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      Incidence and risk factors of lower respiratory tract illnesses during infancy in a Mediterranean birth cohort


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          Aim: To investigate the incidence rate, viral respiratory agents and determinants of lower respiratory tract illnesses (LRTIs) in infants younger than 1 year.

          Methods: A total of 487 infants were recruited at birth for the Asthma Multicenter Infant Cohort Study in Barcelona (Spain). Cases of LRTIs were ascertained through an active register including a home visit and viral test in nasal lavage specimens during the first year of life. Cotinine in cord blood, household aeroallergens, indoor NO 2 and maternal and neonatal IgE were measured. Other maternal and infants' characteristics were obtained from structured questionnaires.

          Results: The incidence rate of at least one LRTI was 38.7 infants per 100 persons‐years. The most frequently isolated viral agent was respiratory syncytial virus (44.7%). The risk of LRTIs was higher in infants with a maternal history of asthma and in those with siblings (OR = 2.4; 95% CI: 0.98–6.08 and OR = 1.8; 95% CI: 1.04–3.21, respectively). The risk of LRTIs was lower in infants who were breast fed for more than 12 weeks (OR = 0.26; 95% CI: 0.26–0.86) and in those from a low socioeconomic class (OR = 0.16; 95% CI: 0.06–0.42).

          Conclusion: Viral LRTIs are frequent in infants younger than 1 year of age and there is an inter‐relationship between maternal asthma, siblings, breast feeding and socioeconomic status.

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          Most cited references28

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          A newly discovered human pneumovirus isolated from young children with respiratory tract disease

          From 28 young children in the Netherlands, we isolated a paramyxovirus that was identified as a tentative new member of the Metapneumovirus genus based on virological data, sequence homology and gene constellation. Previously, avian pneumovirus was the sole member of this recently assigned genus, hence the provisional name for the newly discovered virus: human metapneumovirus. The clinical symptoms of the children from whom the virus was isolated were similar to those caused by human respiratory syncytial virus infection, ranging from upper respiratory tract disease to severe bronchiolitis and pneumonia. Serological studies showed that by the age of five years, virtually all children in the Netherlands have been exposed to human metapneumovirus and that the virus has been circulating in humans for at least 50 years.
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            Rhinovirus illnesses during infancy predict subsequent childhood wheezing.

            The contribution of viral respiratory infections during infancy to the development of subsequent wheezing and/or allergic diseases in early childhood is not established. To evaluate these relationships prospectively from birth to 3 years of age in 285 children genetically at high risk for developing allergic respiratory diseases. By using nasal lavage, the relationship of timing, severity, and etiology of viral respiratory infections during infancy to wheezing in the 3rd year of life was evaluated. In addition, genetic and environmental factors that could modify risk of infections and wheezing prevalence were analyzed. Risk factors for 3rd year wheezing were passive smoke exposure (odds ratio [OR]=2.1), older siblings (OR=2.5), allergic sensitization to foods at age 1 year (OR=2.0), any moderate to severe respiratory illness without wheezing during infancy (OR=3.6), and at least 1 wheezing illness with respiratory syncytial virus (RSV; OR=3.0), rhinovirus (OR=10) and/or non-rhinovirus/RSV pathogens (OR=3.9) during infancy. When viral etiology was considered, 1st-year wheezing illnesses caused by rhinovirus infection were the strongest predictor of subsequent 3rd year wheezing (OR=6.6; P < .0001). Moreover, 63% of infants who wheezed during rhinovirus seasons continued to wheeze in the 3rd year of life, compared with only 20% of all other infants (OR=6.6; P < .0001). In this population of children at increased risk of developing allergies and asthma, the most significant risk factor for the development of preschool childhood wheezing is the occurrence of symptomatic rhinovirus illnesses during infancy that are clinically and prognostically informative based on their seasonal nature.
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              Role of respiratory viruses in acute upper and lower respiratory tract illness in the first year of life: a birth cohort study.

              Although acute respiratory illnesses (ARI) are major causes of morbidity and mortality in early childhood worldwide, little progress has been made in their control and prophylaxis. Most studies have focused on hospitalized children or children from closed populations. It is essential that the viral etiology of these clinical diseases be accurately defined in the development of antiviral drugs. To investigate the role of all common respiratory viruses as upper and lower respiratory tract pathogens in the first year of life. This community-based birth cohort study prospectively collected detailed information on all ARI contracted by 263 infants from birth until 1 year of age. Nasopharyngeal aspirates were collected for each ARI episode, and all common respiratory viruses were detected by polymerase chain reaction. Episodes were classified as upper respiratory illnesses or lower respiratory illnesses (LRI), with or without wheeze. The majority reported 2-5 episodes of ARI in the first year (range, 0-11 episodes; mean, 4.1). One-third were LRI, and 29% of these were associated with wheeze. Viruses were detected in 69% of ARI; most common were rhinoviruses (48.5%) and respiratory syncytial virus (RSV) (10.9%). Compared with RSV, >10 times the number of upper respiratory illnesses and >3 times the number of both LRI and wheezing LRI were attributed to rhinoviruses. Rhinoviruses are the major upper and lower respiratory pathogens in the first year of life. Although RSV is strongly associated with severe LRI requiring hospitalization, the role of rhinoviruses as the major lower respiratory pathogens in infants has not previously been recognized.

                Author and article information

                Acta Paediatr
                Acta Paediatr
                Acta Paediatrica (Oslo, Norway : 1992)
                Blackwell Publishing Ltd (Oxford, UK )
                09 July 2008
                October 2008
                : 97
                : 10 ( doiID: 10.1111/apa.2008.97.issue-10 )
                : 1406-1411
                [ 1 ]Pediatric Department, Environmental and Pediatric Research Unit (URIE), Hospital del Mar, Barcelona, Spain
                [ 2 ]Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
                [ 3 ]Center for Research in Environmental Epidemiology (CREAL), Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain
                [ 4 ]Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanitá, Roma, Italy
                Author notes
                [*] Correspondence 
Dr Oscar Garcia‐Algar, Pediatric Service, Hospital del Mar, Passeig Maritim, 25‐29, 08003 Barcelona, Spain. Tel: +34‐93‐248‐35‐51 | Fax: +34‐93‐248‐32‐54 | Email: 90458@ 123456imas.imim.es
                ©2008 The Author(s)/Journal Compilation ©2008 Foundation Acta Pædiatrica/ Acta Pædiatrica

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                Page count
                links-crossref: 36, Figures: 1, Tables: 1, Equations: 0, References: 30, Pages: 6
                Regular Articles
                Custom metadata
                October 2008
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

                birth cohort,incidence rate,infants,lower respiratory tract illnesses,risk factors,rsv
                birth cohort, incidence rate, infants, lower respiratory tract illnesses, risk factors, rsv


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