Study Pre-protocol for "BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations; a Multi-Centre Prospective Observational Cohort Study".

Background: Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of  essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome.  Information be released on a weekly basis and used to support clinical decision making.

SARS-CoV-2 testing, infections, and hospital admissions with COVID-19 in children and young people in Scotland: a birth cohort study

Background A strong association between deprivation and severe COVID-19 outcomes has been reported among adults. We estimated population-based rates of SARS-CoV-2 testing, laboratory-confirmed infections, and hospital admissions with COVID-19 in children and young people (aged 0–23 years) in Scotland according to sociodemographic risk factors. Methods We used a birth cohort of all children and young people born in Scotland in 1997–2020, consisting of linked vital registration, maternity, hospital admissions, and SARS-CoV-2 PCR testing data. Participants were followed from birth or Jan 1, 2020 (whichever occurred last) until Dec 31, 2020, death, or emigration. Admissions with COVID-19 were defined as participants with a positive SARS-CoV-2 test during or up to 28 days before admission to hospital, or a relevant International Classification of Diseases version 10 code recorded (U07.1/U07.2). We calculated crude rates of tests, laboratory-confirmed infections, and admissions, by age group, sex, and Scottish Index of Multiple Deprivation (SIMD) quintiles with 95% CIs. Findings The cohort included 1 230 290 children and young people living in Scotland during 2020. By Dec 31, 2020, 243 958 (19·8%) were tested for SARS-CoV-2 at least once, and 17 709 (7·3%) had tested positive. Infants (aged <2 years) and 18–23-year-olds were most likely to be tested;there was no clear trend in testing rates by SIMD quintile. 18–23-year-olds, females, and those from the most deprived SIMD quintile were most likely to test positive. 379 participants had an admission with COVID-19, corresponding to a rate of 32·0 per 100 000 person-years (95% CI 28·9–35·4). Females (admission rate 35·4 per 100 000 person-years [95% CI 30·9–40·6]) and infants (143·5 per 100 000 person-years [113·3–181·7]) were most likely to be admitted to hospital. There was a clear gradient in hospital admissions by SIMD, with participants in the most deprived quintile (42·9 per 100 000 person-years [36·1–50·8]) experiencing 1·9 times (95% CI 1·3–2·6) the admission rate compared with those in the least deprived (22·6 per 100 000 person-years [16·9–30·3]). Interpretation Rates of infection and admissions with COVID-19 were associated with area-level deprivation among children and young people. Infants had a relatively low infection rate but the highest admission rate. Analyses examining risk factors, including ethnic group and long-term conditions are underway, to inform the public health response to SARS-CoV-2 in children. Although children and young people in Scotland had low COVID-19-related admission rates versus adults, a socioeconomic gradient was evident, indicating children living in more deprived areas are at increased risk of short-term, and potential long-term, health and education impacts of COVID-19. Funding UKRI Medical Research Council and the Great Ormond Street Biomedical Research Centre.

Study protocol of the Edinburgh and Lothian Virus Intervention Study in Kids: a randomised controlled trial of hypertonic saline nose drops in children with upper respiratory tract infections (ELVIS Kids).

INTRODUCTION: Edinburgh and Lothians' Viral Intervention Study Kids is a parallel, open-label, randomised controlled trial of hypertonic saline (HS) nose drops (~2.6% sodium chloride) vs standard care in children <7 years of age with symptoms of an upper respiratory tract infection (URTI). METHODS AND ANALYSIS: Children are recruited prior to URTI or within 48 hours of developing URTI symptoms by advertising in areas such as local schools/nurseries, health centres/hospitals, recreational facilities, public events, workplaces, local/social media. Willing parents/guardians, of children <7 years of age will be asked to contact the research team at their local site. Children will be randomised to either a control arm (standard symptomatic care), or intervention arm (three drops/nostril of HS, at least four times a day, until 24 hours after asymptomatic or a maximum of 28 days). All participants are requested to provide a nasal swab at the start of the study (intervention arm: before HS drops) and then daily for four more days. Parent/guardian complete a validated daily diary, an end of illness diary, a satisfaction questionnaire and a wheeze questionnaire (day 28). The parent/guardian of a child in the intervention arm is taught to prepare HS nose drops. Parent/guardian of children asymptomatic at recruitment are requested to inform the research team within 48 hours of their child developing an URTI and follow the instructions already provided. The day 28 questionnaire determines if the child experienced a wheeze following illness. Participation in the study ends on day 28. ETHICS AND DISSEMINATION: The study has been approved by the West of Scotland Research Ethics Service (18/WS/0080). It is cosponsored by Academic and Clinical Central Office for Research and Development-a partnership between the University of Edinburgh and National Health Service Lothian Health Board. The findings will be disseminated through peer-reviewed publications, conference presentations and via the study website. TRIAL REGISTRATION NUMBER: NCT03463694.

Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study.

OBJECTIVES: To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020. DESIGN: National retrospective cohort study. SETTING: Emergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records. PARTICIPANTS: 273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years. MAIN OUTCOME MEASURES: Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016-2019. RESULTS: The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared with 2016-2019. CONCLUSIONS: National lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.