RESUMEN
OBJECTIVES: To quantify the cost and distribution of health care resources consumed annually in management of Canadian children from birth to 4 years of age with respiratory syncytial virus (RSV) infection. STUDY DESIGN: Estimates of direct medical expenditures (in 1993 U.S. dollars) were collected from a prospective cohort study of hospitalized children with RSV and from national and provincial databases. RESULTS: The annual cost of RSV-associated illness was almost $18 million. The largest component of direct expenditures (62%) was for inpatient care for the estimated 0.7% of all infected children ill enough to require admission. Physician fees comprised only 4% of inpatient expenses. Expenditures for ambulatory patients accounted for 38% of direct costs. CONCLUSIONS: The greatest reductions in the economic cost of RSV infections will be found in interventions that reduce duration of or prevent hospital stay. Costs for management of RSV infection in children in the Canadian health care system are considerably less than charges reported in the United States.
Asunto(s)
Infecciones por Virus Sincitial Respiratorio/economía , Infecciones del Sistema Respiratorio/economía , Absentismo , Adulto , Atención Ambulatoria/economía , Bronquiolitis/economía , Bronquiolitis/terapia , Bronquiolitis/virología , Canadá , Preescolar , Estudios de Cohortes , Control de Costos , Costo de Enfermedad , Costos Directos de Servicios , Estudios de Evaluación como Asunto , Honorarios Médicos , Femenino , Costos de la Atención en Salud , Asignación de Recursos para la Atención de Salud , Gastos en Salud , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Sistemas de Información , Tiempo de Internación/economía , Admisión del Paciente , Estudios Prospectivos , Infecciones por Virus Sincitial Respiratorio/terapia , Infecciones del Sistema Respiratorio/terapia , Sensibilidad y Especificidad , Estados Unidos , Mujeres TrabajadorasRESUMEN
OBJECTIVE: To describe differences in patients hospitalized with respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) at nine Canadian tertiary care hospitals. In addition, this study describes the variation in use of drug and other interventions. METHODS: Data on patients hospitalized with RSV LRI and their outcomes were prospectively collected. Demographic data were obtained on enrollment by center study nurses. Data recorded daily included clinical assessment, oxygen saturation determination, and interventions (bronchodilators, steroids, ribavirin, antibiotics, intensive care, and mechanical ventilation) received during the day. Patients were divided into those with underlying diseases including congenital heart disease, chronic lung disease, immunodeficiency, or multiple congenital anomalies and those who were previously healthy. Mean RSV-associated length of stay and the proportion of patients receiving each intervention in each group were determined by hospital. RESULTS: A total of 1516 patients were enrolled at nine hospitals during January 1 to June 30, 1993, and January 1 to April 30, 1994. Significant differences were observed among hospitals in the proportion of patients with underlying disease, postnatal age less than 6 weeks, hypoxia, and pulmonary infiltrate on chest radiograph. The mean length of stay varied among hospitals from 8.6 to 11.8 days and 4.6 to 6.7 days in compromised and previously healthy patients, respectively. Except for receipt of bronchodilators, compromised patients were significantly more likely to receive interventions than previously healthy patients. There was variation among hospitals in receipt of most interventions in compromised and previously healthy patients. This variation was statistically significant for previously healthy patients but not statistically significant in those with underlying disease, because the numbers of patients in the latter group were much smaller. The magnitude of the variation for each intervention, however, was not different between those with underlying disease compared with previously healthy patients. CONCLUSION: Differences exist among tertiary pediatric hospitals in the nature of the patients admitted with RSV LRI. Variation occurred in the use of five interventions among the hospitals, regardless of whether the patient had underlying illness or was previously healthy. Given their current widespread use, high cost, and potential side effects, randomized clinical trials are needed to determine the efficacy of different drug treatments used to treat infants hospitalized with RSV.
Asunto(s)
Hospitalización , Infecciones por Virus Sincitial Respiratorio/terapia , Infecciones del Sistema Respiratorio/terapia , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Broncodilatadores/uso terapéutico , Canadá , Hospitales Pediátricos , Humanos , Huésped Inmunocomprometido , Lactante , Recién Nacido , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación , Estudios Prospectivos , Respiración Artificial , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Ribavirina/uso terapéuticoRESUMEN
OBJECTIVE: To determine total and functional serogroup C antibody response after vaccination with a quadrivalent meningococcal polysaccharide vaccine. DESIGN: Prospective, before and after intervention study. SUBJECTS: Study subjects were between the ages of 0.5 and 19.9 years, and were eligible for a community-wide public health immunization campaign against Neisseria meningitidis serogroup C. METHODS: Total and functional antibody response was measured by enzyme-linked immunosorbent assay and bactericidal assay, respectively. RESULTS: One month after vaccination, total capsular polysaccharide antibody significantly increased in all age groups; a significant rise in bactericidal antibody, that correlated with total capsular polysaccharide antibody, was seen in children 18 months of age and older. At 1 year bactericidal antibody titers were maintained but capsular polysaccharide antibody declined substantially in children younger than 5 years. CONCLUSION: Total capsular polysaccharide antibody concentration appears to be a useful surrogate measure of bactericidal antibody in children 18 months and older. Children who originally received the vaccine at less than 18 months of age should be considered for revaccination if there is a new or continuing risk of disease. Because of the differences in the total and bactericidal antibodies formed, vaccine efficacy trials are required to define which serologic measures are associated with protection.
Asunto(s)
Vacunas Bacterianas/inmunología , Infecciones Meningocócicas/inmunología , Neisseria meningitidis/inmunología , Polisacáridos Bacterianos/inmunología , Adolescente , Adulto , Formación de Anticuerpos , Vacunas Bacterianas/uso terapéutico , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoterapia Activa , Lactante , Masculino , Infecciones Meningocócicas/prevención & control , Neisseria meningitidis/aislamiento & purificación , Polisacáridos Bacterianos/uso terapéutico , Estudios Prospectivos , VacunaciónRESUMEN
We explored, during an outbreak of meningococcal disease, whether children of parents with workplace exposure to children were at increased risk of oropharyngeal colonization with Neisseria meningitidis. In comparison with children of parents without workplace exposure to children, the risk of colonization was not increased (odds ratio = 1.62; 95% confidence interval, 0.56 to 4.72). Therefore a parent's occupation does not appear to increase the risk of their children's colonization with N. meningitidis.
Asunto(s)
Neisseria meningitidis/aislamiento & purificación , Ocupaciones , Orofaringe/microbiología , Padres , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Exposición Profesional , Factores de RiesgoRESUMEN
We prospectively followed a group of unimmunized, immunosuppressed children with cancer to determine their relative risk of influenza and the severity of infection compared with those of siblings or matched community controls. The incidence of influenza infection was higher in children with cancer (23/73, 32%) than in control subjects (10/70, 14%, p = 0.02). A preseason hemagglutination inhibition titer greater than or equal to 1:32, generally used as a marker of successful immunization in vaccine trials, was protective for all children in the control groups, but did not prevent influenza infection in 24% of the patients with cancer. Infection rates of patients and community controls with titers greater than or equal to 1:32 differed significantly (p = 0.006). No significant differences were noted in duration of reported symptoms between groups, and clinical complications occurred too infrequently to analyze. However, 2 (11%) of 18 of the cancer patients with positive culture results were hospitalized during the illness and one patient developed a nosocomial infection. None of the control children was hospitalized. These findings suggest the need for further study of the immunologic response of immunosuppressed children to influenza infection and a clinical efficacy trial of the influenza vaccine in these patients.
Asunto(s)
Gripe Humana/etiología , Neoplasias/complicaciones , Adolescente , Anticuerpos Antivirales/análisis , Niño , Femenino , Humanos , Terapia de Inmunosupresión/efectos adversos , Virus de la Influenza A/inmunología , Masculino , Neoplasias/terapiaRESUMEN
To determine whether respiratory virus infections (URI) are associated with exacerbation of nephrotic syndrome (NS) in childhood, a prospective two-winter study of 32 children with NS was done. We obtained pre- and post-season viral serologic studies, biweekly nose and throat viral cultures, daily urinalysis, biweekly telephone follow-up for URI and renal complaints, and clinical assessments as indicated. When a URI occurred, viral cultures were done weekly if the child was at home and twice weekly if hospitalized. Sixty-one URIs occurred; the agent was identified in 33 (51.6%) (respiratory syncytial virus 14, influenza virus five, parainfluenza virus five, varicella zoster virus four, adenovirus three, Mycoplasma pneumoniae one, and Chlamydia trachomatis one). Forty-one exacerbations occurred, 71% with URI; 29% had no URI during the preceding 10 days (P less than 0.01). Total relapse occurred in 29 of 41 exacerbations, 69% with URI and 31% without URI (P less than 0.01). Patients with unstable NS had more exacerbations than those with stable NS (15 of 19 (79%) vs four of 13 (31%), P less than 0.001) and more URI (2.32 vs 1.46 per child, P less than 0.05). Exacerbations in patients with minimal change, mesangioproliferative, and focal glomerulosclerosis occurred in 40%, 60%, and 64%, respectively. We conclude that exacerbations and relapses of childhood NS are temporally related to URI. Inasmuch as multiple viral agents were associated with exacerbations, nonspecific host response to infection, not viral antigen or antibody response, may be the link to NS.
Asunto(s)
Síndrome Nefrótico/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Adolescente , Adulto , Varicela/complicaciones , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Gripe Humana/complicaciones , Masculino , Nariz/microbiología , Orthomyxoviridae/aislamiento & purificación , Infecciones por Paramyxoviridae/complicaciones , Faringe/microbiología , Estudios Prospectivos , Recurrencia , Virus Sincitiales Respiratorios/aislamiento & purificación , Respirovirus/aislamiento & purificación , Estaciones del Año , Encuestas y Cuestionarios , Virosis/complicacionesRESUMEN
This study was designed to corroborate previous observations of low serum concentrations of aminoglycosides after usual doses in patients with cystic fibrosis and to investigate possible mechanisms for this change. We studied gentamicin clearance after single and multiple intravenously administered doses in 10 non-acutely ill patients with mild to moderate CF. The data could best be described by a two-compartment model for drug elimination. The mean 1-hour serum concentration, mean volume of distribution, and mean total plasma clearance of gentamicin were not different from those reported for patients without CF. The similarity of the plasma and the renal gentamicin clearances, supported by the observations that greater than 80% of administered drug was excreted in the urine by 4 hours and that negligible amounts were detected in sweat, saliva, or sputum, implies that the kidney is the major route of elimination in patients with mild CF. The correlation of increased plasma gentamicin clearance as NIH score decreases supports the hypothesis that aminoglycoside pharmacokinetics are changed as the severity of disease increases. For patients with mild CF, standard doses of gentamicin (60 mg/m2) will give safe and therapeutic concentrations.