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1.
Respiratory Medicine and Research ; : 100909, 2022.
Article in English | ScienceDirect | ID: covidwho-1778433

ABSTRACT

STRUCTURED Background Mitigation strategies were implemented during the coronavirus disease 2019 (COVID-19) pandemic that slowed the spread of this virus and other respiratory viruses. The objective of this study is to assess the impact of COVID-19 mitigation strategies on the medical services that children less than 1 year of age with acute bronchiolitis required (emergency department services, hospitalization, critical care services, and mechanical ventilation). Methods This was a retrospective observational cohort study utilizing TriNetX ® electronic health record (EHR) data. We included subjects less than 1 year of age with a diagnosis of acute bronchiolitis. After the query, the study population was divided into two groups [pre-COVID-19 (March 1st, 2019 until February 29th, 2020) and COVID-19 (March 1st, 2020 until February 1th, 2021)]. We analyzed the following data: age, sex, race, diagnostic codes, common terminology procedures (CPT), and antimicrobials administered. Results A total of 5063 subjects (n,%) were included [4378 (86.5%) pre-COVID-19 and 685 (13.5%) during the COVID-19 pandemic]. More subjects were diagnosed with acute bronchiolitis in the pre-COVID time frame (4378, 1.8% of all hospitalizations) when compared to the COVID-19 pandemic time frame (685, 0.5%). When diagnosed with acute bronchiolitis, the frequency of emergency department services, critical care services, hospitalization, and mechanical ventilationwere similar between the two cohorts. Conclusions During the COVID-19 pandemic, less infants were diagnosed with acute bronchiolitis but the frequency of emergency department services, hospitalization, and mechanical ventilation, reportedly required was similar. Longer-term studies are needed to evaluate the benefits of COVID-19 mitigation strategies on common viruses that require critical care.

2.
Arch Argent Pediatr ; 120(2): 99-105, 2022 04.
Article in English, Spanish | MEDLINE | ID: covidwho-1766098

ABSTRACT

INTRODUCTION: Respiratory viruses are the main cause of acute lower respiratory tract infection (ALRTI) in the pediatric population. In March 2020, the World Health Organization declared that the new coronavirus disease 2019 (COVID-19) had reached the pandemic status. Our objective was to describe the impact of COVID-19 pandemic on hospitalizations due to ALRTI at Hospital de Niños Ricardo Gutiérrez (HNRG) and virus circulation. METHODS: Observational, retrospective, and descriptive study of patients hospitalized due to ALRTI comparing 2019 and 2020. RESULTS: In 2020, the rate of hospitalization due to ALRTI decreased by 73%. In 2019, 517 patients with ALRTI were hospitalized; the following viruses were identified in 174: respiratory syncytial virus (RSV) (71.2%), adenovirus (AV) (10.3%), parainfluenza virus (PIV) (9.7%), and influenza virus (FLU) (8.6%). In 2020, 94 patients with ALRTI were hospitalized. Until epidemiological week (EW) 13, cases of ALRTI due to PIV and AV were recorded; in EW 29, there was 1 case of bronchiolitis due to AV and rhinovirus (RV), followed by isolated cases of RV; no ALRTI due to RSV or FLU was recorded. In total, 9 cases of ALRTI due to COVID-19 were recorded: 2 moderate bronchiolitis and 7 focal pneumonia; 1 adolescent with comorbidities died due to COVID-19 pneumonia. In 2020, patients were older and had more comorbidities and prior hospitalizations compared to 2019. Focal pneumonia prevailed. CONCLUSIONS: In 2020, the rate of hospitalization due to ALRTI decreased significantly compared to 2019, with the absence of seasonal respiratory virus circulation in the pediatric population.


Introducción. Los virus respiratorios son la principal causa de infección respiratoria aguda baja (IRAB) en la población pediátrica. En marzo de 2020, la Organización Mundial de la Salud declaró el estado de pandemia de la enfermedad por el nuevo coronavirus 2019 (COVID-19) con un impacto global elevado. El objetivo de este estudio fue describir el impacto de la pandemia de COVID-19 en las internaciones por IRAB en el Hospital de Niños Ricardo Gutiérrez (HNRG) y la circulación viral. Métodos. Estudio observacional, retrospectivo y descriptivo de pacientes internados por IRAB, comparando los años 2019 y 2020. Resultados. En 2020, la tasa de hospitalización por IRAB se redujo un 73 % en el HNRG (575,1/10 000 en 2019 y 155,3/10 000 en 2020). En 2019 se internaron 517 pacientes con IRAB; en 174 se identificaron los virus: sincicial respiratorio (71,2%), adenovirus (AV) (10,3%), parainfluenza (PIF) (9,7 %) e influenza (FLU) (8,6 %). En 2020, se hospitalizaron 94 pacientes con IRAB. Hasta la semana epidemiológica (SE) 13 se registraron casos de IRAB por PIF y AV; en la SE 29 un caso de bronquiolitis por AV y rinovirus (RV), seguido de casos aislados de RV; no hubo IRAB por VSR ni por FLU. Se registraron 9 casos de IRAB por COVID-19: 2 bronquiolitis moderadas y 7 neumonías focales; con un adolescente fallecido por neumonía por COVID-19 con comorbilidades. En 2020, los casos presentaron mayor edad, más comorbilidades e internaciones previas en comparación con el 2019. La neumonía focal fue la presentación clínica predominante. Conclusión. En 2020, la tasa de hospitalización por IRAB se redujo significativamente en comparación con el año anterior, con ausencia de circulación de virus respiratorios estacionales en la población asistida en nuestro centro.


Subject(s)
COVID-19 , Viruses , Adolescent , COVID-19/epidemiology , Child , Hospitals, Pediatric , Humans , Pandemics , Retrospective Studies
3.
Medeni Med J ; 37(1): 92-98, 2022 03 18.
Article in English | MEDLINE | ID: covidwho-1753826

ABSTRACT

Objective: Despite maximum isolation measures taken during the coronavirus disease-2019 (COVID-19) pandemic, the workload of health institutions has increased. Consequently, changes in the number of admissions in clinics and emergency departments by disease groups have been observed. We aimed to quantitatively investigate the changes in the frequency of respiratory infections and asthma in the pediatric population during the COVID-19 pandemic. Methods: We analyzed electronic medical record data of patients who were admitted to the emergency department (ED), outpatient and inpatient clinics, and pediatric intensive care unit (PICU) because of influenza, upper and lower respiratory tract infections (URTI, LRTI), acute bronchiolitis, and asthma during the two-year period (one year pre-COVID period and first year of the pandemic). Results: There were 96,648 admissions in the pre-COVID period and 15,848 during the pandemic. We observed a decline in ED admissions (-73%), outpatient clinic visits (-70%), hospitalizations (-41.5%), and PICU admissions (-42%). While the admission rates of patients with influenza [from 4.26% to 0.37% (p=0.0001)] and URTI [from 81.54% to 75.62% (p=0.0001)] decreased, the ratio of the number of admissions to the total number of admissions due to LRTI [from 8.22% to 10.01% (p=0.0001)], acute bronchiolitis [from 2.76% to 3.07% (p=0.027)], and asthma [from 5.96% to 14% (p=0.0001)] increased. Conclusions: The decrease in viruses that cause acute bronchiolitis and asthma attacks lead to a reduction in admissions to ED of this patient group. The fact that parents preferred not to admit their child in ED during this period may have paved the way for the development of more severe LRTIs.

4.
Infection ; 2022 Mar 22.
Article in English | MEDLINE | ID: covidwho-1750867

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused a variation in the circulation of common respiratory viruses. Our objective was to analyse the epidemiology of respiratory syncytial virus (RSV) bronchiolitis admissions during the COVID-19 pandemic in comparison with previous epidemic seasons. METHODS: We conducted an observational study involving infants with RSV bronchiolitis admitted to a tertiary hospital during two periods: pandemic COVID-19 (15 March 2020-30 September 2021) and pre-pandemic (1 October 2014-14 March 2020). Demographic and clinical characteristics were collected. RESULTS: A total of 270 patients were admitted for RSV bronchiolitis: 253 in the pre-pandemic period with an average of 42 admissions per season vs 17 in the pandemic. During the pandemic, the RSV outbreak started late in June 2021 with a higher percentage of prematurity and PICU admissions. CONCLUSION: A change in RSV seasonality was observed during the COVID-19 pandemic, with an unusual outbreak in summer 2021 of lower magnitude than previous seasons.

5.
Pediatr Pulmonol ; 2022 Mar 21.
Article in English | MEDLINE | ID: covidwho-1750429

ABSTRACT

OBJECTIVES: To investigate whether the three nationwide coronavirus disease 2019 (COVID-19) lockdowns imposed in Israel during the full first pandemic year altered the traditional seasonality of pediatric respiratory healthcare utilization. METHODS: Month by month pediatric emergency department (ED) visits and hospitalizations for respiratory diagnoses during the first full COVID-19 year were compared to those recorded for the six consecutive years preceding the pandemic. Data were collected from the patients' electronic files by utilizing a data extraction platform (MDClone© ). RESULTS: A significant decline of 40% in respiratory ED visits and 54%-73% in respiratory hospitalizations during the first COVID-19 year compared with the pre-COVID-19 years were observed (p < 0.001 and p < 0.001, respectively). The rate of respiratory ED visits out of the total monthly visits, mostly for asthma, peaked during June 2020, compared with proceeding years (109 [5.9%] versus 88 [3.9%] visits; p < 0.001). This peak occurred 2 weeks after the lifting of the first lockdown, resembling the "back-to-school asthma" phenomenon of September. CONCLUSIONS: This study demonstrates important changes in the seasonality of pediatric respiratory illnesses during the first COVID-19 year, including a new "back-from-lockdown" asthma peak. These dramatic changes along with the recent resurgence of respiratory diseases may indicate the beginnings of altered seasonality in pediatric pulmonary pathologies as collateral damage of the pandemic.

6.
Annals of Emergency Medicine ; 78(4):S112, 2021.
Article in English | EMBASE | ID: covidwho-1748250

ABSTRACT

Study Objective: Following the arrival of COVID-19 in the New York metropolitan area in March 2020, pediatric ED visits markedly decreased. Possible reasons for this include parental reluctance to bring their children to the ED due to fear of exposure and mandates to socially isolate (which may have also decreased infectious disease transmission) and increasing use of telemedicine. Our goal was to determine whether ED visits for some common pediatric infectious conditions changed following the arrival of COVID-19 in our area. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Of these, 5 hospitals had dedicated pediatric EDs. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12,000 to 122,000. Population: consecutive ED patients ≤ 18 years old between March 1 and November 30 in 2019 and 2020. Data analysis: We arbitrarily chose to examine the following conditions: otitis media, bronchiolitis, streptococcal pharyngitis, croup and diarrhea, identified by the International Classification of Diseases codes, version 10. We tallied total visits and visits for each of these diagnoses in 2019 and 2020 time periods. We report the percentage changes in visits from 2019 to 2020 along with their 95% confidence intervals (CIs). Results: The database contained 300,627 visits in 2019 and 2020. From 2019 to 2020, total visits decreased by 58%, from 211,018 in 2019 to 89,609 in 2020. Visits in 2019 and 2020 respectively, were: otitis media (7080, 1775);bronchiolitis (2041, 267);streptococcal pharyngitis (2813, 863);croup (2547, 389) and diarrhea (3533, 900). This represents the following decreases from 2019 to 2020: otitis media 75% (95% CI 73-76%), bronchiolitis 87% (95% CI 85-88%), streptococcal pharyngitis 69% (95% CI 67-71%), croup 85% (95% CI 83-86%) and diarrhea 74% (95% CI 73-76%). Conclusion: Total pediatric ED visits and visits for specific infectious conditions markedly decreased following the arrival of COVID-19 in our area. Further studies are needed to investigate the impact that the reduction in ED visits had on patient clinical outcomes.

8.
European Respiratory Journal ; 58:2, 2021.
Article in English | Web of Science | ID: covidwho-1706419
9.
Journal of Investigative Medicine ; 70(2):495, 2022.
Article in English | EMBASE | ID: covidwho-1701537

ABSTRACT

Case Report Purpose of Study Interstitial lung disease (ILD) is a group of pulmonary disorders that cause varying degrees of inflammation and fibrosis of pulmonary architecture. The diagnosis requires good clinical history, examination, appropriate workup, and a high degree of suspicion. This case report draws attention toward a unique case of cryptogenic organizing pneumonia after mold exposure. Methods Used Not applicable. Summary of Results A 36-year-old nonsmoker male with no comorbidities presented with worsening shortness of breath after cleaning a walk-in cooler room contaminated with mold. He was seen at multiple facilities for presumed diagnosis of COVID-19 despite being vaccinated and 4 negative COVID-19 results. He was discharged with 2 liters of supplemental home oxygen and a 7-day course of Levofloxacin, with no resolution of symptoms. The patient presented to our hospital 2 months after initial onset of symptoms. On examination, the patient had bronchial breath sounds with fine crepitations, egophony, and increased vocal resonance. Chest x-ray revealed bilateral airspace consolidation with scattered ground-glass opacities in the apices. Computed Tomography (CT) of the thorax showed peripheral upper lobe ground-glass opacities with interstitial thickening in a 'crazy-paving' pattern. A chest CT angiogram showed patchy ground-glass pulmonary infiltrates with peripheral predominance consistent with severe COVID pneumonia. PCR for SARS-CoV-2 was negative. The patient's oxygen demand increased progressively from 4L on nasal cannula to 40L on high flow nasal cannula to maintain an oxygen saturation of 90%. Labs showed normal leukocyte count, ESR, ALT, and AST with a mildly elevated CRP. Workup for infectious etiology was negative for S. pneumoniae, legionella, coccidioides, HIV, hepatitis panel, Quanti- FERON gold and blood culture. Autoimmune workup was negative for ANA, RF, CCP, ANCA, anti-centromere Antibody, anti-ds DNA. The patient underwent a bronchoalveolar lavage with culture negative for acid fast bacilli, fungi, and P. jirovecii. Bronchoscopic biopsy was subsequently performed and revealed lung parenchyma with foci of mild chronic inflammation with focal fibroblastic proliferation and fibrosis, suggestive of an organizing pneumonia. The patient was started on steroids 1 mg/kg resulting in significant clinical improvement requiring only 3L on nasal cannula on day 5 of treatment. He was then discharged with high dose steroid therapy for 3 months. Conclusions The prognosis and treatment of ILD depends on accurate diagnosis and its subtype. Hence appropriate workup is essential to guide therapy. In the setting of the current pandemic, relatively uncommon causes of ILD like cryptogenic organizing pneumonia may go undiagnosed due to the unconscious bias among health care providers resulting in delayed treatment. This report highlights the importance of considering alternative diagnosis when a disease does not follow an expected course.

10.
J Med Virol ; 2022 Feb 23.
Article in English | MEDLINE | ID: covidwho-1702621

ABSTRACT

Respiratory syncytial virus (RSV) is the most common viral pathogen causing respiratory disease in the pediatric population. An unexpected sudden upsurge of RSV infections among children was observed in September 2021 in Greece. Forty-one rhinopharyngeal samples from children under the age of 2 years with confirmed RSV bronchiolitis were tested to identify the genotype(s) of the RSV strain(s). The children were hospitalized during September-November 2021 in three tertiary hospitals in northern Greece. A one-step RT-PCR which amplifies a fragment of the second hypervariable region of the G protein gene was applied. PCR products were sequenced, and phylogenetic analysis was performed. Most (80.5%) RSV cases were typed as RSV-A, with RSV-B accounting for 19.5% of cases. RSV-A and RSV-B sequences clustered within the ON1 and BA genotypes, respectively. As the same genotypes were detected in cases observed during 2016-2018 in northern Greece, it was suggested that the early upsurge of infections was not related to the emergence of novel strain(s), but it was the result of the absence of immunity among children and their mothers due to the restriction measures taken during the COVID-19 pandemic in the previous RSV season. Awareness is needed to diagnose even the out-of-season RSV infections, while molecular epidemiology plays a key role in monitoring the efficacy of currently available therapeutics and for those under development.

11.
Gazi Medical Journal ; 33(1):P39-P40, 2022.
Article in English | EMBASE | ID: covidwho-1675754

ABSTRACT

Vitamin D [25 (OH)D] plays a role in many of biological processes, such as bone metabolism, immunomodulation, cell proliferation, differentiation, and regulation. Also, it has anti-inflammatory, antifibrotic, and antioxidant effects. Due to the immunomodulatory effects of 25 (OH)D, its deficiency is blamed for a higher risk for COVID-19 infection. Serum concentrations of 25 (OH)D were inversely associated with proinflammatory cytokines such as increased IL-6, CRP levels, and increased risk of pneumonia or ARDS. Lower 25 (OH)D concentrations are associated with a higher risk for infections, especially from the respiratory tract [1]. Chronic vitamin D deficiency can induce the renin-angiotensin system activation and leads to fibrotic changes that can cause lung injury by inducing proinflammatory cytokine production in human monocytes/macrophages (2). Increased frequency of COVID-19 infection at high latitudes and worse prognosis of these cases made clinicians to think that 25 (OH)D levels may affect the risk and prognosis of COVID-19 infection [3]. In previous reports, in the early pandemic, a higher prevalence of vitamin D deficiency has been reported to be related to high rates of COVID-19 infection, higher risk of invasive mechanical ventilation (IMV), and mortality [6]. Whilst, it is reported that 25 (OH)D may not protect against COVID-19 infection in recent studies. Moreover, it was not associated with disease severity or lethality [4-6]. The active form of vitamin D binds to its receptor (VDR) and modulates its responses. VDR is located on chromosome 12q13, consisting of 9 exons. Vitamin D-VDR signaling regulates the expression of a wide range of physiological functions. Herein, VDR polymorphisms cause a dysfunctional receptor that affects VDR activity. Both innate and adaptive immune responses can vary according to different polymorphisms of VDR. Also VDR polymorphisms have been previously found to be associated with bacterial infections such as tuberculosis [7] and severe Respiratory Syncytial Virus (RSV) bronchiolitis in respect to vitamin D deficiency [8]. Moreover, it was demonstrated that different VDR polymorphisms such as FokI, BsmI, ApaI, and TaqI could change the course of RSV infection in several studies, respectively [8-10]. This study aimed to evaluate if there is any association between the VDR gene polymorphism at FokI, TaqI, BsmI, and ApaI alleles and the prognosis of COVID-19 in respect to vitamin D deficiency. Two-hundred ninety-seven (n=297) patients with reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 who were admitted to Marmara University Education and Research Hospital between April and October 2020 were enrolled. The severity of COVID-19 patients was classified into 1-10 according to WHO criteria. The patients' requirement for noninvasive mechanical ventilation (NIMV) or reservoir mask, their requirement for admission to intensive care unit (ICU), mortality, and WHO clinical progression scales were reviewed. Four variant regions of vitamin D receptor (VDR);FokI, BsmI, ApaI, and TaqI were determined using the Restriction Fragment Length Polymorphism (RFLP) technique. To conclude;The effect of VDR polymorphisms on the receptor function causes intensive care unit treatment, disease severity and mortality differences among patients with covid-19 infection in the clinical set-up. VDR Ff genotype was related with disease severity, TT with disease severity and aa with mortality respectively. As a result we have detected that 25 (OH)D levels were not related to COVID-19 infection severity and mortality. Additionally, it indicated that VDR polymorphisms are independently associated with the severity of COVID-19 and the survival of patients. More extensive studies are needed to determine the impact of polymorphisms on COVID-19 and explain the underlying cause.

12.
Nurs Child Young People ; 34(2): 13-21, 2022 Mar 03.
Article in English | MEDLINE | ID: covidwho-1648592

ABSTRACT

Bronchiolitis is a common seasonal viral illness in babies and children aged under two years. Its significance has increased in the light of a predicted surge in respiratory illness in children this winter and the continuing effect of the coronavirus disease 2019 (COVID-19) pandemic on parental anxiety and cross-infection. Children's nurses will have a central role in delivering high-quality care and support to children and families during this time. To support children's nurses to prepare for a surge, this article summarises the pathophysiology of bronchiolitis, risk factors, transmission, diagnosis and clinical management of children with the illness, including recent national policy changes. It also considers the potential effect of the COVID-19 pandemic on the healthcare system, children and families.


Subject(s)
Bronchiolitis , COVID-19 , Bronchiolitis/diagnosis , Bronchiolitis/therapy , Child , Child, Preschool , Humans , Infant , Pandemics , Risk Factors , SARS-CoV-2
13.
BMC Infect Dis ; 22(1): 84, 2022 Jan 24.
Article in English | MEDLINE | ID: covidwho-1648460

ABSTRACT

BACKGROUND: Bronchiolitis is the most common viral infection of the lower respiratory tract in infants under 2 years of age. The aim of this study was to analyze and compare the seasonal bronchiolitis peaks before and during the SARS-CoV-2 pandemic. METHODS: Descriptive, prospective, and observational study. Patients with severe bronchiolitis admitted to the Pediatric Intensive Care Unit (PICU) of a referral tertiary hospital between September 2010 and June 2021 were included. Demographic data were collected. Viral laboratory-confirmation was carried out. Each season was analyzed and compared. The daily average temperature was collected. RESULTS: 1116 patients were recruited, 58.2% of them males. The median age was 49 days. Respiratory syncytial virus (RSV) was isolated in 782 cases (70.1%). In April 2021, the first and only case of bronchiolitis caused by SARS-CoV-2 was identified. The pre- and post-pandemic periods were compared. There were statistically significant differences regarding: age, 47 vs. 73 days (p = 0.006), PICU and hospital length of stay (p = 0.024 and p = 0.001, respectively), and etiology (p = 0.031). The peak for bronchiolitis in 2020 was non-existent before week 52. A delayed peak was seen around week 26/2021. The mean temperature during the epidemic peak was 10ºC for the years of the last decade and is 23ºC for the present season. CONCLUSION: The COVID-19 pandemic outbreak has led to a clearly observable epidemiological change regarding acute bronchiolitis, which should be studied in detail. The influence of the environmental temperature does not seem to determine the viral circulation.


Subject(s)
Bronchiolitis , COVID-19 , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Bronchiolitis/epidemiology , Child , Humans , Infant , Male , Middle Aged , Pandemics , Prospective Studies , Respiratory Syncytial Virus Infections/epidemiology , SARS-CoV-2
14.
Critical Care Medicine ; 50:77-77, 2022.
Article in English | Academic Search Complete | ID: covidwho-1630831

ABSTRACT

B Methods: b We conducted a retrospective chart review of PICU admissions with ICD-10 codes capturing the diagnosis of bronchiolitis from March 29 through June 19, 2021 (post precautions) and compared them with historical cohorts for the same pre-pandemic weeks in 2017, 2018 and 2019. The objective was to determine if more patients with bronchiolitis required PICU admission during the typical "off-season" of critical bronchiolitis compared with pre-pandemic numbers. B Introduction: b Public health measures implemented to slow the spread of the SARS-CoV-2 pandemic resulted in a marked decrease in the overall incidence of viral infections and Pediatric Intensive Care Unit (PICU) admissions nationwide. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

15.
Pediatr Pulmonol ; 57(3): 770-771, 2022 03.
Article in English | MEDLINE | ID: covidwho-1632248

ABSTRACT

Respiratory syncytial virus (RSV) hospitalizations practically disappeared in 2020. Now, with Southern Hemisphere 2021 winter behind us, RSV has returned. Despite it is difficult to weigh the impact of pandemic mitigation measures on common respiratory virus circulation, it appears that acute respiratory infections in children are returning to their usual epidemiology.


Subject(s)
COVID-19 , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Child , Humans , Pandemics , Respiratory Syncytial Virus Infections/epidemiology , SARS-CoV-2
16.
Enferm Infecc Microbiol Clin ; 2021 Dec 22.
Article in Spanish | MEDLINE | ID: covidwho-1630203

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has changed the circulation of some viruses associated with acute bronchiolitis. We analyzed the epidemiology of bronchiolitis admissions during the COVID-19 pandemic compared with 8 previous epidemic seasons. METHODS: An observational and ambispective study was performed, including infants admitted with bronchiolitis in a tertiary hospital during 2 periods: COVID-19 pandemic (15th March 2020 to 3st August 2021) and pre-pandemic (1st September 2012 to 14th March 2020). Demographic, clinical data and etiologies were collected. RESULTS: Five hundred ten patients were hospitalized with bronchiolitis: 486 in the pre-pandemic period with an average of 61 admissions per season vs 24 during the pandemic, observing a 60.7% reduction in bronchiolitis admissions. During the pandemic, bronchiolitis outbreak was delayed until spring-summer 2021. Respiratory syncytial virus was the most frequent etiological agent in both periods. CONCLUSION: We observed a change in the seasonality of bronchiolitis during the pandemic COVID-19, possibly influenced by control measures against SARS-CoV-2.

17.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617064

ABSTRACT

Introduction: Respiratory tract diseases are a major cause of morbidity and mortality in children. This study aimed to compare respiratory illness rates and aetiology requiring hospitalization in 2019 (pre-COVID lockdown in Ireland) and 2020 (during COVID lockdown in Ireland). Methodology: Data from medical admissions were retrospectively collected from the emergency department admissions record of a Tertiary Paediatric Hospital in Dublin, Ireland. This study focused on September, October and November in 2019 and 2020. The documented reason for admission in each case was noted;these were transcribed and grouped into categories. Reasons for admission under the category of respiratory included: bronchiolitis, lower respiratory tract infection, upper respiratory tract infection, wheeze, stridor and exacerbation of asthma. Rates of admission in this category were compared from 2019 versus 2020. Rates of investigative nasopharyngeal swabs for these admissions were documented, as well as the resultant viruses isolated. The results were compared across 2019 and 2020. Results: 1040 admission were included in the study. Of these, 620 were in 2019 and 420 in 2020. This alone shows a decrease of 32% in the admissions rate to Temple Street Children's hospital during COVID-19 restrictions. Of the 620 admissions across September, October and November 2019, 265 were attributed to respiratory illnesses (42.77%). In the same time period of 2020, only 67 admissions were attributed to respiratory causes (15.95%). This shows a dramatic decrease in the number of paediatric respiratory illnesses requiring hospital admission. There was a decrease in the number of respiratory panel nasopharyngeal swabs taken in 2020 compared to 2019, although 89% of respiratory admissions were swabbed for Sars-CoV-2 in 2020. Respiratory syncytial virus accounted for 54.60% of respiratory admissions swabbed in 2019 versus a 0% isolation rate in 2020. The table below further outlines virology differences between 2019 and 2020. (table) Conclusion: SARS-CoV-2 pandemic related social restrictions dramatically interfered with the seasonality of childhood respiratory illnesses. This was reflected in the unexpected reduction in the number of hospitalizations in the paediatric population during this period. There is also an obvious stark contrast in the viruses isolated in children presenting with respiratory illnesses in 2019 and 2020. This study raises serious questions and concerns regarding paediatric immunity to respiratory illnesses and begs the question: will we experience a more severe respiratory season in 2021?

18.
Paediatr Perinat Epidemiol ; 2022 Jan 04.
Article in English | MEDLINE | ID: covidwho-1607458

ABSTRACT

BACKGROUND: Public health measures (PHM) designed to contain the spread of COVID-19 pandemic have influenced the epidemiological characteristics of other viral infections. Its impact on acute RSV bronchiolitis in infants of ≤24 months old has not been systematically studied in our setting. OBJECTIVES: To describe the monthly pattern of visits to the Paediatric Emergency Department (PED) of patients 0 to 14 years of age, the rate of patients diagnosed with RSV acute bronchiolitis per thousand inhabitants of 0 to 24 months, and the rate of them requiring hospital admission during the winter 2020-2021, in the context of local and national COVID-19 restrictions and compare them to the four previous seasons. METHODS: Interrupted time series analysis of patients assisted in the PED and diagnosed with or admitted for RSV acute bronchiolitis in a tertiary University Hospital from January 2016 to February 2020 (pre-intervention period) and from March 2020 to June 2021 (post-intervention period). INTERVENTION: Preventive PHM implemented by the Spanish government weighted by the Containment and Health Index of the Oxford COVID-19 Government Response Tracker. RESULTS: The intervention was followed by an immediate reduction of the rate of visits to the PED of -19.5 (95% confidence interval [CI] -24.0, -14.9) per thousand, and the rate of diagnoses and admissions for RSV acute bronchiolitis of -44.3 (95% CI -73.8, -14.8) and -1.4 (95% CI -2.7, -0.1) per thousand, respectively, with a delayed rebound. CONCLUSIONS: After the implementation of PHM to prevent the spread of SARS-CoV-2 infection, an immediate and important decline in the visits to the PED was observed, with an upward change thereafter. There was also an initial reduction in the diagnoses of and admissions by RSV acute bronchiolitis. An upward trend was observed six to nine months after the usual time of the winter RSV epidemic, coinciding with the relaxation of the preventive PHM.

19.
Blood ; 138:4302, 2021.
Article in English | EMBASE | ID: covidwho-1582148

ABSTRACT

Patients with SARS-CoV-2 may be affected by the acute respiratory distress syndrome (ARDS), which has been associated with high mortality rate. As no specific drugs are available for ARDS, mesenchymal stem cells (MSC) seems to be a promising cell therapy due to immunomodulatory effects on reducing and healing inflammation-induced lung and other tissue injuries. The goal of this Phase I clinical trial was to explore the safety and efficacy of bone marrow-derived MSC (BM-MSC) infusions in patients with COVID-19 ARDS. The inclusions criteria were age between 18 to 70 years and PaO2/FiO2≤200mmHg. The BM-MSC infusions were as follow: one to 3 infusions intravenous doses of BM-MSC of 1x10 6 cells/kg;each dose could be administered with an interval between 3 to 7 days. The primary endpoint was safety (adverse events) within 6 hours;cardiac arrest or death within 24 hours post-infusion. The secondary endpoint includes patient survival at 30 days after the first infusion. Six patients were included in the trial and treated with at least one infusion of BM-MSC. The median age was 60,3 years (54 to 69), 5 were male. The median time between the worsening of respiratory distress and the BM-MSC infusion was 10 days (3 to 31 days). The median of PaO2/FiO2 before infusion was 151.86 (127.80-164.44) and median PaCO2 was 63,85 (39 to 117). One patient was treated with 3 MSC doses, two patients with 2 doses and 3 patients one dose. No serious adverse effects were observed within 24 hours post-infusion;only one death was observed following 30 days of cell administration. None of them showed adverse events during BM-MSC infusion. Only one patient showed signs of pulmonary infection one week after first BM-MSC infusion. This patient was at increased risk for infection due to prolonged intubation and a high dose of corticosteroid. Therefore, it was not possible to conclude its association with BM-MSC treatment. Only two patients showed clinical improvement after BM-MSC infusion. Patient 1 had BM-MSC infusion 72 hours after worsening of respiratory parameters, and thorax CT suggested the hypothesis of cryptogenic organizing pneumonia, which led to decision of using methylprednisolone 125mg I.V. for 3 days and carry on with MSC infusion. We observed a decrease in CRP levels from 126 to 67 mg/dL on day 1 after the first infusion, and PaO2/FiO2 ratio improved from 155 to 297 mmHg on day 5. He received the second dose within 7 days interval and by day 11 of the first infusion a new thorax TC showed complete resolution of alveolar consolidation areas in both lungs (Figure 1A and 1B). Patient 2 had BM-MSC administration 11 days after respiratory worsening and also presented improvement of PaO2/FiO2 ratio (148 to 215 mmHg after 2 days of infusion) and had thorax CT images suggesting cryptogenic organizing pneumonia with administration of methylprednisolone 250mg I.V. Nevertheless, the second dose was not administered due to ventilator-associated pneumonia and urinary infection. Four patients showed a non-sustained increase of PaO2/FiO2 ratio, with higher median PCO2 levels of 69,3 mmHg (range, 61,2 to 117) comparing to 39 and 47,3 mmHg of patients 1 and 2, respectively. PCO2 parameter could be a marker to indicate a worse response to MSC treatment, since it could point out chronic phases of COVID-19 disease. The patients died due to COVID-19 complications. No difference in inflammatory markers, such as interleukin 6, C-protein reactive test, procalcitonin, ferritin was observed before and after treatment. Inclusion criteria did not defined interval between respiratory worsening and first BM-MSC infusion. Four patients had chronic phase of COVID-19 without inflammatory markers and hypercapnia. It could be related to severity of pulmonary disease, such as reported in chronic obstructive pulmonary disease. Two patients were discharged after MSC treatment and they received methylprednisolone to treat cryptogenic organizing pneumonia. There are only a few clinical trials and observational studies evaluating the use of high-dose of glucocorticoid for severe COVID-19 pneumonia. Therefore, it is not possible to conclude that use of glucocorticoid has contributed to favorable outcomes. In conclusion, BM-MSC showed to be a secure therapeutic option for severe COVID-19 pneumonia, possibly with superior benefit in acute phases and lower PCO2 levels. Further studies involving a large cohort or randomized controlled trials are warranted. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

20.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):564, 2021.
Article in English | EMBASE | ID: covidwho-1570389

ABSTRACT

Background: It has been over a year since the outbreak of the SARS-Cov- 2 pandemic. In response to the rapid escalation of infection cases, many countries from all over the world, including Poland, have introduced measures to limit the transmission of the new coronavirus, from the recommendation of social distancing and wearing masks to strict lockdown. Our aim was to investigate how the SARS-Cov- 2 pandemic has changed the morbidity associated with the most common respiratory viruses and the incidence of lower respiratory tract infections in pediatric population. Method: To achieve the objective of the study, data mining analyzing the electronic health record system of the Children's Hospital of Medical University of Warsaw, one of the two largest pediatric hospitals in the capital of Poland, was conducted. Individual medical records involving LRTI (based on ICD-10 codes) and detection rates for rhinovirus, RSV, influenza, adenovirus, and SARS-CoV- 2 infections were collected and compared between March 2020 to February 2021, and four previous seasons (2016-2020). Results: A total of 5182 medical records of LTRI were obtained, classified into the following categories: a) viral infections (including bronchiolitis), b) influenza and flu-like infections, and c) bacterial infections from the last five years. During 2016-2020 seasons the cumulative, as well as segregated, annual admission rates remained steady (mean 1198, ranging from 1081 to 1294). In contrast, this trend was not reflected during the last 2020/2021 season as the total LRTI admission rate sharply and statistically significantly dropped to 468 (p < 0.05). In comparison to the average number of hospitalizations during the 2016-2020 seasons, the reduced hospitalization rates in 2020/2021 in the subgroups of viral infections, bronchiolitis, flu, and bacterial infections accounted for 31% (134/430), 41% (79/193), 65% (76/117), and 27% (179/651) cases, respectively. Conclusion: The results of our study demonstrate a substantial decrease in the hospitalization frequency from March 2020 to February 2021 compared to four previous years. The research illustrates the lockdown and social distancing are not only reflected in the decline of reported SARS-CoV- 2 cases but also in other viral and nonviral respiratory tract infections in children, and shows the effectiveness of restrictions in preventing LRTIs among pediatric patients.

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