[Increase in severe acute respiratory infections in children during the last phase of the COVID-19 pandemic]. / Incremento de infecciones respiratorias agudas graves en niños durante la última etapa de la pandemia COVID-19.

OBJECTIVE: The COVID-19 pandemic has caused a variation in the circulation of respiratory pathogens. Our aim was to analyze the epidemiology of severe acute respiratory infections (SARI) in children during 3 years of the COVID-19 pandemic, in comparison with a previous period. METHODS: An observational study was conducted in a tertiary hospital in Spain, which analyzed the frequency and characteristics of patients admitted for SARI in the Pediatric Intensive Care Unit (PICU) during the COVID-19 pandemic (1 March 2020 to 28 February 2023), compared to pre-pandemic period (1 March 2017 to 29 February 2020). RESULTS: A total of 268 patients were included (59.6% males). The median age was 9.6 months (IQR 1.7 - 37). In the pre-pandemic period, there were 126 admissions with an average of 42 admissions/year. During the pandemic, there were 142 admissions, observing a significant reduction in admissions in the first year (12 admissions/year), in contrast to 82 admissions during the third year, which represented an increase of 95% compared to the average of admissions/year in pre-pandemic. In addition, in the last year there was evidence of an increase in viral coinfections in relation to pre-pandemic period (54.9% vs 39.7%; p=0.032). There were no differences in length of hospital stay or PICU stay. CONCLUSIONS: During the last year, coinciding with low rates of hospitalization for COVID in Spain, we observed a notable increase in admissions to the PICU for SARI. Probably, the prolonged period of low exposure to pathogens due to the measures adopted during the pandemic might have caused a decrease in population immunity with a rise in severe respiratory infections.

Impacto de la gripe durante el periodo epidémico en un hospital de tercer nivel / Impact of the flu during the epidemic period in a tertiary hospital

INTRODUCCIÓN: La gripe es una infección del tracto respiratorio producida por virus de la familia orthomyxoviridae, cuyos géneros más importantes son el Influenza virus A y el Influenza virus B, que afecta a una gran parte de la población pediátrica en los meses de invierno. En niños sanos, su curso suele ser benigno y de corta duración, aunque existen numerosas complicaciones que pueden llegar a evidenciarse. Los test rápidos diagnósticos disponibles tienen una baja sensibilidad, por lo que su uso es poco rentable. El único tratamiento que existe es el oseltamivir, con ciertas limitaciones en su aplicación. POBLACIÓN Y MÉTODOS: Estudio descriptivo retrospectivo de los pacientes diagnosticados en Urgencias Pediátricas de infecciones por el virus de la gripe mediante estudios microbiológicos en muestras respiratorias en el periodo comprendido entre octubre de 2017 y mayo de 2018. El objetivo principal del estudio consiste en describir las características clínicas y epidemiológicas del brote anual de gripe en los pacientes atendidos en el Servicio de Urgencias Pediátricas del Hospital Clínico Universitario de Valladolid, así como realizar un análisis acerca del manejo de los mismos y los posibles cambios de mejora. RESULTADOS: Serie de 149 casos. La edad media fue de 47 meses. Se observó un brote inicial de Gripe B, posteriormente igualándose con Gripe A. Las coinfecciones con otros microorganismos se documentaron en el 37,58% de los pacientes. Desarrollaron complicaciones relacionadas con la infección el 24,8%. Nueve pacientes precisaron ingreso hospitalario, con una media de 6,4 días de estancia. Todos los casos evolucionaron satisfactoriamente. CONCLUSIONES: La gripe es una infección con un gran impacto sanitario en la población en general. En edad pediátrica produce cuadros de fiebre prolongada, pudiendo ocasionar la realización de pruebas diagnósticas innecesarias. La existencia de un test diagnóstico rápido y sensible, point of care, disponible en Urgencias podría, sin duda, minimizar el empleo de pruebas diagnósticas innecesarias

INTRODUCTION: The flu is a respiratory track infection caused by a virus of the family orthomyxoviridae, whose most important types are Influenza A virus and Influenza B virus, which affect a large part of the pediatric population in the winter months. Its course is generally benign and of short duration in healthy children, although numerous complications exist that can become evident. The available rapid diagnostic tests have low sensitivity, so that their use is not very profitable. The only treatment that exists is oseltamivir with some limitations regarding its application. POPULATION AND METHODS: A retrospective descriptive study of the patients diagnosed in Pediatric Emergency Department of infections due to the flu virus by microbiological studies in respiratory samples in the period between October 2017 to May 2018. The principal objective of the study consists of describing the clinical and epidemiological characteristics of the annual outbreak of flu in patients seen in the Pediatric Emergency Department of the Hospital Clínico Universitario of Valladolid, and of conducting an analysis on their management and the possible changes of improvement. RESULTS: Based on a series of 149 cases, with mean age 47 months. An initial outback of Type B Flu, which subsequently became equal to type A Flu, was observed. Coinfections with other microorganisms were documented in 37.58% of the patients. 24.8% developed complications related with the infection. Nine patients required hospital admission, with a mean stay of 6.4 days. All the cases evolved satisfactorily. CONCLUSIONS: The flu is an infection having an important health care impact in the population in general. In the pediatric age, it produces pictures of prolonged fever, and can lead to unnecessary tests. The existence of a rapid and simple test, point of care, available in the Emergency Department, could, undoubtedly, minimize the use of unnecessary diagnostic tests