title: Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador observational study: time series analysis.
abstract: BACKGROUND
  This study documented elevated rates of emergency room (ER) visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000.
  
  
  METHODS
  We abstracted 5169 (43% females) ER records with primary respiratory conditions treated from January 1-December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), and asthma-related conditions in boys and girls for three age groups: 0-4, 5-9, and 10-15 years.
  
  
  RESULTS
  At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER) visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively). The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]). Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460]) additional ER visits due to respiratory conditions.
  
  
  CONCLUSIONS
  The study has demonstrated strong relationship between ash exposure and respiratory effects in children.
authors.affiliation: Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston MA 02111, USA. elena.naumova@tufts.edu
authors.forename: Elena N
authors.initials: EN
authors.lastname: Naumova
authors.forename: Hugo
authors.initials: H
authors.lastname: Yepes
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
authors.forename: Fernando
authors.initials: F
authors.lastname: Sempértegui
authors.forename: Gauri
authors.initials: G
authors.lastname: Khurana
authors.forename: Jyotsna S
authors.initials: JS
authors.lastname: Jagai
authors.forename: Edgar
authors.initials: E
authors.lastname: Játiva
authors.forename: Bertha
authors.initials: B
authors.lastname: Estrella
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000397:Air Pollution / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004484:Ecuador / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016012:Poisson Distribution; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology; D018707:Volcanic Eruptions / Q000009:adverse effects*