ABSTRACT
Introduction: The COVID-19 pandemic forced taking measures to restrain viral transmission. Our aim was to describe the changes in the patterns of childhood respiratory viral infections in admitted patients during the COVID19 pandemic. Method(s): We performed an observational study. Trends in respiratory PCR results, from all children admitted to the pediatric departments between Jan. 2015 to Aug. 2021 were evaluated using time series models. Weekly patterns were compared between pre-COVID era and COVID-19 era. Result(s): A total of 7322 pediatric admissions with respiratory viral panel PCR results from 43,466 admissions were evaluated. When comparing Pre-COVID-19 to the COVID-19 era, there was a significant decrease in the number of admissions in which a respiratory viral panel was performed (18% vs. 12%, p<0.001) and a decrease in the number of panels positive for a respiratory viral pathogen (47% vs. 36%, p<0.001). We observed a change in the circulation pattern of respiratory viruses during the COVID-19 era, with marked differences between different respiratory viruses;Influenza viruses completely disappeared;The peak in RSV infection was delayed from the 1st week of 2021 to the 25th week;HMPV had an attenuated peak in 2020 and peaked normally in 2021;parainfluenza viruses did not peak during 2020 with an early peak in the 1st week of 2021;Adenovirus circulation pattern was only minimally affected. Conclusion(s): This study offers a detailed picture of the change in respiratory viruses in children during the COVID19 pandemic, compared to previous years. The changes in patterns are probably related to the application of measures taken to control the SARS-CoV-2 transmission.
ABSTRACT
Introduction: The COVID-19 pandemic has affected the incidence of respiratory viral infections. Our aim was to assess changes in pediatric admissions due to respiratory diseases and associated respiratory viral infections. Method(s): This was a case control study. All children hospitalized with a respiratory disease from Jan. 2015 to Aug. 2021 to the pediatric departments were included. Cases consisted of children admitted between Mar. 2020 to Aug. 2021 (COVID-19 era) and controls between Jan. 2015 to Mar. 2020 (pre COVID-19 era). Diagnosis, length of stay, demographic data, and viral panel results were compared. Result(s): A total of 8774 patients were included, 7157 controls and 1617 cases. There was a significant decrease in respiratory admission rates during the COVID-19 era (17.4% vs 20.9% of all admission, p<0.001). Cases had decreased rates of admissions due to bronchiolitis (4.72% vs 6.3%, p<0.001) and pneumonia (4.87% vs 6.26%, p<0.001) but not asthma (3.84% vs 3.9%), wheezing illness (2.62% vs 2.38%), complicated pneumonia (2.0% vs 2.0%) or stridor (1.79% vs 1.72%). There was a significant decrease in the detection of a respiratory viral pathogen in cases vs controls (44% vs 52%, p<0.001). This was related to a significant decrease in the detection of RSV (27% vs. 37%, p<0.001) and influenza (0.3% vs 5%, p<0.001), but not other respiratory viruses. Conclusion(s): During the COVID-19 pandemic, a decrease in pediatric admissions due to bronchiolitis and pneumonia was observed and associated with a decreased prevalence of RSV and influenza. This may allow us to estimate the significance of preventive measures and vaccination programs for RSV and influenza on respiratory pediatric diseases.
ABSTRACT
Background: COVID-19 has been associated with high mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Aim: To study outcome over time and identify risk factors for mortality in patients reported to the EBMT registry. Methods: 776 allo-HCT patients reported during the first 21 months of the pandemic up until Nov. 2021 were included. Cox regression models were produced to assess risk factors for mortality. Results: The median age was 49.4 years (min-max;1.0 - 80.7). The median time from HCT to COVID-19 diagnosis was 14.1 (0.0-292.7) months during the first period (February 28 - July 31, 2020), 24.4 (0.1-287.6) months during the 2nd (August 1, 2020 - January 31, 2021), and 24.8 (0.1-324.5) months during the 3rd (February 1 - November 30, 2021). 110/776 (14.2%) patients died a median of 21.5 days after diagnosis of SARS-CoV-2 infection. Children had a significantly lower mortality than adults. In multivariate analysis, increasing age (HR 1.27 (95% CI 1.11-1.44;p = .0004), worse performance status (HR 1.48 (1.32-1.65;p <.0001), contracting COVID-19 within the first 30 days after HCT (HR 4.69 (2.44-9.02);p <.0001), ongoing immunosuppression (HR 2.05 (1.20-3.50);p = .009), and recipient CMV seropositivity (HR 2.38 (1.25-4.52);p = .008) had negative impact on overall survival while patients contracting COVID-19 in the 2nd or 3rd period had higher overall survival (p = .0003). Conclusion: Although the outcome of COVID-19 has improved, patients having risk factors still showed high mortality and preventive measures have to be taken.
ABSTRACT
Introduction COVID-19 is usually a mild disease in immunocompetent children, with ~1% requiring intensive care unit (ICU) admission and <0.1% mortality. Data on its course in children following hematopoietic cell transplantation (HCT) is limited. Methods Data on children following HCT who developed COVID-19 (diagnosed by positive SARS-CoV-2 PCR on respiratory tract samples) during 3.2020-4.2021 were prospectively collected by EBMT and GETH, including demography, HCT data, COVID-related manifestations, ICU admission and mortality. Factors associated with worse outcomes (ICU admission or mortality) were characterized. Results Sixty-two children (34 boys;median age 9;min-max;0.7-17 years) were reported from 27 centers, 16 countries;57 (92%) following allogeneic and 5 (8%) following autologous HCT. Underlying diseases were acute leukemia (23;37%), inherited disorders (9;15%), hemoglobinopathies (7;11%), solid tumor (6;10%), bone marrow failure (5;8%), other malignant (8;13%) and non-malignant (4;6%) diseases. Five (8%) children had high blood pressure;6 (10%) had underlying lung pathology. The median time from the most recent HCT to COVID was 5 months (min-max;0-169). The stem cell source was bone marrow (33);peripheral (22) or cord blood (1). Among the patients with information available, 34 (62%) underwent in-vivo T cell depletion, 20 (33%) received corticosteroids, and 36 (60%) other immunosuppressant drugs(s) within two months prior to and after the COVID-19 episode. The presence of acute grade 2-4 or chronic graft versus host disease (GVHD) was reported in 12/54 (23%) and 8/51 (16%) children, respectively. Clinical presentation (n=57) included fever (28;49%), cough (18;32%), diarrhea (8;14%), upper respiratory tract disease (as rhinorrhea, sinusitis, otitis, or pharyngitis;12;21%);six (10%) required oxygen to maintain oxygen saturation above 92%;20 children (35%) were asymptomatic. The median time from symptoms onset to COVID diagnosis was 1 day (-43-40). Sixty-three percent of patients were hospitalized;43% due to COVID. The proportion of children with neutropenia or lymphocytopenia (<500 cells/mm 3) was 75% and 73%, respectively. Sixteen children (26%) had evidence of viral (n=10), bacterial (n=6) or fungal (n=2) coinfections. The median time from COVID diagnosis to the last follow-up in alive patients was 69 days (min-max;2 - 294). Six (10%) children who developed COVID at a median 6.5 (min-max;2- 16) months following allo-HCT (median age 6 years;5 boys) required ICU care within a median 6 (min-max;-5-15) days after diagnosis. All of them were neutropenic, received steroids, and other immunosuppressive drugs at COVID diagnosis;5 had undergone in-vivo T cell depletion;5 were lymphocytopenic, 5 had GVHD (2 acute and 3 chronic);3 received non-invasive and 2 invasive ventilation. Three children had viral or bacterial coinfections. Three children died. Six (10%) children (5 boys, median age 10.5 years;min-max;4-13) who developed COVID at median 2 (min-max;0-147) months following allo-HCT died within median 35 days (min-max;5-54) after diagnosis. One had high blood pressure, and none suffered from underlying lung pathology. At the time of COVID, 3 were neutropenic, 2 lymphocytopenic;4 had GVHD (2 acute, 2 chronic);3 received steroids and 4 immunosuppressive drugs. Two had viral or bacterial coinfections. Five had positive SARS-CoV-2 PCR at the time of death. In 3, COVID was the primary cause of death. We compared nine children with the worse outcomes to 53 children with benign course. Among patients alive at 100-day post HCT, the probability of worse outcomes was higher in patients with vs. without chronic GVHD (Figure). No other significant differences were observed in demographic, underlying disease, and HCT-related characteristics. Compared to adults following HCT (Ljungman, Leukemia 2021), children had: - Shorter median time from HCT to COVID diagnosis, 5 vs 18 months;- Higher proportion of asymptomatic infections, 35% vs 9%;- Lower proportion of those who required oxygen, 10% vs 35%;- Lower all-cause mortality, 10% vs 29%. Conclusions Children following HCT with COVID-19 have a higher risk of ICU admission and mortality compared to immune competent children. The presence of chronic GVHD at COVID diagnosis was associated with worse outcomes. COVID course following HCT is milder in children compared to adults. [Formula presented] Disclosures: Averbuch: Takeda: Consultancy;Pfizer: Consultancy;GSK: Speakers Bureau. De La Camara: Roche: Consultancy;IQONE: Consultancy. Corbacioglu: Gentium/Jazz Pharmaceuticals: Consultancy, Honoraria. Mikulska: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Gilead: Speakers Bureau;MSD: Speakers Bureau;Janssen: Speakers Bureau;Biotest: Speakers Bureau. Kulagin: Roche: Speakers Bureau;Sanofi: Speakers Bureau;Generium: Speakers Bureau;Biocad: Research Funding;Apellis: Research Funding;Alexion: Research Funding;X4 Pharmaceuticals: Research Funding;Novartis: Speakers Bureau;Johnson & Johnson: Speakers Bureau;Pfizer: Speakers Bureau. Cesaro: Sobi: Membership on an entity's Board of Directors or advisory committees;Gilead: Speakers Bureau. Lawson: Alexion: Honoraria. Kroeger: Neovii: Honoraria, Research Funding;Sanofi: Honoraria;Jazz: Honoraria, Research Funding;Celgene: Honoraria, Research Funding;Riemser: Honoraria, Research Funding;Gilead/Kite: Honoraria;AOP Pharma: Honoraria;Novartis: Honoraria. Styczynski: MSD, Pfizer, Giled, TEVA, Jazz, Novartis: Honoraria, Speakers Bureau. Ljungman: Takeda: Consultancy, Other: Endpoint committee, speaker;Enanta: Other: DSMB;Janssen: Other: Investigator;OctaPharma: Other: DSMB;Merck: Other: Investigator, speaker;AiCuris: Consultancy.