Clinical manifestations and outcome of viral acute lower respiratory infection in hospitalised children in Myanmar

Abstract

Background Acute lower respiratory infection (ALRI) remains the leading cause of death in children worldwide, and viruses have been the major cause of ALRI. In Myanmar, ALRI is associated with high morbidity and mortality in children, and detailed information on ALRI is currently lacking. Methods This prospective study investigated the viral aetiologies, clinical manifestations, and outcomes of ALRI in hospitalised children aged 1 month to 12 years at the Yankin Children Hospital, Yangon, Myanmar from May 2017 to April 2019. The sample size was set to 300 patients for each year. Two nasopharyngeal swabs were obtained for the patients with suspected viral ALRI; one for rapid tests for influenza and respiratory syncytial virus (RSV), and the other for real-time PCR for the 16 ALRI-causing viruses. Pneumococcal colonization rates were also investigated using real-time PCR. Clinical information was extracted from the medical records, and enrolled patients were categorised by age and severity for comparison. Results Among the 5463 patients admitted with a diagnosis of ALRI, 570 (10.4%) were enrolled in this study. The median age of the patients was 8 months (interquartile range, 4–15 months). The most common symptoms were cough (93%) and difficulty in breathing (73%), while the most common signs of ALRI were tachypnoea (78%) and chest indrawing (67%). A total of 16 viruses were detected in 502 of 570 patients’ samples (88%), with RSV B (36%) and rhinovirus (28%) being the most commonly detected. Multiple viruses were detected in 221 of 570 samples (37%) collected from 570 patients. Severe ALRI was diagnosed in 107 of 570 patients (19%), and RSV B and human rhinovirus were commonly detected. The mortality rate was 5%; influenza virus A (29%) and RSV B (21%) were commonly detected, and stunting and lack of immunization were frequently observed in such cases. Additionally, 45% (259/570) of the patients had pneumococcal colonization. Conclusions Viral ALRI in hospitalised children with a median of 8 months has significant morbidity and mortality rates in Myanmar. RSV and rhinovirus were the most commonly detected from nasopharyngeal swabs, while influenza virus and RSV were the most frequently associated with fatal cases.

Detection of parechovirus‐A in hospitalized children with acute lower respiratory infection in Myanmar, 2017–2018

“…We investigated nasopharyngeal (NP) samples obtained from hospitalized children with ALRI who had participated in a prospective viral etiological study. Details of the study have been reported previously 10 . In brief, the study enrolled children with ALRI aged 1 month to 12 years who were admitted to Yankin Children Hospital (YKCH) in Yangon, Myanmar, during the period from April 2017 to March 2019.…”

“…On admission, an NP swab was immediately placed in viral transport media and stored at −80°C in a freezer at YKCH and later transported to the laboratory of Niigata University, Japan, for viral analyses. The definition of ALRI and exclusion criteria for this study were also described in the previous report 10 . Briefly, ALRI was defined as (1) a fever of ≥38°C, (2) cough, (3) onset during the previous 10 days, and (4) need for hospitalization.…”

“…Details of the study have been reported previously. 10 In brief, the study enrolled children with ALRI aged 1 month to 12 years who were admitted to Yankin Children Hospital (YKCH) in Yangon, Myanmar, during the period from April 2017 to March 2019. On admission, an NP swab was immediately placed in viral transport media and stored at −80°C in a freezer at YKCH and later transported to the laboratory of Niigata University, Japan, for viral analyses.…”

Tea consumption and risk of lower respiratory tract infections: a two-sample mendelian randomization study

“…The systematic analysis for the Global Burden of Disease Study 2016 estimated that there were 2,377,697 deaths due to LRTIs globally in 2016 [ 3 ]. Over the past decades, many countries have taken a range of actions to prevent and treat LRTIs, including the improvement of nutrition and hygiene, distribution and usage of influenza antibiotics and antivirals, and global promotion of Haemophilus influenzae type b and pneumococcal conjugate vaccines [ 4 , 5 ]. Despite remarkable progress has been made with these measures, LRTIs still bring huge burden to individuals and society.…”

“…Over the past decades, many countries have taken a range of actions to prevent and treat LRTIs, including the improvement of nutrition and hygiene, distribution and usage of influenza antibiotics and antivirals, Yuting Chen and Jiran Shen contributed equally to this work and should be considered co-first author. and global promotion of Haemophilus influenzae type b and pneumococcal conjugate vaccines [4,5]. Despite remarkable progress has been made with these measures, LRTIs still bring huge burden to individuals and society.…”