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Wang P, Zhang Z, Fang K, Yao J, Huang X, Lu S. Analysis of the epidemic characteristics of common respiratory pathogens infection in children in a 3A special hospital. BMC Infect Dis 2024; 24:879. [PMID: 39210260 PMCID: PMC11360472 DOI: 10.1186/s12879-024-09784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To analyze the epidemic characteristics of common respiratory tract infection pathogens in children with respiratory tract infection, and provide scientific basis for the prevention and control of respiratory tract infection. METHODS A retrospective collection of clinical data was conducted on 11,538 children with respiratory tract infections at Luoyang Maternal and Child Health Hospital from December 2022 to November 2023. The types of respiratory tract infections, including upper and lower respiratory tract infections, as well as five respiratory pathogens: influenza A virus (influenza A), influenza B virus (influenza B virus, adenovirus (ADV), respiratory syncytial virus (RSV), and Mycoplasma pneumoniae (MP) infections, were analyzed and compared for different genders, ages, temperatures, and air quality in different months; And the changes of five pathogens in children with respiratory tract infections of different disease severity. RESULTS From December 2022 to November 2023, a total of 11,538 children with respiratory infections were included in the analysis, including 6436 males and 5102 females, with an age of 4.92 ± 2.03 years. The proportion of upper respiratory tract infections is as high as 72.17%, and lower respiratory tract infections account for 27.83%. Among them, 2387 were positive for Flu A antigen, with a positive rate of 20.69%, 51 cases were positive for Flu B antigen, and the positive rate was 0.4%, 1296 cases were positive for adv antigen, with a positive rate of 11.23%, 868 cases were positive for RSV antigen, with a positive rate of 7.52%, 2481 cases were positive for MP IgM antibody or MP antigen, and the positive rate was 21.50%. Flu B in male children The infection rate of ADV and MP was higher than that of female children (p < 0.05); Among children in different age groups, the older the age, the older the Flu A The higher the infection rate of MP (p < 0.05), the higher the positive rate of RSV in children with younger age (p < 0.05). The positive rate of ADV in children aged 3-6 years and > 6 years was higher than that in children aged 0-3 years (p < 0.05); Flu A and MP are popular throughout the year, and the positive rate peaks during the period of temperature rise and air quality decline from February to March, and during the period of temperature drop and air quality index rise from August to November, The positive rate of RSV peaked after the turning point of temperature rise from March to April. The infection rate was higher during the period of sharp decline in air quality from March to May and sharp decline in temperature in November, The positive rate of ADV was higher at the turning point of temperature rise from February to March, and then the infection rate decreased. During the period of sharp temperature drop from August to November, the positive rate increased sharply, and the peak of infection occurred; As the disease worsens, The positive rates of Flu A, Flu B, RSV, MP and combined infection with more than two pathogens were all increased (p < 0.05). CONCLUSION After the new coronavirus epidemic in 2022, Flu A and MP have the highest infection rate of respiratory pathogens in children, showing a peak growth in general, with epidemic characteristics changing with environmental temperature, air quality and seasons. The main disease type is upper respiratory tract infection, MP and adv infections were mainly in male children, Flu A, MP and ADV infections are more common in older children, RSV infection was more common in younger children; Flu A, Flu B, RSV and MP infection and the co infection of more than two pathogens may more easily lead to the occurrence of severe pneumonia.
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Affiliation(s)
- Pingping Wang
- Department of Medical Laboratory, Luoyang Maternal and Child Health Hospital, 206 Tongqu Road, Luolong District, Luoyang City, Henan Province, 471000, China.
| | - Zhanjun Zhang
- Department of Medical Laboratory, Luoyang Maternal and Child Health Hospital, 206 Tongqu Road, Luolong District, Luoyang City, Henan Province, 471000, China
| | - Kenan Fang
- Department of Critical Care Medicine, Luoyang Maternal and Child Health Hospital, 206 Tongqu Road, Luolong District, Luoyang City, Henan Province, China
| | - Jin Yao
- Department of Infection and Public Health Management, The Second Affiliated Hospital of Henan University of Science and Technology, No. 80 Jinguyuan Road, Xigong District, Luoyang City, Henan Province, China
| | - Xiaorong Huang
- Luoyang Research Center for Inheritance and Innovation of Chinese Historical Civilization, Luoyang Institute of Science and Technology School of Marxism (LIT), Luolong District, No. 90 Wangcheng Avenue, Luoyang City, Henan Province, China
| | - Shouting Lu
- Luoyang Community Construction and Social Development Research Center, Luoyang Institute of Science and Technology School of Marxism (LIT), No. 90 Wangcheng Avenue, Luolong District, Luoyang City, Henan Province, China
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Mao S, Wu L. Coinfection of viruses in children with community-acquired pneumonia. BMC Pediatr 2024; 24:457. [PMID: 39014398 PMCID: PMC11250944 DOI: 10.1186/s12887-024-04939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Virus, particularly respiratory tract virus infection is likely to co-occur in children with community-acquired pneumonia (CAP). Study focusing on the association between common viruses coinfection and children with CAP is rare. We aimed to study the association between seven common viruses coinfection and clinical/laboratory indexes in children with CAP. METHODS Six hundred and eighty-four CAP cases from our hospital were enrolled retrospectively. Seven common viruses, including influenza A (FluA), influenza B (FluB), human parainfluenza virus (HPIV), Esptein-Barr virus (EBV), coxsackie virus (CoxsV), cytomegalovirus (CMV), and herpes simplex virus (HSV) were investigated for their associations with CAP. We analyzed the differences of hospitalization days, white blood cell (WBC), c-reactive protein (CRP), platelet (PLT), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), urine red blood cell (uRBC), blood urea nitrogen (BUN), serum creatinine (Scr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase isoenzyme (CKMB) among different viruses coinfection groups by using one-way ANOVA analysis. The differences of clinical/laboratory indexes between ordinary and severe pneumonia groups, as well as non-virus vs multi co-infection viruses groups, and single vs multi co-infection viruses groups by using independent samples T test. Receiver operating characteristic (ROC) curve analyses were applied to test the the predictive value of the clinical/laboratory parameters for the risk of viruses coinfections among CAP. Binary logistic analysis was performed to test the association between various indexes and viruses co-infection. RESULTS Eighty-four multiple viruses coinfections yielded different prognosis compared with that in 220 single virus coinfection. CMV coinfection was associated with longest hospitalization days, highest ALT, AST and CKMB level. HSV coinfection was associated with highest WBC count, CRP, ESR, and BUN. EBV coinfection was associated with highest PLT and PCT level. FluB coinfection was associated with highest Scr level. CoxsV coinfection was associated with highest uRBC, LDH and CK level. ROC curve analyses showed that CK had the largest area under the curve (AUC: 0.672, p < 10-4) for the risk of viruses coinfections risk in CAP. Significant association between PLT, uRBC, BUN, CK, and CKMB and virus coinfection risk in CAP was observed. CONCLUSIONS Multiple viruses coinfections indicated different prognosis. Different viruses coinfection yielded varying degrees of effects on the cardiac, liver, kidney and inflamatory injury in CAP. The alterations of clinical/laboratory parameters, particularly CK may be associated with the risk of viruses coinfections in CAP.
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Affiliation(s)
- Song Mao
- Department of Pediatrics, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Liangxia Wu
- Department of Pediatrics, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chen W, Gu Y, Ma Y, Dong L, Pan L, Ji C, Guo L, Qi L, Zhang Y, Gao F. Profiling lipid mediators in serum from children with H1N1 influenza. Sci Rep 2024; 14:15186. [PMID: 38956313 PMCID: PMC11219859 DOI: 10.1038/s41598-024-66190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/28/2024] [Indexed: 07/04/2024] Open
Abstract
Influenza A virus subtype H1N1 can cause severe acute respiratory distress syndrome and death in young children and elderly individuals. H1N1 initiates inflammatory responses that aim to contain and eliminate microbial invaders. Various lipid mediators (LMs) are biosynthesized and play a critical role in fighting viruses during inflammation; thus, by profiling the LMs in patients, researchers can obtain mechanistic insights into diseases, such as the pathways disrupted. To date, the relationship between molecular alterations in LMs and the pathogenesis of H1N1 influenza in children is poorly understood. Here, we employed a targeted liquid chromatography coupled with tandem mass spectrometry (LC‒MS/MS) to profile LMs in serum from children with H1N1 influenza (H1N1 children) and recovered children. We found that 22 LM species were altered in H1N1 children with mild symptoms. Analysis of the LM profiles of recovered children revealed a decrease in the levels of thromboxane B2 (TxB2) and thromboxane B3 (TxB3) and an increase in the levels of other 8 altered LM species associated with H1N1 influenza, including cytochrome P450 (CYP) enzyme-derived dihydroxyeicosatrienoic acids (DiHETrEs) and hydroxyeicosatetraenoic acids (HETEs) from arachidonic acid (AA), and epoxyoctadecamonoenoic acids (EpOMEs) from linoleic acid (LA). Taken together, the results of this study revealed that serum LMs change dynamically in H1N1 children with mild symptoms. The dramatically altered LMs in H1N1 children could serve as a basis for potential therapeutics or adjuvants against H1N1 influenza.
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Affiliation(s)
- Weijun Chen
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yitao Gu
- Department of Pediatrics, Shaoxing Shangyu Maternal and Child Health Care Hospital, Shangyu District, Shaoxing, China
| | - Yongjun Ma
- Department of Pediatrics, Shaoxing Shangyu Maternal and Child Health Care Hospital, Shangyu District, Shaoxing, China
| | - Lele Dong
- Durbrain Medical Laboratory, Hangzhou, 310000, Zhejiang, China
| | - Liangxuan Pan
- Durbrain Medical Laboratory, Hangzhou, 310000, Zhejiang, China
| | - Chai Ji
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lanlan Guo
- Department of Pediatrics, Shaoxing Shangyu Maternal and Child Health Care Hospital, Shangyu District, Shaoxing, China
| | - Lianxin Qi
- Department of Clinical Laboratory, Shaoxing Shangyu Maternal and Child Health Care Hospital, Shangyu District, Shaoxing, China
| | - Yuanyuan Zhang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Fei Gao
- Durbrain Medical Laboratory, Hangzhou, 310000, Zhejiang, China.
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Decker SRDR, Wolf JM, Pille A, Freese L, Petek H, de Oliveira Rocha B, Giannini GLT, Bristot G, Andreis TF, de Oliveira FH, Hoffmann EDS, Kunde L, Kern M, Schmitz P, Maccari J, Nedel W, Zavascki AP, Rosa RG, Mutlaq MP, Nasi LA. Temporal trends in respiratory pathogens following the COVID-19 pandemic and climate variables: A unicentric retrospective evaluation of 24 pathogens in a temperate subtropical region. J Med Virol 2024; 96:e29797. [PMID: 38988215 DOI: 10.1002/jmv.29797] [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: 11/15/2023] [Revised: 06/09/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Temperature and humidity are studied in the context of seasonal infections in temperate and tropical zones, but the relationship between viral trends and climate variables in temperate subtropical zones remains underexplored. Our retrospective study analyzes respiratory pathogen incidence and its correlation with climate data in a subtropical zone. Retrospective observational study at Moinhos de Vento Hospital, South Brazil, aiming to assess seasonal trends in respiratory pathogens, correlating them with climate data. The study included patients of all ages from various healthcare settings, with data collected between April 2022 and July 2023. Biological samples were analyzed for 24 pathogens using polymerase chain reaction and hybridization techniques; demographic variables were also collected. The data was analyzed descriptively and graphically. Spearman tests and Poisson regression were used as correlation tests. Tests were clustered according to all pathogens, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses, rhinovirus, and respiratory syncytial virus (RSV). Between April 2022 and July 2023, 3329 tests showed a 71.6% positivity rate. Rhinovirus and RSV predominated, exhibiting seasonal patterns. Temperature was inversely correlated with the viruses, notably rhinovirus, but SARS-CoV-2 was positively correlated. Air humidity was positively correlated with all pathogens, RSV, rhinovirus, and atmospheric pressure with all pathogens and rhinovirus. Our results showed statistically significant correlations, with modest effect sizes. Our study did not evaluate causation effects. Despite the correlation between climate and respiratory pathogens, our work suggests additional factors influencing transmission dynamics. Our findings underscore the complex interplay between climate and respiratory infections in subtropical climates.
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Affiliation(s)
| | - Jonas Michel Wolf
- Office of Value and Clinical Practice, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Arthur Pille
- Office of Value and Clinical Practice, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Luana Freese
- Laboratory of Genetics and Molecular Biology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Helena Petek
- Office of Value and Clinical Practice, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Bruna de Oliveira Rocha
- Laboratory of Genetics and Molecular Biology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | - Giovana Bristot
- Laboratory of Genetics and Molecular Biology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Tiago Finger Andreis
- Laboratory of Genetics and Molecular Biology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | | | - Luciana Kunde
- Internal Medicine Service, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Marcelo Kern
- Internal Medicine Service, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Paulo Schmitz
- Office of Value and Clinical Practice, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Juçara Maccari
- Office of Value and Clinical Practice, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Wagner Nedel
- Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Alexandre Prehn Zavascki
- Infectious Diseases and Infection Control Service, Moinhos de Vento Hospital, Porto Alegre, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Regis Goulart Rosa
- Internal Medicine Service, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | - Luiz Antônio Nasi
- Internal Medicine Service, Moinhos de Vento Hospital, Porto Alegre, Brazil
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Falsaperla R, Sortino V, La Cognata D, Barberi C, Corsello G, Malaventura C, Suppiej A, Collotta AD, Polizzi A, Grassi P, Ruggieri M. Acute Respiratory Tract Infections (ARTIs) in Children after COVID-19-Related Social Distancing: An Epidemiological Study in a Single Center of Southern Italy. Diagnostics (Basel) 2024; 14:1341. [PMID: 39001232 PMCID: PMC11240751 DOI: 10.3390/diagnostics14131341] [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: 03/25/2024] [Revised: 06/06/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
In Sicily (Italy), respiratory syncytial virus (RSV), rhinovirus (HRV), and influenza virus triggered epidemics among children, resulting in an increase in acute respiratory tract infections (ARTIs). Our objective was to capture the epidemiology of respiratory infections in children, determining which pathogens were associated with respiratory infections following the lockdown and whether there were changes in the epidemiological landscape during the post-SARS-CoV-2 pandemic era. MATERIALS AND METHODS We analyzed multiplex respiratory viral PCR data (BioFire® FilmArray® Respiratory Panel 2.1 Plus) from 204 children presenting with respiratory symptoms and/or fever to our Unit of Pediatrics and Pediatric Emergency. RESULTS Viruses were predominantly responsible for ARTIs (99%), with RSV emerging as the most common agent involved in respiratory infections, followed by human rhinovirus/enterovirus and influenza A. RSV and rhinovirus were also the primary agents in coinfections. RSV predominated during winter months, while HRV/EV exhibited greater prevalence than RSV during the fall. Some viruses spread exclusively in coinfections (human coronavirus NL63, adenovirus, metapneumovirus, and parainfluenza viruses 1-3), while others primarily caused mono-infections (influenza A and B). SARS-CoV-2 was detected equally in both mono-infections (41%) and coinfections (59%). CONCLUSIONS Our analysis underlines the predominance of RSV and the importance of implementing preventive strategies for RSV.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, San Marco Hospital, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", University of Catania, 95121 Catania, Italy
- Unit of Clinical Paediatrics, San Marco Hospital, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", 95121 Catania, Italy
- Medical Sciences Department, University of Ferrara, 44124 Ferrara, Italy
| | - Vincenzo Sortino
- Unit of Clinical Paediatrics, San Marco Hospital, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", 95121 Catania, Italy
| | - Daria La Cognata
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Chiara Barberi
- Postgraduate Training Program in Pediatrics, University of Palermo, 90121 Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, 90121 Palermo, Italy
| | | | - Agnese Suppiej
- Medical Sciences Department, University of Ferrara, 44124 Ferrara, Italy
| | - Ausilia Desiree Collotta
- Unit of Clinical Paediatrics, San Marco Hospital, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", 95121 Catania, Italy
| | - Agata Polizzi
- Department of Educational Science, University of Catania, 95123 Catania, Italy
| | - Patrizia Grassi
- Analysis Laboratory, San Marco Hospital, 95121 Catania, Italy
| | - Martino Ruggieri
- Unit of Clinical Pediatrics, AOU "Policlinico", PO "G. Rodolico", University of Catania, 95123 Catania, Italy
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Guo X, Liu C, Zhao Q, Huang S. Efficacy of five different traditional Chinese medicine injections in acute upper respiratory tract infection in children: a network meta-analysis and systematic review. Front Pediatr 2024; 12:1358639. [PMID: 38915872 PMCID: PMC11194337 DOI: 10.3389/fped.2024.1358639] [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: 12/20/2023] [Accepted: 05/10/2024] [Indexed: 06/26/2024] Open
Abstract
Background Acute upper respiratory tract infection (AURI) includes infections caused by a variety of pathogens and is one of the most common diseases in children. Traditional Chinese medicine (TCM) injections are widely used for treating AURI in clinical practice, but their efficacy is unclear because of the lack of clear evidence. In this study, a network meta-analysis (NMA) was used to evaluate the efficacy and safety of TCM injections in the treatment of AURI and to provide a reference for clinical treatment. Methods Eight databases were searched, namely, PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), the Wanfang database, and the Chinese Scientific Journal database (VIP). The search time period was from 1 January 2013 to 1 November 2023. Randomized controlled trials of herbal injections for treating AURI were searched. The Cochrane Risk of Bias 2.0 tool was used to assess the quality of these studies. Review Manager 5.4 and Stata 15.0 were used for the NMA. Results A total of 81 papers involving 11,736 patients were included. These involved five different TCM injections, namely, Xiyanping injection (XYPI), Qingkailing injection (QKLI), Reduning injection (RDNI), Yanhuning injection (YHNI), and Tanreqing injection (TRQI). QKLI was most effective in alleviating symptoms of fever and improving overall clinical effectiveness. TRQI was most effective in relieving cough symptoms. YHNI was most effective in alleviating sore throat, runny nose, and nasal congestion. The overall incidence of adverse effects of these herbal injections in the treatment of AURI was lower, and their safety profiles were better. Conclusions The herbal injections combined with ribavirin improved clinical outcomes, and were superior to ribavirin injection alone in alleviating clinical symptoms such as fever, cough, sore throat, runny nose, and nasal congestion, and have favorable safety profiles. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023484099, CRD42023484099.
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Affiliation(s)
- Xinyi Guo
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Pediatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Changxing Liu
- Graduate Student, Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, China
| | - Qiong Zhao
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Pediatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sajiyue Huang
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Pediatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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AlBahrani S, AlZahrani SJ, Al-Maqati TN, Almehbash A, Alshammari A, Bujlai R, Ba Taweel S, Almasabi F, AlAmari A, Al-Tawfiq JA. Dynamic Patterns and Predominance of Respiratory Pathogens Post-COVID-19: Insights from a Two-Year Analysis. J Epidemiol Glob Health 2024; 14:311-318. [PMID: 38589755 PMCID: PMC11176149 DOI: 10.1007/s44197-024-00213-9] [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: 01/05/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Respiratory tract infections (RTIs) stand out as the most frequent causes leading to visits to the emergency department and hospitalizations. This study aims to assess the types and prevalence of respiratory infections across two years following the end of the COVID-19 pandemic. METHODS Patients presenting with an influenza-like illness (ILI) were tested using multiplex RT-PCR (QIAstat-Dx, Qiagen). The multiplexed RT- PCR test detects 21 respiratory viruses and bacteria. RESULTS During the study period, PCR test was done on a total of 1,790 samples were tested, and 712 (40%) were positive for a total of 796 pathogens. The mean age (± SD) of the participants was 20.1 ± 28.4 years in 2022 and 21.9 ± 27.6 years in 2023. Among the detected pathogens, the most prevalent were Rhinovirus/Enterovirus 222 (12.4%), followed by RSV A&B (103 cases, 5.7%), and H1N1 Influenza (77 cases, 4.3%). Additionally, Influenza A/B constituted 172 (9.6%) while parainfluenza constituted (58, 3.2%). SARS-CoV-2 was identified in 3.97% of the samples. Over the two-year period, the monthly pattern of the identified pathogens exhibited fluctuations in the prevalence. Furthermore, variations were observed in the detected pathogens across different age groups. CONCLUSION In addition to adding significant knowledge to the field of respiratory viral infections, this study emphasizes the necessity of ongoing research and surveillance for the detection and characterization of respiratory viruses, particularly those with the potential for emergence. Such studies would also require setting up a strategy for genotyping and/or sequencing of viruses.
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Affiliation(s)
- Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
- College of medicine-Imam Abdulrahaman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Thekra N Al-Maqati
- Department of Clinical laboratory Science, Prince Sultan Military College of health science, Dammam, Saudi Arabia
| | - Atheer Almehbash
- Molecular laboratory department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Anfal Alshammari
- Molecular laboratory department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Refan Bujlai
- Molecular laboratory department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Sarah Ba Taweel
- Molecular laboratory department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Fares Almasabi
- Radiology Department, Armed Forces Hospital Najran, Najran, Saudi Arabia
| | - Abdullah AlAmari
- Department of pharmacy, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia.
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Zhang L, Wang Y, Xu H, Hao L, Zhao B, Ye C, Zhu W. Prevalence of Respiratory Viruses in Children With Acute Respiratory Infections in Shanghai, China, From 2013 to 2022. Influenza Other Respir Viruses 2024; 18:e13310. [PMID: 38725276 PMCID: PMC11082482 DOI: 10.1111/irv.13310] [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: 09/13/2023] [Revised: 04/05/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND A variety of viruses can cause acute respiratory infections (ARIs), resulting in a high disease burden worldwide. To explore the dominant viruses and their prevalence characteristics in children with ARIs, comprehensive surveillance was carried out in the Pudong New Area of Shanghai. METHODS Between January 2013 and December 2022, the basic and clinical information, and respiratory tract specimens of 0-14 years old children with ARIs were collected in five sentinel hospitals in Shanghai Pudong. Each specimen was tested for eight respiratory viruses, and the positive rates of different age groups, case types (inpatient or outpatient) were analyzed. RESULTS In our study, 30.67% (1294/4219) children with ARIs were positive for at least one virus. Influenza virus (IFV) was the most commonly detected respiratory virus (349/4219, 8.27%), followed by respiratory syncytial virus (RSV) (217/4219, 5.14%), para-influenza virus (PIV) (215/4219, 5.10%), and human coronavirus (HCoV, including 229E, OC43, NL63, and HKU1) (184/4219, 4.36%). IFV was the leading respiratory virus in outpatients aged 5-14 years (201/1673, 12.01%); RSV was the most prevalent respiratory virus in both inpatients (61/238, 25.63%) and outpatients (4/50, 8.00%) for ARI patients aged <6 months old. For PIV, HMPV, HCoV, and HRV, the risk of infection usually was higher among young children. Co-infection with more than two viruses was seen in 3.25% (137/4219). CONCLUSIONS IFV and RSV played important roles in ARIs among children, but the risk populations were different. There are needs for targeted diagnosis and treatment and necessary immunization and non-pharmaceutical interventions.
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Affiliation(s)
- Li Zhang
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
| | - Yuanping Wang
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
| | - Hongmei Xu
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
| | - Lipeng Hao
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
| | - Bing Zhao
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
| | - Chuchu Ye
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
| | - Weiping Zhu
- Shanghai Pudong New Area Center for Disease Control and PreventionShanghaiChina
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Xu D, Chen Z, Zhu G. Change of epidemiological characteristics of four respiratory viral infections in children before and during COVID-19 pandemic. Infect Dis Now 2024; 54:104858. [PMID: 38309644 DOI: 10.1016/j.idnow.2024.104858] [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: 11/20/2023] [Revised: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Viruses are the main infectious agents of acute respiratory infections (ARIs) in children. We aim to describe the changes in epidemic characteristics of viral ARIs in outpatient children before and during the COVID-19 pandemic. PATIENTS AND METHODS From 2017 to 2022, the results of viral detection in oral pharyngeal swabs in 479,236 children with ARIs in the outpatient department of Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. Viral antigens, including adenovirus (ADV), influenza A (FLUA), influenza B (FLUB) and respiratory syncytial virus (RSV) were detected by the colloidal gold method. RESULTS The median age was 3.4 (1.6-5.6) years. Among all the children, 159,895 cases (33.4 %) were positive for at least one virus. The total positive rate for ADV, FLUA and FLUB during the pandemic period was lower than during the pre-pandemic period in every season (pre-pandemic period vs. pandemic period11.7 % vs. 4.7 %, 13.9 % vs. 9.2 %, 7.0 % vs. 5.2 %, respectively, with overall p value < 0.001). However, the positive rate fir RSV was not significantly different between the pre-pandemic period and the pandemic period (5.6 % vs. 5.8 %, p = 0.117). Atypical timing of RSV (summer-autumn 2021) and FLUA (summer 2022) was noted. CONCLUSIONS Public health interventions for different pathogens are maximally effective. While positive rates for ADV, FLUA and FLUB decreased during the COVID-19 pandemic period, positive rates for RSV remained similar. In RSV and FLUA, off-season outbreaks were observed. Measures need to be taken to protect children from possible infection surges due to immunity debt having accrued over the last three years.
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Affiliation(s)
- Dan Xu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China
| | - Zhimin Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China
| | - Guohong Zhu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China.
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Yan H, Zhai B, Yang F, Wang P, Zhou Y. The Impact of Non-pharmacological Interventions Measures Against COVID-19 on Respiratory Virus in Preschool Children in Henan, China. J Epidemiol Glob Health 2024; 14:54-62. [PMID: 38048027 PMCID: PMC11043251 DOI: 10.1007/s44197-023-00168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVES To investigate the long-term effects of non-pharmacological interventions (NPIs) measures on the epidemiological characteristics of common respiratory viruses in preschool children in Henan, China. METHODS This was a retrospective observational study containing data from 17 prefecture-level cities in Henan, China. We analyzed and compared laboratory results and clinical data of preschool children presenting to outpatient clinics for acute respiratory infections (ARTI) after COVID-19 (January 2020-October 2022) and before COVID-19 (December 2017-December 2019). Each year was divided into quarters. The ratio of the odds ratios (ORs) of testing positive for eight respiratory viruses in each year after the pandemic to the prepandemic period was estimated applying a generalized linear model (GLM), using the mean of the positive detection rates in 2018-2019 as a reference. RESULTS A total of 11,400 children were enrolled from December 2017 to October 2022. The number of positive detections for all respiratory viruses decreased in 2020-2022 compared to the average of 2018-2019. Human respiratory syncytial virus (hRSV), human rhinovirus (hRV), and influenza virus (IFV) accounted for a larger proportion of all detected viruses before COVID-19 pandemic, whereas hRV, human bocavirus (hBoV), and human adenovirus (hAdV) accounted for a significantly larger proportion after COVID-19 pandemic. The positive detection rates of enveloped viruses [IFV, human parainfluenza virus (hPIV), hRSV, human metapneumovirus (hMPV), and human coronavirus (hCoV)] decreased sharply and the seasonal activity of these viruses was weakened, while the positive detection rates of non-enveloped viruses (hRV, hBoV, and hAdV) increased, especially hRV. The conditions described above tended to occur more frequently in boys and children older than 1 year, and they were also more sensitive to the NPIs. CONCLUSIONS NPIs transformed the epidemiological profile of common respiratory viruses among preschool children during the COVID-19 pandemic. To improve the overall public health response to all respiratory viruses, interventions targeting non-enveloped viruses need to be strengthened to mitigate their continued transmission.
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Affiliation(s)
- Hui Yan
- Henan Provincial Clinical Research Center for Pediatric Diseases, Henan Key Laboratory of Pediatric Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China
| | - Bo Zhai
- Henan Provincial Clinical Research Center for Pediatric Diseases, Henan Key Laboratory of Pediatric Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China
| | - Fang Yang
- Henan Provincial Clinical Research Center for Pediatric Diseases, Henan Key Laboratory of Pediatric Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China
| | - Penggao Wang
- Henan Provincial Clinical Research Center for Pediatric Diseases, Henan Key Laboratory of Pediatric Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China
| | - Yang Zhou
- Henan Provincial Clinical Research Center for Pediatric Diseases, Henan Key Laboratory of Pediatric Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450018, China.
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11
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Feng Y, Zhang H, Zhang B, Zhou Y, Yuan H. Impact of normalized COVID-19 prevention and control measures on lower respiratory tract infection pathogenesis in hospitalized children. Front Public Health 2024; 12:1367614. [PMID: 38476493 PMCID: PMC10927715 DOI: 10.3389/fpubh.2024.1367614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Objective This study aimed to investigate the epidemiological characteristics of common pathogens contributing to childhood lower respiratory tract infections (LRTIs) in Xiangtan City, Hunan Province before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods A total of 11,891 enrolled patients, aged 1 month to 14 years, diagnosed with LRTIs and admitted to Xiangtan Central Hospital from January 2018 to December 2021 were retrospectively reviewed in this study. Specifically, the epidemiological characteristics of these pathogens before and during the COVID-19 pandemic were analyzed. Results There was a significant decrease in the number of children hospitalized with LRTIs during the COVID-19 pandemic (2020-2021) compared to data from 2018 to 2019 (before the COVID-19 pandemic). Of these cases, 60.01% (7,136/11,891) were male and 39.99% (4,755/11,891) were female. 78.9% (9,381/11,891) cases occurred in children under 4 years of age. The average pathogen detection rate among 11,891 hospitalized LRTIs children was 62.19% (7,395/11,891), with the average pathogen detection rate of 60.33% (4,635/7,682) and 65.57% (2,670/4,209) before and during COVID-19 pandemic, respectively. The detection rates of adenovirus (ADV), bordetella pertussis (BP) and moraxella catarrhalis (M. catarrhalis) decreased dramatically, while the detection rates of influenza viruses (IFV), parainfluenza viruses (PIV), respiratory syncytial virus (RSV), haemophilus influenzae (H. influenzae), streptococcus pneumoniae (S. pneumoniae), and staphylococcus aureus (S. aureus) increased significantly during the COVID-19 pandemic. Overall, RSV, mycoplasma pneumoniae (MP), H. influenzae, and IFV were the major pathogens causing LRTIs in hospitalized children before and during the COVID-19 pandemic. Conclusion Public health interventions for COVID-19 prevention are beneficial to reduce the incidence of LRTIs in children by limiting the prevalence of ADV, MP, BP, and M. catarrhalis, but which have limited restrictive effects on other common LRTIs-associated pathogens. Collectively, the data in this study comprehensively investigated the effects of COVID-19 pandemic on the epidemiological characteristics of respiratory pathogens, which will be beneficial for improving early preventive measures.
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Affiliation(s)
- Yuan Feng
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Huaixiao Zhang
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Bo Zhang
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Yinfei Zhou
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Haibin Yuan
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
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Maison N, Omony J, Rinderknecht S, Kolberg L, Meyer-Bühn M, von Mutius E, Hübner J, von Both U. Old foes following news ways?-Pandemic-related changes in the epidemiology of viral respiratory tract infections. Infection 2024; 52:209-218. [PMID: 37644253 PMCID: PMC10811157 DOI: 10.1007/s15010-023-02085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Following lockdown periods and restricting public health measures in response to the COVID-19 pandemic, respiratory tract infections (RTIs) rose significantly worldwide. This led to an increased burden on children's hospitals compromising medical care of acutely and chronically ill children. We characterized changes in the epidemiological pattern of circulating respiratory viral infections. METHODS We assessed the number of patients with RTIs and the annual distribution of virus detections between 2019 and 2022 based on 4809 clinical samples (4131 patients) from a German pediatric tertiary care-center. We investigated the impact of lockdown periods on spectra of circulating respiratory viruses, pattern of coinfections, age, and seasonality of infections. RESULTS A fourfold increase in the number of respiratory virus detections was observed in 2022 vs 2019 with numbers doubling in 2022 (vs 2021). In 2022, seasonal patterns of circulating virus, particularly Adeno and seasonal Coronavirus were far less pronounced compared to previous years, in fact almost disappeared for Rhinoviruses.". SARS-CoV-2, Parainfluenza- and human Metapneumovirus detections increased significantly in 2022 (2019 vs 2022, p < 0.01). Coinfections with multiple viruses occurred more frequently since 2021 compared to pre-pandemic years, especially in younger children (2019 vs 2022, p < 0.01). CONCLUSION Compared to pre-pandemic years, we observed a dramatic increase in pediatric RTIs with an incrementing spectrum of viruses and a predominance in Rhino/Enterovirus infections - leading to a high rate of hospital admissions, particularly in conjunction with other viruses. This caused an acute shortage in medical care and may also be followed by an increase of virus-triggered secondary chronic respiratory diseases like asthma-rendering a burden on the health system.
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Affiliation(s)
- Nicole Maison
- Department for Asthma and Allergy, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany.
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.
- German Center for Lung Research (DZL), Munich, Germany.
| | - Jimmy Omony
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Sophia Rinderknecht
- Department for Asthma and Allergy, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Laura Kolberg
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
| | - Melanie Meyer-Bühn
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
| | - Erika von Mutius
- Department for Asthma and Allergy, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany
- German Center for Lung Research (DZL), Munich, Germany
| | - Johannes Hübner
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
| | - Ulrich von Both
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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Chao S, Wang Y, Wu B, Li R, Dong J, Ji L, Li X, Li R, Yin X, Zhao X, Liang W. Characterization of viral infections in children with influenza-like-illness during December 2018-January 2019. Front Cell Infect Microbiol 2024; 13:1351814. [PMID: 38304460 PMCID: PMC10830827 DOI: 10.3389/fcimb.2023.1351814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction Respiratory viral infection (RVI) is of very concern after the outbreak of COVID-19, especially in pediatric departments. Learning pathogen spectrum of RVI in children previous the epidemic of COVID-19 could provide another perspective for understanding RVI under current situation and help to prepare for the post COVID-19 infection control. Methods A nucleic acid sequence-based amplification (NASBA) assay, with 19 pairs of primers targeting various respiratory viruses, was used for multi-pathogen screening of viral infections in children presenting influenza-like illness (ILI) symptoms. Children with ILI at the outpatient department of Beijing Tsinghua Changgung Hospital during the influenza epidemic from 12/2018 to 01/2019 were included. Throat swabs were obtained for both the influenza rapid diagnostic test (IRDT) based on the colloidal gold immunochromatographic assay and the NASBA assay, targeting various respiratory viruses with an integrated chip technology. Results and discussion Of 519 patients, 430 (82.9%) were positive in the NASBA assay. The predominant viral pathogens were influenza A H1N1 pdm1/2009 (pH1N1) (48.4%) and influenza A (H3N2) (18.1%), followed by human metapneumovirus (hMPV) (8.8%) and respiratory syncytial virus (RSV) (6.1%). Of the 320 cases identified with influenza A by NASBA, only 128 (40.0%) were positive in the IRDT. The IRDT missed pH1N1 significantly more frequently than A (H3N2) (P<0.01). Influenza A pH1N1 and A (H3N2) were the major pathogens in <6 years and 6-15 years old individuals respectively (P<0.05). In summary, influenza viruses were the major pathogens in children with ILI during the 2018-2019 winter influenza epidemic, while hMPV and RSV were non-negligible. The coexistence of multiple pathogen leading to respiratory infections is the normalcy in winter ILI cases.
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Affiliation(s)
- Shuang Chao
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuejiao Wang
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Baolei Wu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Runqing Li
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingxiao Dong
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lina Ji
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuejun Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ran Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaomei Yin
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiuying Zhao
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Klug TE, Greve T, Caulley L, Hillerup S. The impact of social restrictions on the incidence and microbiology of peritonsillar abscess: a retrospective cohort study. Clin Microbiol Infect 2024; 30:100-106. [PMID: 37562694 DOI: 10.1016/j.cmi.2023.08.003] [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: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA). METHODS We performed a cross-sectional analysis of all patients with PTA and their microbiological findings in the 2 years preceding versus the 2 years following the COVID-19 lockdown in Denmark (11 March 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age-stratified population data for the catchment area were obtained from Statistics Denmark. RESULTS The annual incidence rate was significantly higher in the 2-year period before (21.8 cases/100 000 inhabitants) compared with after (14.9 cases/100 000) the lockdown (p < 0.001). The number of cases with growth of Streptococcus pyogenes was significantly higher in the period before (n = 67) compared with after (n = 28) the lockdown (p < 0.001), whereas the number of cases positive for Fusobacterium necrophorum (n = 60 vs. n = 64) and streptococcus anginosus group (SAG) (n = 37 vs. n = 43) were stabile (p 0.79 and p 0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared with after (28/179, 16%) the lockdown (p 0.007). On the contrary, the relative prevalence of F. necrophorum and SAG is significantly lower before (60/246, 24% and 37/246, 15%) compared with after (64/179, 36% and 43/179, 24%) the lockdown (p 0.013 and p 0.023). DISCUSSION Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG is unrelated to direct social interaction and may be derived from flora imbalance.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Caulley
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sara Hillerup
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hu L, Yang Y, Lin J, Yan Q, Sun C, Li Z, Sun L, Xu J, Chen J, Bai G. Epidemiological characteristics of respiratory syncytial virus infection in pediatric patients before, during the COVID-19 pandemic and after easing of COVID-19 restrictive measures in China. J Med Virol 2024; 96:e29374. [PMID: 38197487 DOI: 10.1002/jmv.29374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/07/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024]
Abstract
We aimed to assess the epidemiological characteristics of respiratory syncytial virus (RSV) infection in Chinese children at different phases of the coronavirus disease 2019 (COVID-19) pandemic, that is, before, during the pandemic and after easing of restrictive measures. We included 123 623 patients aged 0-18 years with respiratory infection symptoms who were suspected with RSV infection from January 1, 2019 to June 30, 2023 in Hangzhou Children's Hospital. Clinical information and RSV test result were extracted from the laboratory information system. We calculated the positive rate of RSV detection by age groups, gender, seasons, types of patients and phases of COVID-19 pandemic. Nonlinear associations between age and risk of RSV infection in three phases of pandemic were assessed by restricted cubic spline regression models. Among 123 623 patients, 3875 (3.13%) were tested as positive. The highest positive rate was observed in children aged 0-28 days (i.e., 12.28%). RSV infection was most prevalent in winter (6.04%), and followed by autumn (2.52%). Although there is no statistical significance regarding the positive rate at three phases of the pandemic, we observed that the rate was lowest during the pandemic and increased after easing the measures in certain age groups (p < 0.05), which was consisted with results from the nonlinear regression analyses. In addition, regression analyses suggested that the age range of children susceptible to RSV got wider, that is, 0-3.5 years, after easing all restrictive measures compared with that before (i.e., 0-3 years) and during the pandemic (i.e., 0-1 year). Based on our findings, we called for attention from health professionals and caregivers on the new epidemiological characteristics of RSV infection in the post-pandemic era after easing the restrictive measures.
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Affiliation(s)
- Lidan Hu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yang Yang
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming, China
| | - Jianyu Lin
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Qingtao Yan
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Changxuan Sun
- Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, Jiangshu, China
| | - Ziqiao Li
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lidan Sun
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jingfang Xu
- Department of Orthopedics, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jie Chen
- Department of Respiratory, Hangzhou Children's Hospital, Hangzhou, Zhejiang, China
| | - Guannan Bai
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Rak A, Isakova-Sivak I, Rudenko L. Nucleoprotein as a Promising Antigen for Broadly Protective Influenza Vaccines. Vaccines (Basel) 2023; 11:1747. [PMID: 38140152 PMCID: PMC10747533 DOI: 10.3390/vaccines11121747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Annual vaccination is considered as the main preventive strategy against seasonal influenza. Due to the highly variable nature of major viral antigens, such as hemagglutinin (HA) and neuraminidase (NA), influenza vaccine strains should be regularly updated to antigenically match the circulating viruses. The influenza virus nucleoprotein (NP) is much more conserved than HA and NA, and thus seems to be a promising target for the design of improved influenza vaccines with broad cross-reactivity against antigenically diverse influenza viruses. Traditional subunit or recombinant protein influenza vaccines do not contain the NP antigen, whereas live-attenuated influenza vaccines (LAIVs) express the viral NP within infected cells, thus inducing strong NP-specific antibodies and T-cell responses. Many strategies have been explored to design broadly protective NP-based vaccines, mostly targeted at the T-cell mode of immunity. Although the NP is highly conserved, it still undergoes slow evolutionary changes due to selective immune pressure, meaning that the particular NP antigen selected for vaccine design may have a significant impact on the overall immunogenicity and efficacy of the vaccine candidate. In this review, we summarize existing data on the conservation of the influenza A viral nucleoprotein and review the results of preclinical and clinical trials of NP-targeting influenza vaccine prototypes, focusing on the ability of NP-specific immune responses to protect against diverse influenza viruses.
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Affiliation(s)
| | | | - Larisa Rudenko
- Department of Virology, Institute of Experimental Medicine, St. Petersburg 197022, Russia; (A.R.); (I.I.-S.)
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17
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Jia HL, Gao J, Ren F, Ma Y. Analysis of the Sputum Culture Spectrum of Children with Respiratory Tract Infection in Wuxi Between 2014 and 2021. Infect Drug Resist 2023; 16:7055-7062. [PMID: 37954505 PMCID: PMC10637187 DOI: 10.2147/idr.s423580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
Objective We retrospectively analysed related clinical data to determine the influencing factors to better prevent and treat children's respiratory tract infection. Methods The study participants were children with respiratory tract infection who had sputum cultured in our hospital between 2014 and 2021. Sputum samples were extracted using negative suction pressure and sent to the hospital microbiological laboratory for testing. The testing results were analysed. Results A total of 4610 sputum samples were collected, and 508 positive samples were detected. The positive rate of pathogenic bacteria was 11.02%. Escherichia coli infection was more common in male patients (11.11%), whereas Haemophilus influenzae infection was more common in female patients (17.54%); the infection rates of these 2 bacteria are increasing annually. There were 304 (59.84%) strains of gram-negative bacteria, 172 (33.86%) strains of gram-positive bacteria and 32 (6.3%) strains of fungi. In children between 0 and 3 years old, the proportions of gram-negative bacteria were significantly higher than those of gram-positive bacteria in 2016-2017, 2018-2019 and 2020-2021 (p < 0.01). In every age group, the constituent ratio of gram-negative bacteria was significantly higher than that of gram-positive bacteria (p < 0.01) except for the 3-6-year age group. The proportion of Staphylococcus aureus in 2014-2015, 2016-2017, 2018-2019 and 2020-2021 was 25.64%, 25.20%, 22.98% and 16.44%, respectively. The proportion of H. influenzae in 2014-2015 was significantly lower than that in other years (p < 0.01). Haemolyticus staphylococcus and E. coli were more common in newborns, accounting for 19.12%. Conclusion The pathogens of respiratory tract infection in children change dynamically. There are significant differences in pathogens of respiratory tract infections among different age groups, years and seasons. Clinicians should pay attention to changes in the pathogen spectrum and improve drug resistance monitoring.
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Affiliation(s)
- Hong-Liang Jia
- Department of Pediatrics, Affiliated Hospital of Jiangnan University, Wuxi, 214122, People’s Republic of China
| | - Jian Gao
- Department of Clinical Laboratory, Affiliated Hospital of Jiangnan University, Wuxi, 214122, People’s Republic of China
| | - Feng Ren
- Department of Clinical Laboratory, Affiliated Hospital of Jiangnan University, Wuxi, 214122, People’s Republic of China
| | - Yaping Ma
- Department of Pediatrics, Affiliated Hospital of Jiangnan University, Wuxi, 214122, People’s Republic of China
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Wu R, Zhang J, Mo L. Analysis of respiratory virus detection in hospitalized children with acute respiratory infection during the COVID-19 pandemic. Virol J 2023; 20:253. [PMID: 37919789 PMCID: PMC10623845 DOI: 10.1186/s12985-023-02218-5] [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: 05/09/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE It is now understood that the Coronavirus disease 2019 (COVID-19) pandemic and its associated containment measures have influenced the epidemiology of other respiratory viruses. This study aimed to characterize respiratory virus infections in pediatric patients hospitalized for acute respiratory infections (ARIs) in East China both prior to and during the COVID-19 pandemic. METHODS We collected nasal secretions from 9782 pediatric ARI patients admitted to Shaoxing Maternal and Child Health Care Hospital between January 2018 and December 2022. We analyzed and compared changes in viral detection rates, epidemiological features, and clinical characteristics. RESULTS A total of 1633 strains from 7 common respiratory viruses were identified, with an overall positive rate of 16.35% (n = 821/5021) in 2018-2019 and 17.06% (n = 812/4761) in 2020-2022. Compared to 2018-2019, the positive rate for RSV significantly increased in 2020-2022, while detection rates for ADV, PIV-2, PIV-3, and flu-B showed reductions (P < 0.05). The RSV-positive rate experienced a more significant increase in winter compared to other seasons both before and during COVID-19 (P < 0.05), whereas PIV-3 predominantly circulated in spring and summer before COVID-19. CONCLUSION During the COVID-19 pandemic, marked variations in age distribution and seasonality of respiratory virus infections were observed among hospitalized children with ARIs in East China. Non-pharmaceutical interventions (NPIs) implemented during the pandemic yielded a limited impact on common respiratory viruses.
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Affiliation(s)
- Ruoya Wu
- Nursing department, Shaoxing Maternity and Child Health Care Hospital, 305 East Street, Yuecheng District, Shaoxing, Zhejiang, P. R. China
| | - Jianwei Zhang
- Department of Pediatrics, Shaoxing Maternity and Child Health Care Hospital, 305 East Street, Yuecheng District, Shaoxing, Zhejiang, P. R. China
| | - Liyan Mo
- Nursing department, Shaoxing Maternity and Child Health Care Hospital, 305 East Street, Yuecheng District, Shaoxing, Zhejiang, P. R. China.
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Lin R, Xing Z, Liu X, Chai Q, Xin Z, Huang M, Zhu C, Luan C, Gao H, Du Y, Deng X, Zhang H, Ma D. Performance of targeted next-generation sequencing in the detection of respiratory pathogens and antimicrobial resistance genes for children. J Med Microbiol 2023; 72. [PMID: 37910007 DOI: 10.1099/jmm.0.001771] [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] [Indexed: 11/03/2023] Open
Abstract
Introduction. Respiratory tract infection, which is associated with high morbidity and mortality, occurs frequently in children. At present, the main diagnostic method is culture. However, the low pathogen detection rate of the culture approach prevents timely and accurate diagnosis. Fortunately, next-generation sequencing (NGS) can compensate for the deficiency of culture, and its application in clinical diagnostics has become increasingly available.Gap Statement. Targeted NGS (tNGS) is a platform that can select and enrich specific regions before data enter the NGS pipeline. However, the performance of tNGS in the detection of respiratory pathogens and antimicrobial resistance genes (ARGs) in infections in children is unclear.Aim and methodology. In this study, we estimated the performance of tNGS in the detection of respiratory pathogens and ARGs in 47 bronchoalveolar lavage fluid (BALF) specimens from children using conventional culture and antimicrobial susceptibility testing (AST) as the gold standard.Results. RPIP (Respiratory Pathogen ID/AMR enrichment) sequencing generated almost 500 000 reads for each specimen. In the detection of pathogens, RPIP sequencing showed targeted superiority in detecting difficult-to-culture bacteria, including Mycoplasma pneumoniae. Compared with the results of culture, the sensitivity and specificity of RPIP were 84.4 % (confidence interval 70.5-93.5 %) and 97.7 % (95.9 -98.8%), respectively. Moreover, RPIP results showed that a single infection was detected in 10 of the 47 BALF specimens, and multiple infections were detected in 34, with the largest number of bacterial/viral coinfections. Nevertheless, there were also three specimens where no pathogen was detected. Furthermore, we analysed the drug resistance genes of specimens containing Streptococcus pneumoniae, which was detected in 25 out of 47 specimens in the study. A total of 58 ARGs associated with tetracycline, macrolide-lincosamide-streptogramin, beta-lactams, sulfonamide and aminoglycosides were identified by RPIP in 19 of 25 patients. Using the results of AST as a standard, the coincidence rates of erythromycin, tetracycline, penicillin and sulfonamides were 89.5, 79.0, 36.8 and 42.1 %, respectively.Conclusion. These results demonstrated the superiority of RPIP in pathogen detection, particularly for multiple and difficult-to-culture pathogens, as well as in predicting resistance to erythromycin and tetracycline, which has significance for the accurate diagnosis of pathogenic infection and in the guidance of clinical treatment.
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Affiliation(s)
- Ruihong Lin
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Zhihao Xing
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Xiaorong Liu
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Qiang Chai
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Zefeng Xin
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Meng Huang
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Chunqing Zhu
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Ce Luan
- Department of Anatomy, College of Basic Medicine, Chongqing Medical University, Chongqing 400042, PR China
| | - Hongdan Gao
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Yao Du
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Xuwen Deng
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Hetong Zhang
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Dongli Ma
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
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20
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Hao Y, Cheng L, Lu D. Epidemiological Study of Respiratory Virus Infections among Hospitalized Children Aged 14 Years and Younger during COVID-19 Pandemic in Wuhan, China, 2018-2022. J Glob Infect Dis 2023; 15:149-155. [PMID: 38292693 PMCID: PMC10824227 DOI: 10.4103/jgid.jgid_138_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 10/10/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The viral etiological characteristics and prevalence of hospitalized children with acute respiratory tract infection were preliminary studied in Wuhan City during the COVID-19 pandemic, to provide a reliable scientific basis for better understanding of the role of various pathogens in cases and for the prevention and clinical treatment of acute respiratory tract infection. Methods A total of 69,086 children with acute respiratory infections hospitalized and treated in our department from January 2018 to December 2022 were enrolled as our research subjects. Sociodemographic and clinical data as well as nasopharyngeal samples were collected from patients. Respiratory syncytial virus (RSV), adenovirus (ADV), infuenza virus A (FluA), infuenza virus B (FluB), and parainfluenza virus (PIV) were detected by direct immunofluorescence (DFA) to understand and analyze the epidemic characteristics of respiratory pathogens in children during the COVID-19 pandemic. Results The total detection rate of respiratory pathogens was 24.52% of the 69,086 hospitalized children. The frequency of respiratory viruses in those ADV, RSV, FluA, FluB, and PIV was 14.67%, 46.40%, 7.76%, 5.23%, and 25.95%. There were significant differences between the various pathogens (P < 0.001). There were the fewest pathogen-positive patients and positive detection rate in 2020 during the COVID-19 pandemic. There were significant differences in the pathogen detection rate among different years (P < 0.001). In addition, the results showed that the total detection rate of respiratory virus tested in different age groups was significantly different (P < 0.001). The positive detection rate was highest in the 1-3-year-old age group, which is prone to acute respiratory infections. We also found that different pathogens showed obvious seasonal fluctuation and epidemic. RSV reached its peak in winter. ADV is mainly prevalent in spring and summer. FluA has a high detection rate in winter. Winter and spring are the peak seasons for FluB infection, whereas PIV is detected in all seasons, with a higher incidence rate in the spring and summer. Conclusion The epidemiological distribution of pathogens of acute respiratory tract infection in hospitalized children in Wuhan from 2018 to 2022 varies with gender, age, and season. Nonpharmaceutical interventions (NPIs) were implemented as control measures worldwide and reduced the transmission of respiratory pathogens. NPIs are likely to be the primary driver of the dramatic reduction in respiratory virus infection activity in the early stages of the COVID-19 pandemic, to dissolving NPIs can lead to a recurrence of viral infection pathogens, especially in children.
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Affiliation(s)
- Yingchan Hao
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Li Cheng
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Dan Lu
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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21
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Geppe NA, Zaplatnikov AL, Kondyurina EG, Chepurnaya MM, Kolosova NG. The Common Cold and Influenza in Children: To Treat or Not to Treat? Microorganisms 2023; 11:microorganisms11040858. [PMID: 37110281 PMCID: PMC10146091 DOI: 10.3390/microorganisms11040858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
The common cold, which is mostly caused by respiratory viruses and clinically represented by the symptoms of acute respiratory viral infections (ARVI) with mainly upper respiratory tract involvement, is an important problem in pediatric practice. Due to the high prevalence, socio-economic burden, and lack of effective prevention measures (except for influenza and, partially, RSV infection), ARVI require strong medical attention. The purpose of this descriptive literature review was to analyze the current practical approaches to the treatment of ARVI to facilitate the choice of therapy in routine practice. This descriptive overview includes information on the causative agents of ARVI. Special attention is paid to the role of interferon gamma as a cytokine with antiviral and immunomodulatory effects on the pathogenesis of ARVI. Modern approaches to the treatment of ARVI, including antiviral, pathogenesis-directed and symptomatic therapy are presented. The emphasis is on the use of antibody-based drugs in the immunoprophylaxis and immunotherapy of ARVI. The data presented in this review allow us to conclude that a modern, balanced and evidence-based approach to the choice of ARVI treatment in children should be used in clinical practice. The published results of clinical trials and systematic reviews with meta-analyses of ARVI in children allow us to conclude that it is possible and expedient to use broad-spectrum antiviral drugs in complex therapy. This approach can provide an adequate response of the child’s immune system to the virus without limiting the clinical possibilities of using only symptomatic therapy.
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22
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Klivleyeva N, Lukmanova G, Glebova T, Shamenova M, Ongarbayeva N, Saktaganov N, Baimukhametova A, Baiseiit S, Ismagulova D, Kassymova G, Rachimbayeva A, Murzagaliyeva A, Xetayeva G, Isabayeva R, Sagatova M. Spread of Pathogens Causing Respiratory Viral Diseases Before and During CoVID-19 Pandemic in Kazakhstan. Indian J Microbiol 2023; 63:129-138. [PMID: 37168842 PMCID: PMC9972336 DOI: 10.1007/s12088-023-01064-x] [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: 09/22/2022] [Accepted: 02/11/2023] [Indexed: 03/06/2023] Open
Abstract
Analyze clinical samples collected and determine the etiology of viral pathogens and the dynamics of their spread. Acute respiratory viral infections remain one of the key health problems worldwide. They constitute etiologically independent diseases, with similar clinical infection manifestations and a single mechanism for the transmission of pathogens. 4712 nasopharyngeal swabs were collected from people before and during the COVID-19 pandemic with acute respiratory infections that tested negative for COVID-19 and were examined in this study. The collected samples were screened by a real-time polymerase chain reaction on a Rotor-Gene Q6 plex instrument. Statistical processing of the results, tabular, and graphical data were analyzed in the MS Excel. The largest number of the nasopharyngeal swabs were collected from children under 17 years of age (60.75%). In 702 samples (9.85%) pathogens of respiratory infections of non-influenza etiology were detected, including adenovirus, bocavirus, coronavirus, metapneumovirus, paramyxovirus types I–IV, respiratory syncytial virus, and rhinovirus. At the same time, both before and during the COVID-19 pandemic, different influenza virus variants co-circulation (A/H1N1, A/H3N2, and type B) were discovered, with a predominance of viruses with the antigenic formula A/H1N1. The results of the study indicate the need for continuous monitoring of the viral pathogens spread, which will expand the existing knowledge of the viral etiology of respiratory diseases and highlight the importance of viruses in the respiratory infections occurrence.
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Affiliation(s)
- Nailya Klivleyeva
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Galina Lukmanova
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Tatyana Glebova
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Mira Shamenova
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Nuray Ongarbayeva
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Nurbol Saktaganov
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Assem Baimukhametova
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Sagadat Baiseiit
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | - Dariya Ismagulova
- The Laboratory of Viral Biochemistry, The Research and Production Center for Microbiology and Virology LLP, 105 Bogenbai Batyr Street, Almaty, Kazakhstan
| | | | - Almagul Rachimbayeva
- The Almaty Branch of National Center for Expertise, 3 Zhibek Zholy Avenue, Almaty, Kazakhstan
| | - Ardak Murzagaliyeva
- The West Kazakhstan Marat Ospanov Medical University, 68 Maresyev Street, Aktobe, Kazakhstan
| | - Gulzakira Xetayeva
- The Children’s City Clinical Infectious Diseases Hospital, SOPE On REM, ChCCIDH, 299a Baizakova Street, Almaty, Kazakhstan
| | - Rauna Isabayeva
- The Communal State Enterprise Regional Region Clinical Hospital (CSE RCH) of Karaganda Regional Health Department, 41/43 Erubaev Street, Karaganda, Kazakhstan
| | - Madisha Sagatova
- The East Kazakhstan Regional Branch of National Center for Expertise, 17 Independence Avenue, Ust-Kamenogorsk, Kazakhstan
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23
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Li W, Wang X, Cui W, Yuan L, Hu X. Clinical Evaluation of a Multiplex PCR Assay for Simultaneous Detection of 18 Respiratory Pathogens in Patients with Acute Respiratory Infections. Pathogens 2022; 12:pathogens12010021. [PMID: 36678368 PMCID: PMC9862116 DOI: 10.3390/pathogens12010021] [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: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Reliable diagnostics are necessary to identify influenza infections, and coronavirus disease 2019 (COVID-19) highlights the need to develop highly specific and sensitive viral detection methods to distinguish severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens to prevent their further spread. In this prospective study, 1070 clinical respiratory samples were collected from patients with acute respiratory infections from January 2019 to February 2021 to evaluate the diagnostic performance of a multiplex probe amplification (MPA) assay, designed to screen 18 pathogens, mainly those causing acute respiratory infections. Ninety-six positive samples and twenty negative samples for the 18 respiratory pathogens defined by the MPA assay and reverse transcription polymerase chain reaction (RT-PCR) were further confirmed by reference next-generation sequencing (NGS). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the MPA assay were 95.00%, 93.75%, 98.96% and 75.00%, respectively. Additionally, the co-infection rate for these positive samples were 25% (24/95). The MPA assay demonstrated a highly concordant diagnostic performance with NGS in the diagnosis of 18 respiratory pathogens and might play an important role in clinical respiratory pathogen diagnosis.
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Affiliation(s)
- Wenmin Li
- Division of Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaoxiao Wang
- Division of Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wenhao Cui
- Division of Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Leyong Yuan
- Department of Clinical Laboratory, Southern University of Science and Technology Hospital, Shenzhen 518055, China
- Correspondence: (L.Y.); (X.H.)
| | - Xuejiao Hu
- Division of Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Correspondence: (L.Y.); (X.H.)
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24
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Xiang WQ, Li L, Guo YJ, Lin J, Li W. The Impact of COVID-19 Public Health Measures on Detection of Other Respiratory Viruses in Children during the Winter of 2020–2021 in Hangzhou, China. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1756712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Objective Acute respiratory tract infection (ARTI) is one of the main diseases in childhood. This study aimed to monitor the distribution of respiratory tract viruses in children with ARTI in the impact of coronavirus disease 2019 (COVID-19).
Methods We conducted surveillance of 2019 novel coronavirus, human metapneumovirus, respiratory syncytial virus, human adenovirus, human parainfluenza virus 1–3, and influenza A and B virus by using quantitative real-time polymerase chain reaction.
Results During the winter of 2020 to 2021, among the 1,442 throat swabs we collected, 937 (64.98%, 937/1,442) were positive for respiratory viruses. Respiratory syncytial virus was the most frequently detected respiratory virus (34.12%, 492/1,442) and 2019 novel coronavirus and influenza A and B virus were not detected in the study period. Coinfection was observed in 156 positive samples including 149 samples of double infection and 7 of triple infection. The positive rate of viral respiratory tract infection in infants less than 6 months was the highest (72.95%) in the study period.
Conclusion There are some differences in the distribution of respiratory viruses in children after the outbreak of COVID-19 in Hangzhou, China.
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Affiliation(s)
- Wen-qing Xiang
- Department of Clinical Laboratory, The Children's Hospital, National Clinical Research Center For Child Health, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Lin Li
- Department of Clinical Laboratory, The Children's Hospital, National Clinical Research Center For Child Health, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Ya-jun Guo
- Department of Clinical Laboratory, The Children's Hospital, National Clinical Research Center For Child Health, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Jian Lin
- Department of Clinical Laboratory, The Children's Hospital, National Clinical Research Center For Child Health, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, National Clinical Research Center For Child Health, Zhejiang University School of Medicine, Hangzhou, P.R. China
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25
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Ye Q, Wang D. Epidemiological changes of common respiratory viruses in children during the COVID-19 pandemic. J Med Virol 2022; 94:1990-1997. [PMID: 34981839 PMCID: PMC9015628 DOI: 10.1002/jmv.27570] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Accepted: 01/02/2022] [Indexed: 12/27/2022]
Abstract
A variety of non‐pharmaceutical interventions (NPIs) have been implemented to control the transmission of COVID‐19 in China. The effect of NPIs on other common respiratory viruses in children of different age groups has not been examined thus far. Respiratory specimens of children were collected to detect common childhood respiratory viruses, including influenza A (FluA), influenza B (FluB), adenovirus, and respiratory syncytial virus (RSV), at the Children's Hospital of Zhejiang University School of Medicine from January 1, 2019 to December 31, 2020. The epidemiological characteristics of the respiratory viruses in 2020 were compared with those in 2019. From January 2019 to December 2020, 165 622 specimens were collected. The proportion of infants aged 0−28 days (683, 2.24% vs. 1295, 0.96%, p = 0.000) and 1−12 months (8560, 28.12% vs. 20 875, 15.43%, p = 0.000) in 2020 increased significantly compared with that in 2019. There were two obvious increases in April and September in the number of specimens in children aged 4−6 years and >7 years. FluA, FluB, and RSV's age distribution patterns were surprisingly consistent with each other in 2020, and the positive rates of children aged 1−12 months were the highest in all age groups (FluA: 4.45%, FluB: 3.30%, RSV: 7.35%). Our study further confirms that the NPIs significantly decreased the transmission of common childhood respiratory viruses. The change in circulation characteristics of common respiratory viruses of children in different age groups varied. Therefore, we recommend that different protection strategies should be introduced for children of different age groups. The epidemiological characteristics of common childhood respiratory viruses varied during the COVID‐19 pandemic. The non‐pharmaceutical interventions significantly decreased the transmission of common childhood respiratory viruses. Different protection strategies should be introduced for children of varying age groups. COVID‐19 article requiring a fast track process.
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Affiliation(s)
- Qing Ye
- Department of clinical laboratory, The Children's Hospital,Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Dongjie Wang
- Department of clinical laboratory, The Children's Hospital,Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
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Gong L, Wu C, Lu M, Huang C, Chen Y, Li Z, Huang G, Liu D, Tang X. Analysis of Incidence and Clinical Characteristics of RSV Infection in Hospitalized Children: A Retrospective Study. Risk Manag Healthc Policy 2021; 14:1525-1531. [PMID: 33889036 PMCID: PMC8054821 DOI: 10.2147/rmhp.s305370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To investigate the incidence and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection, and to provide evidence for the importance of preventive strategies and improvements in supportive care of RSV infection. Methods This retrospective study included children under 14 years who received throat swab test and were diagnosed with RSV infection from January 2019 to December 2020. Throat swabs and intravenous blood were the main sources of samples, which were obtained within 24 hours of hospitalization. Direct immunofluorescence assay was used to diagnose RSV infection. Results Among the 448 hospitalized children with RSV infection, males (71.9%) showed the highest proportion, the highest incidence was found in children<6 months old (45.3%), and 76.6% of them had pneumonia. Pharyngeal redness, cough, expectoration, and mental fatigue were the most common symptoms in hospitalized children of all ages. More than 60% of hospitalized children had increased lymphocyte count, aspartate aminotransferase, creatine kinase-MB form, lactate dehydrogenase, and α-HBDH levels. The rates of myocardial damage, respiratory failure, stay in the intensive care unit (ICU), use of mechanical ventilation, and absorption of oxygen were higher in children<6 months old. Except for children who were 37-60 months old, the percentage of length of hospital stay≥7 days in the other age groups was greater than 62.0%. Except for children who were 0-28 days old and>61 months old, the other age groups showed a re-hospitalization situation due to re-infection with RSV. In hospitalized children diagnosed with RSV infection from throat swabs, we also performed the RSV IgM test and found that 59.2% of them were positive, 8.0% of them were weakly positive, and 32.8% of them were negative. Conclusion This study analyzes the incidence and clinical characteristics of hospitalized children with RSV infection, which provides evidence for the importance of preventive strategies and improvements in supportive care of RSV infection.
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Affiliation(s)
- Ling Gong
- The First Clinical Medical College, Jinan University, Guangzhou, 510632, People's Republic of China.,Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Chunyan Wu
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Mingjie Lu
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Chengyan Huang
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Yongqian Chen
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Zhu Li
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Guichuan Huang
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Daishun Liu
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, People's Republic of China
| | - Xiaoping Tang
- The First Clinical Medical College, Jinan University, Guangzhou, 510632, People's Republic of China.,Infectious Disease Department, Guangzhou Eighth People's Hospital (the Affiliated Hospital ofGuangzhou Medical University), Guangzhou, 510060, People's Republic of China
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27
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Li F, Wang Y, Zhang Y, Shi P, Cao L, Su L, Zhu Q, Wang L, Lu R, Tan W, Shen J. Etiology of Severe Pneumonia in Children in Alveolar Lavage Fluid Using a High-Throughput Gene Targeted Amplicon Sequencing Assay. Front Pediatr 2021; 9:659164. [PMID: 34249808 PMCID: PMC8267249 DOI: 10.3389/fped.2021.659164] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: To evaluate the diagnostic value of a high-throughput gene targeted amplicon sequencing (TAS) assay for detecting pathogenic microorganisms in alveolar lavage fluid (ALF) from children with severe community-acquired pneumonia (SCAP). Methods: A retrospective study was performed on 48 frozen ALF samples from 47 severe pneumonia cases admitted to Children's Hospital of Fudan University from January 1, 2019, to March 31, 2019. All samples were tested by a multiplex PCR (Multi-PCR) assay and a TAS assay. The results of the TAS panels were parallel compared with Multi-PCR and Conventional Tests (CT) including culture, direct fluorescent antibody method (DFA), and singleplex polymerase chain reaction (PCR). Results: The proportion of pathogens detection by CT was 81.2% (39/48). The 8 common respiratory viruses including respiratory syncytial virus (RSV), adenovirus (ADV), influenza A virus (FLUA), influenza B virus (FLUB), parainfluenza virus 1-3 (PIV1-3), and human Metapneumovirus (hMPV) were found in 31.2% (15/48) of the 48 samples by DFA. With the criteria of CT results used as "Golden Standard" for determing of TAS results, the proportion of pathogens detection by TAS was 70.8% (34/48). The difference of proportion of pathogens detection between TAS and CT was not statistically significant (p = 0.232). The sensitivity and specificity of TAS for pathogens detection based on CT were 87.1% (95% CI, 71.77-95.18%) and 100.0% (95% CI, 62.88-100%), the positive predictive value (PPV) and negative predictive value (NPV) were 100.0% (95% CI, 87.35-100%) and 64.2% (95% CI, 35.62-86.02%), respectively. While Multi-PCR results were used as "Golden Standard," the total pathogens detection rate of TAS was 83.3% (40/48), which had a significant difference with that of Multi-PCR (p = 0.003). The sensitivity and PPV of TAS compared with Multi-PCR were 83.3% (95% CI, 69.23-92.03%) and 100.0% (95% CI, 89.08-100%), respectively. High rates of co-infection were proved by CT, Multi-PCR, and TAS. Mycoplasma pneumoniae (MP) and ADV were the two most frequently detected pathogens in all three assays. Conclusion: Compared with the CT and Multi-PCR methods, this TAS assay had a good performance in detecting bacteriological and viral pathogens from ALF. More research is needed to establish interpretation criteria based on TAS reads or analysis platforms.
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Affiliation(s)
- Fei Li
- Infectious Disease Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yin Wang
- Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yuhan Zhang
- Infectious Disease Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Peng Shi
- Statistics and Data Management Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Linfeng Cao
- Virology Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - LiYun Su
- Virology Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Qiguo Zhu
- Respiratory Department, Children's Hospital Xiamen Branch, Xiamen, China
| | - Libo Wang
- Respiratory Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Roujian Lu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Wenjie Tan
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Jun Shen
- Infectious Disease Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Diesner-Treiber SC, Voitl P, Voitl JJM, Langer K, Kuzio U, Riepl A, Patel P, Mühl-Riegler A, Mühl B. Respiratory Infections in Children During a Covid-19 Pandemic Winter. Front Pediatr 2021; 9:740785. [PMID: 34733808 PMCID: PMC8558488 DOI: 10.3389/fped.2021.740785] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023] Open
Abstract
Background: The Covid-19 pandemic compelled the implementation of measures to curb the SARS CoV-2 spread, such as social distancing, wearing FFP2 masks, and frequent hand hygiene. One anticipated ramification of these measures was the containment of other pathogens. This prospective, longitudinal study aimed to investigate the spread of 22 common seasonal non-SARS-CoV-2 pathogens, such as RSV and influenza, among children with an acute respiratory infection during a pandemic. Methods: Three hundred ninety children (0-24 months) admitted to Vienna's largest pediatric center with acute respiratory infection (November 2020-April 2021) were included in this study. The researchers tested nasal swabs for 22 respiratory pathogens by Multiplex PCR, documented clinical features and treatment, and evaluated data for a potential connection with the lockdown measures then in force. Results: The 448 smears revealed the most common pathogens to be rhino-/enterovirus (41.4%), adenovirus (2.2%), and coronavirus NL63 (13.6%). While the first two were active throughout the entire season, coronaviruses peaked in the first trimester of 2021 in conjunction with the lift of the lockdown period (OR 4.371, 95%CI 2.34-8.136, P < 0.001). RSV, metapneumovirus, and influenza were absent. Conclusion: This prospective, longitudinal study shows that Covid-19 measures suppressed the seasonal activity of influenza, RSV, and metapneumovirus among very young children, but not of rhino-/enterovirus and adenovirus. The 0-24 month-olds are considered the lowest risk group and were only indirectly affected by the public health measures. Lockdowns were negatively associated with coronaviruses infections.
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Affiliation(s)
- Susanne C Diesner-Treiber
- First Vienna Pediatric Medical Center, Vienna, Austria.,Medical University of Vienna, Vienna, Austria
| | - Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria.,Medical University of Vienna, Vienna, Austria.,Sigmund Freud University Vienna, Vienna, Austria
| | | | - Klara Langer
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - Ulrike Kuzio
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - Angela Riepl
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - Pia Patel
- First Vienna Pediatric Medical Center, Vienna, Austria
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