ABSTRACT
Objective: Pulmonary sequelae post SARS - CoV-2 infection have been reported in adults; however, there is scant literature regarding pulmonary dysfunction following SARS-CoV-2 infection in children. We studied the long term pulmonary sequelae in children who had SARS-CoV-2 infection. Methods: This single center descriptive study conducted in a public sector tertiary care hospital in Northern India, from June, 2020 to October, 2021. We enrolled children aged 7-18 years admitted with SARS-CoV-2 infection and followed them up for 6 months. A detailed interval history was taken and pulmonary function tests were performed after 6 months, using a spirometer. A convenience sample of 40 children was enrolled. There were 21 males and the median (IQR) age was 13 (10.75, 17) years. Results: Thirty percent of children (n=12) had pulmonary function abnormalities, which was of restrictive pattern in all. Children who were underweight had higher odds of developing pulmonary dysfunction following SARS-CoV-2 infection [OR (95% CI) 5.13 (1.19, 22.11); P=0.028]. There were no significant association with age, sex, severity of initial infection and oxygen requirement during the initial infection. Three children had persistence of dyspnea during follow up. Conclusion: This study is the one of the first Indian studies regarding the pulmonary sequelae in children. A possibility of long term sequelae should be considered in children with history of SARS-CoV-2, presenting with suggestive complaints.
Subject(s)
Lung Diseases , Lung Injury , Sleep Initiation and Maintenance Disorders , Dyspnea , COVID-19ABSTRACT
As the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic expands, genomic epidemiology and whole genome sequencing are being constantly used to investigate its transmissions and evolution. In the backdrop of the global emergence of variants of concern (VOCs) during December 2020 and an upsurge in a state in the western part of India since January 2021, whole genome sequencing and analysis of spike protein mutations using sequence and structural approaches was undertaken to identify possible new variants and gauge the fitness of current circulating strains. Phylogenetic analysis revealed that the predominant clade in circulation was a distinct newly identified lineage B.1.617 possessing common signature mutations D111D, G142D, L452R, E484Q, D614G and P681R, in the spike protein including within the receptor binding domain (RBD). Of these, the mutations at residue positions 452, 484 and 681 have been reported in other globally circulating lineages. The structural analysis of RBD mutations L452R and E484Q along with P681R in the furin cleavage site, may possibly result in increased ACE2 binding and rate of S1-S2 cleavage resulting in better transmissibility. The same two RBD mutations indicated decreased binding to selected monoclonal antibodies (mAbs) and may affect their neutralization potential. Experimental validation is warranted for accessing both ACE2 binding and the effectiveness of commonly elicited neutralizing mAbs for the strains of lineage B.1.617. The emergence of such local variants through the accumulation of convergent mutations during the COVID-19 second wave needs to be further investigated for their public health impact in the rest of the country and its possibility of becoming a VOC.
Subject(s)
Coronavirus Infections , COVID-19ABSTRACT
India first detected SARS-CoV-2, causal agent of COVID-19 in late January-2020, imported from Wuhan, China. March-2020 onwards; importation of cases from rest of the countries followed by seeding of local transmission triggered further outbreaks in India. We used ARTIC protocol based tiling amplicon sequencing of SARS-CoV-2 (n=104) from different states of India using a combination of MinION and MinIT from Oxford Nanopore Technology to understand introduction and local transmission. The analyses revealed multiple introductions of SARS-CoV-2 from Europe and Asia following local transmission. The most prevalent genomes with patterns of variance (confined in a cluster) remain unclassified, here, proposed as A4-clade based on its divergence within A-cluster. The viral haplotypes may link their persistence to geo-climatic conditions and host response. Despite the effectiveness of non-therapeutic interventions in India, multipronged strategies including molecular surveillance based on real-time viral genomic data is of paramount importance for a timely management of the pandemic.