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A Household-based Study of Acute Viral Respiratory Illnesses in Andean Children

Budge, Philip J. MD, PhD*; Griffin, Marie R. MD, MPH; Edwards, Kathryn M. MD‡§; Williams, John V. MD§¶; Verastegui, Hector; Hartinger, Stella M. PhD‖**; Johnson, Monika MS§; Klemenc, Jennifer M. BS§; Zhu, Yuwei MD, MS††; Gil, Ana I. MS; Lanata, Claudio F. MD, MPH; Grijalva, Carlos G. MD, MPH; for the RESPIRA-PERU Group

Pediatric Infectious Disease Journal: May 2014 - Volume 33 - Issue 5 - p 443–447
doi: 10.1097/INF.0000000000000135
Original Studies

Background: Few community studies have measured the incidence, severity and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings.

Methods: We conducted active, household-based ARI surveillance among children aged <3 years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections if tachypnea, wheezing, grunting, stridor or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time, reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression.

Results: During 755.1 child-years of observation among 892 children in 58 communities, 4475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% confidence interval: 5.9–6.5). Families sought medical care for 24% of ARI, 4% were classified as lower respiratory tract infections and 1% led to hospitalization. Of 5 deaths among cohort children, 2 were attributed to ARI. One or more respiratory viruses were detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30 and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus and parainfluenza virus 1–3 comprised a disproportionate share of lower respiratory tract infections compared with other etiologies.

Conclusions: In this high-altitude rural setting with low-population density, ARI in young children were common, frequently severe and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed.

From the *Division of Infectious Diseases, Department of Internal Medicine; Department of Preventive Medicine; Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics; §Department of Pediatrics; Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN; Instituto de Investigacion Nutricional, Lima, Peru; **Swiss Tropical and Public Health Institute, Basel, Switzerland; and †Department of Biostatistics, Vanderbilt University, Nashville, TN.

Accepted for publication October 14, 2013.

This work was supported by the Vanderbilt University CTSA grant UL1 RR024975-01 from NIH, an investigator initiated research grant from Pfizer (IIR WS1898786(0887X1-4492) and a grant from the Thrasher Research Fund (02832-9). P.J.B. was supported by the Agency of Healthcare Research and Quality T32 HS 013833.

The authors have no conflicts of interest to disclose.

Address for correspondence: Carlos G. Grijalva, MD, MPH, Department of Preventive Medicine Vanderbilt University School of Medicine, 1500 21st Avenue South, The Village at Vanderbilt Suite # 2600, Nashville, TN 37212. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.