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Viral Agents of Childhood Respiratory Tract Infection in the United States

As of October, 2019 Gideon www.GideonOnline.com and the Gideon e-book series contain details of 69,204 epidemiological surveys – of which 1,107 (1.6%) are related to the prevalence of specific viral species in patients with respiratory tract infection.  [1-3]

The following chronology of published studies summarizes the relative proportion of viral agents associated with non-influenza childhood respiratory infection in the United States.  Additional details and primary references are available on request.

1976 – 2001 Tennessee
hMPV accounted for 20% of acute respiratory illness among children ages 0 to 5 years having no other identifiable etiology. 78% of infections in this group occurred during the months December to April.

1977 – 2001 Tennessee
Coronaviruses were found in 5.0% of nasal wash specimens from children below age 5 years with URI or LRI – 9% of these 229 E, 59% OC43 and 33% NL63

1982 – 2001 Tennessee – Nashville
hMPV accounted for 5% of upper respiratory tract infections among children, when other viruses are not identified

2000 – 2001 New York
hMPV was found in 3.9% of children ages 0 to 5 years, hospitalized for respiratory
illness

2001 – 2002 Ohio
HcoV-HKU1 was found in 1% of children below age 5 years with suspected viral infection in whom other viruses were not found

2001 – 2003 Multiple locations
Coronaviruses were found in 2.2% of children below age 2 years hospitalized for acute respiratory symptoms or fever

2001 – 2003 Multiple locations
hMPV was found in 3.8% of children below age <5 years old hospitalized with acute respiratory infection (rate 120 per 100,000 per year)

2001 – 2002 Connecticut
hMPV accounted for 6.4% of lower respiratory tract infections in children below the age of 5 years

2003 – 2004 Multiple locations
Rhinoviruses were found in 8.1% of children below age 5 years hospitalized with acute respiratory infection vs. 2.2% of a control group

2003 – 2009 Multiple locations
hMPV accounted for 6% of acute respiratory illness or fever among inpatient and outpatient children less than 5 years of age in three counties

2003 Washington – Seattle
hMPV was found in 11% of children with bronchiolitis, Coronavirus 8%, RSV 77%, Adenovirus 15%, Parainfluenza virus 6%

2003 – 2004 Missouri – St. Louis
WU polyomavirus (WUPyV) was found in 2.7% of children with respiratory infection

2004 Connecticut
Rhinoviruses were found in 26.3% of children below age 2 years with wheezing and 3% of asymptomatic children

2004 Connecticut
HBoV was present in 5.2% of respiratory specimens submitted from children below age 2 years, and negative for other detectable viruses

2004 – 2005 Colorado
Coronaviruses were found in 5% samples from children with respiratory infections which were negative for common viral etiologies

2004 New York
HBoV was found in 5.5% of tonsil samples from children undergoing elective tonsillectomy/adenoidectomy

2005 – 2006 Multiple locations
hMPV was found in 9% of children below age 2 years with acute bronchiolitis, and Rhinoviruses in 16%

2005 – 2007 Alaska
Rhinoviruses were found in 44% of Alaskan children below age 3 years hospitalized with respiratory infection, Adenovirus 30%, RSV 23%, Parainfluenza virus 18%, hMPV 15% and Coronavirus 6%

2005* Connecticut – New Haven
New Haven Coronavirus infection was identified in 8.8% of children below age 5 with respiratory disease

2006* California
Human Bocavirus (HBoV) was present in 5.6% of children with lower respiratory tract infection

2007 – 2011 na
Non-influenza respiratory viruses accounted for 41% of unexplained respiratory disease outbreaks investigated by CDC

2007 – 2010 Multiple locations
RSV was found in 51% of hospitalized children age <2 years with bronchiolitis, and Rhinovirus in 21%

2007 – 2008 Washington
HBoV was found in 2% of children ages 2 to 11 years with respiratory illness, and 3% of asymptomatic controls

2008* na
WU polyomavirus was found in 7.1% of symptomatic children and 6.3% of asymptomatic children

2008* na
KI polyomavirus (KIPyV) in 2.2% of symptomatic children and 0% of asymptomatic children

2008* California – San Diego
HBoV was found in 5.6% and hMPV in 5.2% of children presenting to an Emergency Department

2009 Missouri
Human parechovirus (HPeV) was found in respiratory specimens from 3% of children

2009 – 2013 Colorado
Viruses were identified in the nasopharynx of 41.9% of children hospitalized for Kawasaki disease

2010* Washington
HBoV was found in 59% of children attending daycare

2010 – 2011 Tennessee – Memphis
Rhinoviruses were found in 62% to 65% of children with cancer and respiratory tract infection

2011* na
Rhinovirus was the most commonly-detected virus (23.1% of viruses) in children ages 6 to 18 with cystic fibrosis

2012* na
Viruses were identified during 52% of febrile episodes among neutropenic children without bacterial infection

2012* Multiple locations
RSV and / or Human Rhinovirus was found in 84.5% of children below age 2 years hospitalized with severe bronchiolitis

2012* Multiple locations
hMPV was found in 9.0% of high-risk children with severe lower respiratory tract infection, and RSV in 45%

2012 – 2013 Georgia
RSV infection was identified in 6.4% of children admitted to Intensive Care, and respiratory Picornaviruses in 22.6%

2013* Tennessee
Rhinovirus was identified in 62% of children with sickle cell disease and acute respiratory illness

2015* Washington, DC
hMPV was found in 11% of children ages <=5 years with viral respiratory infection

2015* Multiple locations
Viruses were identified in 66% of children hospitalized for community-acquired pneumonia

2017* na
Human bocavirus DNA was identified in 10.4% of children with community-acquired pneumonia

*     Year of publication

na   Location of study not available

 

References:

  1. Berger SA. Gideon Guide to Surveys. 2019. 4,441 pages, 10,603 tables, 59,327 references. Gideon e-books, https://www.gideononline.com/ebooks/surveys/
  2. Berger SA. Miscellaneous Respiratory Viruses: Global Status, 2019. 94 pages, 1,395 references. Gideon e-books, https://www.gideononline.com/ebooks/disease/miscellaneous-respiratory-viruses-global-status/
  3. Berger SA. Infectious Diseases of the United States, 2019. 1,422 pages, 513 graphs, 18,048 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/

Coccidioidomycosis in the United States

Although largely limited to the western and southwestern states, Coccidioidomycosis is more commonly reported than legionellosis. More Americans die from Coccidioidomycosis than from the other two regional mycoses, Blastomycosis and Histoplasmosis. [1,2]

 

While Coccidioidomycosis is best known as a disease of California (“Valley Fever”) , highest incidence is reported from Arizona.  These data are even more striking when adjusted for relative population size (cases per 100,000 population).

 

References:

  1. Berger S. Infectious Diseases of the United States, 2019. 1,422 pages , 513 graphs , 18,048 references.  Gideon e-books,  https://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
  2. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/

India: Diphtheria, Pertussis and Tetanus

Although global incidences of Diphtheria, Pertussis and Tetanus declined dramatically during the second half of the twentieth century, relatively high rates for these diseases continue to be reported from India.  India accounted for 17.7% of the total World’s population in 2018, but reported 46% of global Tetanus, 53% of global Diphtheria (and only 10.2% of global Pertussis) that year.  Similarly, 68% of the population of Southeast Asia (SEA) live in India, while that country accounted for 85% of Diphtheria, 75% of Pertussis and 90% of tetanus for SEA in 2018. [1-4]   Trends for these data are charted in the following three graphs. [5]

References:

  1. Berger S. Infectious Diseases of India, 2019. 620 pages , 109 graphs , 6,807 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-india/
  2. Berger S. Diphtheria: Global Status, 2019. 389 pages , 451 graphs , 699 references. Gideon e-books, https://www.gideononline.com/ebooks/disease/diphtheria-global-status/
  3. Berger S. Tetanus: Global Status, 2019. 561 pages , 816 graphs , 390 references. Gideon e-books, https://www.gideononline.com/ebooks/disease/tetanus-global-status/
  4. Berger S. Pertussis: Global Status, 2019. 417 pages , 514 graphs , 1,028 references. Gideon e-books, https://www.gideononline.com/ebooks/disease/pertussis-global-status/
  5. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/

Campylobacteriosis in Scandinavia

For more than twenty years, rates of campylobacteriosis in Scandinavia have been 50% above those of Europe as a whole. [1]. During 1995 to 2000, approximately 20-to-60 cases per 100,000 were reported in Denmark, Finland, Norway and Sweden; increasing to 60-to-100 cases per 100,000 during 2010 to 2018. [2]  Similar regional trends have been reported for EHEC (enterohemorrhagic E. coli) infection; while rates of yersiniosis have been decreasing.

Sweden = Laboratory reports     other countries = Cases

References:

1. Berger S. Campylobacteriosis: Global Status, 2019. 157 pages , 102 graphs , 1,584 references. Gideon e-books,  https://www.gideononline.com/ebooks/disease/campylobacteriosis-global-status/
2. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/

Note featured on ProMED

 

 

Venereal Diseases in Europe

As of 2017, the reported incidence of syphilis in the European Union is higher that that of HIV infection.   In the following chart, I’ve contrasted trends of venereal diseases for the region. [1]  Data are derived from GIDEON www.GideonOnline.com and the Gideon e-book series. [2]  Note that gonorrhea is most common, followed by syphilis, HIV / AIDS and lymphogranuloma venereum (LGV).  In fact, if current trends continue, LGV infection may become more common than AIDS in the near future.  As depicted in the second chart,  reported cases of chlamydial infection are higher than the combined total for all other venereal diseases, and continue to be rise at an alarming rate.

References:
1. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/

2. Berger S. Infectious Diseases of the World, 2019. 1,750 pages , 456 graphs , 42,302 references. Gideon e-book series,  https://www.gideononline.com/ebooks/country/infectious-diseases-of-the-world/

Japanese Encephalitis in India

Outbreaks in Japanese encephalitis (JE) / Acute encephalitis syndrome (AES) have been reported from Assam and Uttar Pradesh in recent weeks.  Since 2008, official reports from India do distinguish between these two entities.  The following chart [1] indicates that although India has experienced increasing rates for both JE and AES on a national level,  incidence has not increased in these two states. [2,3]

 

References:
1. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/
2. Berger S. Infectious Diseases of India, 2019. 620 pages , 109 graphs , 6,807 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-india/
3. Berger S. Japanese Encephalitis: Global Status, 2019. 100 pages , 66 graphs , 1,208 references.  Gideon e-books, https://www.gideononline.com/ebooks/disease/japanese-encephalitis-global-status/

Histoplasmosis in Travelers

In 2019, several Canadian tourists acquired histoplasmosis while exploring caves in Cuba.  The Gideon database maintains an ongoing record of all cross-border Infectious Diseases events, including importation of animals and foods associated with zoonotic disease. [1-3]

As of 2019, 76 episodes of histoplasmosis had been associated with travel, involving at least 574 individual cases (8 fatal).  18 of these events were related to cave exposure, including two involving caves in Cuba.  Four publications described acquisition of histoplasmosis by Canadian travelers – two involving cave exposure.

In the following screen-shot, the frame to the left displays an interactive chronicle of cross-border histoplasmosis.  Users can sort data by year of event, country of exposure / origin, etc.  In this example I’ve selected “Setting” in order to study cases related to “cave exposure.”  Additional details and electronically-linked references appear when the user clicks on “Show event notes”

References:

  1. Gideon Online.  www.GideonOnline.com
  2. Berger S. Histoplasmosis: Global Status, 2019. Gideon e-books, https://www.gideononline.com/ebooks/disease/histoplasmosis-global-status/
  3. Berger S. GIDEON Guide to Cross Border Infections, 2019. 256 pages, 134 tables, 4,543 references.  https://www.gideononline.com/ebooks/travel/

Note featured on ProMED

Bolivian Hemorrhagic Fever

In 2019, a small outbreak of Bolivian hemorrhagic fever was reported at a hospital in La Paz, Bolivia.  The following background data on Bolivian hemorrhagic fever are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]  Primary references are available from the author.

Bolivian hemorrhagic fever (BHF) is caused by Machupo virus (Arenaviridae, Tacaribe complex, Mammarenavirus).  The disease was initially described in 1959 as a sporadic hemorrhagic illness in rural areas of Beni department, eastern Bolivia; and the virus itself was first identified in 1963.  BHF is most common during April to July in the upper savanna region of Beni.  Principal exposure occurs through rodents (Calomys callosus) which enter homes in endemic areas.

BHF is one of several human Arenaviruses diseases reported in the Americas: Argentine hemorrhagic fever (Junin virus), Brazilian hemorrhagic fever (Sabia virus), Lymphocytic choriomeningitis, Venezuelan hemorrhagic fever (Guanarito virus) and Whitewater Arroyo virus infection.  (At least two related diseases are reported in Africa: Lassa fever and Lujo virus infection)

Infection of C. callosus results in asymptomatic viral shedding in saliva, urine, and feces; 50% of experimentally infected C. callosus are chronically viremic and shed virus in their bodily excretions or secretions.  C. callosus acquires the virus after birth, and start shedding it through their urine and saliva while suckling.  When mice acquire the virus as adults, they may develop immunity and no longer shed the virus.

Although the infectious dose of Machupo virus in humans is unknown, exposed persons may become infected by inhaling virus in aerosolized secretions or excretions of infected rodents, ingestion of food contaminated with rodent excreta, or by direct contact of excreta with abraded skin or oropharyngeal mucous membranes. Nosocomial and human-to-human spread have been documented.  Hospital contact with a patient has resulted in person-to-person spread of Machupo virus to nursing and pathology laboratory staff.

In 1994, fatal secondary infection of six family members in Magdalena, Bolivia from a single naturally acquired infection further suggested the potential for person-to-person transmission.

During December 2003 to January 2004, a small focus of hemorrhagic fever was reported in the area of Cochabamba. A second Arenavirus, Chapare virus, was recovered from one patient with fatal infection.

Early clinical manifestations consist of nonspecific signs and symptoms including fever, headache, fatigue, myalgia, and arthralgia.  Within seven days patients may develop hemorrhagic signs, including bleeding from the oral and nasal mucosa and from the bronchopulmonary, gastrointestinal, and genitourinary tracts. Case fatality rates range from 5% to 30%.

Ribavirin has been used successfully in several cases of BHF.  The recommended adult regimen is: 2.0 g IV, followed by 1.0 g IV Q6h X 4 days, and then 0.5 g Q8h X 6 days

Note that the etiologic agent and clinical features of BHF are similar to those of Argentine hemorrhagic fever (AHF).  Neurological signs are more common in AHF, while hemorrhagic diatheses are more common in BHF.  A vaccine available for AHF could theoretically be effective against BHF as well.

References:

  1. Berger S. American Hemorrhagic Fevers: Global Status, 2019. Gideon e-books,  https://www.gideononline.com/ebooks/disease/american-hemorrhagic-fevers-global-status/
  2. Berger S. Infectious Diseases of Bolivia, 2019. 342 pages, 87 graphs, 495 references.  https://www.gideononline.com/ebooks/country/infectious-diseases-of-bolivia/

Note featured on ProMED

 

Diphtheria in Thailand

Although two fatal cases of diphtheria were recently reported in Thailand [1], rates of this disease have declined dramatically since the 1970’s.  In fact, Thailand can serve as an icon for the effectiveness of vaccination.  In the following graph, I’ve contrasted rates of diphtheria, pertussis and tetanus with WHO estimates of DPT vaccine uptake.  The second graph depicts the effect of DPT vaccination on diphtheria mortality in this country. [2,3]

References:

  1. http://www.promedmail.org/post/6453182
  2. Berger S. Infectious Diseases of Thailand, 2019. 506 pages , 169 graphs , 2,339 references. Gideon e-books,  https://www.gideononline.com/ebooks/country/infectious-diseases-of-thailand/
  3. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/

Note featured on ProMED

Measles: Correlation of Vaccine Uptake with Disease Rates

The following is a country-by-country analysis of measles reporting trends vs. vaccine uptake.  For purposes of consistency, incidence data and population statistics used to calculate rates per 100,000 will be limited to those published by the World Health Organization (WHO).  Resultant graphs were generated by Gideon and abstracted from the Gideon e-book series [1,2]  True estimates of vaccination update statistics are those published by WHO, in most cases available only since 1980.  Data published by the countries themselves were not used, to avoid possible bias or inconsistency when comparing data among countries. Historical disease data which precede 1980 have also been appended to graphs to further appreciate the impact of vaccination.

The reader will note that in virtually all cases, the presumed impact of vaccine uptake on disease incidence occurs when vaccine uptake exceeds 80%, and again when rates increase beyond 90%.   As such, the few countries which have not achieved 80% uptake, or have consistently reported >90% uptake since 1980 are excluded.  Graphs are not included for countries for which data are not reported, or reported only sporadically.

Individual graphs for 135 countries are presented below in alphabetical order.  In 127 (94%) of these, a clear relationship seems to exist between increasing vaccine uptake and decreasing rates of measles.  In eight cases, temporary “spikes” in disease incidence were reported during years of high vaccine uptake: Japan, Jordan, Republic of Korea, Seychelles, Solomon Islands, South Africa, Sri Lanka and Syria.

I have not attempted to perform a statistical analysis of this phenomenon, and cannot say with certainty that a confounding (third) factor does not exist.  Nevertheless, these graphs appear to indicate a favorable effect of vaccination on measles incidence.

Measles Vaccine Uptake vs. Disease rates (per 100,000)

References:

  1. Gideon e-Gideon multi-graph tool,   https://www.gideononline.com/cases/multi-graphs/
  2. Berger S. Measles: Global Status, 2019. 548 pages , 538 graphs , 5,779 references. Gideon e-books,  https://www.gideononline.com/ebooks/disease/measles-global-status/

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