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Friedrich F, Lumertz MS, Petry LM, Pieta MP, Bittencourt LB, Nunes BB, Garcia LDCE, Antunes MOB, Scotta MC, Stein RT, Jones MH, Comaru T, Pinto LA. Seasonality of the incidence of bronchiolitis in infants - Brazil, 2016-2022: An interrupted time-series analysis. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 43:e2023203. [PMID: 38985050 PMCID: PMC11251454 DOI: 10.1590/1984-0462/2025/43/2023203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/03/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To evaluate the seasonality of acute bronchiolitis in Brazil during the 2020-2022 season and compare it with the previous seasons. METHODS Data from the incidence of hospitalizations due to acute bronchiolitis in infants <1 year of age were obtained from the Department of Informatics of the Brazilian Public Health database for the period between 2016 and 2022. These data were also analyzed by macro-regions of Brazil (North, Northeast, Southeast, South, and Midwest). To describe seasonal and trend characteristics over time, we used the Seasonal Autoregressive Integrated Moving Averages Model. RESULTS Compared to the pre-COVID-19 period, the incidence of hospitalizations related to acute bronchiolitis decreased by 97% during non-pharmacological interventions (March 2020 - August 2021) but increased by 95% after non-pharmacological interventions relaxation (September 2021 - December 2022), resulting in a 16% overall increase. During the pre-COVID-19 period, hospitalizations for acute bronchiolitis followed a seasonal pattern, which was disrupted in 2020-2021 but recovered in 2022, with a peak occurring in May, approximately 4% higher than the pre-COVID-19 peak. CONCLUSIONS This study underscores the significant influence of COVID-19 interventions on acute bronchiolitis hospitalizations in Brazil. The restoration of a seasonal pattern in 2022 highlights the interplay between public health measures and respiratory illness dynamics in young children.
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Affiliation(s)
- Frederico Friedrich
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Magali Santos Lumertz
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Lucas Montiel Petry
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Marina Puerari Pieta
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | - Bruno Brocker Nunes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | | | | | - Renato Tetelbom Stein
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Marcus Herbert Jones
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Talitha Comaru
- Instituto Federal de Education, Ciência e Tecnologia de Farroupilha, Santo Ângelo, RS, Brazil
| | - Leonardo Araújo Pinto
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Brisca G, Strati MF, Buratti S, Mariani M, Ferretti M, Pirlo D, Meleca V, Piccotti E, Castagnola E, Moscatelli A. The increase of bronchiolitis severity in the 2022-2023 season in an Italian tertiary children's hospital: An isolated phenomenon or a warning sign? Pediatr Pulmonol 2024; 59:1236-1245. [PMID: 38289096 DOI: 10.1002/ppul.26891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 04/30/2024]
Abstract
AIM Recent literature has shown epidemiological changes in bronchiolitis with an increased incidence in the post-SARS-CoV-2 pandemic period but reports regarding disease severity are conflicting. We aimed to describe the epidemiology, disease severity, and microbiology of bronchiolitis during the 2022-2023 cold season compared to the previous 5 years. METHODS This single-center retrospective observational study at IRCCS Gaslini, Italy, included all children aged 0-2 years hospitalized for bronchiolitis from 1 September 2017 to 31 August 2023. Findings from the 2022-2023 season were compared to the previous 5 years. RESULTS We observed a statistically significant increase in the 2022-2023 season in the absolute number of bronchiolitis admissions. Children who required mechanical ventilation (MV) dramatically increased from a total of seven patients in the previous five seasons to 17 in the 2022-2023 season alone (p = .001). All other severity parameters significantly increased: the need for respiratory support (p = .002), the median length of stay (5 days vs. 4 days, p = .001), and the median duration of respiratory support (4 days vs. 3 days, p = .016). CONCLUSIONS We report a substantial increase in the severity of bronchiolitis in the season 2022-2023 with a remarkable number of previously healthy infants requiring MV. Further studies are needed to confirm whether our findings are an isolated phenomenon or part of a true global trend. Health systems need to be prepared and protective preventive measures should be implemented for all newborns.
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Affiliation(s)
- Giacomo Brisca
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Maternal and Child Health, DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Silvia Buratti
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marcello Mariani
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Ferretti
- Paediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Pirlo
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Vincenzo Meleca
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Maternal and Child Health, DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Emanuela Piccotti
- Paediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Peri F, Lorenzon B, Cason C, Amaddeo A, Norbedo S, Comar M, Barbi E, Cozzi G. Urgent Hospitalizations Related to Viral Respiratory Disease in Children during Autumn and Winter Seasons 2022/2023. Viruses 2023; 15:2425. [PMID: 38140665 PMCID: PMC10748011 DOI: 10.3390/v15122425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
AIM The loosening of social distancing measures over the past two years has led to a resurgence of seasonal epidemics associated with respiratory viral infections in children. We aim to describe the impact of such infections through urgent hospitalizations in a pediatric emergency department. METHODS We performed a retrospective review of medical records of all children and adolescents with a positive nasal swab admitted at the children's hospital IRCCS Burlo Garofolo of Trieste, in Italy, from September 2021 to March 2022, and September 2022 to March 2023. RESULTS Respiratory Syncytial Virus and Influenza viruses accounted for up to 55% of hospitalizations for respiratory infections during the study periods. During the last season, the number of hospitalizations related to the Influenza virus was five times higher than those related to SARS-CoV-2 (25% vs. 5%). Respiratory Syncytial Virus was associated with a greater need for respiratory support, mostly HFNC (High Flow Nasal Cannula). CONCLUSIONS Respiratory Syncytial Virus and Influenza virus had a more significant impact on urgent hospitalizations during the past wintery seasons than SARS-CoV-2.
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Affiliation(s)
- Francesca Peri
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; (B.L.); (E.B.)
| | - Beatrice Lorenzon
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; (B.L.); (E.B.)
| | - Carolina Cason
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34100 Trieste, Italy; (C.C.); (M.C.)
| | - Alessandro Amaddeo
- Emergency Department, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34100 Trieste, Italy; (A.A.); (S.N.); (G.C.)
| | - Stefania Norbedo
- Emergency Department, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34100 Trieste, Italy; (A.A.); (S.N.); (G.C.)
| | - Manola Comar
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34100 Trieste, Italy; (C.C.); (M.C.)
- Department of Medical Sciences, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; (B.L.); (E.B.)
- Department of Pediatrics, Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy
| | - Giorgio Cozzi
- Emergency Department, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34100 Trieste, Italy; (A.A.); (S.N.); (G.C.)
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Orzołek I, Ambrożej D, Makrinioti H, Zhu Z, Jartti T, Feleszko W. Severe bronchiolitis profiling as the first step towards prevention of asthma. Allergol Immunopathol (Madr) 2023; 51:99-107. [PMID: 37169566 DOI: 10.15586/aei.v51i3.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 05/13/2023]
Abstract
Bronchiolitis is the most common respiratory infection leading to hospitalization and constitutes a significant healthcare burden. The two main viral agents causing bronchiolitis, respiratory syncytial virus (RSV) and rhinovirus (RV), have distinct cytopathic, immune response, and clinical characteristics. Different approaches have been suggested for subtyping bronchiolitis based on viral etiology, atopic status, transcriptome profiles in blood, airway metabolome, lipidomic data, and airway microbiota. The highest risk of asthma at school age has been in a subgroup of bronchiolitis characterized by older age, high prevalence of RV infection, previous breathing problems, and/or eczema. Regarding solely viral etiology, RV-bronchiolitis in infancy has been linked to a nearly three times higher risk of developing asthma than RSV-bronchiolitis. Although treatment with betamimetics and systemic corticosteroids has been found ineffective in bronchiolitis overall, it can be beneficial for infants with severe RV bronchiolitis. Thus, there is a need to develop a more individualized therapeutic approach for bronchiolitis and follow-up strategies for infants at higher risk of asthma in the future perspective.
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Affiliation(s)
- Izabela Orzołek
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Ambrożej
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhaozhong Zhu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tuomas Jartti
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, University of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland;
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