In Qinghai-Tibet the incidence or prevalence of PHAHD or ISMS is corresponding higher. From 1978 to 1985, an epidemiological study on PHAHD among 6,823 Han infants and children (after birth to 14 years of age) was carried out on the Qinghai-Tibetan plateau. The diagnosis of PHAHD was based on history, symptoms, clinical examination, electrocardiogra-phy (ECG), echocardiography, chest radiography, blood count and arterial oxygen saturation (see below). Incidence was 3.66% among Han infants and 1.52% in Han children at 3050 to 5226 m. The incidence increased with increasing altitude and decreased with increasing age .
In the 70s to 80s of the 20th century in Tibet, a very high prevalence of PHAHD was also represented by the hospital pediatric population. In the Tibetan People's Hospital in Lhasa (3658 m), a total of 238 patients with PHAHD had been admitted to the hospital, during the period from 1/1962 to 12/1963, making a prevalence of 20.7% for the disease in the total hospital pediatric population . During the period from 1/1974 to 12/1975, a total of 412 patients with PHAHD were admitted to the same hospital, accounting for 16.2% of pediatric cases hospitalized during the same period . All the above patients were of Han origin except two, who were native Tibetans.
Over the next two decades, more effective prevention among the altitude children was performed in Tibet, but the incidence of the disease decreased slowly because changing poor acclimatization of the Han children is difficult and takes time.
We found no clear data on the incidence of PHAHD or ISMS in South and North American children. However, more than ten million children have been born and live permanently above 3000 m in the mountainous areas of the world. In addition, several million individuals visit high altitudes annual for work or for recreation, some of them with their children and thus the risk of acute and subacute mountain sickness in these children will increase. Therefore, questions about the altitude tolerance of children are receiving increasing attention.
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