphere associated with an abrupt decrease in Atlantic meridional overturning circulation. However, significant warming in West Antarctica began at least 2,000 years earlier. Circum-Antarctic sea-ice decline, driven by increasing local insolation, is the likely cause of this warming. The marine-influenced West Antarctic records suggest a more active role for the Southern Ocean in the onset of deglaciation than is inferred from ice cores in the East Antarctic interior, which are largely isolated from sea-ice changes.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Exploration of the microbiology in igneous, 'hard rock' oceanic crust represents a major scientific frontier. The igneous crust harbours the largest aquifer system on Earth, most of which is ...hydrologically active, resulting in a substantial exchange of fluids, chemicals and microorganisms between oceanic basins and crustal reservoirs. Study of the deep-subsurface biosphere in the igneous crust is technically challenging. However, technologies have improved over the past decade, providing exciting new opportunities for the study of deep-seated marine life, including in situ and cross-disciplinary experimentation in microbiology, geochemistry and hydrogeology. In this Progress article, we describe the recent advances, available technology and remaining challenges in the study of the marine intraterrestrial microbial life that is harboured in igneous oceanic crust.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Routine vaccination of US infants against rotavirus was implemented in 2006, prompting the Centers for Disease Control and Prevention New Vaccine Surveillance Network to begin population-based acute ...gastroenteritis surveillance among US children<3 years of age. This surveillance system establishes baseline estimates of rotavirus disease burden and allows for the prospective monitoring of rotavirus vaccination impact.
Eligible children with acute gastroenteritis (>or=3 episodes of diarrhea and/or any vomiting in a 24-hour period) who were hospitalized, were seen in emergency departments, or visited selected outpatient clinics in 3 US counties during the period of January through June 2006 were enrolled. Epidemiological and clinical information was obtained through parental interview and medical chart review, and stool specimens were tested for rotavirus with enzyme immunoassays. Rotavirus-positive specimens were genotyped by using reverse transcription-polymerase chain reaction assays.
Stool specimens were collected from 516 of the 739 enrolled children with acute gastroenteritis (181 inpatient, 201 emergency department, and 134 outpatient) and 44% tested positive for rotavirus (227 of 516 specimens). The most common strain was P8G1 (84%), followed by P4G2 (5%) and P6G12 (4%). None of the 516 children had received rotavirus vaccine. The rotavirus detection rate was 50% for hospitalized acute gastroenteritis cases, 50% for emergency department visits, and 27% for outpatient visits. Rotavirus-related acute gastroenteritis cases were more likely than non-rotavirus-related acute gastroenteritis cases to present with vomiting, diarrhea, fever, and lethargy. Directly calculated, population-based rates for rotavirus hospitalizations and emergency department visits were 22.5 hospitalizations and 301.0 emergency department visits per 10 000 children<3 years of age, respectively. A sentinel outpatient clinic visit rate of 311.9 outpatient visits per 10,000 children<3 years of age was observed.
Population-based, laboratory-confirmed rotavirus surveillance in the final rotavirus season before implementation of the US rotavirus vaccine program indicated a considerable burden of disease on the US health care system.
The goal was to estimate the effectiveness of influenza vaccination against laboratory-confirmed influenza during the 2003-2004 and 2004-2005 influenza seasons in children 6 to 59 months of age.
We ...conducted a case-control study with children with medically attended, acute respiratory infections who received care in an inpatient, emergency department, or outpatient clinic setting during 2 consecutive influenza seasons. All children residing in Monroe County, New York, Davidson County, Tennessee, or Hamilton County, Ohio, were enrolled prospectively at the time of acute illness and had nasal/throat swabs tested for influenza with cultures and/or polymerase chain reaction assays. Children with laboratory-confirmed influenza were case subjects and children who tested negative for influenza were control subjects. Child vaccination records from the parent and the child's physician were used to determine and to validate influenza vaccination status. Influenza vaccine effectiveness was calculated as (1 - adjusted odds ratio) x 100.
We enrolled 288 case subjects and 744 control subjects during the 2003-2004 season and 197 case subjects and 1305 control subjects during the 2004-2005 season. Six percent and 19% of all study children were fully vaccinated according to immunization guidelines in the respective seasons. Full vaccination was associated with significantly fewer influenza-related inpatient, emergency department, or outpatient clinic visits in 2004-2005 (vaccine effectiveness: 57%) but not in 2003-2004 (vaccine effectiveness: 44%). Partial vaccination was not effective in either season.
Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.
Background Sensitization to house dust mite allergens is strongly correlated with asthma. Der p 7 elicits strong IgE antibody and T-cell responses in patients with mite allergy. However, the ...structure and biological function of this important allergen are unknown. Allergen function might contribute to allergenicity, as shown for the protease activity of group 1 mite allergens and the interaction with the innate immune system by group 2 mite allergens. Objective We sought to determine the crystal structure of Der p 7 and to investigate its biological function. Methods X-ray crystallography was used to determine the Der p 7 structure. Nuclear magnetic resonance analysis and biochemical assays were used to examine the binding of Der p 7 to predicted ligands. Results Der p 7 has an elongated structure, with two 4-stranded antiparallel β-sheets that wrap around a long C-terminal helix. The fold of Der p 7 is similar to that of LPS-binding protein (LBP), which interacts with Toll-like receptors after binding LPS and other bacterially derived lipid ligands. Nuclear magnetic resonance and biochemical assays indicate that Der p 7 does not bind LPS but binds with weak affinity to the bacterial lipopeptide polymyxin B in the predicted binding site of Der p 7. Conclusions Der p 7 binds a bacterially derived lipid product, a common feature of some allergens. The finding that the group 7, as well as the group 2, mite allergens are structurally similar to different proteins in the Toll-like receptor pathway further strengthens the connections between dust mites, innate immunity, and allergy.
Type I interferons (IFNs) play critical roles in anti-viral and anti-tumor immunity. However, they also suppress protective immune responses in some infectious diseases. Here, we identify type I IFNs ...as major upstream regulators of CD4+ T cells from visceral leishmaniasis (VL) patients. Furthermore, we report that mice deficient in type I IFN signaling have significantly improved control of Leishmania donovani, a causative agent of human VL, associated with enhanced IFNγ but reduced IL-10 production by parasite-specific CD4+ T cells. Importantly, we identify a small-molecule inhibitor that can be used to block type I IFN signaling during established infection and acts synergistically with conventional anti-parasitic drugs to improve parasite clearance and enhance anti-parasitic CD4+ T cell responses in mice and humans. Thus, manipulation of type I IFN signaling is a promising strategy for improving disease outcome in VL patients.
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•Type I IFNs are major upstream regulators of CD4+ T cells from VL patients•Type I IFN signaling-deficient mice have improved control of Leishmania donovani•Type I IFNs inhibit IFNγ but promote IL-10-producing antigen-specific CD4+ T cells•Blocking type I IFN signaling enhances anti-parasitic CD4+ T cell responses
CD4+ T cells are critical for control of intracellular parasites such as Leishmania donovani. Kumar et al. show that type I interferons (IFNs) suppress Th1 cells and promote IL-10-producing CD4+ T cells during visceral leishmaniasis (VL). Thus, manipulation of type I IFN signaling may improve disease outcome in VL patients.
Background. The contribution of human rhinovirus (HRV) to severe acute respiratory illness (ARI) is unclear. Objective. To assess the association between HRV species detection and ARI ...hospitalizations. Methods. Children < 5 years old hospitalized for ARI were prospectively enrolled between December 2003 and April 2005 in 3 US counties. Asymptomatic controls were enrolled between December 2003 and March 2004 and between October 2004 and April 2005 in clinics. Nasal and throat swab samples were tested for HRV and other viruses (ie, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, and influenza virus) by reverse-transcription-polymerase chain reaction, and genetic sequencing identified HRV species and types. HRV species detection was compared between controls and patients hospitalized during months in which controls were enrolled. Results. A total of 1867 children with 1947 ARI hospitalizations and 784 controls with 790 clinic visits were enrolled and tested for HRV. The HRV-A detection rate among participants ≥24 months old was 8.1% in the hospitalized group and 2.2% in the control group (P = .009), and the HRV-C detection rates among those ≥6 months old were 8.2% and 3.9%, respectively (P = .002); among younger children, the detection rates for both species were similar between groups. The HRV-B detection rate was ≤1 % . A broad diversity of HRV types was observed in both groups. Clinical presentations were similar among HRV species. Compared with children infected with other viruses, children with HRV detected were similar for severe hospital outcomes and more commonly had histories or diagnoses of asthma or wheezing. Conclusions. HRV-A and HRV-C were associated with ARI hospitalization and serious illness outcomes.
BACKGROUND:Human coronaviruses (HCoVs) have been detected in children with upper and lower respiratory symptoms, but little is known about their relationship with severe respiratory illness.
...OBJECTIVE:To compare the prevalence of HCoV species among children hospitalized for acute respiratory illness and/or fever (ARI/fever) with that among asymptomatic controls and to assess the severity of outcomes among hospitalized children with HCoV infection compared with other respiratory viruses.
METHODS:From December 2003 to April 2004 and October 2004 to April 2005, we conducted prospective, population-based surveillance of children <5 years of age hospitalized for ARI/fever in 3 US counties. Asymptomatic outpatient controls were enrolled concurrently. Nasal/throat swabs were tested for HCoV species HKU1, NL63, 229E, and OC43 by real-time reverse-transcription polymerase chain reaction. Specimens from hospitalized children were also tested for other common respiratory viruses. Demographic and medical data were collected by parent/guardian interview and medical chart review.
RESULTS:Overall, HCoV was detected in 113 (7.6%) of 1481 hospitalized children (83 5.7% after excluding 30 cases coinfected with other viruses) and 53 (7.1%) of 742 controls. The prevalence of HCoV or individual species was not significantly higher among hospitalized children than controls. Hospitalized children testing positive for HCoV alone tended to be less ill than those infected with other viruses, whereas those coinfected with HCoV and other viruses were clinically similar to those infected with other viruses alone.
CONCLUSIONS:In this study of children hospitalized for ARI/fever, HCoV infection was not associated with hospitalization or with increased severity of illness.
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