Klin Padiatr 2005; 217(5): 259-267
DOI: 10.1055/s-2004-820352
Original Article

© Georg Thieme Verlag Stuttgart · New York

The Descriptive Epidemiology of Severe Lower Respiratory Tract Infections in Children in Kiel, Germany

Die deskriptive Epidemiologie von tiefen Atemwegsinfektionen bei Kindern im Raum KielJ. A. I. Weigl1 , 2 , W. Puppe1 , O. Belke1 , J. Neusüß1 , F. Bagci1 , H. J. Schmitt2
  • 1Pediatric Infectious Diseases, Department of General Pediatrics, University of Kiel, Germany
  • 2Department of Pediatrics, University of Mainz, Germany
Further Information

Publication History

Publication Date:
18 May 2005 (online)

Abstract

Background: Lower respiratory tract infections (LRI) inflict a high burden of disease in children worldwide. Longitudinal, descriptive epidemiological data on different forms of LRI are urgently needed to differentiate this burden, compare population-based incidence rates between countries and to recognize trends.
Patients and Methods: From July 1996 to June 2000, all children hospitalized with LRI, i. e. laryngo-tracheo-bronchitis (LTB), bronchitis, wheezing bronchitis-bronchiolitis (WBB), bronchopneumonia and pneumonia, in the municipal area of Kiel, Schleswig-Holstein, Germany, were analyzed by cross-sectional studies. Naso-pharyngeal aspirates (NPA) were analyzed by an in-house 9-valent multiplex-RT-PCR. Results: In the 4-year observational period, 1 072 children aged 0 to 16 years (median 23 months) were hospitalized with LRI: 12 % (median 28 months) with LTB, 11 % (median 17 months) with bronchitis, 28 % (median 13 months) with WBB, 26 % (median 26 months) with bronchopneumonia and 22 % (median 47 months) with pneumonia. The prevalence of chronic underlying conditions (20 %) and low gestational age (13 %) varied in the different forms of LRI. The cumulative incidence rate of LRI rose steadily over the 4 years. The highest fraction was contributed by WBB, while pneumonia declined. The highest incidence rate ratio was attributable to respiratory syncytial virus (RSV, 0.46) and to children under 2 years of age. Conclusions: LRI, especially obstructive forms of LRI, are increasing in Germany as described earlier for the USA, UK and Sweden. The major burden is carried by children under 2 years. RSV is the single pathogen with the highest impact.

Zusammenfassung

Hintergrund: Tiefe Atemwegsinfektionen (LRI) verursachen eine hohe Morbidität bei Kindern weltweit. Longitudinale, deskriptiv-epidemiologische Daten zu verschiedenen Formen von LRI werden dringend gebraucht, um diese Morbidität besser aufschlüsseln, die populationsbezogenen Inzidenzraten zwischen Ländern vergleichen und Trends erkennen zu können. Patienten und Methoden: Von Juli 1996 bis Juni 2000 wurden alle Kinder mit einer LRI, d. h. einer Laryngotracheobronchitis (LTB), Bronchitis, obstruktiven Bronchitis-Bronchiolitis (WBB), Bronchopneumonie und Pneumonie, im Raum Kiel, Schleswig-Holstein, mittels Querschnittsstudien erfasst. Nasopharyngeale Aspirate (NPA) wurden mittels einer eigenen 9-valenten multiplex-RT-PCR untersucht. Ergebnisse: In dem Beobachtungszeitraum von 4 Jahren wurden 1 072 Kinder im Alter von 0 bis 16 Jahre (Median 23 Monate) wegen LRI hospitalisiert: 12 % mit LTB (Median 28 Monate), 11 % mit Bronchitis (Median 17 Monate), 28 % mit WBB (Median 13 Monate), 26 % mit Bronchopneumonie (Median 26 Monate) und 22 % mit Pneumonie (47 Monate). Die Prävalenz von Patienten mit Grundkrankheiten (20 %) und Frühgeburtlichkeit (13 %) variierte zwischen den verschiedenen Formen der LRI. Die kumulative Inzidenz pro Jahr stieg in den vier Jahren kontinuierlich an. Den höchsten Anteil dabei hatten WBB während Pneumonien abnahmen. Die höchste Inzidenzratio mit 0,46 (46 %) konnte dem RS-Virus und Kindern unter zwei Jahren zugeordnet werden. Schlussfolgerungen: LRI, insbesondere LRI, die mit einer Obstruktion der Atemwege einhergehen, nehmen in Deutschland zu wie bereits schon früher in den USA, Großbritannien und Schweden beschrieben. Die Hauptlast tragen Kinder unter zwei Jahren. RS-Viren haben den höchsten Anteil.

References

  • 1 Ärztekammer Schleswig-Holstein .Perinatalerhebung 1997, Bad Segeberg. Bad Segeberg 1997; 13
  • 2 Balfour-Lynn I M. Why do viruses make infants wheeze?.  Arch Dis Child. 1996;  74 251-259
  • 3 Boyce T G, Mellen B G, Mitchel E F, Wright P F, Griffin M R. Rates of hospitalization for respiratory syncytial virus infection among children in Medicaid.  J Pediatr. 2000;  137 865-870
  • 4 Channock R M, Parrott R H. Acute respiratory disease in infancy and childhood: present understanding and prospects for prevention.  Pediatrics. 1965;  36 21-39
  • 5 Davis H D, Wang E EL, Manson D, Babyn P, Shuckett B. Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children.  Pediatr Infect Dis J. 1996;  15 600-604
  • 6 Dawson B, Trapp R G. Basic & clinical biostatistics. 3rd ed. Lange Medical Books, McCraw-Hill, New York 2001; 192
  • 7 Forster J. Bronchitis, obstruktive Bronchitis und Bronchiolitis. In: Rieger C, von der Hardt H, Sennhauser FH, Wahn U, Zach M (eds). Pädiatrische Pneumologie. Springer, Berlin, Heidelberg, New York 1999; 718-724
  • 8 Geyer S, Peter R, Siegrist J. Socioeconomic differences in children's and adolescents' hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories.  J Epidemiol Community Health. 2002;  56 109-114
  • 9 Glezen W P. Emerging infections: pandemic influenza.  Epidemiol Rev. 1996;  18 64-76
  • 10 Glezen W P, Paredes A, Allison J E, Taber L H, Frank A L. Risk of respiratory syncytial virus infection for infants from low-income families in relationship to age, sex ethnic group, and maternal antibody level.  J Pediatr. 1981;  98 708-715
  • 11 Glezen W P, Denny F W. Epidemiology of acute lower respiratory disease in children.  N Engl J Med. 1973;  288 498-505
  • 12 Graham N MH. Respiratory infections. In: Pless IB (ed). The epidemiology of childhood disorders. Oxford University Press, Oxford, New York 1994; 173-210
  • 13 Gröndahl B, Puppe W, Hoppe A, Kühne I, Weigl J AI, Schmitt H-J. Rapid identification of nine microorganisms causing acute respiratory tract infections by single-tube multiplex reverse transcription-PCR: Feasibility study.  J Clin Microbiol. 1999;  37 1-7
  • 14 Hemming V G. Viral respiratory diseases in children: Classification, etiology, epidemiology and risk factors.  J Pediatr. 1994;  124 S13-S16
  • 15 Hjern A, Haglund B, Bremberg S. Lower respiratory tract infections in an ethnic and social context.  Paediatr Perinat Epidemiol. 2000;  14 53-60
  • 16 Holberg C J, Wright A L, Martinez F D, Ray C G, Tausig L M, Lebowitz M D. Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life.  Am J Epidemiol. 1991;  133 1135-1151
  • 17 Isaacs D. Is bronchiolitis an obsolete term?.  Current Opin Pediatr. 1998;  10 1-3
  • 18 Isaacs D. Problems in determining the etiology of community-acquired childhood pneumonia.  Pediatr Infect Dis J. 1989;  8 143-148
  • 19 Leinonen M. Serological diagnosis of pneumococcal pneumonia-will it ever become a clinical reality.  Sem Respir Infect. 1994;  9 189-191
  • 20 Leowski J. Mortality from acute respiratory infections in children under 5 years of age. Global estimates.  World Health Stat Q. 1986;  39 138-144
  • 21 McConnocie K M, Roghmann K J, Liptak G S. Hospitalization for lower respiratory tract illness in infants: Variation in rates among counties in New York State and areas within Monroe County.  J Pediatr. 1995;  126 220-229
  • 22 McConnochie K M. Bronchiolitis. What's in the name?.  Am J Dis Child. 1983;  137 11-13
  • 23 Meert K, Heidemann S, Abella B, Sarnaik A. Does prematurity alter the course of respiratory syncytial virus infection?.  Crit Care Med. 1990;  18 1357-1359
  • 24 Michaud C M, Murray C JL, Bloom B R. Burden of disease - Implications for Future Research.  J Am Med Assoc. 2001;  285 534-539
  • 25 Ministerium für Arbeit, Gesundheit und Soziales des Landes Schleswig-Holstein .Zur Gesundheitslage der Kinder in Schleswig-Holstein-Daten, Einschätzungen, Fragen. b + c computergraphik, Kiel 1997; 3-4
  • 26 Müller-Pebody B, Edmunds W J, Zambon M C, Gay N J, Crowcroft N S. Contribution of RSV to bronchiolitis and pneumonia-associated hospitalizations in English children, April 1995-March 1998.  Epidemiol Infect. 2002;  129 99-106
  • 27 Munto A S, Lehmann D. Acute respiratory infections (ARI) in children: prospects for prevention.  Vaccine. 1998;  16 1582-1588
  • 28 Nolte E, Koupilova I, McKee M. The increase in very-low-birthweight infants in Germany: Artefact or reality?.  Paediatr Perinatal Epidemiol. 2002;  16 131-140
  • 29 Nohynek H, Eskola J, Laine E, Halonen P, Ruutu P, Saikku P, Kleemola M, Leinonen M. The causes of hospital-treated acute lower respiratory tract infection in children.  Am J Dis Child. 1991;  145 618-622
  • 30 Puppe W, Weigl J AI, Aron G, Gröndahl B, Schmitt H J, Niesters H GM, Groen J. Evaluation of a multiplex reverse transciptase PCR ELISA for the detection of nine respiratory tract pathogens.  J Clin Virology. 2004;  30 165-174
  • 31 Shay D K, Holman R C, Newman R D, Liu L L, Stout J W, Anderson L J. Bronchiolitis-associated hospitalizations among US children, 1980-1996.  J Am Med Assoc. 1999;  282 1440-1446
  • 32 Simoes E AF, Carbonell-Estrany X. Impact of severe disease caused by respiratory syncytial virus in children in developed countries.  Pediatr Infect Dis J. 2003;  22 S13-S20
  • 33 Statistisches Bundesamt .Datenreport 2002, Zahlen und Fakten über die Bundesrepublik Deutschland. Bundeszentrale für politische Bildung, Bonn 2002; 45-48
  • 34 Statistisches Bundesamt .Statistical yearbook 2002 for the Federal Republic of Germany. Metzler-Poeschel, Stuttgart, Wiesbaden 2002; 58 and 78
  • 35 Staten Serum Institut .EUVAC.NET and measles in the EU. In: EPI-NEWS 2003; 10
  • 36 Stensballe L G, Devansundaram J K, Simoes E AF. Respiratory syncytial virus epidemics: the ups and downs of a seasonal virus.  Pediatr Infect Dis J. 2003;  22 S21-S32
  • 37 Sullender W M. Respiratory syncytial virus genetic and antigenic diversity.  Clin Microbiol Rev. 2000;  13 1-15
  • 38 Wang E EL, Law B, Stephens D. Pediatric investigators collaborative network on infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.  J Pediatr. 1995;  126 212-219
  • 39 Weigl J AI, Bader H M, Everding A, Schmitt H J. Population-based burden of pneumonia until school entry in Germany.  Eur J Pediatr. 2003;  162 309-316
  • 40 Weigl J AI, Puppe W, Rockahr S, Schmitt H J. Burden of disease in hospitalized RSV-positive children in Germany.  Klin Pädiatr. 2002;  214 334-342
  • 41 Weigl J AI, Puppe W, Schmitt H J. The incidence of influenza-associated hospitalizations in children in Germany.  Epidemiol Infect. 2002;  129 525-534
  • 42 Weigl J AI, Puppe W, Schmitt H J. Seasonality of respiratory syncytial virus-positive hospitalizations in children in Kiel, Germany, over a 7 year period.  Infection. 2002;  30 186-192
  • 43 Weigl J AI, Puppe W, Schmitt H-J. Incidence of respiratory syncytial virus-positive hospitalizations in Germany.  Eur J Clin Microbiol Infect Dis. 2001;  20 452-459
  • 44 Weisman L E. Population at risk for developing respiratory syncytial virus and risk factors for respiratory syncytial virus severity: infants with predisposing conditions.  Pediatr Infect Dis J. 2003;  22 S33-S39
  • 45 Wickman W, Farahmand B Y, Persson P G, Pershagen G. Hospitalization for lower respiratory disease during 20 yrs among under 5-yr-old children in Stockholm County: a population based survey.  Eur Respir J. 1998;  11 366-370

Dr. Josef Weigl

Pediatric Infectious Diseases · Department of General Pediatrics · Christian-Albrechts-University

Schwanenweg 20

24105 Kiel

Germany

Phone: +49/4 31/5 97/16 78

Fax: +49/4 31/5 97/16 80

Email: weigl@pediatrics.uni-kiel.de