Nose-Picking Can Spread Pneumonia

MedicalResearch.com Interview with:
"still picking her nose" by quinn norton is licensed under CC BY 2.0Dr Victoria Connor 

Clinical Research Fellow
Liverpool School of Tropical Medicine and Royal Liverpool Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pneumococcus is a bacteria which is very common and causes lots of different infections (pneumococcal disease). Infections can be non-invasive or invasive. Non-invasive diseases include middle ear infections, sinusitis and bronchitis. Invasive infections including chest infection (pneumonia), infections of brain and spinal cord (meningitis) and blood infections (sepsis).

Invasive pneumococcal infections is a major cause of death around the world and in the UK, is estimated that is responsible for 1.3 million deaths in children under 5 annually. Pneumococcal disease causes more deaths in low and middle income countries where approximately 90% of pneumonia deaths occur.

Pneumococcus also is commonly carried (colonises) the nose/throat of children and adults. This colonisation is important to understand as it is the main source of the bacterial transmission and is also the first step in pneumococcal infections.

The understanding of transmission of pneumococcus is currently poor. It is generally thought that transmission occurs through breathing in the respiratory sections of someone carrying pneumococcus in their nose which are infected with pneumococcus.

However more recently studies especially in mice have shown that there may be a role of hands or other objects as vehicles for the transmission of pneumococcus.

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Short Office Visits Linked To More Antibiotic Prescriptions

MedicalResearch.com Interview with:

Dr. Kathryn A. Martinez PhD MPH CanSORT Cancer Surveillance and Outcomes Research Team Cleveland Clinic

Dr Martinez

Dr. Kathryn A. Martinez PhD MPH
CanSORT Cancer Surveillance and Outcomes Research Team
Cleveland Clinic

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Most upper respiratory infections are viral and therefore should not be treated with antibiotics. Despite this, physicians commonly prescribe them for these conditions. Patients often expect antibiotics for respiratory tract infections.  As a result, physicians may find it easier to give patients what they want rather than explain to them why antibiotics aren’t needed.

We hypothesized it also might be more time consuming for physicians to explain to patients why they don’t need antibiotics, which creates a further incentive to prescribe them. To explore this potential phenomenon, we used data from a large direct to consumer telemedicine system to assess differences in medical encounter length by prescription outcome for patients diagnosed with respiratory tract infections.

We found that encounters resulting in antibiotics were 0.33 minutes shorter than those that resulted in no prescriptions, supporting our hypothesis that prescribing an antibiotic takes less time than prescribing nothing.

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Air Pollution Linked To Increased Respiratory Infections in Kids

MedicalResearch.com Interview with:

Benjamin D. Horne, PhD Director of Cardiovascular and Genetic Epidemiology Intermountain Heart Institute Intermountain Medical Center Salt Lake City, Utah 

Dr. Horne

Benjamin D. Horne, PhD
Director of Cardiovascular and Genetic Epidemiology
Intermountain Heart Institute
Intermountain Medical Center
Salt Lake City, Utah 

MedicalResearch.com: What is the background for this study?

Response: Evidence suggests that short-term elevations (even for just a few days) of fine particulate matter air pollution (PM2.5, which is particulate matter less than 2.5 um or about one-thirtieth the diameter of a human hair) is associated with various poor health outcomes among adults, including myocardial infarction, heart failure exacerbation, and worsening of chronic obstructive pulmonary disease symptoms. Studies of long-term exposure to moderately elevated levels of PM2.5 indicate that chronic daily air pollution exposure may contribute to death due to pneumonia and influenza.

Research regarding the association of short-term elevations in PM2.5 has provided some limited evidence of a possible association between short-term PM2.5 increases and infection with respiratory syncytial virus (RSV) or bronchiolitis in children, but scientifically these reports have been weak and unreliable, probably because they have only looked at a period of a few days to a week after short-term PM2.5 elevations. An evaluation of a very large population in a geographic location that provides a wide variation in PM2.5 levels from lowest to highest levels and that examines longer periods of time after the PM2.5 elevations is needed to determine whether a PM2.5 association with lower respiratory infection exists.

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How Do Viruses Trigger Cough In Asthmatic Children, Even Without Allergies

MedicalResearch.com Interview with:

Giovanni Piedimonte, MD Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education Professor & Chair of Pediatrics Cleveland Clinic Lerner College of Medicine Case Western Reserve University

Dr. Piedimonte

Giovanni Piedimonte, MD
Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education
Professor & Chair of Pediatrics
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study proves that asthmatic children already have a hyperactive calcium channel that’s extremely sensitive to environmental triggers.

If these children contract a virus, such as RSV, the hyperactive channel causes more severe symptoms that may require care in a hospital setting.

When a child developed asthma or bronchitis in the past, doctors thought these conditions could only be triggered by environmental allergens. There was no explanation why two out of three children ages five and under who wheeze and cough – and still test negative for allergies.

We needed to explore the mechanisms of the calcium molecule and the epithelial cells, which seem to trigger these symptoms without an allergic reaction. If the molecule’s behavior is producing the cough, we just need to figure out how to control the molecule to properly deactivate the cough mechanism in the asthmatic child

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High Dose Vitamin D No Advantage In Preventing Pediatric Viral Infections

MedicalResearch.com Interview with:

Jonathon Maguire MD MSc FRCPC Scientist, Li Ka Shing Knowledge Institute

Dr. Maguire

Jonathon Maguire MD MSc FRCPC
Scientist, Li Ka Shing Knowledge Institute
Staff Pediatrician, Department of Pediatrics, St. Michael’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vitamin D has been hypothesized as being protective of seasonal viral upper respiratory tract infections.  In this randomized clinical trial, high dose wintertime vitamin D supplementation (2000 IU/day) was compared with standard-dose vitamin D supplementation (400 IU/day) among 703 children.  The number of laboratory confirmed viral upper respiratory tract infections was not statistically different between groups.

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PaxVax Commences Trial to Modernize Adenovirus Vaccine

MedicalResearch.com Interview with:

Nima Farzan Chief Executive Officer & President of PaxVax

Nima Farzan

Nima Farzan
Chief Executive Officer & President of PaxVax

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: PaxVax is developing a new and improved version of the vaccine, known as the Modernized Production Adenovirus Vaccine (MPAV) Prototype A. The Company was chosen as the Small Business Innovation Research and Regulatory Sponsor for the development of the Modernized Production Adenovirus Vaccine (MPAV) Prototype A due to the company’s prior experience working with multiple strains of Adenovirus. An Investigational New Drug (IND) application for MPACV was submitted to the U.S. Food and Drug Administration (FDA) on January 30, 2017. The Phase I clinical trial has been initiated and will be conducted at the Larner College of Medicine at the University of Vermont and Cincinnati Children’s Hospital. PaxVax expects to see results of the Phase I clinical trial in early 2018.

Complications of adenovirus 4/7 can include headache, pneumonia, sore throat and eye infections. In severe cases, adenovirus can lead to acute respiratory distress syndrome and other serious complications related to organ system damage (including GI tract and bladder) that can result in death, if left untreated.

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Study Compares Zinc Lozenges Used to Treat the Common Cold

MedicalResearch.com Interview with:

Dr-Harri-Hemilae.jpg

Dr. Harri Hemilae

Harri Hemilä, MD, PhD
Department of Public Health
University of Helsinki

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Some zinc lozenges intended for treating the common cold have contained zinc acetate and some others have contained zinc gluconate. There have been proposals that zinc acetate might be more optimal salt for lozenges than zinc gluconate.
Therefore I compared the randomized trials that have used zinc acetate with zinc gluconate to see if there is difference between the lozenges. Although the average effect in 3 studies with zinc acetate lozenges was greater (40%) than the average effect in 4 studies with zinc gluconate lozenges (28%), that difference was explained by random variation.

I also analyzed the dose dependency of the effect and found that 2 studies that used 192 and 207 mg per day elemental zinc did not find greater benefit than 5 studies that used 80 to 92 mg per day zinc. The overall average effect of zinc lozenges was 33% reduction in common cold duration and that effect seems to be reached with doses less than 100 mg per day.

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Ear Infections Decreasing in Babies Due to Breastfeeding and Vaccines

MedicalResearch.com Interview with:

Tasnee Chonmaitree, M.D. Professor, Pediatrics and Pathology Division of Pediatric Infectious Diseases Department of Pediatrics University of Texas Medical Branch Galveston, TX 77555-0371

Dr. Tasnee Chonmaitree

Tasnee Chonmaitree, M.D.
Professor, Pediatrics and Pathology
Division of Pediatric Infectious Diseases
Department of Pediatrics
University of Texas Medical Branch
Galveston, TX 77555-0371

MedicalResearch.com: What is the background for this study?

Dr. Chonmaitree: Respiratory infections are common in infants and young children; they are caused by viruses and/or bacteria. Viral upper respiratory tract infection or the common cold is exceedingly common and leads to bacterial complications such as ear infection, which the leading cause of antibiotic prescription in the US and the most common reason children undergo surgery (ear tube placement). In the past few decades, some bacterial and viral vaccines have become available aiming to reduce respiratory infections in children.

MedicalResearch.com: What are the main findings?

Dr. Chonmaitree: Our study looked to update information on how often infants in the first year of life acquired the common cold, and ear infection in the new vaccine era. The study was performed between 2009 and 2014 and included 367 infants followed closely from near birth up to one year of age. We found that on average, an infant had about 3 colds in the first year of life, and almost half of infants had ear infection by age 1 year. This was less than what happened in the past few decades. The reduction of ear infection may have been the result of many factors from bacterial and viral vaccine use, to increased breastfeeding rate and reduction in household smoking. Risk factors for ear infection included carriage of bacteria in the nose, frequencies of common cold and lack of breastfeeding.

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Insufficient Evidence N95 Respirators Protect Health Care Workers From Respiratory Infections Better Than Face Masks

MedicalResearch.com Interview with:
Dr. Gary Garber MD
Chief of infection prevention and control
Public Health Ontario
Professor of medicine
University of Ottawa 

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Garber: There are conflicting recommendations regarding the use of respirators vs face masks to protect healthcare workers against acute respiratory infections. Our systematic review and meta-analysis show that although N95 respirators have improved efficiency in reducing filter penetration under laboratory conditions, there is insufficient data to show a protective advantage compared to surgical mask in clinical settings.

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Oxygen Saturation Poor Predictor of Return Visits For Infant Respiratory Infections

MedicalResearch.com Interview with:

Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto

Dr. Suzanne Schuh

Suzanne Schuh, MD, FRCP(C), ABPEM
The Hospital for Sick Children affiliated with the
University of Toronto

Medical Research: What is the background for this study?

Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home.

The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home.

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Early Antibiotics May Benefit Children With History Of Severe Respiratory Illness

Leonard B. Bacharier, MD Professor of pediatrics Clinical Director, Division of Allergy, Immunology and Pulmonary Medicine St Louis School of Medicine Washington University St Louis, Missouri

Dr. Bacharier

MedicalResearch.com Interview with:
Leonard B. Bacharier, MD

Professor of pediatrics
Clinical Director, Division of Allergy, Immunology and Pulmonary Medicine
St Louis School of Medicine
Washington University
St Louis, Missouri 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bacharier: Oral corticosteroids such as prednisone have become the standard of care for children whose colds tend to progress and lead to severe wheezing and difficulty breathing.

“But there are some studies that suggest these treatments don’t consistently work for young children. That’s why we want to find ways to prevent upper respiratory infections from progressing to lower respiratory tract illnesses. Once the episode gets going, standard interventions are less effective than would be desired”​​​​​​​​​​​​​​​​, reported Dr. Bacharier.

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Pediatrics Outcomes of EV-D68 Infections Not As Bad As Feared

Dominik Mertz, MD, MSc, FMH (CH) Assistant Professor, McMaster University Department of Medicine, Division of Infectious Diseases Associate Membership Department of Clinical Epidemiology and Biostatistics / Pathology and Molecular Medicine Medical Director Infection Prevention & Control, Hamilton Health Sciences Juravinski Hospital and Cancer Center Hamilton, ON, Canada

Dr. Mertz

MedicalResearch.com Interview with:
Dominik Mertz, MD, MSc, FMH (CH)
Assistant Professor, McMaster University
Department of Medicine, Division of Infectious Diseases
Associate Membership Department of Clinical Epidemiology and Biostatistics / Pathology and Molecular Medicine
Medical Director Infection Prevention & Control, Hamilton Health Sciences
Juravinski Hospital and Cancer Center
Hamilton, ON, Canada 

Medical Research: What is the background for this study? What are the main findings?

Dr. Mertz: There was a perception that there was an increase in ICU admissions and deaths, initially in Kansas City and Chicago, which was found to be related to the enterovirus strain EV-D68, which had previously not resulted in any major outbreaks in North America.

We have one of the first laboratories that was able to provide a specific EV-D68 PCR routine testing allowing us identify EV-D68 cases and to compare the outcomes in patients infected with this strain to children infected by other rhino/enteroviruses.

We found a substantial overlap in how the patients presented between patients with EV-D68 and non-EV-D68 infection. It seems that children infected with EV-D68 were in deed at higher risk for having respiratory distress and needing hospital admission, with children with allergies being at a higher risk. We did not find an increase in more severe outcomes, though, i.e. no higher risk for ICU admission (23 vs 15%) and 0 deaths in the EV-D68 group. We also did not find any evidence of in-hospital transmission of EV-D68.

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Five Risk Factors for 30-day Mortality in Patients With Pneumonia

Yuichiro Shindo, M.D., Ph.D. Visiting Researcher Department of Anesthesiology Washington University School of Medicine St. Louis, MO Assistant Professor Institute for Advanced Research, Nagoya University, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine Showa-ku, Nagoya Japan

Dr. Yuichiro Shindo

MedicalResearch.com Interview with:
Yuichiro Shindo, M.D., Ph.D.
Assistant Professor
Institute for Advanced Research, Nagoya University,
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine
Showa-ku, Nagoya Japan

Medical Research: What is the background for this study? What are the main findings?

Dr. Shindo: Appropriate initial antibiotic treatment is essential for the treatment of pneumonia.  However, many patients may develop adverse outcomes, even if they receive appropriate initial antibiotics.  To our knowledge, there have been no studies that clearly demonstrated the risk factors in patients who receive appropriate antibiotic treatment.  If these factors are clarified, we can identify those patients with pneumonia for whom adjunctive therapy other than antibiotic treatment can prove beneficial in terms of improved outcomes.  This study aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotic treatment and elucidate potential candidates for adjunctive therapy.

In this study, the 30-day mortality in 579 pneumonia patients who received appropriate initial antibiotics was 10.5%.  The independent risk factors included albumin < 3.0 mg/dL, nonambulatory status, pH < 7.35, respiration rate ≥ 30/min, and blood urea nitrogen ≥ 20 mg/dL.  The 30-day mortality for the number of risk factors was 0.8% (0), 1.2% (1), 16.8% (2), 22.5% (3), and 43.8% (4–5).

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Men At Higher Risk of Severe Pneumonia

Annabelle de St. Maurice MD, MPH Pediatric Infectious Disease Fellow Vanderbilt Children's HospitaMedicalResearch.com Interview with:
Annabelle de St. Maurice MD, MPH
Pediatric Infectious Disease Fellow
Vanderbilt Children’s Hospital

 Medical Research: What is the background for this study? What are the main findings?

Dr. de St. Maurice: Susceptibility to certain infectious diseases appears to vary by gender. For example, males may be at increased risk of certain infections in childhood, including lower respiratory tract infections such as RSV, however females may have more severe infections, such as influenza, during pregnancy. Some early studies have suggested that males may be at increased risk of pneumococcal infections but this has not been confirmed. Furthermore, whether those potential gender differences remain after introduction of pneumococcal conjugate vaccines is unknown.

Invasive pneumococcal disease, which includes meningitis, bacteremic pneumonia and bacteremia/septicemia, is a significant cause of morbidity and mortality in the United States in children and adults. The 7-valent pneumococcal conjugate vaccine (PCV7) and the 13-valent pneumococcal conjugate vaccine (PCV13) led to declines in invasive pneumococcal disease rates as well as eliminated racial disparities in regards to invasive pneumococcal disease rates. Our study sought to identify potential gender differences in the incidence of invasive pneumococcal disease, and to determine the impact of vaccines on gender differences in the susceptibility to these diseases.

We conducted a large study that used data from a population-based surveillance system of invasive pneumococcal diseases in Tennessee. This is part of a large CDC funded network of surveillance sites for these diseases. For our study, we identified patients with laboratory-confirmed invasive pneumococcal disease, and calculated the incidence of invasive pneumococcal diseases from 1998-2013 by gender. We also stratified the calculations by age groups and race, both well-known factors that affect the occurrence of invasive pneumococcal disease.

Our study found that males had generally higher rates of invasive pneumococcal disease than females across age groups, regardless of race. Although introduction of the pneumococcal conjugate vaccines led to a significant decrease in invasive pneumococcal disease rates, males continued to have higher rates than females in several age groups.

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Steroids May Improve Outcomes For Community-Acquired Pneumonia

Reed A.C. Siemieniuk, MD Department of Clinical Epidemiology & Biostatistics Ontario CanadaMedicalResearch.com Interview with:
Reed A.C. Siemieniuk, MD
Department of Clinical Epidemiology & Biostatistics
Ontario Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of  benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration.

Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence).

For an interactive summary of findings table that shows the study’s findings, please see: http://isof2.epistemonikos.org/#/finding/550bc6acf30d0c43083e63a0.

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Community-Acquired Pneumonia Requiring Hospitalization Remains Significant Burden Especially For Elderly

MedicalResearch.com Interview with:
Seema Jain, MD Medical Epidemiologist Epidemiology and Prevention Branch, Influenza Division Centers for Disease Control and Prevention Atlanta, GA 30329Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329

Medical Research: What is the background for this study? What are the main findings?

Dr. Jain: Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. The last population-based study of community-acquired pneumonia was conducted in the 1990s before the pneumococcal conjugate vaccine and improved diagnostics (molecular detection and urine antigen tests) were available.  Thus, this was an opportune time to examine this question again.  The CDC Etiology of Pneumonia in the Community (EPIC) study attempts to fill in gaps in knowledge about pneumonia in adults, including older adults, by providing estimates of the incidence of community-acquired pneumonia hospitalizations in U.S. adults, as well as its viral and bacterial causes.

The main findings were that the burden of community-acquired pneumonia requiring hospitalization in adults was substantial, with the greatest burden found in adults 80 years of age and older. Human rhinovirus (HRV), influenza and Streptococcus pneumoniae were the most commonly detected pathogens.  However, no pathogen was detected in the majority of adults hospitalized with community-acquired pneumonia.

Medical Research: What should clinicians and patients take away from your report?

Dr. Jain:

  • Increasing coverage of recommended influenza and pneumococcal vaccines and developing effective vaccines and treatments for human metapneumovirus (HMPV), respiratory syncytial virus (RSV) and parainfluenza viruses (PIV) could reduce the pneumonia burden among adults.
  • It’s crucial for adults, especially older adults and adults with certain medical conditions, to receive recommended influenza and pneumococcal vaccines to prevent pneumonia.
  • A yearly flu vaccine is recommended for everyone age 6 months and older.
  • Pneumococcal vaccines are recommended for all adults age 65 and older and for adults younger than 65 years who have certain medical conditions or who smoke cigarettes.
  • In the majority (62%) of patients, no pathogen was detected, highlighting the need for development of new, more sensitive rapid diagnostic tests and methods to accurately identify pneumonia pathogens and target appropriate treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Jain: We need future research to help the development of better diagnostic tests for determining microbiological causes of pneumonia, including tests that can distinguish between bacteria, viruses, and other pathogens.  In addition, for the respiratory pathogens we do know contribute to pneumonia but for which we do not have any prevention methods, such as HMPV and RSV, we need to develop prevention methods that could reduce the burden of disease, this includes vaccines.  We also need to determine factors associated with use of vaccines that we have at hand- both for influenza and pneumococcus- to increase uptake in the adult population.

Citation:

Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults

Seema Jain, M.D., Wesley H. Self, M.D., M.P.H., Richard G. Wunderink, M.D., Sherene Fakhran, M.D., M.P.H., Robert Balk, M.D., Anna M. Bramley, M.P.H., Carrie Reed, Ph.D., Carlos G. Grijalva, M.D., M.P.H., Evan J. Anderson, M.D., D. Mark Courtney, M.D., James D. Chappell, M.D., Ph.D., Chao Qi, Ph.D., Eric M. Hart, M.D., Frank Carroll, M.D., Christopher Trabue, M.D., Helen K. Donnelly, R.N., B.S.N., Derek J. Williams, M.D., M.P.H., Yuwei Zhu, M.D., Sandra R. Arnold, M.D., Krow Ampofo, M.D., Grant W. Waterer, M.B., B.S., Ph.D., Min Levine, Ph.D., Stephen Lindstrom, Ph.D., Jonas M. Winchell, Ph.D., Jacqueline M. Katz, Ph.D., Dean Erdman, Dr.P.H., Eileen Schneider, M.D., M.P.H., Lauri A. Hicks, D.O., Jonathan A. McCullers, M.D., Andrew T. Pavia, M.D., Kathryn M. Edwards, M.D., and Lyn Finelli, Dr.P.H. for the CDC EPIC Study Team

July 14, 2015DOI: 10.1056/NEJMoa1500245

Seema Jain, MD (2015). Community-Acquired Pneumonia Requiring Hospitalization Remains Significant Burden Especially For Elderly 

Respiratory Viral Infections Leading to Pediatric Pneumonia

Seema Jain, MD Medical Epidemiologist Epidemiology and Prevention Branch, Influenza Division Centers for Disease Control and Prevention Atlanta, GA 30329MedicalResearch.com Interview with:
Seema Jain, MD

Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009.  The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children.  Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection.

During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died.  Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%).  One or more viruses were detected in 1,472 (66%) of these children.  Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%).  The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period.  The highest incidence was among children younger than 2 years old (62.2/10,000).  Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia.  Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia.  Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%).  The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests. Continue reading

Childhood Outbreak of Acute Flaccid Paralysis Linked To Respiratory Virus

Samuel Dominguez MD Departments of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, COMedicalResearch.com Interview with:
Samuel Dominguez MD

Departments of Pediatric Infectious Diseases
Children’s Hospital Colorado and University of Colorado School of Medicine Aurora, CO

Medical Research: What is the background for this study? What are the main findings?

Dr. Dominguez: Due to global poliovirus eradication efforts, clusters of acute flaccid paralysis (AFP) and/or cranial nerve dysfunction in children are rare and associated with few pathogens, primarily enteroviruses and flaviviruses.  Our study reports the first geographically and temporally defined cluster of acute flaccid paralysis and cranial nerve dysfunction in children associated with an outbreak of EV-D68 respiratory illness, strengthening the potential link between EV-D68 and neurologic disease in children.

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Structure of EV-D68 Common Respiratory Virus Delineated

Michael G. Rossmann PhD Hanley Professor of Biological Sciences Hockmeyer Hall of Structural Biology Purdue University, West Lafayette INMedicalResearch.com Interview with:
Michael G. Rossmann PhD

Hanley Professor of Biological Sciences
Hockmeyer Hall of Structural Biology
Purdue University, West Lafayette IN

Medical Research: What is the background for this study? What are the main findings?

Dr. Rossmann: My laboratory has long been interested in the structure of viruses and especially of Picornaviruses (e.g. EV-D68). We published the first 3D, near atomic resolution map of any animal virus in 1985. That was of Human Rhino (common cold) virus serotype 14. We then went on to show where and how the virus would bind to cellular receptors and also how certain small capsid binding compounds inhibited the viral infectivity. The latter was a collaboration first with the Sterling Winthrop company and later with ViroPharma. Thus our work on EV-D68 is a direct continuation of my interest in picornaviruses.

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PCV13 Vaccine Markedly Protects Elderly Against Community Acquired Pneumonia

Dr. Susanne Huijts – Pulmonary resident UMC Utrecht | Research physician UMCU Julius Center for Health Sciences and Primary Care NetherlandsMedicalResearch.com Interview with: 
Dr. Susanne Huijts
Research Physician at UMCU Julius Center for Health Sciences Pulmonary resident, UMC Utrecht Center
Utrecht, Netherlands

 

Medical Research: What are the main findings of the study?

Dr. Huijts: The CAPiTA trial evaluated the efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13) in adults of 65 years and older. In the per protocol analysis vaccine efficacy of 45.6% was demonstrated for the first episode vaccine type (VT) pneumococcal community acquired pneumonia (CAP); 45.0% for the first episode of non-bacteremic/ non-invasive (NB/NI) VT-CAP, and 75.0% for the first episode of VT-invasive pneumococcal disease.

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Closing in On Effective Treatment for RSV Virus Infections

John DeVincenzo, M.D. Professor of Pediatrics Division of Infectious Diseases Professor of Microbiology, Immunology and Biochemistry University of Tennessee School of Medicine. University of Tennessee. Medical Director, Molecular Diagnostics and Virology Laboratories Le Bonheur Children's Hospital Memphis, TennesseeMedicalResearch.com Interview with:
John DeVincenzo, M.D.
Professor of Pediatrics
Division of Infectious Diseases
Professor of Microbiology, Immunology and Biochemistry
University of Tennessee School of Medicine.
Le Bonheur Children’s Hospital Memphis, Tennessee

Medical Research: What are the main findings of the study?

Dr. DeVincenzo: The main findings are

  • a) This is the first time that anyone has shown that the infection caused by the RSV virus can be effectively reduced in a human after the infection has already started.
  •  b) We also show for the first time that once we reduce the amount of virus in the patient, that very quickly, they start to feel better. This clinical improvement was not expected to occur so rapidly.
  • c) The antiviral appeared safe and it was easy to give.

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Hospitalized Pneumonia Patients May Benefit from Azithromycin

Dr. Eric M. Mortensen, M.D., M.Sc. VA North Texas Health Care System and University of Texas Southwestern Medical Center, DallasMedicalResearch.com Interview with:
Dr. Eric M. Mortensen, M.D., M.Sc.
VA North Texas Health Care System and
University of Texas Southwestern Medical Center, Dallas

 

MedicalResearch: What are the main findings of the study?

Dr. Mortensen: The main findings of our study was that for older patients hospitalized with pneumonia that with the use of azithromycin although there is a small increase in the number of non-fatal heart attacks there was a much lower decrease in mortality.   In addition there were no other significant increases in cardiac events.  So the overall risk:benefit ratio was that for each non-fatal heart attack there were 7 deaths that were prevented.
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Pneumonia Risk Increased From Sleep Apnea

Dr. Vincent Yi-Fong Su Department of Chest Medicine Taipei Veterans General Hospital Taipei, TaiwanMedicalResearch.com Interview with:
Dr. Vincent Yi-Fong Su
Department of Chest Medicine
Taipei Veterans General Hospital
Taipei, Taiwan


MedicalResearch.com: What are the main findings of the study?

Answer: We found interestingly that patients with sleep apnea experienced a 1.20-fold (95% CI, 1.10-1.31; p <0.001) increase in incident pneumonia compared to patients without sleep apnea. We also demonstrated an “exposure-response relationship,” in that the patients with more severe sleep apnea might have a higher risk for pneumonia than did those of milder severity.
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Most Febrile Childhood Illnesses Are Viral, Do Not Need Antibiotics

Valérie D'Acremont, MD, PhD Group leader Swiss Tropical and Public Health Institute | Basel | Switzerland Médecin-adjointe, PD-MER Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | SwitzerlandMedicalResearch.com Interview with:
Valérie D’Acremont, MD, PhD
Group leader
Swiss Tropical and Public Health Institute | Basel | Switzerland
Médecin-adjointe, PD-MER
Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | Switzerland

MedicalResearch.com: What are the main findings of the study?

Dr. D’Acremont: We discovered that, in a rural and an urban area of Tanzania, half of the children with fever (temperature >38°C) had an acute respiratory infection, mainly of the upper tract (5% only had radiological pneumonia). These infections were mostly of viral origin, in particular influenza. The other children had systemic viral infections such as HHV6, parvovirus B19, EBV or CMV. Overall viral diseases represented 71% of the cases. Only a minority (22%) had a bacterial infection such as typhoid fever, urinary tract infection or sepsis due to bacteremia. Malaria was found in only 10% of the children, even in the rural setting.
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Obstructive Sleep Apnea: Outcomes in Hospitalized Pneumonia Patients

Dr. Peter Lindenauer MD MS Director, Center for Quality of Care Research Baystate Medical Center, Springfield, MA, USMedicalResearch.com Interview Invitation with:
Dr. Peter Lindenauer MD MS
Director, Center for Quality of Care Research
Baystate Medical Center, Springfield, MA, US

MedicalResearch.com: What are the main findings of the study?

Answer: Among a cohort of 250,000 patients hospitalized for pneumonia at 347 US hospitals, those with a diagnosis of obstructive sleep apnea were twice as likely to be intubated at the time of hospital admission than patients without sleep apnea.  In addition, patients with sleep apnea had approximately 50% higher risk of needing to be transferred to the ICU after initial admission to a regular bed, and a 70% increased risk of requiring intubation later in the hospital stay.  Patients with sleep apnea stayed longer in the hospital and incurred higher costs than those without sleep apnea.

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