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Back to school time! Respiratory infections are back too…

As days are getting shorter, colder, children are about to spend more time in crowded nurseries or classrooms… and are at higher risks of respiratory tract infections.

Why?

  • Spending more time indoors, in crowded areas (school, nursery…) is associated with increase respiratory tract infections
  • Chronic bronchitis and asthma in susceptible children are more frequent in fall (1)
  • Under temperate climates, epidemics of the main virus responsible for lower respiratory infections (RSV) starts around end of October (2)
  • In children, invasive pneumococcal disease peaks in September, and maintains a high incidence throughout the fall (3)
  • School-aged children (5-19 years old) show higher frequency of infectious disease as a cause for hospital visit when compared to infants and younger children (4)

 

Respiratory tract infections in children

A US study shows that, altogether, respiratory tract infections represent the most frequent cause of children visits to hospital emergency departments (ED) linked to infectious diseases (in total, 1.91 million visits were examined) (4).

Condition Proportion among children infectious desease-related ED visit
Upper respiratory  tract infections 41%
Otitis media 18%
Lower respiratory  tract infections 14%

Legend: Frequency of respiratory tract infections among infectious diseases-related emergency department visits for children in the US in the year 2011 (among  a total of 1.91 million visits) (Adapted from Hasegawa et al., 2015).

  • URTI: upper respiratory tract infections (URTI) are the most frequent in children. URTI refers to acute infections involving the nose, paranasal sinuses, pharynx, larynx and trachea, but also the ear and eardrum (otitis), which have a direct link with the sinuses. URTIs range in seriousness from the common cold to life-threatening illnesses such as epiglottitis. If most of these pathologies are of viral origin, they are frequently overlapped and complicated by a bacterial surinfection that often requires antibiotherapy: acute respiratory infections are responsible for the largest number of antibiotic prescriptions.
  • LRTI: Infections of the lower respiratory tract (LRTI) in children include pneumonia, bronchitis, and tuberculosis. Young children and seniors are the most susceptible to LRTI. Early exposure to infectious agents due to socialization and a slow down shift of TH1 – TH2 lymphocytes are the main causes of LRTI in early childhood. Pneumonia and acute bronchitis are the most common LRTI in children. Whereas viral pathogens dominate as the most common causes of LRTI in infants and children, Streptococcus pneumoniae remains the most common bacterial cause.

At time of higher risk, prevention is key, in particular as the reasoned use of antimicrobial has become a key public health objective worldwide.

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references

  1. Osborne ML, Vollmer WM, Buist AS.Chest. 1996 Dec;110(6):1458-62.
  2. Haynes AK, Mila MPH, Prill M. et al. CDCP Morbidity and Mortality Weekly Report – 2014 Dec; 63(48);1133-1136
  3. Dowell SF., Whitney CG, Wright C. et al. Emerging Infectious Diseases. 2003 May; 9(5): 573- 579
  4. Hasegawa K, Tsugawa Y, Cohen A, Camargo CA Jr. Infectious Disease-related Emergency Department Visits Among Children in the US. Pediatr Infect Dis J. 2015 Jul; 34(7):681-