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Efficacy of Anaferon for Children in the Treatment of Influenza and Acute Respiratory Viral Infections in Children

Primary Purpose

Influenza and Acute Respiratory Viral Infections

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
Anaferon for Children
Sponsored by
Materia Medica Holding
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Influenza and Acute Respiratory Viral Infections

Eligibility Criteria

3 Years - 12 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients of both sexes aged 3-12 years inclusively.
  2. Diagnosis of influenza/ARVI according to physician's examination: body temperature ≥ 38.0°C at the time of examination + symptom score ≥ 4 (at least 1 systemic symptom ≥2 and 1 nasal/throat/chest symptom ≥2 or several symptoms ≥ 1 score).
  3. The first 24 hours from the beginning of manifestations of influenza/ARVI.
  4. The possibility to start therapy within 24 hours from the first symptoms of ARVI.
  5. Availability of a patient information sheet (Informed Consent form) for parents/adoptive parents for participation in the study signed by one of the parents/adoptive parents.

Exclusion Criteria:

  1. Suspected pneumonia, bacterial infection or severe disease requiring antibacterial products (including sulfanilamides) starting from the first day of the disease.
  2. Clinical symptoms of severe influenza/ARVI requiring hospitalization.
  3. Suspected initial manifestations of the diseases having the symptoms similar to the ones of influenza/ARVI (other infectious diseases, influenza-like syndrome at debut of systemic connective tissue diseases, oncohematological and other diseases).
  4. Medical history of primary and secondary immunodeficiencies: а) lymphoid system immunodeficiencies (Т-cell and/or B-cell, immunodeficiencies with predominant antibody deficiency); b) phagocytic deficiencies; c) complement factor deficiency; d) combined immunodeficiencies including AIDS secondary to HIV-infection; toxic, autoimmune, infectious, radiation panleukopenic syndrome; systemic lymphocytopenic syndrome; polyclonal lymphocytic activation syndrome; postsplenectomic syndrome; congenital asplenia; immune complex pathological syndrome associated with infectious, autoimmune and allergic diseases.
  5. Medical history of sarcoidosis.
  6. Oncology.
  7. Exacerbation or decompensation of chronic diseases affecting ability to participate in the clinical study.
  8. Medical history of polyvalent allergy.
  9. Allergy/intolerance to any of the components of medications used in the treatment.
  10. Malabsorption syndrome, including congenital or acquired lactase or other disaccharidase deficiency, galactosemia.
  11. Intake of medicines listed in the section "Prohibited concomitant therapy" within 1 month prior to the inclusion in the study.
  12. Drug addiction, alcohol consumption at more than 2 alcohol units per day by the subject's parents/adoptive parents.
  13. Mental diseases of the subject, parents/adoptive parents.
  14. Subjects whose parents/adoptive parents, according to the investigator's point of view, will not follow the observation requirements during the study or study product dosing regimen.
  15. Participation in other clinical studies within 3 months prior to the inclusion in the study.
  16. Parent/adoptive parent of the subject is related to the investigator team of medical facility directly involved in the study or is a close relative of the investigator. Close relatives include spouse, parents, children or brothers (sisters) regardless of whether they are biological or adoptive ones.
  17. Parent/adoptive parent of the subject is working in OOO "NPF "Materia Medica Holding", i.e. is the company official, temporary contract worker or an appointed official responsible for the study or their close relatives.

Sites / Locations

  • City Child Health Clinical Polyclinic №13
  • Municipal Health Care Institution "City Child Health Clinical Polyclinic №10"
  • City Child Health Clinical Polyclinic №17
  • Clinic of State Budgetary Institution "Research Institute of nutrition" of the Russian Academy of Medical Sciences
  • Russian National Research Medical University named after N.I. Pirogov
  • Russian National Research Medical University
  • Russian National Research Pirogov Medical University
  • State Educational Institution of Higher Professional Education "Moscow State Medical Academy named after I.M. Sechenov"
  • State Budgetary Institution of Health, "Children's City Hospital № 9 named after G.N. Speranskii"
  • State Budgetary Educational Institution of Additional Professional Education "Russian Russian Medical Academy of Postgraduate Education" of Ministry of Health of Russian Federation
  • State Budgetary Educational Institution of Higher Professional Education " Nizhny Novgorod State Medical Academy" of Ministry of Health of Russian Federation
  • State Budgetary Educational Institution of Higher Professional Education ''Novosibirsk State Medical University'' of Ministry of Health of Russian Federation
  • Municipal Health Care Institution "City Child Health Clinical Polyclinic №5"
  • State Budgetary Educational Institution of Higher Professional Education "Rostov State Medical University"
  • St. Petersburg State Budgetary Health Care Institution "Сity Polyclinic №44"
  • St. Petersburg State health institution " City Child Health Polyclinic № 45"
  • State Budgetary Educational Institution of Higher Professional Education "St. Petersburg State Pediatric Medical Academy" of Ministry of Health of Russian Federation
  • Co.Ltd "Clinic Allergomed"
  • State Health Care Institution "Child Health City Hospital №22"
  • Limited Liability Company "Alliance Biomedical-Russian group"
  • Bashkir State Medical University of Ministry of Health of Russian Federation
  • State Budgetary Educational Institution of Higher Professional Education " Yaroslavl State Medical Academy" of Ministry of Health of Russian Federation
  • State Budgetary Educational Institution of Higher Professional Education "Yaroslavl State Medical Academy"
  • State Budgetary Educational Institution of Higher Professional Education "Yaroslavl State Medical Academy
  • Yaroslavl State Medical Academy
  • Vinnytsya M.I. Pyrogov National Medical University
  • Public institution "Zaporizhzhya city multidisciplinary children's hospital №5"

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Anaferon for Children

Placebo

Arm Description

On day 1, five tablets are taken in the first 2 hours (one tablet every 30 min), followed by three more tablets regularly spaced during the rest of the day. From day 2 through 5, one tablet is administered three times daily.

On day 1, five tablets are taken in the first 2 hours (one tablet every 30 min), followed by three more tablets regularly spaced during the rest of the day. From day 2 through 5, one tablet is administered three times daily.

Outcomes

Primary Outcome Measures

Average Illness Duration
Disease duration is assessed until recovery or significant improvement. Average illness duration is defined as the interval between the start of the trial treatment and the start of the first 24-hour period in which the non-specific symptoms and nasal/ throat/ chest symptoms improve to "absent" or "mild" (Total Symptom Score of severity had decreased to ≤2 points) and body temperature returns to 37.2°C or below. Based on patient diary data.

Secondary Outcome Measures

Percentage of Patients With Recovery/Improvement in Health
Based on Days 2, 3, 4 and 5 of observation treatment (according to the patient's diary), on days 3 and 5 of therapy (according to physician's objective examination).
Changes in Body Temperature
Changes in Body Temperature Based on Patient Diary Data
Percentage of Patients With Normal Body Temperature (≤37.0ºС)
Based on the patient diary data. Axillary temperature (morning and evening) decline to or below 37.0 ºС.
Severity of Clinical Manifestations of Influenza / Acute Respiratory Viral Infection by Total Symptom Score.
Total Symptom Score is based on the severity of each Influenza / Acute Respiratory Viral Infection symptom. Total Symptom Score includes 13 symptoms: body temperature, non-specific symptoms (headache, chills, sweating, weakness, muscle pain, drowsiness), nasal/throat/chest symptoms. The severity of non-specific and nasal/throat/chest symptom is scored on a symptom severity scale (0=no symptoms; 1=mild symptoms; 2=moderate symptoms; 3=severe symptoms). Minimum score=0; maximum score=39. The severity of symptoms is recorded by the doctors on the case record form on days 3, 5 and by parents/adopter on a diary card twice a day on days 2-6.
Assessment of the Severity of Influenza Virus / Acute Respiratory Viral Infection Using the "Area Under the Curve" for an Overall Symptom Assessment
Total Symptom Score is based on the severity of each disease symptom. The TSS includes 13 symptoms: body temperature/fever, non-specific symptoms (headache, chills, sweating, weakness, muscle pain, drowsiness), nasal/throat/chest symptoms (runny nose, nasal congestion, sneezing, sore throat, hoarseness, cough, chest pain/tightness of the chest). Minimum score=0; maximum score=39. The area under the curve 1 = on days 1, 3, 5 and 7 on the results of doctor's examination The area under the curve 2 = based on days 1-7 on the patient diary data
Number of Intakes of Antipyretics
Number of Intakes of Antipyretics based on patient diary data
Change in Viral Load During the Treatment and Follow-up Periods
Viral load is evaluated in subjects with positive influenza A and B tests. Virus load [log10 copies influenza А/В RNA per 1 mL] in nasal and pharyngeal swabs is determined using real-time PCR on days 1, 3, 5 and 7.
Percentage of Patients With Exacerbation of the Disease Course
The development of disease complications requiring antibiotics drugs or hospitalization

Full Information

First Posted
February 14, 2014
Last Updated
July 11, 2019
Sponsor
Materia Medica Holding
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1. Study Identification

Unique Protocol Identification Number
NCT02072174
Brief Title
Efficacy of Anaferon for Children in the Treatment of Influenza and Acute Respiratory Viral Infections in Children
Official Title
International Multicenter Double-blind Placebo-controlled Randomized Parallel Group Clinical Trial of Efficacy of Anaferon for Children in the Treatment of Influenza and Acute Respiratory Viral Infections in Children
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
October 8, 2014 (Actual)
Primary Completion Date
April 16, 2018 (Actual)
Study Completion Date
April 16, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Materia Medica Holding

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
The purpose of this study is: • To obtain additional data on therapeutic efficacy of Anaferon for children in the treatment of influenza and acute respiratory viral infections in children
Detailed Description
The study will enroll outpatient subjects of both sexes aged 3-12 years with clinical manifestations of influenza/Acute Respiratory Viral Infections (ARVI), including fever ≥ 38.0°С having an appointment with a doctor within the first day after the illness onset. Тhe physician will collect medical history information, perform an objective examination, record the concomitant therapy, and obtain nasal swab specimens for a rapid diagnostic influenza test. If the swab is positive, the doctor shall obtain swab specimens from the nasal cavity and oropharynx (nasopharyngeal swab) for a subsequent real time reverse transcription-polymerase chain reaction (RT-PCR) to determine the viral load of influenza A and/or B virus. If the swab is negative for influenza the doctor shall collect a nasopharyngeal swab for a subsequent PCR test for other respiratory viruses. If inclusion criteria are met and exclusion criteria are absent at visit 1 (Day 1), the patient will be enrolled in the trial and randomized into one of the two groups: group 1 patients will take Anaferon for children following a 5-day regimen; group 2 patients will receive Placebo using the Anaferon for children 5-day regimen. The parent/adopter of patient will receive a diary where they should record the child's axillary temperature data in the morning and evening, and score the severity of symptoms. The subject will be monitored for 14 days (screening, randomization - 1 day, treatment - 5 days, follow-up - 1 day; late-scheduled phone "visit" - day 14). At Visits 2-4, the physician will document objective examination data; obtain nasopharyngeal swabs from subjects with positive influenza tests for subsequent RT-PCR to determine the viral load and its reduction in the course of treatment; monitor the prescribed and concomitant therapy, and check the patient's diary data. The phone "visit" will be made to elicit information from the parents regarding the patient's general health, presence/absence of secondary bacterial/viral complications, and use of antibacterial drugs. Interim statistical analysis is stipulated by the study protocol. Interim analysis will be performed using the data obtained from the examination and treatment of the protocol-defined number of patients who completed the study. Based on the expected effect, the minimum required Particular Per Protocol (pPP) sample size will be 254 patients (127 subjects in each group - Anaferon for children and Placebo).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Influenza and Acute Respiratory Viral Infections

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
569 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Anaferon for Children
Arm Type
Experimental
Arm Description
On day 1, five tablets are taken in the first 2 hours (one tablet every 30 min), followed by three more tablets regularly spaced during the rest of the day. From day 2 through 5, one tablet is administered three times daily.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
On day 1, five tablets are taken in the first 2 hours (one tablet every 30 min), followed by three more tablets regularly spaced during the rest of the day. From day 2 through 5, one tablet is administered three times daily.
Intervention Type
Drug
Intervention Name(s)
Anaferon for Children
Other Intervention Name(s)
Anaferon for Children in tablets
Intervention Description
Anaferon for children: For oral use.
Primary Outcome Measure Information:
Title
Average Illness Duration
Description
Disease duration is assessed until recovery or significant improvement. Average illness duration is defined as the interval between the start of the trial treatment and the start of the first 24-hour period in which the non-specific symptoms and nasal/ throat/ chest symptoms improve to "absent" or "mild" (Total Symptom Score of severity had decreased to ≤2 points) and body temperature returns to 37.2°C or below. Based on patient diary data.
Time Frame
From the time of randomization until the time of recovery/improvement (days 1-14)
Secondary Outcome Measure Information:
Title
Percentage of Patients With Recovery/Improvement in Health
Description
Based on Days 2, 3, 4 and 5 of observation treatment (according to the patient's diary), on days 3 and 5 of therapy (according to physician's objective examination).
Time Frame
on days 2, 3, 4 and 5 of the treatment
Title
Changes in Body Temperature
Description
Changes in Body Temperature Based on Patient Diary Data
Time Frame
baseline and days 2, 3, 4 and 5 of observation treatment
Title
Percentage of Patients With Normal Body Temperature (≤37.0ºС)
Description
Based on the patient diary data. Axillary temperature (morning and evening) decline to or below 37.0 ºС.
Time Frame
on days 2, 3, 4 and 5 of observation treatment
Title
Severity of Clinical Manifestations of Influenza / Acute Respiratory Viral Infection by Total Symptom Score.
Description
Total Symptom Score is based on the severity of each Influenza / Acute Respiratory Viral Infection symptom. Total Symptom Score includes 13 symptoms: body temperature, non-specific symptoms (headache, chills, sweating, weakness, muscle pain, drowsiness), nasal/throat/chest symptoms. The severity of non-specific and nasal/throat/chest symptom is scored on a symptom severity scale (0=no symptoms; 1=mild symptoms; 2=moderate symptoms; 3=severe symptoms). Minimum score=0; maximum score=39. The severity of symptoms is recorded by the doctors on the case record form on days 3, 5 and by parents/adopter on a diary card twice a day on days 2-6.
Time Frame
on days 2-6 of observation treatment
Title
Assessment of the Severity of Influenza Virus / Acute Respiratory Viral Infection Using the "Area Under the Curve" for an Overall Symptom Assessment
Description
Total Symptom Score is based on the severity of each disease symptom. The TSS includes 13 symptoms: body temperature/fever, non-specific symptoms (headache, chills, sweating, weakness, muscle pain, drowsiness), nasal/throat/chest symptoms (runny nose, nasal congestion, sneezing, sore throat, hoarseness, cough, chest pain/tightness of the chest). Minimum score=0; maximum score=39. The area under the curve 1 = on days 1, 3, 5 and 7 on the results of doctor's examination The area under the curve 2 = based on days 1-7 on the patient diary data
Time Frame
on days 1-7 of observation (based on days 1-7 on the patient diary data; on days 1, 3, 5 and 7 of observation - according to physician's objective examination)
Title
Number of Intakes of Antipyretics
Description
Number of Intakes of Antipyretics based on patient diary data
Time Frame
on days 1-5 of therapy
Title
Change in Viral Load During the Treatment and Follow-up Periods
Description
Viral load is evaluated in subjects with positive influenza A and B tests. Virus load [log10 copies influenza А/В RNA per 1 mL] in nasal and pharyngeal swabs is determined using real-time PCR on days 1, 3, 5 and 7.
Time Frame
on days 1, 3, 5, 7 of observation treatment
Title
Percentage of Patients With Exacerbation of the Disease Course
Description
The development of disease complications requiring antibiotics drugs or hospitalization
Time Frame
14 days of observation treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients of both sexes aged 3-12 years inclusively. Diagnosis of influenza/ARVI according to physician's examination: body temperature ≥ 38.0°C at the time of examination + symptom score ≥ 4 (at least 1 systemic symptom ≥2 and 1 nasal/throat/chest symptom ≥2 or several symptoms ≥ 1 score). The first 24 hours from the beginning of manifestations of influenza/ARVI. The possibility to start therapy within 24 hours from the first symptoms of ARVI. Availability of a patient information sheet (Informed Consent form) for parents/adoptive parents for participation in the study signed by one of the parents/adoptive parents. Exclusion Criteria: Suspected pneumonia, bacterial infection or severe disease requiring antibacterial products (including sulfanilamides) starting from the first day of the disease. Clinical symptoms of severe influenza/ARVI requiring hospitalization. Suspected initial manifestations of the diseases having the symptoms similar to the ones of influenza/ARVI (other infectious diseases, influenza-like syndrome at debut of systemic connective tissue diseases, oncohematological and other diseases). Medical history of primary and secondary immunodeficiencies: а) lymphoid system immunodeficiencies (Т-cell and/or B-cell, immunodeficiencies with predominant antibody deficiency); b) phagocytic deficiencies; c) complement factor deficiency; d) combined immunodeficiencies including AIDS secondary to HIV-infection; toxic, autoimmune, infectious, radiation panleukopenic syndrome; systemic lymphocytopenic syndrome; polyclonal lymphocytic activation syndrome; postsplenectomic syndrome; congenital asplenia; immune complex pathological syndrome associated with infectious, autoimmune and allergic diseases. Medical history of sarcoidosis. Oncology. Exacerbation or decompensation of chronic diseases affecting ability to participate in the clinical study. Medical history of polyvalent allergy. Allergy/intolerance to any of the components of medications used in the treatment. Malabsorption syndrome, including congenital or acquired lactase or other disaccharidase deficiency, galactosemia. Intake of medicines listed in the section "Prohibited concomitant therapy" within 1 month prior to the inclusion in the study. Drug addiction, alcohol consumption at more than 2 alcohol units per day by the subject's parents/adoptive parents. Mental diseases of the subject, parents/adoptive parents. Subjects whose parents/adoptive parents, according to the investigator's point of view, will not follow the observation requirements during the study or study product dosing regimen. Participation in other clinical studies within 3 months prior to the inclusion in the study. Parent/adoptive parent of the subject is related to the investigator team of medical facility directly involved in the study or is a close relative of the investigator. Close relatives include spouse, parents, children or brothers (sisters) regardless of whether they are biological or adoptive ones. Parent/adoptive parent of the subject is working in OOO "NPF "Materia Medica Holding", i.e. is the company official, temporary contract worker or an appointed official responsible for the study or their close relatives.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elena Andrianova, Professor
Organizational Affiliation
Materia Medica Holding
Official's Role
Study Director
Facility Information:
Facility Name
City Child Health Clinical Polyclinic №13
City
Minsk
ZIP/Postal Code
220024
Country
Belarus
Facility Name
Municipal Health Care Institution "City Child Health Clinical Polyclinic №10"
City
Minsk
ZIP/Postal Code
220118
Country
Belarus
Facility Name
City Child Health Clinical Polyclinic №17
City
Minsk
ZIP/Postal Code
220131
Country
Belarus
Facility Name
Clinic of State Budgetary Institution "Research Institute of nutrition" of the Russian Academy of Medical Sciences
City
Moscow
ZIP/Postal Code
109240
Country
Russian Federation
Facility Name
Russian National Research Medical University named after N.I. Pirogov
City
Moscow
ZIP/Postal Code
117997
Country
Russian Federation
Facility Name
Russian National Research Medical University
City
Moscow
ZIP/Postal Code
117997
Country
Russian Federation
Facility Name
Russian National Research Pirogov Medical University
City
Moscow
ZIP/Postal Code
117997
Country
Russian Federation
Facility Name
State Educational Institution of Higher Professional Education "Moscow State Medical Academy named after I.M. Sechenov"
City
Moscow
ZIP/Postal Code
119991
Country
Russian Federation
Facility Name
State Budgetary Institution of Health, "Children's City Hospital № 9 named after G.N. Speranskii"
City
Moscow
ZIP/Postal Code
123317
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Additional Professional Education "Russian Russian Medical Academy of Postgraduate Education" of Ministry of Health of Russian Federation
City
Moscow
ZIP/Postal Code
123995
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education " Nizhny Novgorod State Medical Academy" of Ministry of Health of Russian Federation
City
Nizhnij Novgorod
ZIP/Postal Code
603005
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education ''Novosibirsk State Medical University'' of Ministry of Health of Russian Federation
City
Novosibirsk
ZIP/Postal Code
630091
Country
Russian Federation
Facility Name
Municipal Health Care Institution "City Child Health Clinical Polyclinic №5"
City
Perm
ZIP/Postal Code
614066
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education "Rostov State Medical University"
City
Rostov-na-Donu
ZIP/Postal Code
344022
Country
Russian Federation
Facility Name
St. Petersburg State Budgetary Health Care Institution "Сity Polyclinic №44"
City
St. Petersburg
ZIP/Postal Code
192212
Country
Russian Federation
Facility Name
St. Petersburg State health institution " City Child Health Polyclinic № 45"
City
St. Petersburg
ZIP/Postal Code
193312
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education "St. Petersburg State Pediatric Medical Academy" of Ministry of Health of Russian Federation
City
St. Petersburg
ZIP/Postal Code
194100
Country
Russian Federation
Facility Name
Co.Ltd "Clinic Allergomed"
City
St. Petersburg
ZIP/Postal Code
196084
Country
Russian Federation
Facility Name
State Health Care Institution "Child Health City Hospital №22"
City
St. Petersburg
ZIP/Postal Code
196650
Country
Russian Federation
Facility Name
Limited Liability Company "Alliance Biomedical-Russian group"
City
St.Petersburg
ZIP/Postal Code
194356
Country
Russian Federation
Facility Name
Bashkir State Medical University of Ministry of Health of Russian Federation
City
Ufa
ZIP/Postal Code
450000
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education " Yaroslavl State Medical Academy" of Ministry of Health of Russian Federation
City
Yaroslavl
ZIP/Postal Code
150000
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education "Yaroslavl State Medical Academy"
City
Yaroslavl
ZIP/Postal Code
150000
Country
Russian Federation
Facility Name
State Budgetary Educational Institution of Higher Professional Education "Yaroslavl State Medical Academy
City
Yaroslavl
ZIP/Postal Code
150000
Country
Russian Federation
Facility Name
Yaroslavl State Medical Academy
City
Yaroslavl
ZIP/Postal Code
150000
Country
Russian Federation
Facility Name
Vinnytsya M.I. Pyrogov National Medical University
City
Vinnytsya
ZIP/Postal Code
21018
Country
Ukraine
Facility Name
Public institution "Zaporizhzhya city multidisciplinary children's hospital №5"
City
Zaporozh'ye
ZIP/Postal Code
69076
Country
Ukraine

12. IPD Sharing Statement

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Efficacy of Anaferon for Children in the Treatment of Influenza and Acute Respiratory Viral Infections in Children

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