February 2022 - CHILD AND CHEST HEALTH CARE

Bronchiolitis/Azithromycin/Recurrent Wheeze,Dr.Dev.M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 26 Feb, 2022 - Medical Guide,Professionals Guide, - 0 Comment

Acute bronchiolitis is very common condition in infants
It is viral disease ,most commonly caused by Respiratory Syncytial virs(RSV)
In most of the cases, it is mild and does not require hospitalisation
Only symptomatic treatment is needed in most of the cases
It has been observed that most of the physicians prescribe antibiotics for this condition which does work and not needed
Azithromycin is very frequently prescribed in this condition and it is believed that it will prevent future episodes of wheezing in infants and children
Azithromycin is known to reduce the airway inflammation.
To know that,the oral use of Azithromycin in severe RSV infection reduces recurrent wheeze in infants,Researchers studied on 200 children between the age of 1 months to 18 months hospitalised with severe RSV infection with no comorbid conditions.It was a single centre double blind placebo controlled trial.Recurrent wheeze was defined as third episode of wheeze in next 2-4 years and it was the primary outcome of study.Secondary outcomes were annualised use of inhalational salbutamol,annualised episodes of respiratory symptoms,subsequent use of antibiotics and subsequent use of oral corticosteroids
Children were divided into 2 cohorts.One cohort received oral Azithromycin 10 mg/kg for 7 days then 5 mg/kg for next 7 days.Second cohort received placebo.
It was observed that the risk of recurrent wheeze was not different in Azithromycin and placebo groups(Adjusted Hazard Ratio [aHR] 1.45; 95% CI, 0.92-2.29; P =.11). There was no difference in secondary outcomes between two cohorts.
It was seen that the level of interleukin 8 in nasal wash ,which is a marker of neutrophilic inflammation was low in Azithromycin treated group.
It was concluded that the use of Azithromycin does not reduce the risk of recurrent wheeze in children with severe RSV infection although it reduces inflammation.
The study is a part of conference coverage of American Academy of Allergy,Asthma and Immunology, Feb 2022
REFERENCES:
Beigelman A, Srinivasan M, Goss C, et al. Azithromycin to prevent recurrent wheeze following severe RSV bronchiolitis: the APW-RSV II clinical trial. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ. Abstract 456.

MMR Immunisation protects child from COVID-19,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 19 Feb, 2022 - Child Health Guides,Common Childhood Disease,Parents’ Guide,Professionals Guide, - 0 Comment

It has been observed that ,children usually suffer from mild to moderate disease due to SARS CoV 2 infection causing COVID 19,in comparision to adults
Mortality due to COVID 19 in children is less in comparision to adults
Children suffering from COVID 19 require less hospitalisation in comparision to adults
The reason for less severity of this disease in children is not clear
In an observational study done in Delhi,India,researchers included 210 children who were immunised for common childhood diseases and were suffering from SARS CoV2 infection as confirmed by Rapid antigen test and RT-PCR test ,considering the incidence of COVID 19 as 2% in children.Data were collected from Distric Immunisation Officer central district New Delhi regarding immunisation and from CDMO Central district New Delhi regarding various stages of severity of disease in children.Children who received 3 doses of Pentavac containing DPT,HiB,HepB,1 dose of BCG,3 doses of Rotavirus ,3 doses of oral polio,2 doses of fractional injectable polio and 1 dose of MR till the age of 1 year were considered compltely immunised.
It has been observed that ,children who received MR/MMR before 1 year of age had less severity of COVID-19 in comparision to children who did not receive MR/MMR.The similar result was not found in mice study.The reason for less severity of COVID 19 in children immunised for MMR is the component of vaccine virus cross react with SARS CoV2 virus.So antibody against Measles and or Rubella produced after immunisation is also protective against COVID-19.BCG vaccinated children also showed less severity of COVID19 in comparision to non BCG Vaccinated children
Other explanation of less severity of COVID 19 in children is that the children have low immunity so do not react strongly to SARS CoV2 virus
It has been concluded that MMR Vaccination provide neutralising antibody against COVID19 causing SARS CoV2
REFERENCES;
1. Salman S, Salem ML. Routine childhood immunization may
protect against COVID-19. Med Hypoth. 2020;140:
109689.
2. Sidiq KR, Sabir DK, Ali SM, et al. Does early childhood
vaccination protect against COVID-19? Front Mol Biosci.
2020;7:1-6.
3. Gomber S, Arora S, Das S, et al. Immune response to second
dose of MMR vaccine in Indian children. Indian J Med Res.
2011;134:302-6.
Indian Pediatrics,Feb 2022

Influenza Vaccine even mismatched to Flu virus can protect children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Mohan Nagar Ghaziabad,NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 12 Feb, 2022 - Child Health Guides,Professionals Guide, - 0 Comment

Influenza vaccine is given to children for protection against Flu
It is given every year according to the guideline by WHO
Every year WHO declears the matched virus vaccine separately for Northern and Southern Hemisphere
In 2019-2020 children suffered from influenza mismatched to vaccine virus
Researchers studied children admitted with the disease from 17 hospitals
All children less than 18 years, underwent RT-PCR test on their respiratory specimen for the diagnosis of Influenza/Flu.
Positive test results were case cohort ,(159 children with median age 6 years),while negative test results were control cohort,(132 children with median age 4 years).
Critical cases were defined by deaths,need of vasopressors,hemodynamic instability, and need of mechanical ventilation
In case cohort ,51% were found to be A/H1N1pdm09 and 25% B Victoria virus.Among A/H1NI pdm09 sequenced 56 children ,52% were vaccine mismatched and 41% were vaccine matched.Among B- lineage, most were vaccine mismatched
It has been found on analysis that the vaccine was effective in 63% cases for any virus,64% against A/H1N1pdm09 and 68% against B- lineage
Vaccine was effective in 75% life threatening cases and 57% non life threatening cases.
vaccine is effective in 78% matched A/HIN1pdmo9 virus and 47 % mismatched virus.It was found to be effective in 78% against mismatched B-lineage virus

It has been concluded that the vaccination reduced the life threatening influenza by 75%

Vaccine efffectiveness were assessed by odds of vaccination in case cohort v/s control cohort
THE MOST IMPOTANT MESSAGE IS ,ALL CHILDREN SHOULD BE INOCULATED WITH INFLUENZA VACCINE YEARLY ACCORDING TO THE AVAILABILITY OF THE VACCINE

REFERENCES:
Olson SM, Newhams MM, Halasa NB, et al. Vaccine effectiveness against life-threatening influenza illness in US children. Clin Infect Dis. Published online January 13, 2022. doi:10.1093/cid/ciab931

Nitric Oxide ,an Air pollutant, can cause Asthma in children,Dr Dev,M.D.,Pediatrician and Pediatric Pulmonologist Mohan Nagar,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 03 Feb, 2022 - Professionals Guide, - 0 Comment

Asthma is the most common chronic disease in children

It is caused by airway inflammation

NO2 ,which is emitted by fossil fuel burning(OIL AND GAS Burning) is responsible for causing airway inflammation

NO2 is mostly emitted by vehicles,agriculture machinary and power plants

Its level is rising particularly in South East Asia

Researchers from George Washington University US have studied in more than 13000 cities about the ground concentration of NO2 and incidence of Asthma between 2000 and 2019 and found that nearly 2 million new cases of asthma in children can be attributed to NO2 in 2019.

Nearly 262 million people are suffering from Asthma according to Global Burden of disease study

NO2 can be a causative factor for asthma and may be exacebating factor as well

This study highlights the importance of controlling air pollution

REFERENCES:LANCET PLANETARY HEALTH ,JANUARY ,2022