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BACKGROUND: Allergic diseases are under-investigated and overlooked health conditions in developing countries. We measured the prevalence of food allergy (FA), airborne allergic disease, and allergic sensitisation among adolescents living in 2 socio-demographically disparate regions in Ecuador. We investigated which risk factors are associated with these conditions. METHODS: A cross-sectional study involved 1338 students (mean age: 13 ± 0.9 years old) living in Cuenca (n = 876) and Santa Isabel (n = 462). History of allergic symptoms (noted by parents or doctor) to food, house dust mites (HDM), pollen, and pets were recorded. Sociodemographic characteristics, environmental exposures, and parental history of allergic disorders data were collected. Sensitisation to 19 food and 20 aeroallergens was measured by skin-prick testing (SPT). FA and airborne allergic diseases (to HDM, pollen, cat, or dog) were defined as a report of allergic symptoms noted by doctor, together with a positive SPT (wheal size ≥3 mm). Logistic regression models were used to identify environmental and parental factors associated with allergic conditions. RESULTS: FA was prevalent among 0.4% (95% CI 0.2%-0.9%), and food sensitisation among 19.1% of the adolescents. Shrimp was the most frequent food linked with FA and food sensitisation. Risk factors associated with FA could not be evaluated due to the low prevalence. Food sensitisation was higher among adolescents exposed to family smoking (OR 1.63, 95% CI 1.14-2.34, p = 0.008) and those with parental history of allergic disorders (OR 1.68, 95% CI 1.13-2.49, p = 0.01), but less common among adolescents owning dogs (OR 0.59, 95% CI 0.41-0.84, p = 0.003).Airborne allergic diseases were prevalent amongst 12.0% of the adolescents (95% CI: 10.4-13.9, n = 1321), with HDM as the primary allergen (11.2%). Airborne allergic diseases were less common among adolescents with more siblings (OR 0.79, 95% CI 0.65-0.96, p = 0.02) and those who lived with farm animals in the first year of life (OR 0.47, 95% CI 0.23-0.95, p = 0.04), but, most common among adolescents with a smoking family (OR 1.67, 95% CI 1.04-2.70, p = 0.03) and with a parental history of allergic disorders (OR self-perceived: 2.62, 95% CI 1.46-4.71, p = 0.001; OR diagnosed by a doctor: 4.07, 95% CI 2.44-6.80, p < 0.001). CONCLUSIONS: FA and airborne allergies are less prevalent in Ecuador than in developed regions; there is a great dissociation between the prevalence of allergic disease and allergic sensitisation. Shrimp and HDM were the most prevalent allergens. Risk factors identified in this study to be related to allergic diseases should be considered by physicians, health practitioners, and epidemiologists in Ecuador.

RESUMO

OBJECTIVE: To determine the epidemiology of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae invasive infections in hospitalized Guatemalan children. This is an important issue since Hib vaccine has not been incorporated into the routine immunization program in Guatemala and information from hospital records in 1995 indicated a low incidence of Hib and S. pneumoniae as causes of meningitis and invasive infections. METHODS: Children who were hospitalized in Guatemala City with clinical signs compatible with bacterial infections were evaluated for evidence of Hib or S. pneumoniae infection. Normally sterile body fluids were cultured, and antigen detection was performed on cerebrospinal fluid (CSF) and pleural fluid. RESULTS: Of 1 203 children 1-59 months of age hospitalized over a 28-month period, 725 of them (60.3 percent) had a primary diagnosis of pneumonia, 357 (29.7 percent) of meningitis, 60 (5.0 percent) of cellulitis, and 61 (5.1 percent) of sepsis and other conditions. Hib was identified in 20.0 percent of children with meningitis and S. pneumoniae in 12.9 percent. The average annual incidence of Hib meningitis was 13.8 cases per 100 000 children under 5 years of age, and 32.4 percent of meningitides caused by Hib and 58.7 percent of S. pneumoniae meningitides occurred prior to 6 months of age. Case fatality rates were 14.1 percent, 37.0 percent, and 18.0 percent, respectively, for children with Hib, S. pneumoniae, and culture-negative and antigen-negative meningitis. Prior antibiotic therapy was common and was associated with significant reductions in CSF-culture-positive results for children with other evidence of Hib or S. pneumoniae meningitis. CONCLUSIONS: Improvements in case detection, culture methods, and latex agglutination for antigen detection in CSF resulted in identification of Hib and S. pneumoniae as important causes of severe disease in Guatemalan children. Using a cutoff of > 10 white blood cells per cubic millimeter in CSF would improve the sensitivity for detection of bacterial meningitis and help estimate the burden of bacterial meningitis in Guatemala and other developing countries.

Objetivo. Determinar las características epidemiológicas de las infecciones invasoras por Haemophilus influenzae tipo b (Hib) y Streptococcus pneumoniae en niños hospitalizados en Guatemala. La importancia de este tema radica en que la vacunación contra Hib no ha sido incorporada a los programas de inmunización establecidos en Guatemala y en que los registros hospitalarios de 1995 indicaban una baja incidencia de meningitis e infecciones invasoras causadas por Hib y S. pneumoniae. Métodos. Los niños hospitalizados en la Ciudad de Guatemala con signos clínicos de infección bacteriana se estudiaron en busca de indicios de infección por Hib o S. pneumoniae. Se cultivaron líquidos corporales normalmente estériles y se hicieron pruebas de detección de antígenos en líquidos cefalorraquídeo (LCR) y pleural. Resultados. De los 1 203 niños de 1 a 59 meses de edad hospitalizados en un período de 28 meses, 725 (60,3%) tenían un diagnóstico primario de neumonía, 357 (29,7%) de meningitis, 60 (5,0%) de celulitis y 61 (5,1%) de sepsis u otras afecciones. En 20,0% de los niños con meningitis se detectó Hib y en 12,9% S. pneumoniae. La incidencia media anual de meningitis por Hib fue de 13,8 casos por 100 000 niños menores de 5 años de edad; 32,4% de los casos de meningitis causados por Hib y 58,7% de los causados por S. pneumoniae ocurrieron en niños menores de 6 meses de edad. La tasa de letalidad fue de 14,1%, 37,0% y 18,0%, respectivamente, para los casos de meningitis por Hib, por S. pneumoniae y con resultados negativos tanto en el cultivo como en las pruebas de detección de antígeno. El tratamiento previo con antibióticos fue frecuente y se vio asociado con una reducción significativa de resultados positivos en el cultivo de LCR en los niños que presentaban otros signos de meningitis por Hib o S. pneumoniae. Conclusiones. El perfeccionamiento de la detección de casos, los métodos de cultivo y las pruebas de aglutinación con látex para la detección antigénica en LCR permitió identificar a Hib y S. pneumoniae como causas importantes de enfermedades graves en niños guatemaltecos. El empleo de un punto de corte de más de 10 leucocitos por milímetro cúbico de LCR mejoraría la sensibilidad de la detección de la meningitis bacteriana y ayudaría a calcular la carga de esta enfermedad en Guatemala y otros países en desarrollo.

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RESUMO

OBJECTIVE: To determine the epidemiology of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae invasive infections in hospitalized Guatemalan children. This is an important issue since Hib vaccine has not been incorporated into the routine immunization program in Guatemala and information from hospital records in 1995 indicated a low incidence of Hib and S. pneumoniae as causes of meningitis and invasive infections. METHODS: Children who were hospitalized in Guatemala City with clinical signs compatible with bacterial infections were evaluated for evidence of Hib or S. pneumoniae infection. Normally sterile body fluids were cultured, and antigen detection was performed on cerebrospinal fluid (CSF) and pleural fluid. RESULTS: Of 1 203 children 1-59 months of age hospitalized over a 28-month period, 725 of them (60.3%) had a primary diagnosis of pneumonia, 357 (29.7%) of meningitis, 60 (5.0%) of cellulitis, and 61 (5.1%) of sepsis and other conditions. Hib was identified in 20.0% of children with meningitis and S. pneumoniae in 12.9%. The average annual incidence of Hib meningitis was 13.8 cases per 100 000 children under 5 years of age, and 32.4% of meningitides caused by Hib and 58.7% of S. pneumoniae meningitides occurred prior to 6 months of age. Case fatality rates were 14.1%, 37.0%, and 18.0%, respectively, for children with Hib, S. pneumoniae, and culture-negative and antigen-negative meningitis. Prior antibiotic therapy was common and was associated with significant reductions in CSF-culture-positive results for children with other evidence of Hib or S. pneumoniae meningitis. CONCLUSIONS: Improvements in case detection, culture methods, and latex agglutination for antigen detection in CSF resulted in identification of Hib and S. pneumoniae as important causes of severe disease in Guatemalan children. Using a cutoff of > 10 white blood cells per cubic millimeter in CSF would improve the sensitivity for detection of bacterial meningitis and help estimate the burden of bacterial meningitis in Guatemala and other developing countries.

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