Acute respiratory infections in children from a deprived urban population from Uruguay

Hortal, Maria; Contera, Myriam; Mogdasy, Cristina; Russi, José Carlos

doi:10.1590/S0036-46651994000100009

Abstracts

To obtain base line data on incidence, duration, clinical characteristics and etiology of acute respiratory infections (ARI), 276 children from deprived families living in Montevideo were followed during 32 months. The target population was divided into two groups for the analysis of the results: children aged less than 12 months and those older than this age. During the follow-up period 1.056 ARI episodes were recorded. ARI incidence was 5.2 per child/year. It was 87% higher in infants than in the older group, as was the duration of the episodes. Most of the diseases were mild. Tachypnea and retractions were seldom observed, but 12 children were refered to the hospital, and 2 infants died. Viral etiology was identified in 15.3% of the episodes. RSV was the predominant agent producing annual outbreaks. Moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae (32.3%) and Hemophilus sp. (18.9%) was recorded during ARI episodes. This community-based study furnish original data on ARI in Uruguay. It enabled to asses the impact of these infections on childhood.

Respiratory tract infections; Respiratory syncytial viruses; S. pneumoniae; Haemophilus infections

Para obter informação básica sobre a incidência, duração, características clínicas e etiologia das infecções respiratórias agudas (IRA), foram observadas 276 crianças de famílias pobres que moram em Montevidéo durante 32 meses. A população alvo foi dividida em dois grupos para análise dos resultados: Crianças com menos de 12 meses e acima dessa idade. Durante o período de seguimento foram registrados 1056 episódios de IRA. A incidência de IRA foi 5.2 por criança/ano. Foi 87% mais alta nos lactentes do que nos grupos de mais idade, com duração maior dos episódios. A maioria das infecções foi pouco grave. Observaram-se poucos casos com taquipnéia e retrações, mas 12 crianças foram hospitalizadas e dois lactentes morreram. Etiologia viral foi identificada em 15.3% dos episódios. RSV foi o agente predominante, produzindo epidemias anuais. Registrou-se durante os episódios de IRA a colonização moderada até alta no trato respiratório superior de S. pneumoniae (32.3%) e Hemophilus sp. (18.9%). Este estudo de comunidade forneceu informações originais sobre IRA no Uruguai. Permitiu avaliar o impacto destas infecções nas crianças.

EPIDEMIOLOGY

Acute respiratory infections in children from a deprived urban population from Uruguay

Infecções respiratórias agudas em crianças de famílias pobres de Montevideo

Maria Hortal; Myriam Contera; Cristina Mogdasy; José Carlos Russi

Central Public Health Laboratory and Maternal-Child Program, Ministry of Public Health, Montevideo, Uruguay

^{Address for correspondence} Address for correspondence: Dr. M. Hortal Divison de Laboratorios de Salud Publica Av 8 de octubre 2720 Montevideo, 11.600, Uruguay

SUMMARY

To obtain base line data on incidence, duration, clinical characteristics and etiology of acute respiratory infections (ARI), 276 children from deprived families living in Montevideo were followed during 32 months. The target population was divided into two groups for the analysis of the results: children aged less than 12 months and those older than this age.

During the follow-up period 1.056 ARI episodes were recorded. ARI incidence was 5.2 per child/year. It was 87% higher in infants than in the older group, as was the duration of the episodes. Most of the diseases were mild. Tachypnea and retractions were seldom observed, but 12 children were refered to the hospital, and 2 infants died.

Viral etiology was identified in 15.3% of the episodes. RSV was the predominant agent producing annual outbreaks. Moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae (32.3%) and Hemophilus sp. (18.9%) was recorded during ARI episodes.

This community-based study furnish original data on ARI in Uruguay. It enabled to asses the impact of these infections on childhood.

Keywords: Respiratory tract infections; Respiratory syncytial viruses; S. pneumoniae; Haemophilus infections.

RESUMO

Para obter informação básica sobre a incidência, duração, características clínicas e etiologia das infecções respiratórias agudas (IRA), foram observadas 276 crianças de famílias pobres que moram em Montevidéo durante 32 meses. A população alvo foi dividida em dois grupos para análise dos resultados:

Crianças com menos de 12 meses e acima dessa idade. Durante o período de seguimento foram registrados 1056 episódios de IRA. A incidência de IRA foi 5.2 por criança/ano. Foi 87% mais alta nos lactentes do que nos grupos de mais idade, com duração maior dos episódios. A maioria das infecções foi pouco grave. Observaram-se poucos casos com taquipnéia e retrações, mas 12 crianças foram hospitalizadas e dois lactentes morreram. Etiologia viral foi identificada em 15.3% dos episódios. RSV foi o agente predominante, produzindo epidemias anuais.

Registrou-se durante os episódios de IRA a colonização moderada até alta no trato respiratório superior de S. pneumoniae (32.3%) e Hemophilus sp. (18.9%).

Este estudo de comunidade forneceu informações originais sobre IRA no Uruguai. Permitiu avaliar o impacto destas infecções nas crianças.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

Informed consent was obtained from the patient's parents or guardians, and the Ministry guidelines for human experimentation were followed.

We thank the U.S. National Academy of Sciences/National Research Council for financial support by means of a grant from U. S. Agency for International Development. We also thank Lic. M. Meny for his advice in the statistical analysis and Drs. P. Charache and A. P. Kendal for their valuable suggestions.

Recebido para publicação em 06/07/1993.

Aceito para publicação em 29/10/1993.

1. ARRUDA, E.; HAYDEN, F.G.; Mc AULIFFE, J.F. et al. - Acute respiratory viral infections in ambulatory children of urban northeast Brazil. J. infect. Dis., 164: 252-258, 1991.
2. AZEVEDO BARROS, M.B. - Morbidade e mortalidade hospitalar de crianças menores de um ano, em Riberăo Preto, SP (Brasil) 1975. Rev. Saúde públ. (S. Paulo), 15: 308-320, 1981.
3. BERMAN, S.; DUENAS, A.; BEDOYA, A. et al. - Acute lower respiratory tract illness in Cali, Colombia: a two year ambulatory study. Pediatrics, 21: 210-218, 1983.
4. BERMAN, S. & McINTOSH, K. - Selective primary health care: strategies for control of diseases in the developing world. XXI. Acute respiratory infections. Rev. infect. Dis., 7: 674-791, 1983.
5. EVANS, H.E. - Infections of the lower respiratory tract in infancy and early childhood. In: PENNTINGTON, J. E., ed. - Respiratory infections: diagnosis and management. 2 ed. New York, Raven Press, 1989. p. 187-206.
6. GARDNER, P. & McQUILLING, V. - Rapid virus diagnosis. 2. ed. London, Butterworth, 1974.
7. GIEBINK, G.S. & CANAFAX, D.M. - Controversies in the management of acute otitis media. Advanc. Pediat. infect. Dis., 3: 47-63, 1988.
8. GLEZEN, W.P. & DENNY, F.W. - Epidemiology of acute respiratory diseases in children. New Engl. J. Med., 288: 498-505, 1973.
9. HORTAL, M.; BENITEZ, A.; CONTERA, M. et al. - A community-based study of acute respiratory tract infections in children in Uruguay. Rev. infect. Dis., 12: S966-S973, 1989.
10. HORTAL, M.; MONTANO, A. & MENY, M. - Simple clinical signs for diagnosis of acute repiratory infections. Lancet, 25: 1225, 1989.
11. HORTAL, M.; RUSSI, J.C.; ARBIZA, J.R. et al. - Identification of viruses in acute respiratory infection study in children from Uruguay. Rev. infect. Dis., 12: (Suppl. 8): S995-S997, 1989.
12. HORTAL, M.; MOGDASY, C.; RUSSI, J.C.; DELEON, C. & SUAREZ, A. - Etiology of pneumonia in children (Letter). Clin. infect. Dis., 14: 617, 1992.
13. LANG, T.; LAFAIX, C.; FASSIN, D. et al. - Acute respiratory infections: a longitudinal study of 151 children in Burkina-Faso. Int. J. Epidem., 15: 553-560, 1986.
¹⁴
MINISTERIO DE SALUD PUBLICA - Encuesta general de salud 1982. Informe General, 1983.
¹⁵
MINISTERIO DE SALUD PUBLICA - Departamento de estadística. Informe Anual, 1988.
16. MONTO, A.S. - Acute respiratory infections in children of developing countries: challenge of the 1990s. Rev. infect. Dis., 11: 498-505, 1989.
17. MORELLI, A. & QUESADA, G. - Salud infantil en Uruguay. Documento Especial, MSP-Unicef, Dic. 1989.
18. MURPHY, T.F.; HENDERSON, F.W.; CLYDE, W.A.; COLLIER, A.M. & DENNY, F.W. - Pneumonia: an eleven-year study in a pediatric practice. Amer. J. Epidem., 113: 12-21, 1981.
19. NASCIMENTO, J.P.; SIQUEIRA, M.M.; SUTMOLLER, F. et al. - Longitudinal study of acute respiratory diseases in Rio de Janeiro: occurrence of respiratory viruses during four consecutive years. Rev. Inst. Med. trop. S. Paulo., 33: 287-296, 1991.
20. ROTHMAN, K.J. - Modern epidemiology. Boston, Little Brown, 1986.
21. SANTOSHAM, M.; YOLKEN, R.H.; QUIROZ, E. et al. - Detection of rotavirus in respiratory secretions of children with pneumonia. J. Pediat., 103: 583-585, 1983.
22. STANFIELD, S.K. - Acute respiratory infections in the developing world: strategies for prevention, treatment and control. Pediat. infect. Dis., 6: 622-628, 1987.
23. SHANN, F.; HART, K. & THOMAS, D. - Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull. Wld. Hlth. Org., 62: 749-753, 1984.
24. SUTMOLLER, F.; NASCIMENTO, J.P.; CHAVES, J.R.S.; FERREIRA, V. & PEREIRA, M.S. - Viral etiology of acute respiratory diseases in Rio de Janeiro: first two years of a longitudinal study. Bull. Wld. Hlth. Org., 61: 845-852, 1983.
25. WOOLCOCK, A.J. & PEAT, J.K. - The relationship between acute respiratory infections and chronic respiratory disease. In: DOUGLAS, R.M. & KERBY-EATON, E., ed. - Acute respiratory infections in childhood. Procedings of International Workshop. Sydney, 1984. Adelaide, University of Adelaide, 1985. p. 21-29.

Address for correspondence:

Dr. M. Hortal

Divison de Laboratorios de Salud Publica

Av 8 de octubre 2720

Montevideo, 11.600, Uruguay

Publication Dates

Publication in this collection
20 Sept 2006
Date of issue
Feb 1994

History

Accepted
29 Oct 1993
Received
06 July 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARRUDA, E.; HAYDEN, F.G.; Mc AULIFFE, J.F. et al. - Acute respiratory viral infections in ambulatory children of urban northeast Brazil. J. infect. Dis., 164: 252-258, 1991.

[2] 2. AZEVEDO BARROS, M.B. - Morbidade e mortalidade hospitalar de crianças menores de um ano, em Riberăo Preto, SP (Brasil) 1975. Rev. Saúde públ. (S. Paulo), 15: 308-320, 1981.

[3] 3. BERMAN, S.; DUENAS, A.; BEDOYA, A. et al. - Acute lower respiratory tract illness in Cali, Colombia: a two year ambulatory study. Pediatrics, 21: 210-218, 1983.

[4] 4. BERMAN, S. & McINTOSH, K. - Selective primary health care: strategies for control of diseases in the developing world. XXI. Acute respiratory infections. Rev. infect. Dis., 7: 674-791, 1983.

[5] 5. EVANS, H.E. - Infections of the lower respiratory tract in infancy and early childhood. In: PENNTINGTON, J. E., ed. - Respiratory infections: diagnosis and management. 2 ed. New York, Raven Press, 1989. p. 187-206.

[6] 6. GARDNER, P. & McQUILLING, V. - Rapid virus diagnosis. 2. ed. London, Butterworth, 1974.

[7] 7. GIEBINK, G.S. & CANAFAX, D.M. - Controversies in the management of acute otitis media. Advanc. Pediat. infect. Dis., 3: 47-63, 1988.

[8] 8. GLEZEN, W.P. & DENNY, F.W. - Epidemiology of acute respiratory diseases in children. New Engl. J. Med., 288: 498-505, 1973.

[9] 9. HORTAL, M.; BENITEZ, A.; CONTERA, M. et al. - A community-based study of acute respiratory tract infections in children in Uruguay. Rev. infect. Dis., 12: S966-S973, 1989.

[10] 10. HORTAL, M.; MONTANO, A. & MENY, M. - Simple clinical signs for diagnosis of acute repiratory infections. Lancet, 25: 1225, 1989.

[11] 11. HORTAL, M.; RUSSI, J.C.; ARBIZA, J.R. et al. - Identification of viruses in acute respiratory infection study in children from Uruguay. Rev. infect. Dis., 12: (Suppl. 8): S995-S997, 1989.

[12] 12. HORTAL, M.; MOGDASY, C.; RUSSI, J.C.; DELEON, C. & SUAREZ, A. - Etiology of pneumonia in children (Letter). Clin. infect. Dis., 14: 617, 1992.

[13] 13. LANG, T.; LAFAIX, C.; FASSIN, D. et al. - Acute respiratory infections: a longitudinal study of 151 children in Burkina-Faso. Int. J. Epidem., 15: 553-560, 1986.

[14] ¹⁴
MINISTERIO DE SALUD PUBLICA - Encuesta general de salud 1982. Informe General, 1983.

[15] ¹⁵
MINISTERIO DE SALUD PUBLICA - Departamento de estadística. Informe Anual, 1988.

[16] 16. MONTO, A.S. - Acute respiratory infections in children of developing countries: challenge of the 1990s. Rev. infect. Dis., 11: 498-505, 1989.

[17] 17. MORELLI, A. & QUESADA, G. - Salud infantil en Uruguay. Documento Especial, MSP-Unicef, Dic. 1989.

[18] 18. MURPHY, T.F.; HENDERSON, F.W.; CLYDE, W.A.; COLLIER, A.M. & DENNY, F.W. - Pneumonia: an eleven-year study in a pediatric practice. Amer. J. Epidem., 113: 12-21, 1981.

[19] 19. NASCIMENTO, J.P.; SIQUEIRA, M.M.; SUTMOLLER, F. et al. - Longitudinal study of acute respiratory diseases in Rio de Janeiro: occurrence of respiratory viruses during four consecutive years. Rev. Inst. Med. trop. S. Paulo., 33: 287-296, 1991.

[20] 20. ROTHMAN, K.J. - Modern epidemiology. Boston, Little Brown, 1986.

[21] 21. SANTOSHAM, M.; YOLKEN, R.H.; QUIROZ, E. et al. - Detection of rotavirus in respiratory secretions of children with pneumonia. J. Pediat., 103: 583-585, 1983.

[22] 22. STANFIELD, S.K. - Acute respiratory infections in the developing world: strategies for prevention, treatment and control. Pediat. infect. Dis., 6: 622-628, 1987.

[23] 23. SHANN, F.; HART, K. & THOMAS, D. - Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull. Wld. Hlth. Org., 62: 749-753, 1984.

[24] 24. SUTMOLLER, F.; NASCIMENTO, J.P.; CHAVES, J.R.S.; FERREIRA, V. & PEREIRA, M.S. - Viral etiology of acute respiratory diseases in Rio de Janeiro: first two years of a longitudinal study. Bull. Wld. Hlth. Org., 61: 845-852, 1983.

[25] 25. WOOLCOCK, A.J. & PEAT, J.K. - The relationship between acute respiratory infections and chronic respiratory disease. In: DOUGLAS, R.M. & KERBY-EATON, E., ed. - Acute respiratory infections in childhood. Procedings of International Workshop. Sydney, 1984. Adelaide, University of Adelaide, 1985. p. 21-29.

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