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Won YK, Cho SI, Chung EH. Analysis of exacerbating factors of pediatric asthma before and after the COVID-19 pandemic. World Allergy Organ J 2024; 17:100961. [PMID: 39310370 PMCID: PMC11415765 DOI: 10.1016/j.waojou.2024.100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 07/18/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose The incidence of the existing respiratory virus and air pollutants had disappeared or decreased due to social distancing during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, there was no increase in asthma exacerbations in 2020. This study aimed to analyze the emergency department (ED) visits of children and adolescent patients with asthma before and after the COVID-19 outbreak and examine the effects of respiratory virus infection and air pollutants. Methods This study included pediatric and adolescent patients with asthma aged 2-18 years who visited 419 EDs nationwide during February to December in 2018, 2019, and 2020. The patients who were diagnosed with asthma, ie, J45 or J46 (International Classification of Diseases, 10th revision) in the ED medical history, diagnosis history at discharge, and diagnosis at discharge after hospitalization through the ED were included using the National Emergency Department Information System. Data were analyzed by dividing the period as follows: pre-COVID-19 (from February to December 2018 and 2019) and COVID-19 pandemic (from February to December 2020). Results The monthly average of 673 visiting patients (95% confidence interval [CI], 474-872) during the pre-COVID-19 period decreased to 176 (95% CI, 113-239) during the COVID-19 pandemic, which is a 73.8% decrease (p < 0.001).In the pre-COVID-19 period, peaks were observed in spring and autumn. Meanwhile, during the COVID-19 pandemic, a peak was observed only during autumn. During the COVID-19 pandemic, no relationship was found between the rhinovirus infection and asthma exacerbations (p < 0.001). Conclusions Respiratory virus infections are strongly associated with asthma exacerbations in children and adolescents. In this study, air pollution is not a major factor for ER visits due to asthma exacerbations. Even though the prevalence of respiratory viruses is decreasing, ED visits due to worsening asthma are trending in the fall. This phenomenon may indicate that asthma has worsened due to other causes such as pollen or fluctuations in temperature and air pressure.
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Affiliation(s)
- Youn Kyoung Won
- Department of Pediatrics, Pocheon Woori Hospital, Pocheon-si, Gyeonggi-do, South Korea
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, South Korea
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Weary TE, Pappas T, Tusiime P, Tuhaise S, Otali E, Emery Thompson M, Ross E, Gern JE, Goldberg TL. Common cold viruses circulating in children threaten wild chimpanzees through asymptomatic adult carriers. Sci Rep 2024; 14:10431. [PMID: 38714841 PMCID: PMC11076286 DOI: 10.1038/s41598-024-61236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
Reverse zoonotic respiratory diseases threaten great apes across Sub-Saharan Africa. Studies of wild chimpanzees have identified the causative agents of most respiratory disease outbreaks as "common cold" paediatric human pathogens, but reverse zoonotic transmission pathways have remained unclear. Between May 2019 and August 2021, we conducted a prospective cohort study of 234 children aged 3-11 years in communities bordering Kibale National Park, Uganda, and 30 adults who were forest workers and regularly entered the park. We collected 2047 respiratory symptoms surveys to quantify clinical severity and simultaneously collected 1989 nasopharyngeal swabs approximately monthly for multiplex viral diagnostics. Throughout the course of the study, we also collected 445 faecal samples from 55 wild chimpanzees living nearby in Kibale in social groups that have experienced repeated, and sometimes lethal, epidemics of human-origin respiratory viral disease. We characterized respiratory pathogens in each cohort and examined statistical associations between PCR positivity for detected pathogens and potential risk factors. Children exhibited high incidence rates of respiratory infections, whereas incidence rates in adults were far lower. COVID-19 lockdown in 2020-2021 significantly decreased respiratory disease incidence in both people and chimpanzees. Human respiratory infections peaked in June and September, corresponding to when children returned to school. Rhinovirus, which caused a 2013 outbreak that killed 10% of chimpanzees in a Kibale community, was the most prevalent human pathogen throughout the study and the only pathogen present at each monthly sampling, even during COVID-19 lockdown. Rhinovirus was also most likely to be carried asymptomatically by adults. Although we did not detect human respiratory pathogens in the chimpanzees during the cohort study, we detected human metapneumovirus in two chimpanzees from a February 2023 outbreak that were genetically similar to viruses detected in study participants in 2019. Our data suggest that respiratory pathogens circulate in children and that adults become asymptomatically infected during high-transmission times of year. These asymptomatic adults may then unknowingly carry the pathogens into forest and infect chimpanzees. This conclusion, in turn, implies that intervention strategies based on respiratory symptoms in adults are unlikely to be effective for reducing reverse zoonotic transmission of respiratory viruses to chimpanzees.
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Affiliation(s)
- Taylor E Weary
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
| | - Tressa Pappas
- Department of Paediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Emily Otali
- The Kasiisi Project, Fort Portal, Uganda
- Kibale Chimpanzee Project, Fort Portal, Uganda
| | - Melissa Emery Thompson
- Kibale Chimpanzee Project, Fort Portal, Uganda
- Department of Anthropology, University of New Mexico, Albuquerque, NM, USA
| | | | - James E Gern
- Department of Paediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tony L Goldberg
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA.
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Weary TE, Tusiime P, Tuhaise S, Mandujano Reyes JF, Ross E, Gern JE, Goldberg TL. Respiratory disease patterns in rural Western Uganda, 2019-2022. Front Pediatr 2024; 12:1336009. [PMID: 38650995 PMCID: PMC11033374 DOI: 10.3389/fped.2024.1336009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Respiratory disease is a major cause of morbidity and mortality in the developing world, but prospective studies of temporal patterns and risk factors are rare. Methods We studied people in rural Western Uganda, where respiratory disease is pervasive. We followed 30 adults (ages 22-51 years; 534 observations) and 234 children (ages 3-11 years; 1,513 observations) between May 2019 and July 2022 and collected monthly data on their respiratory symptoms, for a total of 2,047 case records. We examined associations between demographic and temporal factors and respiratory symptoms severity. Results The timing of our study (before, during, and after the emergence of COVID-19) allowed us to document the effects of public health measures instituted in the region. Incidence rates of respiratory symptoms before COVID-19 lockdown were 568.4 cases per 1,000 person-months in children and 254.2 cases per 1,000 person-months in adults. These rates were 2.6 times higher than the 2019 global average for children but comparable for adults. Younger children (ages 3-6 years) had the highest frequencies and severities of respiratory symptoms. Study participants were most likely to experience symptoms in February, which is a seasonal pattern not previously documented. Incidence and severity of symptoms in children decreased markedly during COVID-19 lockdown, illustrating the broad effects of public health measures on the incidence of respiratory disease. Discussion Our results demonstrate that patterns of respiratory disease in settings such as Western Uganda resemble patterns in developed economies in some ways (age-related factors) but not in others (increased incidence in children and seasonal pattern). Factors such as indoor air quality, health care access, timing of school trimesters, and seasonal effects (rainy/dry seasons) likely contribute to the differences observed.
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Affiliation(s)
- Taylor E. Weary
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
| | | | | | | | | | - James E. Gern
- Department of Pediatrics, University of Wisconsin Hospital and Clinics, Madison, WI, United States
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
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Potts BK, Pelletier JH, Rawdon L, Forbes ML. Short stay unit led by pediatric hospital medicine advanced practice providers. J Hosp Med 2024; 19:83-91. [PMID: 38151792 DOI: 10.1002/jhm.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND In response to a critical pediatric bed shortage in 2022, an urgent process change was required to provide safe and timely medical care. We proposed a pilot for an advanced practice provider (APP)-run short stay unit (SSU) for select pediatric hospital medicine (PHM) patients. OBJECTIVE To compare length of stay (LOS) and cost before and after implementation of a PHM APP-led SSU pilot at a tertiary pediatric hospital. DESIGNS, SETTINGS, AND PARTICIPANTS Single-center prospective pilot observational cohort study with historical control. Observation encounters for patients with asthma, bronchiolitis, croup, and dehydration were included. INTERVENTION An independent-practice model SSU staffed by APPs on the PHM service. MAIN OUTCOME AND MEASURES SSU encounters (September 1, 2022-December 1, 2022) were compared against pre-SSU encounters (September 1, 2021-August 31, 2022). Cohorts were described with summary statistics. SSU encounters were matched against pre-SSU encounters based on demographics and diagnosis, and the average effect of treatment was calculated. LOS was abstracted from the enterprise data warehouse and standardized unit cost from the Pediatric Health Information Systems database. RESULTS There were 1110 encounters included, 155 in the SSU cohort and 955 in the pre-SSU cohort: 24.2% asthma, 30.8% bronchiolitis, 8.3% croup, and 36.7% dehydration. Median (interquartile range) unit LOS decreased from 21 (16-26) to 18 (10-22) h, p < .001. Cost decreased from $3593 ($3031-$4560) to $2958 ($2278-$3856), p < .001. After matching, the average treatment effect was reduction of 3.88 h (95% confidence interval [CI] 1.91-5.85) and $593 (95% CI $348-$839). There were no significant differences in 7-day ED revisit rates.
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Affiliation(s)
- Brittany K Potts
- Division of Hospital Medicine, Akron Children's Hospital, Akron, Ohio, USA
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Jonathan H Pelletier
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA
| | - Leah Rawdon
- Division of Hospital Medicine, Akron Children's Hospital, Akron, Ohio, USA
| | - Michael L Forbes
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
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Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol 2023; 21:195-210. [PMID: 36253478 PMCID: PMC9574826 DOI: 10.1038/s41579-022-00807-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 01/14/2023]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused substantial global morbidity and deaths, leading governments to turn to non-pharmaceutical interventions to slow down the spread of infection and lessen the burden on health care systems. These policies have evolved over the course of the COVID-19 pandemic, including after the availability of COVID-19 vaccines, with regional and country-level differences in their ongoing use. The COVID-19 pandemic has been associated with changes in respiratory virus infections worldwide, which have differed between virus types. Reductions in respiratory virus infections, including by influenza virus and respiratory syncytial virus, were most notable at the onset of the COVID-19 pandemic and continued in varying degrees through subsequent waves of SARS-CoV-2 infections. The decreases in community infection burden have resulted in reduced hospitalizations and deaths associated with non-SARS-CoV-2 respiratory infections. Respiratory virus evolution relies on the maintaining of a diverse genetic pool, but evidence of genetic bottlenecking brought on by case reduction during the COVID-19 pandemic has resulted in reduced genetic diversity of some respiratory viruses, including influenza virus. By describing the differences in these changes between viral species across different geographies over the course of the COVID-19 pandemic, we may better understand the complex factors involved in community co-circulation of respiratory viruses.
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Affiliation(s)
- Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
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Paediatric group A streptococcal disease in England from October to December, 2022. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:e2-e4. [PMID: 36566755 DOI: 10.1016/s2352-4642(22)00374-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
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Thanik E, Harada K, Garland E, Bixby M, Bhatia J, Lopez R, Galvez S, Dayanov E, Vemuri K, Bush D, DeFelice NB. Impact of COVID-19 on pediatric asthma-related healthcare utilization in New York City: a community-based study. BMC Pediatr 2023; 23:41. [PMID: 36691011 PMCID: PMC9868511 DOI: 10.1186/s12887-023-03845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND COVID-19 disproportionately affects families of low socioeconomic status and may worsen health disparities that existed prior to the pandemic. Asthma is a common chronic disease in children exacerbated by environmental exposures. METHODS A cross-sectional survey was conducted to understand the impact of the initial stage of the pandemic on environmental and social conditions, along with access to care for children with asthma in New York City (NYC). Participants were recruited from a community-based organization in East Harlem and a nearby academic Pediatric Pulmonary clinic and categorized as having either public or private insurance (n = 51). RESULTS Factors significantly associated with public compared to private insurance respectively were: increased reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%). Participants with public insurance were more likely to experience conditions less conducive to social distancing compared to respondents with private insurance, such as remaining in NYC (92% vs 38%) and using public transportation (44% vs 4%); families with private insurance also had greater access to remote work (81% vs 8%). Families with public insurance were significantly more likely to test positive for SARS-CoV-2 (48% vs 15%) but less likely to have gotten tested (76% vs 100%). Families with public insurance also reported greater challenges accessing office medical care and less access to telehealth, although not statistically significant (44% vs 19%; 68% vs 85%, respectively). CONCLUSIONS Findings highlight disproportionate burdens of the pandemic, and how these disparities affect children with asthma in urban environments.
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Affiliation(s)
- Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Kaoru Harada
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Garland
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Moira Bixby
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Jasmine Bhatia
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Ray Lopez
- LSA Family Health Service, New York, NY, USA
| | | | - Elan Dayanov
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Krishna Vemuri
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Douglas Bush
- Department of Pediatrics, Division of Pulmonary, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas B DeFelice
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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