IntroductionRecent data suggest 8-52% of babies on the NICU have evidence of a viral respiratory tract infection (VRTI) (Ronchi 2014, Bennett 2012). These studies, and our own data, indicate babies ...with VRTIs spend twice as long in hospital and have significantly worse respiratory outcomes such as chronic lung disease and the need for home oxygen. There is little evidence exploring ways of reducing these infections in the NICU. Our recent survey demonstrates significant variation in UK NICU visiting practices and isolation policies for babies with RVTIs.AimTo establish the impact of visitor restriction on the incidence of NICU VRTIs.MethodsWe performed a retrospective study of all admissions between 2007 and 2013 at two large UK tertiary NICUs (13,300 bed days/year). Normal visiting policy included parents, family and friends. During the periods November to April of 2009, 2010 and 2011, in response to the H1N1 pandemic, we restricted visiting to parents/carers only. No other variations in practice occurred. We identified all babies positive for VRTIs. We used a Poisson generalised additive model (GAM), factoring in workload intensity and incidence of community VRTIs, to calculate the impact of these 3 winter restriction periods compared with normal visiting.ResultsThere were 100 PCR proven VRTIs in 93 babies during this period (16/yr). Rhinovirus (n = 71), RSV (n = 8) and H1N1 (n = 5) were the most common. The median gestation of infected babies was 29 weeks (IQR 26-34 Weeks) and 46% required an escalation of respiratory support. Two of five H1N1 positive babies died. The results from the GAM suggest there was a 39% reduction (P < 0.05) in VRTIs during restricted visiting periods compared to normal visiting (Incident Rate Ratio 0.61, 95% CI 0.38-0.99). Extrapolating this to the UK, based on the NHS NICU tariff, the extra bed days associated with VRTIs cost between pound sterling 7M and pound sterling 25M/year.ConclusionThis is the first study demonstrating a significant reduction in NICU VRTIs through restricting visiting practices. VRTIs are associated with significant neonatal respiratory morbidity and have short and long-term resource implications. We need to explore better ways of minimising the impact of VRTIs in this vulnerable population.
Rhinovirus is the main cause of the common cold, which remains the most frequent infection worldwide among humans. Knowledge and understanding of the rhinovirus transmission route is important to ...reduce morbidity as only preventive measures are effective. In this study, we investigated the potential of rhinovirus to survive on fingers. Rhinovirus-B14 was deposited on fingers for 30, 60, 90 and 120 min. Survival was defined as the ability of the virus to grow after 7 days, confirmed by immunofluorescence. Rhinovirus survival was not dependent on incubation time on fingers. Droplet disruption had no influence on survival. Survival was frequent with high rhinovirus concentrations, but rare with low-concentration droplets, which corresponded to the usual rhinovirus concentrations in mucus observed in children and adults, respectively. Our study confirms that rhinovirus infectiousness is related to the viral concentration in droplets and suggests that children represent the main transmission source, which occurs only rarely via adults. It confirms also that rhinovirus hand-related transmission is possible and supports hand hygiene as a key prevention measure.
BackgroundRespiratory Syncythial Virus (RSV) is a common lower respiratory tract viral infection. RSV and a wide variety of other respiratory viruses are common triggers for bronchiolitis.AimTo ...determine the length of stay in infants with acute RSV bronchiolitis vs. Non-RSV.Materials and methodsA retrospective study was conducted at Hamad Medical Corporation (HMC). Infants and children ages 0 to 18 months hospitalised with acute bronchiolitis from October 2010 to March 2013 were included. The data collected: age at diagnosis, sex, direct fluorescent antibody (DFA) and length of stay.ResultsThe study included 838 infants, mean age 3.6( plus or minus 3.5) months, and boys constituted 60%. DFA was conducted on 770 infant, where 352 Were RSV positive (45.7%), 142 were RSV negative (18.4%) and other non-RSV viruses (Adenoviurs, RhinoVirus, InfluenzaVirus, Parainflenzavirus, and Bocavirus)276 (35.8%). The mean length of stay for RSV-positive was 8.03 days, 95% C. I. (7.26-8.79), and 6.94 days, 95% C. I. (5.89-8.00) for RSV-negative compared to 9.76 days, 95%C. I. (8.31-11.21) for other non-RSV. The p value was 0.723 when comparing the length of stay in infants who tested positive RSV to those tested negative RSV, while the p-value was (0.059)when comparing RSV-positive to other non-RSV viruses. There was a statistically significance difference in length of stay for RSV negative compared to other non-RSV viruses (p = 0.010).ConclusionsOur data showed, there is no difference in length of stay in infants hospitalised with RSV-positive bronchiolitis compared to the group with RSV-negative; however the length of stay was statistically significant longer with Non-RSV viruses compared to RSV-negative infection.
Asthma Martinez, Fernando D; Vercelli, Donata
The Lancet (British edition),
10/2013, Letnik:
382, Številka:
9901
Journal Article
Recenzirano
Asthma is a heterogeneous group of conditions that result in recurrent, reversible bronchial obstruction. Although the disease can start at any age, the first symptoms occur during childhood in most ...cases. Asthma has a strong genetic component, and genome-wide association studies have identified variations in several genes that slightly increase the risk of disease. Asthma is often associated with increased susceptibility to infection with rhinoviruses and with changes in the composition of microbial communities colonising the airways, but whether these changes are a cause or consequence of the disease is unknown. There is currently no proven prevention strategy; however, the finding that exposure to microbial products in early life, particularly in farming environments, seems to be protective against asthma offers hope that surrogates of such exposure could be used to prevent the disease. Genetic and immunological studies point to defective responses of lung resident cells, especially those associated with the mucosal epithelium, as crucial elements in the pathogenesis of asthma. Inhaled corticosteroids continue to be the mainstay for the treatment of mild and moderate asthma, but limited adherence to daily inhaled medication is a major obstacle to the success of such therapy. Severe asthma that is refractory to usual treatment continues to be a challenge, but new biological therapies, such as humanised antibodies against IgE, interleukin 5, and interleukin 13, offer hope to improve the quality of life and long-term prognosis of severe asthmatics with specific molecular phenotypes.
Asthma Martinez, Fernando D; Vercelli, Donata
The Lancet (British edition),
10/2013, Letnik:
382, Številka:
9901
Journal Article
Recenzirano
Asthma is a heterogeneous group of conditions that result in recurrent, reversible bronchial obstruction. Although the disease can start at any age, the first symptoms occur during childhood in most ...cases. Asthma has a strong genetic component, and genome-wide association studies have identified variations in several genes that slightly increase the risk of disease. Asthma is often associated with increased susceptibility to infection with rhinoviruses and with changes in the composition of microbial communities colonising the airways, but whether these changes are a cause or consequence of the disease is unknown. There is currently no proven prevention strategy; however, the finding that exposure to microbial products in early life, particularly in farming environments, seems to be protective against asthma offers hope that surrogates of such exposure could be used to prevent the disease. Genetic and immunological studies point to defective responses of lung resident cells, especially those associated with the mucosal epithelium, as crucial elements in the pathogenesis of asthma. Inhaled corticosteroids continue to be the mainstay for the treatment of mild and moderate asthma, but limited adherence to daily inhaled medication is a major obstacle to the success of such therapy. Severe asthma that is refractory to usual treatment continues to be a challenge, but new biological therapies, such as humanised antibodies against IgE, interleukin 5, and interleukin 13, offer hope to improve the quality of life and long-term prognosis of severe asthmatics with specific molecular phenotypes.
A new and potentially more pathogenic group of human rhinovirus (HRV), group C (HRVC), has recently been discovered. We hypothesised that HRVC would be present in children with acute asthma and cause ...more severe attacks than other viruses or HRV groups. Children with acute asthma (n = 128; age 2-16 yrs) were recruited on presentation to an emergency department. Asthma exacerbation severity was assessed, and respiratory viruses and HRV strains were identified in a nasal aspirate. The majority of the children studied had moderate-to-severe asthma (85.2%) and 98.9% were admitted to hospital. HRV was detected in 87.5% and other respiratory viruses in 14.8% of children, most of whom also had HRV. HRVC was present in the majority of children with acute asthma (59.4%) and associated with more severe asthma. Children with HRVC (n = 76) had higher asthma severity scores than children whose HRV infection was HRVA or HRVB only (n = 34; p = 0.018), and all other children (n = 50; p = 0.016). Of the 19 children with a non-HRV virus, 13 had HRV co-infections, seven of these being HRVC. HRVC accounts for the majority of asthma attacks in children presenting to hospital and causes more severe attacks than previously known HRV groups and other viruses.
To determine links between human rhinoviruses (HRV) and asthma, we used data from a case-control study, March 2003-February 2004, among children with asthma. Molecular characterization identified ...several likely new HRVs and showed that association with asthma exacerbations was largely driven by HRV-A and a phylogenetically distinct clade of 8 strains, genogroup C.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
