Захворюваність на гострі інфекції верхніх дихальних шляхів множинної або невизначеної локалізації серед дитячого населення України

The incidence of influenza and acute respiratory infections (ARI) continues to grow, including due to limited opportunities for immunoprophylaxis of the most common respiratory infections, in particular, acute respiratory viral infections (ARVI). Attempts are being made to reduce the children susceptibility to respiratory pathogens through the rational use of nonspecific immunoprophylactic agents, among which bacterial lysates (BL) occupy a special place. BL key patterns, contributing to the prevention of viral infections, are innate immune response activation, excessive inflammatory response prevention, adaptive immune response stimulation. BL contain fragments of inactivated various pathogenic bacteria strains that are important in the ARI etiology. Obtaining lysates of bacterial strains is possible by mechanical or chemical lysis. The article discusses the results of preclinical and clinical studies on BL, as well as suggests the expediency of further study concerning the BL pharmacodynamic effects within the modern concept of trained immunity. The authors conclude that BL as a trained immunity inducer according to the rationally selected regimen can contribute to the respiratory infections' prevention both during COVID-19 pandemic and post-pandemic period. KEYWORDS: acute respiratory infections, acute respiratory viral infections, influenza, trained immunity, immunoprophylaxis, bacterial lysate. FOR CITATION: Zaplatnikov A.L., Kanner E.V., Kanner I.D., Girina A.A., Farber I.M., Maximov M.L. Promising immunomodulatory effects of bacterial lysates in the prevention and treatment of acute and recurrent respiratory infections in children. Russian Journal of Woman and Child Health. 2023;6(3):290–297 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-12.

Acute respiratory infection (ARI) is an infection that may interfere with normal breathing. Many children who die in developing countries as a result of ARI do not receive adequate treatment during the early stage of the disease because mothers do not recognize the severity of illness well ahead. Simple measure taken by mothers while the children get acute respiratory infection, can prevent many deaths due to these illnesses. This cross sectional study conducted among 285 mothers to assess the mothers’ perception regarding acute respiratory tract infection in children under five years of age. The interview of respondents was performed by using the semi-structured questionnaire. Majority (47.7%) of the respondents were in age group 26-30 years with mean age 26.51 (S.D of ±3.74) years. Maximum mothers (46.7%) had education class 6 to class 10. Mean monthly family income 29535.1 taka with S.D=21600.946. The study also revealed that around all respondents heard the name of acute respiratory tract infection. Fever were described by 100% of the mothers as the common symptoms of acute respiratory tract infection. Regarding health care seeking pattern, 85.6% of the respondents consulted with doctor. Most (97.1%) of the respondents mentioned cold food/drink as the causes of acute respiratory tract infection. In this study, perception level was found to be associated with education level (P=0.000), total monthly family income (P=0.014). Key Words: Perception, Acute Respiratory Tract Infection, Mothers

Introduction: Respiratory tract infections account for majority of acute illnesses in children. About 13 million children under 5 years of age die every year in the world, 95% of them in developing countries, one third of total deaths are due to ARI. On an average, children below 5 years of age suffer about 5 episodes of ARI per child per year, thus accounting for about 238 million attacks. The study was carried out to assess the level of knowledge regarding acute respiratory infection (ARI) and its prevention among the mothers having underfive children with a view to develop an information booklet in selected hospitals of Guwahati, Assam. Methods: A descriptive survey design was adopted for the study. Non - probability convenience sampling technique was used to collect data from 158 mothers having underfive children attending pediatric OPD of Gauhati Medical College and Hospital, Mahendra Mohan Choudhury Hospital and Maternal and Child Welfare Hospital, Assam. Data were collected by using structured interview schedule. Data analysis was done by descriptive and inferential statistics. Results: It revealed that majority number i.e. 106 (67.1%) out of 158 mothers had moderately adequate knowledge regarding acute respiratory infection (ARI) and its prevention, 30 (19%) had adequate knowledge and 22 (13.9%) had inadequate knowledge. The overall mean was 18.18 with SD ±4.45 which imply that the subjects had moderately adequate knowledge on average. The area wise distribution on level of knowledge showed highest mean knowledge level of 3.97 (66.17%) with SD ± 1.34 in the area of introduction of acute respiratory infection (ARI) and the lowest mean knowledge level of 1.89 (47.25%) with SD ± 1.04 was noted in the area of acute lower respiratory infection (ALRI). The study findings showed significant association between level of knowledge and the age of the mother (?2=35.62, df (6), p - value=<0.001), religion (?2=26.52, df (6), p - value=<0.001), education of the mother (?2=88.65, df (12), p - value=<0.001), occupation of the mother (?2=24.43, df (8), p - value=0.002), monthly income of the family (?2=33.40, df (10), p - value=<0.001), age of the child (?2=19.43, df (8), p - value=0.013) and occurrence of acute respiratory infection in underfive children (?2=18.58, df (6), p - value=0.005) where p<0.05. The information booklet regarding acute respiratory infection (ARI) and its prevention for the mothers having underfive children was developed, validated and distributed after the interview schedule. Conclusion: On the basis of the study findings, it can be concluded that majority of mothers had moderately adequate knowledge regarding acute respiratory infection (ARI) and its prevention. The result of this study may provide important baseline information about awareness on acute respiratory infection (ARI) and its preventions among the mothers having underfive children. There was a need to increase the level of knowledge on acute respiratory infection (ARI) and its prevention. Therefore, health care professionals should develop various effective programs to help them acquire adequate knowledge for the betterment of children as a whole.

Objectives: This study determined the percent positivity of acute respiratory bacterial infections and their association with malnutrition in children under 5. Acute respiratory infections (ARIs) cause 6% of all diseases worldwide, with bacterial pneumonia being the leading cause of child mortality. Malnutrition accounts for 56% of childhood mortality worldwide, when combined with ARIs. Materials and Methods: This study included 185 hospitalized children under 5 diagnosed with ARIs. The nasal swabs were collected for bacterial isolation and analyzed using nutrient and blood agar and by Gram’s staining. The bacterial pathogens were purified on Mannitol salt agar, chocolate agar, and MacConkey agar and identified using specific biochemical tests. Children’s height and weight were compared with standards to assess their nutritional status. The data were statistically analyzed for percent positivity and Chi-square test. Results: The positive samples were collected from Allied Hospital (38.3%), Children Hospital (9.1%), and Faisal Hospital (11.8%). ARIs were categorized as mild pneumonia (35), moderate pneumonia (28), severe pneumonia (19), and no pneumonia/cold and cough (103). Among isolated bacteria, Staphylococcus aureus was the most prevalent bacterial species (23.2%), followed by Klebsiella pneumoniae (21.6%), Pseudomonas aeruginosa (7.57%), and Streptococcus pneumoniae (7.02%). Children with 24% stunted, 19% wasted, 23% underweight, and 34% having normal nutritional status were observed. Chi-square test ( P = 0.007) showed significant results. Conclusion: It was concluded that there is a positive correlation between malnutrition and acute respiratory bacterial infections, as 66% of malnourished children were observed suffering from ARIs.

The aim: to study the etiological structure of acute respiratory infections in children aged 3 to 12 hospitalized in the early stages of the disease in the department of respiratory infections of the children’s hospital, and to reveal the features of their clinical course and the timing of DNA / RNA elimination of respiratory viruses from nasal secretions, depending on the method of therapy. Materials and methods: 100 children with acute respiratory infections aged 3 to 12 years were monitored. The nasal secrets on the DNA / RNA of respiratory viruses were studied by PCR. Depending on the method of therapy, patients were divided into 2 groups: patients of group 1 (comparison) received basic treatment (without the use of antiviral drugs), in patients of the 2nd group (main), along with basal therapy, the drug was used umifenovir in a 5-day course at the ageappropriate dosage. Results: In the etiologic structure of ARVI in children from 3 to 12 years, the leading place was taken by rhinovirus, influenza and metapneumovirus infections (isolated – 18%, 19% and 20% respectively, in the form of a mixed infection – 11%). The main syndromic diagnosis at the height of the disease was rhinopharyngitis. Complications were observed in 42% of cases, as often as possible with flu – 53% of cases. Features of metapneumovirus infection in children of this age group were: predominance of non-severe forms of the disease in the form of acute fever with symptoms of rhinopharyngitis, as well as a small incidence of lower respiratory tract infections. The use of the drug umiphenovir in children with acute respiratory viral infections of various etiologies contributed to significantly faster elimination of viral DNA / RNA from the nasal secretion, which was accompanied by a ecrease in the duration of the main clinical and hematological symptoms of the disease, a decrease in the incidence of complications, and reduced the duration of stay in hospital. Conclusion: application of modern molecular genetic methods of diagnostics made it possible to identify the leading role of influenza, metapneumovirus and rhinovirus infections in the etiology of acute respiratory viral infection in patients aged 3 to 12 years, and to determine a number of clinical features characteristic of this age group. The results of the study testify to the effectiveness of umiphenovir in the treatment of children with acute respiratory viral infections of various etiologies and allow us to recommend this drug as an effective and safe etiotropic agent.

Antimicrobial resistance is one of the most significant causes of morbidity and mortality worldwide, including in the paediatric population. Its primary cause is the excessive and inappropriate use of antibacterial agents. In children, the most common reason for prescribing antibacterial therapy is upper and lower respiratory tract infections, which are most often self-limiting viral illnesses. However, up to 80% of these infections are treated with antibacterial therapy, although antibiotic treatment is generally not beneficial. The factors underlying extensive antibiotic prescribing are complex and multifactorial. The most significant problems are related to difficulties in differentiating viral and bacterial etiology based solely on clinical signs, as well as concerns about missing severe bacterial infections. The situation is worsened by physician workload, restricted consultation times, and parental or patient pressure to obtain antibacterial therapy. To reduce the prescription of antibacterial therapy, it is necessary to improve the diagnosis of acute illnesses and enhance physicians’ knowledge about prudent antibiotic use. The aim of the study was to investigate antibiotic prescribing habits and the use of diagnostic tests in children with acute infections in primary care in Latvia, and to evaluate the effect of multifactorial interventions (general practitioner education training and access to the use of C-reactive protein point-of-care testing (CRP POCT), as well as the long-term impact of the educational intervention on prescribing practices. Until now, there has been limited research on antibacterial prescribing and diagnostic practices in the paediatric population in Latvia, and no intervention studies focusing on education and diagnostic strategies to decrease antibiotic use in primary care for children have been carried out. A randomized controlled intervention study was carried out, during which 80 general practitioners from different regions of Latvia recorded data on paediatric patients with acute illnesses who attended in-person consultations. The study consisted of two phases, during which general practitioners were randomly divided into two groups. In the first phase, one group received a combined intervention—participation in an educational seminar and the introduction of CRP POCT into practice—while the other group continued routine practice without interventions and served as the control group. After three months, the groups were switched: the control group then received an equivalent combined intervention, while the other group continued routine practice without access to CRP POCT. Since the latter group had previously received the educational intervention, the long-term effect of education was assessed. A total of 3317 patients with a median age of 4.0 years were included in the study. The majority of patients (95.6%) presented with acute respiratory tract infections, most frequently acute upper respiratory tract infections. Antibacterial therapy was prescribed to 29.3% of patients, and in approximately one-third of cases broad-spectrum antibacterial agents were chosen. Therapy was often initiated within the first days of illness or for potentially self-limiting infections. The lowest frequency of antibacterial prescribing was observed in the long-term education group. In both intervention groups, there was a tendency to use delayed prescriptions more frequently compared to the control group. However, overall, the effect of combined and educational interventions on the frequency of antibacterial prescribing was not statistically significant. Decisions regarding the prescription of antibacterial therapy were predominantly based on clinical signs rather than objective test results when such tests were unavailable during the consultation. The availability of CRP POCT substantially increased the use of diagnostic testing in children with acute infections. In both intervention groups, the number of patients prescribed antibacterial therapy at low CRP values (&lt;20 mg/L), which are rarely associated with severe bacterial infections, decreased. Although overall rates of antibacterial prescribing were relatively low, further improvements are necessary. The integration of POCT with clinical assessment has the potential to improve the diagnostic process and reduce inappropriate use of antibacterial therapy; however, the availability of CRP POCT alone is insufficient. Further research is required to develop standardized criteria for test interpretation and indications. While general practitioner education is essential in promoting prudent antibiotic use, a single passive educational session is insufficient and may need to be supplemented with interactive seminars, individualized practice improvement recommendations, or patient education to enhance its effectiveness. The Doctoral Thesis was developed at Rīga Stradiņš University, Latvia. Defence of the Doctoral Thesis will take place at the public session of the Promotion Council of Clinical Medicine on 26 February 2026 at 15.00 in the 2nd Auditorium, 16 Dzirciema Street, Rīga Stradiņš University. 3.2. Clinical Medicine; Sub-Sector – Paediatrics. Keywords: Acute infection; antibacterial treatment; children; primary care; physician education; CRO POCT.

Inhaled antibiotics for acute lower respiratory tract infections in primary care: a hypothesis

Book ReviewsThe Management of Acute Respiratory Infections in Children: Practical Guidelines for Outpatient Care Husn FrayhaMD Husn Frayha Head, Section of Infectious Diseases, Department of Pediatrics, MBC 58, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author Published Online:24 Apr 2019https://doi.org/10.5144/0256-4947.1997.264aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionAcute respiratory tract infections are frequent in children, and are associated with high morbidity and mortality, particularly in underdeveloped and developing countries. Children with acute respiratory infections account for a significant proportion of patients seen at primary health facilities. It is estimated that pneumonia is responsible for 25% of deaths in children under five years of age in developing countries.This WHO book is intended for health staff working in outpatient first-level health care facilities. It provides guidelines for initial assessment and management of children with acute respiratory infections, and identification of children whose condition is sufficiently serious to warrant referral to hospital. The aim is to improve the outcome of children with acute respiratory infections, particularly young infants who are at the highest risk of complications and death from pneumonia.The approach to case management is summarized in two fold-out charts. One deals with the “Management of the Child with Cough or Difficult Breathing,” and the other with the “Management of the Child with an Ear Problem or Sore Throat.” These charts are reasonably sized and suitable for posting on an office wall and/or carrying around in a folder. They serve as quick and practical references to the management of children presenting with acute respiratory problems.Each chapter ends with a list of the essential skills and knowledge required by health workers for the management of acute respiratory infections. The book uses simple and clear terminology that makes it easy to read. The instructions are easy to follow. Technical words are defined at the end of the book.The first chapter includes a description of how to select the appropriate case management chart for assessment, classification and treatment of acute respiratory infections. Chapters 2, 3 and 4 focus on the assessment of a child presenting with cough or breathing difficulty. They provide instructions on how to obtain the necessary information about the child's illness by asking the appropriate questions, and looking for physical signs and symptoms that would identify those with severe disease that require referral to a hospital for treatment. These chapters contain many well-designed illustrative diagrams and case examples that reinforce their educational objective. Chapter 5 describes treatment guidelines for children who do not require hospitalization. These include detailed instructions on the dosages and administration of a select number of antibiotics, home care instructions to prevent dehydration and malnutrition, monitoring of fever and use of antipyretics and bronchodilators whenever indicated. While many of the acute lower respiratory tract infections may be due to a viral etiology and thus may not require antibiotics, the lack of viral diagnostic testing and close follow-up, and the possibility of superimposed bacterial infections may justify the empirical use of antibiotics in many of these patients. Such practices, on the other hand, may contribute to the global problem of increasing bacterial resistance.Chapter 6 deals with the assessment, classification and management of a child presenting with an ear problem. The instructions for the management of chronic ear infection are particularly well designed.Chapter 7 describes the management of a child with sore throat. The criteria for use of antibiotics in these health facilities where cultures are not available are pertinent.The annexes complement the material described in the main chapters. Of particular usefulness are the recommendations for use of rapid-acting bronchodilators. The failure to mention erythromycin for treatment of pertussis (Annex 2) is a shortcoming.This book will be useful for its stated purpose, i.e., health workers in primary health care centers in underdeveloped and developing countries with limited health facilities. While the recommendation for widespread use of antibiotics in young children with pneumonia is largely understandable, this practice will undoubtedly contribute to the ever-increasing problem of bacterial resistance. The choice of antibiotics, particularly for treatment of lower respiratory infections, is influenced by cost considerations. The applicability of the antibiotic treatment guidelines to other health care settings is limited. Previous article Next article FiguresReferencesRelatedDetailsCited byKhoja D (2019) The Management of Acute Respiratory Infections: Saudi National Protocol for Diagnosis and Treatment, Annals of Saudi Medicine , 18:1, (86-86), Online publication date: 1-Jan-1998. Volume 17, Issue 2March 1997 Metrics History Published online24 April 2019 InformationCopyright © 1997, Annals of Saudi MedicinePDF download

Objective To isolate and identify human rhinovirus (HRV) from throat swab samples from patients with acute respiratory infection in Anhui Bengbu. Methods The throat swab specimens from 108 patients with acute upper respiratory tract infection diagnosed in the Anhui Bengbu were selected as samples. RNA was extracted and detected by HRV universal primers; H1-Hela cells were infected with the positive samples for virus isolation, and HRV VP1 gene amplification was performed and gene phylogenetic tree analysis of the successfully isolated HRV strains was done. Results Only 5 samples were positive for HRV by the real-time PCR, and only one sample showed significant cytopathic effects after three passages of H1-Hela cells were infected, and the HRV VP1 gene was amplified by RT-PCR in the sample that was named TYZQ201901. The sequence analysis showed that the VP1 nucleotide homology of the strain with other representative HRV A strains was over 95%. The gene phylogenetic tree analysis showed that the strain had the closest genetic distance to the RMH127/2013 strain, and both were on a branch and was confirmed to be HRV type A virus. Conclusions An HRV type A strain virus was isolated from throat swab samples from patients with acute respiratory infection in Anhui Province by the H1-Hela cells, and the HRV virus separation technology system were initially established. Key words: Acute respiratory infection; Throat swab; Rhinovirus

Introduction:While acute respiratory tract infections are the main cause of paediatric mortality and morbidity worldwide, pathogen patterns shift due to factors such as hygiene, vaccinations, and antibiotic resistance. Knowledge about current cause of respiratory infections is lacking, particularly in low- and middle-income countries. The aim of this study was to identity the various respiratory pathogens causing acute respiratory tract infections in children below 5 years of age visiting a sub-urban primary care clinic in Senegal.Methods:A case-control study was performed in September and October 2018. Oropharyngeal swabs were collected from cases; infants with fever and respiratory symptoms, and controls; children involved in the vaccination programme. Viral identification was conducted by polymerase chain reaction for 21 different viruses; bacteria were identified by culture studies. Associations between microorganisms, acute respiratory infection and severity of disease were calculated by multivariate regression adjusting for confounders such as age, sex, and living area.Results:Overall, 102 cases and 96 controls were included. Microorganisms were detected in 90.1% of cases and 53.7% of controls (P < .001). Influenza virus A (including H1N1), influenza virus B, respiratory syncytial virus (RSV), and Streptococcus pneumoniae were independently associated with acute respiratory tract infections. Co-detection of two or more pathogens was present in 49.5% of cases; 31.7% of cases had a pneumonia and 90.2% was treated with antibiotics.Conclusions:This case-control study in a primary care setting in sub-Saharan Africa found influenza virus A and B, RSV, and S pneumoniae to be the main causes of acute respiratory tract infections in children below 5 years of age. We recommend evaluation of antibiotics prescription behaviour in this setting.

Every year, acute respiratory viral infections (ARVI) hold leading positions in terms of morbidity and economic damage both in the world and in the Russian Federation. A medical organization requires the use of not individual preventive measures, but an integrated approach. Objective: to optimize a set of measures aimed at ensuring epidemiological safety during the period of increased incidence of influenza and acute respiratory viral infections. To achieve this goal, a set of measures was adapted for use in medical organizations based on current regulatory documents on the prevention of influenza and acute respiratory viral infections. The work was carried out at the inpatient department of a large multidisciplinary medical center for the period 2020–2024. The developed set of measures included three areas: organizational, preventive and anti-epidemic. Organizational measures were carried out both during the period of no increase in the incidence of influenza and acute respiratory viral infections and during the period of increased incidence. Preventive measures carried out in the hospital are aimed at minimizing the possibility of introducing the infectious agent from outside, eliminating infection directly in the hospital and preventing the removal of the pathogen outside the hospital. The use of the developed set of measures led to a decrease in the number of introductions of ARVI and flu pathogens into the hospital of a medical organization, and the absence of group morbidity.

Five hundred seventeen consecutive nasopharyngeal aspirates were collected between October 1998 and May 1999 for episodes of acute respiratory tract infections in children presenting at the University Hospital of Antwerp. Culture and nucleic acid amplification techniques--nucleic acid sequence-based amplification (NASBA) and reverse transcription-PCR (RT-PCR)--were applied to detect rhinoviruses (RVs). Other respiratory viruses were detected by immunofluorescence (IF) analysis of the specimens and IF analysis of shell vial cultures. Among the 517 specimens, 219 viral agents were identified. They were, in decreasing order, rhinoviruses (93 [18.0%]), respiratory syncytial virus (76 [14.7%]), adenoviruses (16 [3.1%]), influenza viruses (15 [2.9%]), enteroviruses (15 [2.9%]), and herpes simplex virus (4 [0.8%]). For the evaluation of rhinovirus detection, culture positivity and/or a positive reaction in the two independent amplification methods was used as an expanded "gold standard." Based on this standard, the sensitivity, specificity, positive predictive value, and negative predictive value of culture were 44.7, 100, 100, and 99.8%, and those of NASBA and RT-PCR were 85.1, 98.3, 83.3, and 98.5% and 82.9, 93.4, 55.7, and 98.2%, respectively. NASBA and RT-PCR produced comparable results and were significantly more sensitive than virus culture. RVs showed the highest incidence in acute respiratory tract infections in children.

This article presents the resolution and materials of the Expert Council meeting held in Saint Petersburg on May 24, 2023. The meeting was devoted to topical issues of treatment of oropharyngeal infections in children. Leading infectious disease specialists, pediatricians and immunologists from Moscow, Saint Petersburg, Kazan, and other cities of Russia took part in the discussion. According to the resolution, today in the Russian Federation there is a high incidence of acute respiratory infections among children with a high frequency of complications, and fatal outcomes are registered. Numerous cases of active herpesvirus infections are recorded, especially among frequently ill children. The current clinical guidelines for the treatment of acute respiratory viral infections lack algorithms for differentiated therapeutic approaches that reduce disease duration, prevent the development of complications and recurrent episodes of respiratory infections. In clinical practice, there is excessive, often unjustified prescription of antimicrobial therapy, which aggravates intestinal disorders, reducing colonization and immune resistance, and provokes oral infections and inflammations caused by opportunistic pathogens. Based on the presented data, it is necessary to correct clinical recommendations for the treatment of acute respiratory viral infections in children with the introduction of indications for prescribing benzydamine in cases of tonsillitis, pharyngitis (tonsillopharyngitis) and stomatitis as a first-choice medication for sore mouth and throat. It also seems necessary to include data on the efficacy of inosine pranobex in symptoms of acute respiratory viral infections of various etiologies, including COVID-19 and active herpesvirus infections. Key words: benzydamine, herpesvirus infections, inosine pranobex, microbiome, acute respiratory viral infections, ARI, tonsillitis, tonsillopharyngitis, pharyngitis, COVID-19, SARS-CoV-2

SummaryBackgroundRespiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infection in young children. We previously estimated that in 2015, 33·1 million episodes of RSV-associated acute lower respiratory infection occurred in children aged 0–60 months, resulting in a total of 118 200 deaths worldwide. Since then, several community surveillance studies have been done to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated acute lower respiratory infection morbidity and mortality at global, regional, and national levels in children aged 0–60 months for 2019, with focus on overall mortality and narrower infant age groups that are targeted by RSV prophylactics in development.MethodsIn this systematic analysis, we expanded our global RSV disease burden dataset by obtaining new data from an updated search for papers published between Jan 1, 2017, and Dec 31, 2020, from MEDLINE, Embase, Global Health, CINAHL, Web of Science, LILACS, OpenGrey, CNKI, Wanfang, and ChongqingVIP. We also included unpublished data from RSV GEN collaborators. Eligible studies reported data for children aged 0–60 months with RSV as primary infection with acute lower respiratory infection in community settings, or acute lower respiratory infection necessitating hospital admission; reported data for at least 12 consecutive months, except for in-hospital case fatality ratio (CFR) or for where RSV seasonality is well-defined; and reported incidence rate, hospital admission rate, RSV positive proportion in acute lower respiratory infection hospital admission, or in-hospital CFR. Studies were excluded if case definition was not clearly defined or not consistently applied, RSV infection was not laboratory confirmed or based on serology alone, or if the report included fewer than 50 cases of acute lower respiratory infection. We applied a generalised linear mixed-effects model (GLMM) to estimate RSV-associated acute lower respiratory infection incidence, hospital admission, and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. We estimated country-level RSV-associated acute lower respiratory infection incidence through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality. This review was registered in PROSPERO (CRD42021252400).FindingsIn addition to 317 studies included in our previous review, we identified and included 113 new eligible studies and unpublished data from 51 studies, for a total of 481 studies. We estimated that globally in 2019, there were 33·0 million RSV-associated acute lower respiratory infection episodes (uncertainty range [UR] 25·4–44·6 million), 3·6 million RSV-associated acute lower respiratory infection hospital admissions (2·9–4·6 million), 26 300 RSV-associated acute lower respiratory infection in-hospital deaths (15 100–49 100), and 101 400 RSV-attributable overall deaths (84 500–125 200) in children aged 0–60 months. In infants aged 0–6 months, we estimated that there were 6·6 million RSV-associated acute lower respiratory infection episodes (4·6–9·7 million), 1·4 million RSV-associated acute lower respiratory infection hospital admissions (1·0–2·0 million), 13 300 RSV-associated acute lower respiratory infection inhospital deaths (6800–28 100), and 45700 RSV-attributable overall deaths (38 400–55 900). 2·0% of deaths in children aged 0–60 months (UR 1·6–2·4) and 3·6% of deaths in children aged 28 days to 6 months (3·0–4·4) were attributable to RSV. More than 95% of RSV-associated acute lower respiratory infection episodes and more than 97% of RSV-attributable deaths across all age bands were in low-income and middle-income countries (LMICs).InterpretationRSV contributes substantially to morbidity and mortality burden globally in children aged 0–60 months, especially during the first 6 months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease worldwide, with one in every 50 deaths in children aged 0–60 months and one in every 28 deaths in children aged 28 days to 6 months attributable to RSV. For every RSV-associated acute lower respiratory infection in-hospital death, we estimate approximately three more deaths attributable to RSV in the community. RSV passive immunisation programmes targeting protection during the first 6 months of life could have a substantial effect on reducing RSV disease burden, although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented.FundingEU Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe (RESCEU).

ASIA is a continent with many people who still have and use biomass or solid fuel use (SFU) for cooking and various household air pollution. Previous research has mentioned the negative effects of household air pollution on the incidence of acute respiratory infections in children under 5 years. Acute respiratory diseases have even become the cause of at least 4 million deaths of children under 5 years old every year in the world. The meta-analysis aimed to estimate the correlation between household air pollution and the incidence of acute respiratory infections in children under five in ASIA. This study was a meta-analysis. Primary data is taken through the electronic databases such as: PubMed, Science Direct, Web of Science, Springer Link and Cochrane Database. By using the search keywords "Household air pollution AND acute respiratory tract infections AND adjusted odds ratio", "indoor air pollution AND acute respiratory tract infections AND adjusted odds ratio", and "paparan asap rumah tangga DAN ISPA DAN adjusted odds ratio". Articles taken between 2013-2023. Statistical analysis was performed using the RevMan 5.3. 7 articles qualified for quantitatively analysis. The exposure of household air pollution can increases the risk of acute respiratory infections 3 times in children under five and statistically significant (OR 3.36; 95% CI: 2.96 – 3.81; p value &lt; 0.001). Exposureto household air pollution is a significant risk factor for the incidence of acute respiratory infections in children under 5 years.&#x0D;