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Arimura K, Kikuchi K, Sato Y, Miura H, Sato A, Katsura H, Kondo M, Itabashi M, Tagaya E. SARS-CoV-2 co-detection with other respiratory pathogens-descriptive epidemiological study. Respir Investig 2024; 62:884-888. [PMID: 39098246 DOI: 10.1016/j.resinv.2024.07.016] [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: 05/17/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Co-detection of respiratory pathogens with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is poorly understood. This descriptive epidemiological study aimed to determine the effect of the interaction of different respiratory pathogens on clinical variables. METHODS We retrospectively reviewed the results of comprehensive multiplex polymerase chain reaction (PCR) testing from November 2020 to March 2023 to estimate respiratory pathogen co-detection rates in Shinjuku, Tokyo. We evaluated the interactions of respiratory pathogens, particularly SARS-CoV-2, between observed and expected co-detection. We estimated the trend of co-detection with SARS-CoV-2 in terms of age and sex and applied a multiple logistic regression model adjusted for age, testing period, and sex to identify influencing factors between co-detection and single detection for each pathogen. RESULTS Among 57,746 patients who underwent multiplex PCR testing, 10,516 (18.2%) had positive for at least one of the 22 pathogens. Additionally, 881 (1.5%) patients were confirmed to have a co-detection. SARS-CoV-2 exhibited negative interactions with adenovirus, coronavirus, human metapneumovirus, parainfluenza virus, respiratory syncytial virus, and rhino/enterovirus. SARS-CoV-2 co-detection with other pathogens occurred most frequently in patients of the youngest age group (0-4 years). A multiple logistic regression model indicated that younger age was the most influential factor for SARS-CoV-2 co-detection with other respiratory pathogens. CONCLUSION The study highlights the prevalence of SARS-CoV-2 co-detection with other respiratory pathogens in younger age groups, necessitating further exploration of the clinical implications and severity of SARS-CoV-2 co-detection.
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Affiliation(s)
- Ken Arimura
- Tokyo Women's Medical University, Department of Respiratory Medicine, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan.
| | - Ken Kikuchi
- Tokyo Women's Medical University, Department of Infectious Diseases, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
| | - Yasuto Sato
- Shizuoka Graduate University of Public Health, Graduate School of Public Health, 4-27-2, Kita ando, Aoi, Shizuoka, Shizuoka, 4200881, Japan
| | - Hitomi Miura
- Tokyo Women's Medical University Hospital, Central Clinical Laboratory, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
| | - Asako Sato
- Tokyo Women's Medical University Hospital, Department of Clinical Laboratory, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
| | - Hideki Katsura
- Tokyo Women's Medical University, Department of Respiratory Medicine, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
| | - Mitsuko Kondo
- Tokyo Women's Medical University, Department of Respiratory Medicine, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
| | - Michio Itabashi
- Tokyo Women's Medical University, Department of Surgery, Division of Inflammatory Bowel Disease Surgery, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
| | - Etsuko Tagaya
- Tokyo Women's Medical University, Department of Respiratory Medicine, 8-1, Kawadacho, Shinjuku, Tokyo, 1628666, Japan
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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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Di Maio VC, Scutari R, Forqué L, Colagrossi L, Coltella L, Ranno S, Linardos G, Gentile L, Galeno E, Vittucci AC, Pisani M, Cristaldi S, Villani A, Raponi M, Bernaschi P, Russo C, Perno CF. Presence and Significance of Multiple Respiratory Viral Infections in Children Admitted to a Tertiary Pediatric Hospital in Italy. Viruses 2024; 16:750. [PMID: 38793631 PMCID: PMC11126044 DOI: 10.3390/v16050750] [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: 04/23/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Viral co-infections are frequently observed among children, but whether specific viral interactions enhance or diminish the severity of respiratory disease is still controversial. This study aimed to investigate the type of viral mono- and co-infections by also evaluating viral correlations in 3525 respiratory samples from 3525 pediatric in/outpatients screened by the Allplex Respiratory Panel Assays and with a Severe Acute Respiratory Syndrome-COronaVirus 2 (SARS-CoV-2) test available. Overall, viral co-infections were detected in 37.8% of patients and were more frequently observed in specimens from children with lower respiratory tract infections compared to those with upper respiratory tract infections (47.1% vs. 36.0%, p = 0.003). SARS-CoV-2 and influenza A were more commonly detected in mono-infections, whereas human bocavirus showed the highest co-infection rate (87.8% in co-infection). After analyzing viral pairings using Spearman's correlation test, it was noted that SARS-CoV-2 was negatively associated with all other respiratory viruses, whereas a markedly significant positive correlation (p < 0.001) was observed for five viral pairings (involving adenovirus/human bocavirus/human enterovirus/metapneumoviruses/rhinovirus). The correlation between co-infection and clinical outcome may be linked to the type of virus(es) involved in the co-infection rather than simple co-presence. Further studies dedicated to this important point are needed, since it has obvious implications from a diagnostic and clinical point of view.
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Affiliation(s)
- Velia Chiara Di Maio
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Rossana Scutari
- Multimodal Laboratory Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Lorena Forqué
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Luna Colagrossi
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Luana Coltella
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Stefania Ranno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Giulia Linardos
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Leonarda Gentile
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Eugenia Galeno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Anna Chiara Vittucci
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (S.C.)
| | - Mara Pisani
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (S.C.)
| | - Sebastian Cristaldi
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (S.C.)
| | - Alberto Villani
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy (S.C.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Bernaschi
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Cristina Russo
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.C.D.M.)
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Chan WS, Ho CWY, Chan TC, Hung J, To MY, Leung SM, Lai KC, Wong CY, Leung CP, Au CH, Wan TSK, Zee JST, Ma ESK, Tang BSF. Clinical Evaluation of the BIOFIRE SPOTFIRE Respiratory Panel. Viruses 2024; 16:600. [PMID: 38675941 PMCID: PMC11055108 DOI: 10.3390/v16040600] [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: 02/24/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The BIOFIRE SPOTFIRE Respiratory (R) Panel is a novel, in vitro diagnostic PCR assay with 15 pathogen targets. The runtime is about 15 min which is the shortest among similar panels in the market. We evaluated the performance of the SPOTFIRE R Panel with 151 specimens, including 133 collected from the upper respiratory tract (URT), 13 from the lower respiratory tract (LRT) and 5 external quality assessment program (EQAP) samples. The respiratory specimens were enrolled throughout the first two post-COVID-19 influenza seasons in Hong Kong (March to December 2023). For URT specimens, full concordance was observed between the SPOTFIRE R Panel and the standard-of-care FilmArray Respiratory 2.1 plus Panel (RP2.1plus) for 109 specimens (109/133, 81.95%). After discrepant analysis, the SPOTFIRE R Panel identified more pathogens than the RP2.1plus in 15 specimens and vice versa in 3 specimens. The per-target negative and positive percentage agreement (NPA and PPA) were 92.86-100% except the PPA of adenovirus (88.24%). For LRT and EQAP samples, all results were fully concordant. To conclude, the performance of the SPOTFIRE R Panel was comparable to the RP2.1plus.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Bone Siu-Fai Tang
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China; (W.-S.C.); (C.-H.A.)
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5
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Chan WS, Wong KP, Yau SK, Wong CY, Chan TC, Hung J, Lai KTW, Leung CP, Wang CLN, Au CH, Wan TSK, Ma ESK, Tang BSF. Clinical Evaluation of Xpert Xpress CoV-2/Flu/RSV plus and Alinity m Resp-4-Plex Assay. Diagnostics (Basel) 2024; 14:683. [PMID: 38611596 PMCID: PMC11012021 DOI: 10.3390/diagnostics14070683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The performance of the Xpert Xpress CoV-2/Flu/RSV plus and Alinity m Resp-4-Plex Assays were evaluated using 167 specimens, including 158 human respiratory specimens and 9 external quality assessment program (EQAP) samples. For respiratory specimens, CoV-2/Flu/RSV plus exhibited perfect agreement with the standard-of-care (SOC) methods (Cohen's κ: 1, 100% agreement). The overall positive and negative percent agreement (PPA and NPA) were 100%, with 95% confidence intervals of 96.50 to 100% and 85.70 to 100%, respectively. On the other hand, Resp-4-Plex revealed an almost perfect agreement with the SOC methods (Cohen's κ: 0.92, 97.71% agreement). The overall PPA and NPA were 100% (95.76 to 100%) and 88.46% (70.20 to 96.82%), respectively. For EQAP samples, the results of CoV-2/Flu/RSV plus (9/9) and Resp-4-Plex (4/4) were concordant with the expected results. The experimental limit of detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was the lowest (25 copies/mL for both methods), and that of the respiratory syncytial virus was the highest (400 copies/mL for CoV-2/Flu/RSV plus and 100 copies/mL for Resp-4-Plex). Threshold cycle (Ct) value correlation showed a large positive linear association between CoV-2/Flu/RSV plus and Resp-4-Plex, with R-squared values of 0.92-0.97, and on average, the Ct values of CoV-2/Flu/RSV plus were higher than that of Resp-4-Plex by 1.86-2.78, except for Flu A1 target (-0.66). To conclude, the performance of both assay was comparable to the SOC methods for both upper and lower respiratory specimens. Implementation of these rapid assay may reinforce the diagnostic capacity for the post-pandemic co-circulation of SARS-CoV-2 and other respiratory viruses.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Bone Siu-Fai Tang
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China; (W.-S.C.); (C.-H.A.); (E.S.-K.M.)
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6
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Long Y, Zheng Y, Li C, Guo Z, Li P, Zhang F, Liu W, Wang Y. Respiratory pathogenic microbial infections: a narrative review. Int J Med Sci 2024; 21:826-836. [PMID: 38617014 PMCID: PMC11008481 DOI: 10.7150/ijms.93628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
Respiratory infectious diseases have long been recognised as a substantial global healthcare burden and are one of the leading causes of death worldwide, particularly in vulnerable individuals. In the post COVID-19 era, there has been a surge in the prevalence of influenza virus A and other multiple known viruses causing cold compared with during the same period in the previous three years, which coincided with countries easing COVID-19 restrictions worldwide. This article aims to review community-acquired respiratory illnesses covering a broad spectrum of viruses, bacteria, and atypical microorganisms and focuses on the cluster prevalence of multiple known respiratory pathogens in China, thereby providing effective prevention and control measures.
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Affiliation(s)
- Yiyin Long
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yan Zheng
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Changlin Li
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Zhanjun Guo
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Peng Li
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Fuqing Zhang
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Wei Liu
- Tianjin Children's Hospital, Children's Hospital, Tianjin University, Tianjin 300134, China
| | - Yuliang Wang
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
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Demirhan S, Goldman DL, Herold BC. Differences in the Clinical Manifestations and Host Immune Responses to SARS-CoV-2 Variants in Children Compared to Adults. J Clin Med 2023; 13:128. [PMID: 38202135 PMCID: PMC10780117 DOI: 10.3390/jcm13010128] [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: 11/24/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The COVID-19 pandemic challenged the medical field to rapidly identify and implement new approaches to the diagnosis, treatment and prevention of SARS-CoV-2 infections. The scientific community also needed to rapidly initiate basic, translational, clinical and epidemiological studies to understand the pathophysiology of this new family of viruses, which continues to evolve with the emergence of new genetic variants. One of the earliest clinical observations that provided a framework for the research was the finding that, in contrast to most other respiratory viruses, children developed less severe acute and post-acute disease compared to adults. Although the clinical manifestations of SARS-CoV-2 infection changed with each new wave of the pandemic, which was dominated by evolving viral variants, the differences in severity between children and adults persisted. Comparative immunologic studies have shown that children mount a more vigorous local innate response characterized by the activation of interferon pathways and recruitment of innate cells to the mucosa, which may mitigate against the hyperinflammatory adaptive response and systemic cytokine release that likely contributed to more severe outcomes including acute respiratory distress syndrome in adults. In this review, the clinical manifestations and immunologic responses in children during the different waves of COVID-19 are discussed.
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Affiliation(s)
| | | | - Betsy C. Herold
- Department of Pediatrics, Division of Infectious Diseases, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, 1225 Morris Park Avenue, Bronx, NY 10461, USA; (S.D.); (D.L.G.)
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Chan WS, Yau SK, To MY, Leung SM, Wong KP, Lai KC, Wong CY, Leung CP, Au CH, Wan TSK, Ma ESK, Tang BSF. The Seasonality of Respiratory Viruses in a Hong Kong Hospital, 2014-2023. Viruses 2023; 15:1820. [PMID: 37766227 PMCID: PMC10536933 DOI: 10.3390/v15091820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
We reviewed the multiplex PCR results of 20,127 respiratory specimens tested in a hospital setting from January 2014 to April 2023. The seasonal oscillation patterns of 17 respiratory viruses were studied. Compared with 2014-2019, a prominent drop in PCR positivity (from 64.46-69.21% to 17.29-29.89%, p < 0.001) and virus diversity was observed during the COVID-19 pandemic, with predominance of rhinovirus/enterovirus, sporadic spikes of parainfluenza viruses 3 and 4, respiratory syncytial virus and SARS-CoV-2, and rare detection of influenza viruses, metapneumovirus, adenovirus and coronaviruses. The suppressed viruses appeared to regain activity from the fourth quarter of 2022 when pandemic interventions had been gradually relaxed in Hong Kong. With the co-circulation of SARS-CoV-2 and seasonal respiratory viruses, surveillance of their activity and an in-depth understanding of the clinical outcomes will provide valuable insights for improved public health measures and reducing disease burden.
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Affiliation(s)
- Wai-Sing Chan
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Siu-Kei Yau
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Man-Yan To
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Sau-Man Leung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Kan-Pui Wong
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Ka-Chun Lai
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Ching-Yan Wong
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Chin-Pang Leung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Chun-Hang Au
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | | | - Edmond Shiu-Kwan Ma
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Bone Siu-Fai Tang
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
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