DIAGNOSIS OF COUGH: IMMUNOLOGICAL RESPONSE IN IMMUNIZED AND NON-IMMUNIZED CHILDREN
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Background: Cough is a frequent symptom in pediatric practice with multifactorial etiologies ranging from viral infections to allergic reactions. Immunization against common respiratory pathogens may modulate the host immune response, thereby altering the clinical and immunological presentation of cough. Objective: This study aimed to compare the immunological responses associated with cough in fully immunized versus non-immunized children and to evaluate their diagnostic implications. Methods: In this prospective, multicenter observational study, 480 children aged 6 months to 12 years presenting with acute cough were enrolled and stratified based on their immunization status into fully immunized (n = 240) and non-immunized (n = 240) groups. Immunological assessments included serum cytokine profiles (interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α], interferon-gamma [IFN-γ]), immunoglobulin levels (IgA, IgM, IgG), and white blood cell (WBC) differentials. Clinical data, including cough duration, severity (using a standardized cough score), and associated symptoms, were recorded at presentation and during follow-up at days 7 and 14.
Results: Fully immunized children exhibited significantly lower mean cough severity scores (4.1 ± 1.3 vs. 5.3 ± 1.6, p < 0.001) and shorter duration of cough (median 5 days vs. 8 days, p < 0.001) compared to non-immunized children. Immunologically, the fully immunized group showed a balanced cytokine response with lower levels of IL-6 (mean 18.2 ± 5.6 pg/mL vs. 25.4 ± 6.8 pg/mL, p < 0.001) and TNF-α, and a higher proportion of regulatory T-cell markers, suggesting an attenuated inflammatory response. In contrast, non-immunized children had elevated pro-inflammatory cytokines and a higher neutrophil-to-lymphocyte ratio. Multivariate logistic regression analysis identified full immunization as an independent predictor for reduced cough severity (adjusted OR 0.47, 95% CI 0.33–0.67, p < 0.001). Conclusions: The findings indicate that full immunization is associated with a more favorable immunological response in children with cough, leading to milder clinical manifestations. This study supports the role of immunization in modulating immune responses, thereby aiding in the diagnostic evaluation and management of pediatric cough.
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References
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