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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Expanded Programme on Immunization (EPI) dramatically increased coverage. In 1990, approximately 80% of the world's children younger than 1 year received measles vaccine, and it was estimated that around 2 million deaths were prevented. Still in 1990 an estimated 45 million cases and around 1 million deaths occurred in developing countries. In one community study in Kenya in 1985 measles accounted for 35% of reported deaths in infants 1-12 months old and for 40% of deaths in children 1-4 years old. The Schwarz vaccine was introduced in the 1960s; under most field conditions its efficacy is about 85% for children receiving the vaccine at 9 months or older. The urban poor, who usually have less access to immunization services, are usually the most at risk. Other high-risk groups include specific age groups (school children who represent cohorts from previous years when coverage was lower and who may not have been exposed to measles infection), ethnic minorities (who may have been underserved or may have rejected immunization for cultural reasons), hospitalized children who are at high risk of nosocomial transmission, and children in refugee camps. Vitamin A administered to children acutely ill with measles reduces mortality. Results from a trial in South Africa showed children treated with vitamin A had reduced risk of dying, recovered more quickly from pneumonia and diarrhea, and had less croup. In addition, symptomatic treatment for cases requires antibiotics to combat bacterial complications, and oral rehydration salts for dehydration following diarrhea. Case fatality rates can be lowered if cases reach health care facilities where appropriate care is offered early. For uncomplicated cases, supportive fluids, antipyretics, and nutritional therapy may be required. Many children need increased food intake for 4-8 weeks to recover their premeasles nutritional status.
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PMID:The epidemiology of measles. 146 63

Treatment with high dose vitamin A has recently been recommended for children with measles in communities where vitamin A deficiency is a recognized problem. However, the relationship between vitamin A and measles mortality has not been clearly established. We studied serum vitamin A levels in 283 children less than or equal to 5 years of age admitted to Mama Yemo and Kalembe Lembe Hospitals in Kinshasa, Zaire, between January and March, 1987. Vitamin A levels were determined by high performance liquid chromatography. Vitamin A levels ranged from less than 5 to 63 micrograms/dl (median, 8). The overall case-fatality rate was 26 per cent. On univariate analysis, age less than 24 months, pneumonia on admission, lymphopenia (less than 2000/mm3), and lower vitamin A levels were associated with death during hospitalization. In a multivariate logistic regression model, a vitamin A level less than 5 micrograms/dl was associated with fatal outcome for children younger than 24 months old (relative risk = 2.9, 95 per cent CI 1.3, 6.8), but not for older children. Further studies are needed to determine whether low vitamin A levels predispose children to severe measles and the role of vitamin A supplements in the prevention of measles mortality.
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PMID:Vitamin A levels and mortality among hospitalized measles patients, Kinshasa, Zaire. 275 67

Effect of vitamin A on phagocytic activity and the state of bactericide system involving myeloperoxidase and cationic proteins was studied in neutrophils from peripheric blood of volunteers and of the patients with chronic pneumonia and lung cancer. Vitamin A was administered per os within 1 week at a daily dose of 500,000 IU. In healthy persons vitamin A, not affecting the ability of neutrophils to capture and lyse microbes, activated myeloperoxidase and increased the cationic proteins content. Under conditions of lung cancer the vitamin did not alter any patterns of phagocytosis studied. Vitamin A did not affect the capture and lysis of microbes in chronic pneumonia but increased distinctly the myeloperoxidase activity in neutrophils, impaired during the disease, and normalized partially the content of cationic proteins.
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PMID:[Vitamin A: effect on phagocytosis and neutrophil bactericidal systems under normal conditions and in various pathological states]. 409 Mar 90

Vitamin A has been shown to be important in immunity and in differentiation of epithelial tissues. Serum concentrations of vitamin A (retinol) were measured at birth, in 54 preterm and 24 full term infants. Vitamin A concentrations were significantly lower in the preterm compared to the full term infants (9.81 +/- 0.58 micrograms/dl v. 15.58 +/- 1.00 micrograms/dl, P = 0.0001). Serum retinol and birth weight were positively correlated (r = 0.39, P = 0.0004); however, there was no correlation between maternal and infant vitamin A concentrations. The initially reduced vitamin A levels in the preterm infants were not associated with respiratory distress syndrome or pneumonia.
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PMID:Serum vitamin A (retinol) concentrations and association with respiratory disease in premature infants. 756 76

Acute infections of childhood are associated with an increased of xerophthalmia, apparently due to depletion of vitamin A stores. The mechanism responsible for this is not known. Recently, it has been reported that severe infections in adult patients (ie, sepsis and pneumonia) result in excretion of large quantities of retinol in the urine. In 44 children hospitalized for treatment of acute diarrhea we found mean urinary excretions of 1.44 mumol retinol/24 h on day 1 of hospitalization, 0.62 mumol retinol/24 h on day 2, and 0.23 mumol/24 h on day 3. Healthy control subjects matched for age did not excrete measurable amounts of retinol in the urine. Retinol excretion was associated strongly with rotavirus diarrhea and presence of fever. Furthermore, serum retinol concentration was negatively associated with duration of diarrhea before hospitalization, suggesting that urinary excretion of retinol may be an important contributor to vitamin A depletion.
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PMID:Urinary excretion of retinol in children with acute diarrhea. 776 30

Vitamin A supplementation during acute pneumonia has not improved recovery in most human clinical trials. We hypothesize that high vitamin A intake may decrease the production of T-helper type-1 (Th1) cytokines and thereby inhibit antiviral responses. Such decreases might impair recovery from viral respiratory infections. We thus examined the effect of three interventions on viral pneumonia: 1) a high level vitamin A [250,000 IU/kg diet or 75,000 retinol equivalents (RE)/kg], or 2) control diet (4000 IU/kg diet or 1200 RE/kg) given before and during infection, and 3) initiating the high level diet upon infection to simulate the adjuvant therapy used in clinical trials. No difference was seen among the interventions in severity of disease (weight loss, lung virus titers and survival). However, both the high level diet group and the group in which vitamin A was increased at the time of infection had greater salivary immunoglobulin (Ig)A responses (geometric means, 166 and 105 microg/L, respectively) than did the control group (59 microg/L) (P = 0.0019). In contrast, the serum IgG response was higher in the control group (324+/-158 mg/L) than in the high level group (225+/-95 mg/L) (P = 0.028), although it did not differ from the group in which the diet was changed upon infection (230+/-163 mg/L) (P = 0.084). The production of interferon-gamma (IFN-gamma), a Th1 cytokine, was lower in the high level diet group (median, 0.153 microg/L) compared with the control group (median, 0.839 microg/L) (P = 0.014), whereas the production of interleukin-10 (IL-10), a Th2 cytokine, was higher with the high level diet (median, 0.304 microg/L) than with the control (median, 0.126 microg/L) (P = 0.022). This change in the Th1/Th2 pattern was not sufficient to affect recovery from viral pneumonia but may account for the increased IgA and decreased IgG responses seen with high level dietary vitamin A in this study. These data reinforce the lack of utility of vitamin A in treating acute pneumonia in children and suggest that high dose vitamin A supplements may enhance Th2-mediated immune responses, which are particularly beneficial in the case of extracellular bacterial and parasitic infections and IgA-mediated responses to mucosal infections.
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PMID:High-level dietary vitamin A enhances T-helper type 2 cytokine production and secretory immunoglobulin A response to influenza A virus infection in BALB/c mice. 1080 9

The associations of hemoglobin, hematocrit, and packed cell volume with socioeconomic factors, malaria, human immunodeficiency virus (HIV) infection, and nutritional status were examined among 687 children admitted to hospital with pneumonia participating in a double blind, placebo-controlled trial of vitamin A supplementation. Children were randomized to receive 2 doses of vitamin A (200,000 IU) or placebo at baseline, and additional doses at 4 and 8 months after discharge from hospital. Hemoglobin levels were measured at enrollment and, on a subset of 161 children, during follow-up. At baseline, hemoglobin concentration was positively associated with the number of possessions in the household, maternal level of education and quality of water supply, and inversely related to malaria infection after controlling for potential confounding variables. Children infected with HIV experienced a significant fall in mean hemoglobin levels over time. The risk of developing severe anemia (< 7 g/dL) during follow-up was lower for children who were breastfed for longer than 18 months as compared to those with less than 6 months of breastfeeding (adjusted prevalence ratio = 0.14, 95% confidence interval [CI] = 0.02, 0.93; P = 0.04), and higher for children over two years of age as compared to 6 to 11 months-old infants (adjusted prevalence ratio = 8.11, 95% CI = 1.2, 55.8; P = 0.03). Children with repeated diagnoses of malaria had 4.1 times the risk of developing severe anemia than did children without the diagnosis (95% CI = 1.3, 13.5; P = 0.02). Vitamin A supplements were associated with an overall nonsignificant reduction of 14% in the risk of developing severe anemia (adjusted prevalence ratio = 0.86, 95% CI = 0.37, 1.99; P = 0.73). We conclude that malaria, HIV infection, low socioeconomic status, and short duration of breastfeeding are strong and independent determinants of adverse hematologic profiles in this population.
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PMID:Vitamin A supplementation and other predictors of anemia among children from Dar Es Salaam, Tanzania. 1128 70

Increasing data link micronutrient deficiencies to excess childhood morbidity and mortality, and similar relationships have been noted in the study of nutrition and HIV infection. We review epidemiologic studies that have examined the relationship between micronutrient deficiencies and health outcomes in childhood and HIV infection, as well as clinical trials of micronutrient supplementation. Vitamin A supplementation among communities at risk of deficiency effectively reduces mortality and morbidity in children younger than age 5, and vitamin A may be especially effective in HIV-infected children. Vertical transmission of HIV has not to date been affected by maternal micronutrient supplementation. In children with poor dietary zinc intake and/or bioavailability, zinc supplementation reduces the incidence and severity of diarrheal diseases, as well as the occurrence of pneumonia. Vitamin A therapy has not been associated with improved growth, whereas some trials have shown that zinc supplementation is associated with greater increments in height. Further trials of micronutrient supplementation are warranted.
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PMID:Micronutrients and child health: studies in international nutrition and HIV infection. 1172 Mar 41

Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.
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PMID:Reducing infant mortality. 1228 45

Dr. Nils Daulaire, senior health adviser to the US Agency for International Development (USAID), announced their plan to supplement basic food products with vitamin A which will save millions of children in Third World countries from death and diseases. Vitamin A testing conducted in Nepal and Indonesia resulted to significant reductions in the rate of childhood death. Aside from reducing the death rates from illnesses such as pneumonia, diarrhea, and malaria, vitamin A also decreases the severity of the symptoms. In recognition of these benefits, USAID and other major food and drug companies will soon begin their first vitamin A fortification and distribution projects in India, Nicaragua, and Bangladesh. The plan will also be initiated in Zambia on May 13 with a program to fortify sugar. The US government will allocate $25 million for child survival programs.
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PMID:Vitamin A: lifesaver for the Third World. AID, private sector to bring it. 1232 6


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