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European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2267927


Introduction: Nasopharyngeal swabs (NPS) are considered the gold standard for diagnosis of respiratory syncytial virus (RSV). Although highly sensitive, NPS come with sampling burden, a time interval between sampling and PCR test results, and high personnel and resource costs. Moreover, collection can cause discomfort in the patient. A saliva-based method for RSV detection would make large-scale and frequent clinical and community sampling more feasible. In this study, we evaluated detection of RSV in paired NPS and saliva samples. Method(s): Matched NPS and saliva samples were obtained by trained study personnel from hospitalised infants with viral respiratory infection. NPS and saliva samples were tested with SalivaDirect+, a saliva-based PCR test authorized by the US FDA for detection of SARS-CoV-2, expanded to also target RSV. Result(s): To date, 29 paired samples have been collected from infants with medically-attended respiratory infections. As a proof of concept, we analysed the first 10 samples including 5 samples from RSV positive infants and 5 from infants with other respiratory viruses. RSV, rhinovirus, and enterovirus could be detected in all 10 samples in both NPS and saliva. Sampling discomfort was considered to be significantly higher for NPS compared to saliva. More data will be available at the time of the conference. Conclusion(s): We detected RSV in all saliva samples. Our preliminary findings indicate that saliva is a viable and preferable alternative to NPS for RSV detection. Saliva could allow for frequent repeated testing. With further validation, widespread implementation of saliva sampling could transform RSV diagnosis and surveillance in children.

Open Forum Infectious Diseases ; 9(Supplement 2):S898, 2022.
Article in English | EMBASE | ID: covidwho-2190029


Background. During the early Covid-19 pandemic, we observed a close-to-full disappearance of the activity of 4 respiratory viruses (RSV, hMPV, influenza, and parainfluenza), followed by an off-season sequential re-emergence in 2021. Surprisingly, a striking similarity between the dynamics of pneumococcus-associated disease (PAD;namely community-acquired alveolar pneumonia [CAAP;often considered pneumococcal] and bacteremic-pneumococcal pneumonia [IPD-Pneumonia]), was also observed. In contrast, adenovirus and rhinovirus activities did not change during COVID-19. We examined the association between PAD and RSV, hMPV, influenza, and parainfluenza (PAD-viruses). Methods. Surveillance of CAAP and IPD-Pneumonia incidences and viral activity in children < 5 years was described in detail previously [Danino D. et al. Clin Infect Dis. 2022,]. We extended the observations until December 2021, to capture the sequential re-emergence of the 4 PAD-viruses. A hierarchical linear regression model was used to quantify the association between PAD-viruses (each virus individually and combined), adenovirus and PAD. After fitting the models, the contribution of each virus was estimated. Results. The Figure shows striking similarities in the dynamics of CAAP, IPD-Pneumonia, and PAD-viruses both before and during the COVID-19 pandemic. During the expected peak season (Oct 2020 - Apr 2021) PAD episodes were extremely low. However, off-season peaks were seen during May - Dec 2021. Overall, 78% and 25% of all CAAP and IPD-Pneumonia episodes, respectively, were attributable to these viruses in children < 5 (Table). In CAAP, cases were attributable to each of the 4 PAD-viruses individually throughout the first 5 years of life: RSV and hMPV combined contributed 80%, 63%, and 42% of all CAAP episodes in children aged < 1, 1, and 2-4 years, respectively. The respective figures for influenza and parainfluenza combined were 13%, 21%, and 22%. Only RSV significantly contributed to IPD-Pneumonia (19%). Adenovirus did not contribute to PAD episodes. Conclusion. Our model suggests an important causative association between RSV, hMPV, influenza, and parainfluenza viruses and CAAP, and between RSV and IPD-Pneumonia. (Figure Presented).

Open Forum Infectious Diseases ; 8(SUPPL 1):S257, 2021.
Article in English | EMBASE | ID: covidwho-1746692


Background. Streptococcus pneumoniae (pneumococcus) is a common colonizer of the upper respiratory tract and can progress to cause invasive and mucosal disease. Additionally, infection with pneumococcus can complicate respiratory viral infections (influenza, respiratory syncytial virus, etc.) by exacerbating the initial disease. Limited data exist describing the potential relationship of SARS-CoV-2 infection with pneumococcus and the role of co-infection in influencing COVID-19 severity. Methods. Inpatients and healthcare workers testing positive for SARS-CoV-2 during March-August 2020 were tested for pneumococcus through culture-enrichment of saliva followed by RT-qPCR (to identify carriage) and for inpatients only, serotype-specific urine antigen detection (UAD) assays (to identify pneumococcal pneumonia). A multinomial multivariate regression model was used to examine the relationship between pneumococcal detection and COVID-19 severity. Results. Among the 126 subjects who tested positive for SARS-CoV-2, the median age was 62 years;54.9% of subjects were male;88.89% were inpatients;23.5% had an ICU stay;and 13.5% died. Pneumococcus was detected in 17 subjects (13.5%) by any method, including 5 subjects (4.0%) by RT-qPCR and 12 subjects (13.6%) by UAD. Little to no bacterial growth was observed on 21/235 culture plates. Detection by UAD was associated with both moderate and severe COVID-19 disease while RT-qPCR detection in saliva was not associated with severity. None of the 12 individuals who were UAD-positive died. Conclusion. Pneumococcal pneumonia (as determined by UAD) continues to occur during the ongoing pandemic and may be associated with more serious COVID-19 outcomes. Detection of pneumococcal carriage may be masked by high levels of antibiotic use. Future studies should better characterize the relationship between pneumococcus and SARS-CoV-2 across all disease severity levels.

Open Forum Infectious Diseases ; 8(SUPPL 1):S749, 2021.
Article in English | EMBASE | ID: covidwho-1746303


Background. Despite the widespread use of pneumococcal conjugate vaccines, particularly in children, an important burden of pneumococcal disease remains in older adults. The acquisition and transmission rates of pneumococcus between older adults have not been well characterized. Methods. Between October 2020-June 2021, couples living in the Greater New Haven Area were enrolled if both individuals were over the age of 60 years and did not have any individuals under the age of 60 years living in the household. Saliva samples and questionnaires regarding social patterns and medical history were obtained every 2 weeks for a period of 10 weeks. Following culture-enrichment, extracted DNA was tested using qPCR for pneumococcus-specific sequences piaB and lytA. Individuals were considered positive for pneumococcal carriage when qPCR Ct-values for piaB +/- lytA were less than 40. Results. To date, we have collected 495 saliva samples from 95 individuals (48 households). Of 495 saliva samples, 31 (5.9%) have tested positive for pneumococcus by either piaB only (n=9) or both lytA and piaB (n=22). Of 95 individuals, 16 (16.8%) (representing 13, or 27.1% households) have tested positive at least once. Six of the 16 (37.5%) carriers tested positive at multiple timepoints, though none were colonized at all 6 time points over the course of the 10 weeks of study enrolment. For 3 of the 48 (6.3%) households, both members of the couple were identified as carriers, though not necessarily at the same sampling moment. Conclusion. The preliminary findings of this longitudinal transmission model demonstrate evidence of pneumococcal acquisition among older adults measured by molecular tools. These transmission patterns and high rates of pneumococcal carriage in adults were observed during a period when the COVID-19 pandemic led to numerous preventative public health measures that may have reduced pneumococcal transmission (e.g., social distancing, mask wearing, bans on mass gatherings, restaurant closures, travel restrictions).

Stroke ; 52(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1234357


Introduction: The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus-19 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related death and characterize its association with psychosocial factors and emerging COVID-19 related mortality. Methods: U.S. and state-level excess cerebrovascular deaths from January-May 2020 were quantified by Poisson regression models built using National Center for Health Statistic (NCHS) data. Weekly excess cerebrovascular deaths in the U.S. were analyzed as functions of time-varying, weekly stroke-related EMS calls and weekly COVID-19 deaths by univariable linear regression. A state-level negative binomial regression analysis was performed to determine the association between excess cerebrovascular deaths and social distancing (degree of change in mobility per Google COVID-19 Community Mobility Reports) during the height of the pandemic after the first COVID-19 death (February 29, 2020), adjusting for cumulative COVID-19 related deaths and completeness of deaths attributable to COVID-19 in NCHS. Findings: There were 918 more cerebrovascular deaths than expected from January 1-May 16 , 2020 in the U.S. Excess cerebrovascular mortality occurred during every week between March 28- May 2 , 2020, up to 7.8% during the week of April 18 . Decreased stroke-related EMS calls were associated with excess stroke deaths one (β -0.06, 95% CI -0.11, -0.02) and two weeks (β -0.08, 95% CI -0.12, -0.04) later. There was no significant association between weekly excess stroke death and COVID-19 death. Twenty-three states and NYC experienced excess cerebrovascular mortality during the pandemic height. At the state level, a 10% increase in social distancing was associated with a 4.3% increase in stroke deaths (IRR 1.043, 95% CI 1.001-1.085) after adjusting for COVID- 19 mortality. Conclusions: Excess U.S. cerebrovascular deaths during the COVID-19 pandemic were observedwith decreases in stroke-related EMS calls nationally and less mobility at the state level. Publichealth measures are needed to identify and counter the reticence to seeking medical care for acutestroke during the COVID-19 pandemic.