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Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence.

ABSTRACT: In Taiwan, there were only 799 confirmed COVID-19 cases in 2020. The unique backdrop amidst a pandemic and promotion of nonpharmaceutical interventions generated some distinct changes in the epidemiology of common respiratory pathogens. In this study, we aimed to investigate the dynamic changes in respiratory pathogens in children during 2020. We performed a retrospective cohort study at a tertiary hospital in southern Taiwan during 2020. Patients aged 0-18 years who visited the pediatric emergency department were enrolled. Children who presented with clinical symptoms (fever or respiratory illness) and received nasopharyngeal swabs for multiplex polymerase chain reaction (PCR) were included in our analysis. We also compared respiratory syncytial virus (RSV) trends from previous years by PCR and lateral flow immunochromatographic assays from 2017 to 2020. A total of 120 children were tested. The overall detection rate was 55%. With strengthened restrictions, the detection rate dropped from 70% to 30%. However, non-enveloped viruses (rhinovirus/enterovirus and adenovirus) were in constant circulation. Upon easing prevention measures, the detection rate remained above 60%, and an outbreak of an enveloped virus (RSV and parainfluenza virus) was noted. Compared with 2017-2019, the cyclical RSV epidemic was delayed, with a large surge in late 2020. We observed a constant circulation of non-enveloped viruses when strict nonpharmaceutical interventions were employed and a delayed surge of enveloped viruses during the easing of restrictions. Continuous surveillance and monitoring of the evolutionary dynamics of respiratory viruses is important, while easing restrictions requires balanced judgment.

SUBMITTER: Sim JY

PROVIDER: S-EPMC9767794 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence.

Sim Jun Yi JY Chen Yu-Chin YC Hsu Wei-Yun WY Chen Wei-Yu WY Chou Yun Y Chow Julie Chi JC Lai Yi-Ching YC Tang Hung-Jen HJ Chen Chi-Chung CC Ho Chung-Han CH Chang Tu-Hsuan TH

Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 20220414 6 Pt 2

<h4>Background</h4>In Taiwan, there were only 799 confirmed COVID-19 cases in 2020. The unique backdrop amidst a pandemic and promotion of nonpharmaceutical interventions generated some distinct changes in the epidemiology of common respiratory pathogens. In this study, we aimed to investigate the dynamic changes in respiratory pathogens in children during 2020.<h4>Methods</h4>We performed a retrospective cohort study at a tertiary hospital in southern Taiwan during 2020. Patients aged 0-18 year ...[more]

PMID: 35450828

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Project description:ObjectiveThis study aimed to assess the prevalence and distribution of respiratory pathogens in children under 18 years old with Acute Respiratory Infections (ARTIs) in Lanzhou, Northwest China, from July 2019 to January 2024.MethodsThe respiratory pathogens studied were FluA, FluB, PIV, RSV, ADV, MP, CP, CB, and LP, detected by indirect immunofluorescence assay (IIF). Data were obtained from the laboratory information system (LIS) of the Lanzhou University Second Hospital. As in Lanzhou, NPIs were implemented in January 2020, and were lifted in December 2022, data were divided into pre-NPIs (July 2019 to December 2019), NPIs (January 2020 to December 2022) and post-NPIs (January 2023 to January 2024) periods for analysis. Pearson's chi-square test, ANOVA, and Fisher's exact test were used to evaluate statistical significance in variable differences, with P < 0.05 considered significant.ResultsA total of 29,659 children diagnosed with ARTIs were included in the study, with 13030(43.93%) test positive for at least one pathogen. Single-pathogen infections predominated (33.10%), while co-detection of MP and PIV was the most common among multi-pathogen cases (52.96%). Pathogen detection rates were notably higher in female children (50.62%) and preschool-aged children (53.45%) and exhibited seasonal variations, with a pronounced increase in winter (47.61%) and a peak in November (48.92%). MP had the highest detection rate (38.59%), followed by PIV (10.18%). Detection rates significantly increased following the lifting of NPIs, rising from 33.82% (SD ± 13.13) during NPIs to 64.42% (SD ± 4.67) (P < 0.001), with 2023 showing the highest detection rate (64.61%) and largest participant count (9,591). In November 2023, detection rates reached their highest level at 73.09%. Post-NPI, most pathogens, except CB and LP, demonstrated significantly higher prevalence (P<0.001).ConclusionIn the Lanzhou region, MP and PIV were identified as the most prevalent respiratory pathogens among children with ARTIs, with peak detection rates during the winter season. Boys and school-age children exhibited higher susceptibility to these infections. NPIs played a critical role in reducing respiratory pathogen transmission. Once NPIs were lifted, a marked resurgence in pathogen incidence highlighted their impact on controlling infection spread.

Project description:Respiratory tract infections (RTIs) are extremely common especially in the first year of life. Knowledge of the etiology of a RTI is essential to facilitate the appropriate management and the implementation of the most effective control measures. This perspective explains why laboratory methods that can identify pathogens in respiratory secretions have been developed over the course of many years. High-complexity multiplex panel assays that can simultaneously detect up to 20 viruses and up to four bacteria within a few hours have been marketed. However, are these platforms actually useful in pediatric clinical practice? In this manuscript, we showed that these platforms appear to be particularly important for epidemiological studies and clinical research. On the contrary, their routine use in pediatric clinical practice remains debatable. They can be used only in the hospital as they require specific equipment and laboratory technicians with considerable knowledge, training, and experience. Moreover, despite more sensitive and specific than other tests routinely used for respiratory pathogen identification, they do not offer significantly advantage for detection of the true etiology of a respiratory disease. Furthermore, knowledge of which virus is the cause of a respiratory disease is not useful from a therapeutic point of view unless influenza virus or respiratory syncytial virus are the infecting agents as effective drugs are available only for these pathogens. On the other hand, multiplex platforms can be justified in the presence of severe clinical manifestations, and in immunocompromised patients for whom specific treatment option can be available, particularly when they can be used simultaneously with platforms that allow identification of antimicrobial resistance to commonly used drugs. It is highly likely that these platforms, particularly those with high sensitivity and specificity and with low turnaround time, will become essential when new drugs effective and safe against most of the respiratory viruses will be available. Further studies on how to differentiate carriers from patients with true disease, as well as studies on the implications of coinfections and identification of antimicrobial resistance, are warranted.

Project description:ObjectivesPediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist with trial design. We aimed to develop and validate mortality prediction models for patients with pediatric acute respiratory distress syndrome.DesignLeveraging additional data collection from a preplanned ancillary study (Version 1) of the multinational Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology study, we identified predictors of mortality. Separate models were built for the entire Version 1 cohort, for the cohort excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths. Models were externally validated in a cohort of intubated pediatric acute respiratory distress syndrome patients from the Children's Hospital of Philadelphia.SettingThe derivation cohort represented 100 centers worldwide; the validation cohort was from Children's Hospital of Philadelphia.PatientsThere were 624 and 640 subjects in the derivation and validation cohorts, respectively.InterventionsNone.Measurements and main resultsThe model for the full cohort included immunocompromised status, Pediatric Logistic Organ Dysfunction 2 score, day 0 vasopressor-inotrope score and fluid balance, and PaO2/FIO2 6 hours after pediatric acute respiratory distress syndrome onset. This model had good discrimination (area under the receiver operating characteristic curve 0.82), calibration, and internal validation. Models excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths also demonstrated good discrimination (all area under the receiver operating characteristic curve ≥ 0.84) and calibration. In the validation cohort, models for intubated pediatric acute respiratory distress syndrome (including and excluding neurologic deaths) had excellent discrimination (both area under the receiver operating characteristic curve ≥ 0.85), but poor calibration. After revision, the model for all intubated subjects remained miscalibrated, whereas the model excluding neurologic deaths showed perfect calibration. Mortality models also stratified ventilator-free days at 28 days in both derivation and validation cohorts.ConclusionsWe describe predictive models for mortality in pediatric acute respiratory distress syndrome using readily available variables from day 0 of pediatric acute respiratory distress syndrome which outperform severity of illness scores and which demonstrate utility for composite outcomes such as ventilator-free days. Models can assist with risk stratification for clinical trials.

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Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence.

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Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence.

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