Incidence of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic.

Background: Incidence data of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRTI) are sparse in low- and middle-income countries (LMICs). We estimated RSV-LRTI incidence rates (IRs) in infants in LMICs using World Health Organization case definitions. Methods: This prospective cohort study, conducted in 10 LMICs from May 2019 to October 2021 (largely overlapping with the coronavirus disease 2019 [COVID-19] pandemic), followed infants born to women with low-risk pregnancies for 1 year from birth using active and passive surveillance to detect potential LRTIs, and quantitative reverse-transcription polymerase chain reaction on nasal swabs to detect RSV. Results: Among 2094 infants, 32 (1.5%) experienced an RSV-LRTI (8 during their first 6 months of life, 24 thereafter). Seventeen (0.8%) infants had severe RSV-LRTI and 168 (8.0%) had all-cause LRTI. IRs (95% confidence intervals [CIs]) of first RSV-LRTI episode were 1.0 (.3-2.3), 0.8 (.3-1.5), and 1.6 (1.1-2.2) per 100 person-years for infants aged 0-2, 0-5, and 0-11 months, respectively. IRs (95% CIs) of the first all-cause LRTI episode were 10.7 (8.1-14.0), 11.7 (9.6-14.0), and 8.7 (7.5-10.2) per 100 person-years, respectively. IRs varied by country (RSV-LRTI: 0.0-8.3, all-cause LRTI: 0.0-49.6 per 100 person-years for 0- to 11-month-olds). Conclusions: RSV-LRTI IRs in infants in this study were relatively low, likely due to reduced viral circulation caused by COVID-19-related nonpharmaceutical interventions. Clinical Trials Registration: NCT03614676.

Neumonía bacteriana: escala diagnóstica / Diagnostic scale for bacterial pneumonia

La neumonía es causa importante de morbimortalidad en la infancia. La diferenciación entre las bacterianas y las que no lo son puede generar dificultades para el clínico. La escala de Laura Moreno combina aspectos clínicos, radiológicos y de laboratorio con una sensibilidad del 100% y especificidad del 93.9%, en el diagnóstico de neumonía bacteriana. Objetivo: describir la concordancia observada en el diagnóstico de neumonía bacteriana, al aplicar una escala de predicción aplicada por el pediatra y el radiólogo comparada con el diagnostico clínico, en los pacientes del servicio de pediatría del Hospital de San José. Metodología: se estudiaron niños con edades que variaron entre un mes y cinco años, hospitalizados con diagnóstico de neumonía en el periodo del 1º de septiembre al 30 de noviembre de 2007. Se analizaron 73 pacientes que cumplieron los criterios de inclusión. Resultados: según el diagnóstico clínico 52 pacientes tenían NB, 18 neumonía viral y tres no fueron clasificados al ingreso. La frecuencia según sexo fue 31(42%) para las niñas; el síntoma más frecuente fue la tos 72 (98%); el hallazgo radiológico común fue el infiltrado bien definido 27(37%). El grado de concordancia entre radiólogo y pediatra fue bueno (k=0,77) y el observado entre la escala y el diagnóstico clínico fue bajo (k=0,19). Conclusiones: los datos encontrados al aplicar la escala de Laura Moreno crean el interrogante de si estamos sobrediagnosticando neumonías bacterianas, lo cual debe ser un estímulo para nuevos estudios en nuestra población.

Pneumonia is a major cause of morbidity and mortality in children. Clinicians often experience diffi-culty to distinguish between bacterial pneumonia (BP) and pneumonia caused by other agents. The Laura Moreno Scale combines clinical, radiological and laboratory aspects and shows a sensibility of 100% and specificity of 93.9% for the diagnosis of bacterial pneumonia. Objective: To describe the consistency rates for the diagnosis of bacterial pneumonia when the pediatrician and radiologist apply a predictor scale or use clinical criteria in patients admitted to the Pediatrics Service at the San José Hospital. Methodology: Children between the age of one month and five years admitted to the hospitalbetween September 1 and November 30, 2007 were included in the study. Seventy-three (73) patients who fulfilled the inclusion criteria were analyzed. Results: According to clinical diagnosis, 52 patients had BP, 18 had viral pneumonia and 3 were not classified upon admission. Gender-related frequency was 31(42%) for girls; cough 72 (78%), was the most frequent symptom and the most common shared radiological finding was a well defined infíltrate in 27 (37%) subjects. The consistency rate between the radiologist and pediatrician was good (k=0.77) and was low between the scale and clinical diagnosis (k=0.19) Conclusions: Data obtained through the use of the Laura Moreno Scale raises the question: Are we over diagnosing bacterial pneumonias? This must encourage additional studies to be conducted in our population.