Saliva as an alternative to nasopharyngeal swabs for detection of respiratory syncytial virus (RSV)in children

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.

Clinical Manifestations and Disease Severity of Sars-Cov-2 Infection among Infants in Canada

BACKGROUND: There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. OBJECTIVE(S): The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2. DESIGN/METHODS: This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged <1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 31st 2021, and were classified by disease severity and primary cause of hospitalization. Multivariable logistic regression was performed to identify infants' characteristics associated with hospitalization. RESULT(S): A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions, and infants <1 month had higher odds of hospitalization than infants aged 1-3 months (Table). In total, 20 infants (3.8%) met criteria for severe disease. CONCLUSION(S): We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group is uncommon with most infants having mild disease. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.

Features of an Aseasonal 2021 Rsv Epidemic in the Uk and Ireland: Analysis of the First 10,000 Patients

Aims Respiratory syncytial virus (RSV) causes annual winter epidemics that usually peak in December in the UK and Ireland. Infants are disproportionately affected, with infection leading to lower respiratory tract disease, most commonly bronchiolitis, that often result in emergency department visits and hospitalisations. Non-pharmaceutical interventions (NPIs) introduced globally to limit the spread of SARS-CoV-2 led to disruption of the typical RSV seasonality. Studies examining the aseasonal resurgence of RSV have been limited by sample size, and lack of information on secondary care episodes and clinical features. The BronchStart study is a prospective multicentre cohort study with the objective to monitor RSV disease in children under two years of age attending emergency departments (EDs) across the UK and Ireland and examine the impact on timing, age and severity of clinical presentations as NPI restrictions are reduced throughout the UK and Ireland in 2021. Methods Paediatric emergency departments (PED) within PERUKI (Paediatric Emergency Research in the UK and Ireland) submit data on all children under 2 years of age who visit a PED with symptoms of an acute lower respiratory tract infection (diagnosed as bronchiolitis, lower respiratory tract infection, or first episode of acute wheeze), to a secure online Research Electronic Data Capture (REDCap) database. Followup information is submitted 7 days later. Here we present initial data for 10,347 infants and children from 44 study sites for the period 1st June to 5th December 2021. Results At the time of submission the aseasonal 2021 RSV epidemic in the UK has now come to an end, with infections having peaked in August (figure 1A). Comparing the age distribution of hospitalised infants <12 months to previous years at two large paediatric centres currently participating in the BronchStart Study (Leicester Children's Hospital and Bristol Royal Hospital for Children), we observed a similar age distribution (figure 1B). This suggests reduced community exposure to RSV during the 15 months preceding the start of the season did not result in a clinically significant lack of protective maternal antibody transfer to those <3 months of age, or that the NPIs introduced were not strong enough to prevent low level transmission. Disease severe enough to require intensive care was 2.5% in our cohort (for those aged 6 weeks to one year), comparable to 4.2% reported in previous studies. We also observed a substantial number of PED visits and admissions for RSV positive 12-23 month old children in BronchStart: 362 out of 1,468 (24.7%) admissions were in this age group. Conclusion We found that the 2021 summer lower respiratory tract infection peak in the UK and Ireland, although temporally disrupted and with an attenuated disease burden, predominantly affected younger age groups as in previous years The overall lower burden of disease in 2021 suggests incomplete infection by RSV of its usual susceptible population, probably due to the effect of ongoing non-pharmaceutical interventions over the study time period, and raises the strong possibility of a further wave of infection in the coming months.

IMPLEMENTATION OF A SHARED READING CAMPAIGN IN THE NICU: A QUALITY INITIATIVE STUDY

Purpose of Study Language exposure is essential for speech and language development in newborns. NICU infants by virtue of their prolonged hospitalizations or multiple complications are more likely exposed to less language. Based on a low rate of reading measured in our NICU, this initiative was designed to target this deficiency. Methods Used A family reading survey used for two-week old infants at home (modified from Before and After Books and Reading Survey and the Stony Brook Family Reading Survey) was adapted for inpatients. The survey, consisting of 22 questions, was given to caretakers of infants in the NICU at >7 days to 2 months' time period. The R.E.A.D. (Read to, Enjoy, And Develop) Your Baby program was developed to promote shared reading and educate parents about the importance of language. The campaign consists of giving baby books to families with an infant in the NICU >7 days and bi-weekly for chronically hospitalized infants. Books were made available by the Reach Out and Read Program and by acquisition using a regional grant fund. Using historical cohorts, the survey was given to parents before and after instituting the R.E.A.D. Your Baby program. Comparisons of proportions of parents reporting reading or verbalizing activity was analyzed using N-1 two proportion test. Summary of Results The initial survey was conducted with 50 families in 2019;the post-intervention survey collection is still ongoing and currently 12 families have participated. Demographic data of caretakers are included in Table 1. One item asked parents to name three favorite activities to do with your baby in the NICU by free text-25.2% (37/150) responses centered about language (talking, singing, or reading) in the pre-phase;41.7% (15/36) provided language responses (p=0.024) in the post-intervention phase. Reading represented 5.3% (8/150) of responses in the pre-phase, whereas it represented 13.9% (5/36) of the responses in the post-phase, p=0.00001. A multiple-choice question later asked do you read to your baby in the NICU? in which 22% (11/50) of parents answered yes in the pre-phase;91.7% (11/12) respondents answered yes in the post-phase, p=0.00000. Conclusions Shared reading was occurring for a minority of infants in our urban-setting NICU before the R.E.A.D. Your Baby campaign. Initially we had aimed to improve the reading rate to 50%. Already in the early stages of surveying postintervention, a remarkable increase has been observed. One confounding factor may be a long interval of time between pre- and post-intervention (which was mostly due to the Covid-19 pandemic);another factor may be higher number of parents with education beyond high school in the post-phase. Beyond exposing infants to language in the NICU, additional benefits of reading together likely include promoting parentinfant bonding, providing parental stress coping techniques, and priming for continued reading at home. (Table Presented).

Disease Severity and Clinical Manifestations of SARS-CoV-2 Infection among Infants over the First Year of the Pandemic in Canada

Background. There is limited data on outcomes of SARS-CoV-2 infection among infants (< 1 year of age). In the absence of any approved vaccines for infants, understanding the risk factors for hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and targeted public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and risk factors for hospitalization among infants with SARS-CoV-2 infection in Canada. Methods. This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged < 1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 11th 2021, and classified by disease severity, and primary cause of hospitalization. Logistic regression was performed to identify risk factors for hospitalization and severe disease. Results. A total of 393 cases were reported, including 229 (58.3%) non-hospitalized and 164 (41.7%) hospitalized infants. The most common symptoms included fever (63.4%), runny nose (45.0%), cough (35.1%) and decreased oral intake (24.9%). Significant risk factors for hospitalization included younger age and presence of comorbid conditions (excluding prematurity), as shown in the Table. Among hospitalized infants, 108 (65.9%) were admitted because of COVID-19-related illness, and 52 (31.7%) were admitted for reasons other than COVID-19. A total of 31 (7.9%) infants developed severe or critical disease. Risk factors for severe disease included prematurity and younger age (Table). Conclusion. We describe one of the largest cohort of infants with SARS-CoV-2 infection. Severe disease in this age group is uncommon, with younger age and prematurity being significant risk factors for severe COVID-19.