Wood-Burning Stoves and Lower Respiratory Tract Infection in American Indian Children

Morris, Karen; Morganlander, Marcia; Coulehan, John L.; Gahagen, Sheila; Arena, Vincent C.

doi:10.1001/archpedi.1990.02150250117047

Cited by 84 publications

(86 citation statements)

References 21 publications

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“…[26][27][28] In addition, exposure to smoke from wood-burning stoves (common in both regions) was associated with increased risk of hospitalization attributable to lower respiratory illness among Navajo children Ͻ2 years of age. 29,30 The high RSV hospitalization rates for the 2 regions suggest that AI/AN infants living in these regions are at high risk for RSV disease. Additional studies of RSV illness, including cost-benefit analyses for RSV prophylaxis, should be considered for infants living in these regions.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

et al. 2004

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ABSTRACT. Objective. To determine the burden of respiratory syncytial virus (RSV) disease among American Indian (AI) and Alaska Native (AN) infants, by examining RSV-associated hospitalizations.Methods. Infant hospitalizations from 1997 through 2001 with RSV listed as a diagnosis were selected by using Indian Health Service/tribal hospital discharge data for AIs/ANs and National Hospital Discharge Survey data for the general US population.Results. In 2000 -2001, RSV disease was listed as a diagnosis for 14.4% of all AI/AN infant hospitalizations, with bronchiolitis attributable to RSV infection (12.2%) being among the top 5 listed diagnoses. The rate of RSV-specific hospitalizations was 34.4 hospitalizations per 1000 infants for AI/AN infants and 27.4 hospitalizations per 1000 births for the general US infant population. The hospitalization rates for AI/AN infants living in the Alaska and Southwest regions (70.9 and 48.2 hospitalizations per 1000 infants, respectively) were much higher than the overall rate for US infants. R espiratory syncytial virus (RSV) infection remains a major cause of lower respiratory tract disease among infants and children. 1,2 Most RSV-related childhood hospitalizations occur among infants Ͻ6 months of age, and almost all children are infected with RSV by 2 years of age. 2,3 One study estimated that between 73 000 and 126 000 RSVassociated hospitalizations per year occurred among US infants in 1994 -1996. 1 Another study, using the newly introduced, RSV-specific diagnostic codes, estimated that ϳ96 000 RSV hospitalizations occurred annually in 1997-2000. 4 That study also noted that bronchiolitis attributable to RSV was the leading cause of hospitalization among the general population of infants in the United States. Conclusions. RSV infection is one of the leading causes of hospitalization among all infants in the UnitedThe availability of effective prophylaxis for some infants and young children and the promise of future vaccines make the identification of at-risk populations and the quantification of risk levels important for developing RSV prevention strategies. The risk of severe RSV-associated disease varies with age and is increased by the presence of comorbidities, such as underlying lung, cardiac, and immune-compromising conditions. 2,5,6 Infants born prematurely are also at increased risk for RSV disease. In addition, previous studies suggested that American Indian (AI) and Alaska Native (AN) children and infants have higher rates of hospitalization associated with respiratory infections, compared with the general US population, with RSV being considered an important cause of these infections. [7][8][9][10][11][12][13][14] One study reported that almost 75% of all infectious disease hospitalizations among AI/AN infants were associated with lower respiratory tract infections. 13 It is estimated that 50% to 80% of infant hospitalizations for treatment of bronchiolitis and one-third of hospitalizations for treatment of pneumonia are RSV-related. 1,6 RSV-specific International...

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Section: Discussionmentioning

confidence: 99%

Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

et al. 2004

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“…3,4 During the past 2 decades, RSV attributable hospitalization rates among young US children have increased from 12.9 per 1000 to 31.2 per 1000. 3 Known risk factors for serious RSV infection include congenital heart disease (CHD), chronic lung disease of prematurity (CLD), prematurity, immunodeficiency, male gender, crowding, passive smoke exposure, lack of breastfeeding, 4,[5][6][7][8][9][10][11][12][13][14] and low titers of passively acquired RSV-neutralizing antibody. 8 American Indian and Alaska Natives have been documented to have higher rates of various infectious diseases (eg, Haemophilus influenzae, Streptococcus pneumoniae, and hepatitis A) compared with the general US population.…”

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confidence: 99%

Respiratory Syncytial Virus Infection in Navajo and White Mountain Apache Children

Bocková

O’Brien²,

Oski³

et al. 2002

Pediatrics

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ABSTRACT. Objective. The hospitalization rate for bronchiolitis of any cause among US children younger than 1 year is estimated at 31.2 per 1000. No data exist on respiratory syncytial virus (RSV)-specific hospitalization rates among high-risk Native Americans other than Alaska Natives, for whom the incidence of RSV hospitalization was estimated at 150 per 1000 among infants younger than 1 year. We aimed to estimate RSV hospitalization rates among Navajo and White Mountain Apache children younger than 2 years.Methods. We conducted prospective population-level hospital-based surveillance to determine RSV hospitalization rates among Navajo and White Mountain Apache children younger than 2 years. From 1997 to 2000, all children who were admitted for acute lower respiratory tract infection between October 1 and March 31 had a nasopharyngeal aspirate obtained and tested for RSV by commercial enzyme immunoassay kits. We reviewed charts of children who tested positive for RSV antigen to determine disease severity.Results. During 3 RSV seasons (1997-2000), 51.3% of 1837 admissions for acute lower respiratory tract infection among children younger than 2 years were attributed to RSV infection. The overall seasonal RSV hospitalization rate among children younger than 2 years was 63.6 per 1000 and 91.3 per 1000 among children younger than 1 year. In a univariate analysis, predictors of severity included age <6 months (relative risk: 6.8; 95% confidence interval: 3.1-17.0).Conclusions. Navajo and White Mountain Apache children are at high risk for RSV disease requiring hospitalization. A lower threshold for hospitalization or underlying chronic conditions that predispose to severe RSV disease do not seem to explain high RSV hospitalization rates in this population. Pediatrics 2002;110(2). URL: http://www.pediatrics.org/cgi/content/full/110/2/ e20; respiratory syncytial virus, American Indian, hospitalization, lower respiratory tract infection, bronchiolitis, surveillance.ABBREVIATIONS. RSV, respiratory syncytial virus; CHD, congenital heart disease; CLD, chronic lung disease; ALRI, acute lower respiratory tract infection; IHS, Indian Health Service; NP, nasopharyngeal aspirate; JHH, Johns Hopkins Hospital; OR, odds ratio. R espiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease and hospitalization among young children throughout the world. 1,2 The rates of hospitalization for bronchiolitis of any cause among US children younger than 1 year are estimated to be between 31 and 41 per 1000 children by studies of International Classification of Diseases, Ninth Revision discharge codes. 3,4 During the past 2 decades, RSV attributable hospitalization rates among young US children have increased from 12.9 per 1000 to 31.2 per 1000. 3 Known risk factors for serious RSV infection include congenital heart disease (CHD), chronic lung disease of prematurity (CLD), prematurity, immunodeficiency, male gender, crowding, passive smoke exposure, lack of breastfeeding, 4,5-14 and low titers of passively acquire...

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“…Some investigators have demonstrated the association between wood burning stoves and increased risk for acute respiratory infections. [17][18][19] On the Navajo Nation, we have determined that infants who present with acute lower respiratory infections are more likely to have severe disease if they come from a home with wood burning stoves. 20 Smoking by parents or caretakers is rare among Navajos (9% in our study), which may explain why it did not appear to be associated with Hib disease.…”

Section: Discussionmentioning

confidence: 99%

A case-control study of risk factors for Haemophilus influenzae type B disease in Navajo children.

Wolff

Moulton²,

Newcomer³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. To understand the potential risk factors and protective factors for invasive Haemophilus influenzae type b (Hib) disease, we conducted a case-control study among Navajo children less than two years of age resident on the Navajo Nation. We analyzed household interview data for 60 cases that occurred between August 1988 and February 1991, and for 116 controls matched by age, gender, and geographic location. The Hib vaccine recipients were excluded from the analyses. Conditional logistic regression models were fit to examine many variables relating to social and environmental conditions. Risk factors determined to be important were never breast fed (odds ratio [OR] ϭ 3.55, 95% confidence interval [CI] ϭ 1.52, 8.26), shared care with more than one child less than two years of age (OR ϭ 2.32, 95% CI ϭ 0.91, 5.96); wood heating (OR ϭ 2.14, 95% CI ϭ 0.91, 5.05); rodents in the home (OR ϭ 8.18, 95% CI ϭ 0.83, 80.7); and any livestock near the home (OR ϭ 2.18, 95% CI ϭ 0.94, 5.04).Before the widespread use of conjugate vaccines, incidence rates of invasive Haemophilus influenzae type b (Hib) disease among Navajo children were demonstrated to be much higher than in the general U.S. population. During the 1970s, the incidence of Hib meningitis for Navajo children less than five years of age was 152 per 100,000 child-years, 1 compared with 19-60 per 100,000 in various non-Native American communities. 2 The reasons for these elevated rates are not well understood, although environmental factors, genetic predisposition, and delayed maturation of immune functions all may be implicated.Many factors have been identified in population groups other than the Navajo as being associated with increased risk of Hib disease incidence. These include the use of shared child care facilities, 3-7 large family size or crowding, 5,6,8,9 low socioeconomic status, 8 and smoking. 8 Breast feeding has been shown to be protective. 3,5,6,9,10 In a case-control study of Navajo children, we investigated these and other factors that were unique to the environmental and cultural characteristics of this population, including heating fuels, husbandry practices, and arts and crafts activities.Although Hib disease has been virtually eliminated in this Navajo population, it is a leading cause of serious childhood illnesses in many countries where Hib vaccines are not routinely administered. 11,12 This case-control study, conducted in a predominantly rural and disadvantaged community just prior to licensure of Hib conjugate vaccines, has relevance to many less industrialized populations. MATERIALS AND METHODSSurveillance for Hib disease. From July 1988 through July 1990, active laboratory-based surveillance for Hib disease was carried out on the Navajo Nation in Arizona and New Mexico as part of a trial designed to evaluate the safety and efficacy of a Hib conjugate vaccine (Hib-OMPC: PedvaxHIB; Merck, Blue Bell, PA). 13 Further surveillance for Hib disease was conducted as part of a study to evaluate the effectiveness of implementation of a Hib va...

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Wood-Burning Stoves and Lower Respiratory Tract Infection in American Indian Children

Cited by 84 publications

References 21 publications

Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

Respiratory Syncytial Virus Infection in Navajo and White Mountain Apache Children

A case-control study of risk factors for Haemophilus influenzae type B disease in Navajo children.

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