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Zhang C, Wang X, Sun D, Li Y, Feng Y, Zhang R, Zheng Y, Kou Z, Liu Y. Modification effects of long-term air pollution levels on the relationship between short-term exposure to meteorological factors and hand, foot, and mouth disease: A distributed lag non-linear model-based study in Shandong Province, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 272:116060. [PMID: 38310825 DOI: 10.1016/j.ecoenv.2024.116060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
The occurrence of hand, foot, and mouth disease (HFMD) is closely related to meteorological factors. However, location-specific characteristics, such as persistent air pollution, may increase the complexity of the impact of meteorological factors on HFMD, and studies across different areas and populations are largely lacking. In this study, a two-stage multisite time-series analysis was conducted using data from 16 cities in Shandong Province from 2015 to 2019. In the first stage, we obtained the cumulative exposure-response curves of meteorological factors and the number of HFMD cases for each city. In the second stage, we merged the estimations from the first stage and included city-specific air pollution variables to identify significant effect modifiers and how they modified the short-term relationship between HFMD and meteorological factors. High concentrations of air pollutants may reduce the risk effects of high average temperature on HFMD and lead to a distinct peak in the cumulative exposure-response curve, while lower concentrations may increase the risk effects of high relative humidity. Furthermore, the effects of average wind speed on HFMD were different at different levels of air pollution. The differences in modification effects between subgroups were mainly manifested in the diversity and quantity of significant modifiers. The modification effects of long-term air pollution levels on the relationship between sunshine hours and HFMD may vary significantly depending on geographical location. The people in age<3 and male groups were more susceptible to long-term air pollution. These findings contribute to a deepening understanding of the relationship between meteorological factors and HFMD and provide evidence for relevant public health decision-making.
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Affiliation(s)
- Chao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250000, China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Dapeng Sun
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Yan Li
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Yiping Feng
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Rongguo Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250000, China
| | - Yongxiao Zheng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250000, China
| | - Zengqiang Kou
- Shandong Center for Disease Control and Prevention, Jinan, China.
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250000, China; Climate Change and Health Center, Shandong University, Jinan, Shandong 250012, China.
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Hong JH, Paek SH, Kim T, Kim S, Ko E, Ro YS, Kim J, Kwon JH. Characteristics of pediatric emergency department visits before and during the COVID-19 pandemic: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023; 10:S13-S25. [PMID: 37967859 PMCID: PMC10662514 DOI: 10.15441/ceem.23.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE : As of 2018, approximately 1.2 million pediatric patients visited emergency departments (EDs) in Korea, showing a steady increase. Given the distinct differences between children and adults, it is vital to examine the epidemiological characteristics of pediatric patients visiting the ED. METHODS : This study retrospectively analyzed the ED use patterns of pediatric patients <18 years old in Korea from January 1, 2018, to December 31, 2022, using data from the National Emergency Department Information System (NEDIS). RESULTS : Most pediatric ED patients were boys, with an average age of 6.6±5.3 years. Patients younger than 1 year and those in critical condition had longer ED stays and more frequently required hospital admission and used the 119-ambulance service. The primary symptom was fever, and the most common discharge diagnosis was gastroenteritis. Following the declaration of the COVID-19 pandemic in 2020, ED visits decreased by 49%. Meanwhile, there was an increase in in-hospital mortality rate/age- and sex-standardized mortality rate per 100,000 ED visits, Admission and transfer rates remained similar between before and after the start of the pandemic. CONCLUSION : Through this analysis, we identified the characteristics of pediatric patients visiting EDs in Korea. We observed a sharp decline in ED visits after the start of the COVID-19 pandemic. From there, ED visits slowly increased but remained below prepandemic levels for 3 years. This research will serve as a foundational resource for appropriately allocating and preparing pediatric ED resources.
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Affiliation(s)
- Jin Hyuck Hong
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - So Hyun Paek
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongjung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jungeon Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jae Hyun Kwon
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Abushawish A, Haro K, Hoshina T, Kitajima N, Kusuhara K. Environmental factors related to differences in the microbiota in the upper respiratory tract in young children: Focusing on the impact of early nursery attendance. Front Pediatr 2023; 11:1015872. [PMID: 36798144 PMCID: PMC9927022 DOI: 10.3389/fped.2023.1015872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Microbial colonization of the upper respiratory tract (URT) during the first years of life differs significantly according to environmental factors. We investigated the association between early nursery attendance, URT infection (URTI) and drugs used for its treatment and the differences in the URT microbiota. METHODS This prospective study included 33 young children (11 and 22 with and without nursery attendance during their infancy, respectively). URT secretions were collected from the nasopharynx of these children at 2, 4, 6, 12, 18 and 24 months old. Clinical information after the latest sampling, including histories of URTI and the uses of antibiotics or cold medicines, was collected from all children. URT bacteria were identified by a clone library analysis of the 16S rRNA gene. RESULTS In the diversity of URT microbiota using the Shannon index, we did not detect any associations between variations in the URT microbiota and environmental factors (nursery attendance, development of URTIs, or the uses of antibiotics or cold medicines). However, in a clustering analysis, the proportion of the samples classified as Corynebacterium propinquum-dominant cluster was significantly lower in children ≥6 months old with nursery attendance than in those without nursery attendance. In addition, the URT microbiota was significantly different between samples from children ≥6 months old with and without a history of ≥3 URTI episodes after the first sampling. Furthermore, the URT microbiota was also significantly different between samples from these children with and without antibiotic use between the previous and present samplings. CONCLUSION Early nursery attendance and its related factors, including the frequency of URTI and antibiotic treatment, may be associated with the differences in the URT flora in young children.
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Affiliation(s)
- Asmaa Abushawish
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kaoru Haro
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Department of Pediatrics, Sato Children's Clinic, Kitakyushu, Japan
| | - Takayuki Hoshina
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoko Kitajima
- Department of Pediatrics, Onga Nakama Medical Association, Onga Hospital, Onga, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Impact of national COVID-19 restrictions on incidence of notifiable communicable diseases in England: an interrupted time series analysis. BMC Public Health 2022; 22:2318. [PMID: 36510205 PMCID: PMC9742638 DOI: 10.1186/s12889-022-14796-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-pharmaceutical interventions (NPIs), such as travel restrictions, social distancing and isolation policies, aimed at controlling the spread of COVID-19 may have reduced transmission of other endemic communicable diseases, such as measles, mumps and meningitis in England. METHODS An interrupted time series analysis was conducted to examine whether NPIs was associated with trends in endemic communicable diseases, using weekly reported cases of seven notifiable communicable diseases (food poisoning, measles, meningitis, mumps, scarlet fever and pertussis) between 02/01/2017 to 02/01/2021 for England. RESULTS Following the introduction of COVID-19 restrictions, there was an 81.1% (95% CI; 77.2-84.4) adjusted percentage reduction in the total number of notifiable diseases recorded per week in England. The greatest decrease was observed for measles, with a 90.5% percentage reduction (95% CI; 86.8-93.1) from 42 to 5 cases per week. The smallest decrease was observed for food poisoning, with a 56.4% (95%CI; 42.5-54.2) decrease from 191 to 83 cases per week. CONCLUSIONS A total reduction in the incidence of endemic notifiable diseases was observed in England following the implementation of public health measures aimed at reducing transmission of SARS-COV-2 on March 23, 2020. The greatest reductions were observed in diseases most frequently observed during childhood that are transmitted via close human-to-human contact, such as measles and pertussis. A less substantive reduction was observed in reported cases of food poisoning, likely due to dining services (i.e., home deliveries and takeaways) remaining open and providing a potential route of transmission. This study provides further evidence of the effectiveness of non-pharmaceutical public health interventions in reducing the transmission of both respiratory and food-borne communicable diseases.
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Sim JY, Wu PS, Cheng CF, Yiang GT, Yu CH. Characteristics, contacts, and relative risk of SARS-CoV-2 infection among children during school closures. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1108-1115. [PMID: 35016846 PMCID: PMC8719363 DOI: 10.1016/j.jmii.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/01/2021] [Accepted: 12/25/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Characteristics of children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Taiwanese households is nascent. We sought to characterize SARS-CoV-2 infection, and estimate the relative risk of infection among children within households during school closures in Taipei and New Taipei City. METHODS We reviewed consecutive children below 18 years presenting to our emergency department from May 18, 2021 to July 12, 2021 who underwent real-time reverse-transcription polymerase chain reaction (rRT-PCR) for SARS-CoV-2 from respiratory swabs. Demographics, symptoms, and contacts were captured from medical records. Household contact was defined as an individual with confirmed COVID-19 living in the same residence as the child. RESULTS Among 56 children with SARS-CoV-2, twenty-five (45%) were male with mean age of 7.9 years. Symptoms were nonspecific, with 29% having fever, 32% having cough, and 48% were asymptomatic. The median cycle threshold (Ct) value of SARS-CoV-2 rRT-PCR was 25 (range 11-38). All 56 children reported 94 contacts with a COVID-19 patient, of which 99% were household contacts. The relative risk of infection was 8.5 (95% CI 5.0-14.7) for children whose parent(s) were COVID-19 patients, and 7.3 (95% CI 4.9-11.0) for children whose household grandparent(s) were patients, as compared to children without respective contacts. Children without COVID-19 contacts were all tested negative. CONCLUSIONS During school closures in Taipei and New Taipei City, children with SARS-CoV-2 infection in our cohort had one or more COVID-19 contacts, mostly within their households. While diagnosing pediatric COVID-19 is challenging as children were often asymptomatic, those without contacts were likely uninfected.
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Affiliation(s)
- Jun Yi Sim
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City 23142, Taiwan
| | - Ping-Sheng Wu
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City 23142, Taiwan,Department of Pediatrics, Buddhist Tzu Chi University College of Medicine, Hualien, Taiwan
| | - Ching-Feng Cheng
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City 23142, Taiwan,Department of Pediatrics, Buddhist Tzu Chi University College of Medicine, Hualien, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan,Department of Emergency Medicine, Buddhist Tzu Chi University College of Medicine, Hualien, Taiwan
| | - Chun-Hsien Yu
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City 23142, Taiwan,Department of Pediatrics, Buddhist Tzu Chi University College of Medicine, Hualien, Taiwan,Corresponding author. Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City 23142, Taiwan
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Huang J, Ma Y, Lv Q, Liu Y, Zhang T, Yin F, Shui T. Interactive effects of meteorological factors and air pollutants on hand, foot, and mouth disease in Chengdu, China: a time-series study. BMJ Open 2022; 12:e067127. [PMID: 36450433 PMCID: PMC9716848 DOI: 10.1136/bmjopen-2022-067127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Hand, foot, and mouth disease (HFMD) is a viral infectious disease that poses a substantial threat in the Asia-Pacific region. It is widely reported that meteorological factors are associated with HFMD. However, the relationships between air pollutants and HFMD are still controversial. In addition, the interactive effects between meteorological factors and air pollutants on HFMD remain unknown. To fill this research gap, we conducted a time-series study. DESIGN A time-series study. SETTING AND PARTICIPANTS Daily cases of HFMD as well as meteorological and air pollution data were collected in Chengdu from 2011 to 2017. A total of 184 610 HFMD cases under the age of 15 were included in our study. OUTCOME MEASURES Distributed lag nonlinear models were used to investigate the relationships between HFMD and environmental factors, including mean temperature, relative humidity, SO2, NO2, and PM10. Then, the relative excess risk due to interaction (RERI) and the proportion attributable to interaction were calculated to quantitatively evaluate the interactions between meteorological factors and air pollutants on HFMD. Bivariate response surface models were used to visually display the interactive effects. RESULTS The cumulative exposure-response curves of SO2 and NO2 were inverted 'V'-shaped and 'M'-shaped, respectively, and the risk of HFMD gradually decreased with increasing PM10 concentrations. We found that there were synergistic interactions between mean temperature and SO2, relative humidity and SO2, as well as relative humidity and PM10 on HFMD, with individual RERIs of 0.334 (95% CI 0.119 to 0.548), 0.428 (95% CI 0.214 to 0.642) and 0.501 (95% CI 0.262 to 0.741), respectively, indicating that the effects of SO2 and PM10 on HFMD were stronger under high temperature (>17.3°C) or high humidity (>80.0%) conditions. CONCLUSIONS There were interactive effects between meteorological factors and air pollutants on HFMD. Our findings could provide guidance for targeted and timely preventive and control measures for HFMD.
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Affiliation(s)
- Jiaqi Huang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Qiang Lv
- Department of Acute Infectious Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yaqiong Liu
- Department of Acute Infectious Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Fei Yin
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Tiejun Shui
- Department of Leprosy Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
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Hu YL, Chen CM, Wang ET, Kuo HW, Shih WL, Fang CT, Liu DP, Chang LY. The secular trend of enterovirus A71 after the implementation of preventive measures in Taiwan. BMC Public Health 2022; 22:1483. [PMID: 35927656 PMCID: PMC9351194 DOI: 10.1186/s12889-022-13916-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/29/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Enterovirus A71 (EV A71) is one of the most important enteroviruses related to morbidity and mortality in children worldwide. This study aimed to analyse the secular trend of EV A71 in Taiwan from 1998 to 2020 and to evaluate the effectiveness of infection control measures. METHODS We collected the epidemiological data of EV A71 from disease surveillance systems in Taiwan. We analysed the association between the secular trend of EV A71 and preventive measures such as hand washing, case isolation, and suspension of classes. RESULTS The incidence of enterovirus infections with severe complications (EVSC) decreased from 16.25 per 100,000 children under six in 1998 to less than 9.73 per 100,000 children under six after 2012 (P = 0.0022). The mortality rate also decreased significantly, from 3.52 per 100,000 children under six in 1998 to 0 per 100,000 children under six in 2020 (P < 0.0001). The numbers of EVSC and fatalities were significantly higher in the years when EV A71 accounted for more than 10% of the annual predominant serotypes (p < 0.05). After the implementation of many non-pharmaceutical interventions in 2012, the incidence of EVSC and mortality rate decreased significantly (p < 0.001). CONCLUSIONS After implementing active enterovirus surveillance and preventive measures, we found that the incidence of EVSC and fatalities due to EV A71 in Taiwan decreased significantly from 1998 to 2020. Continuous surveillance and strengthened infection control policies are still needed in the future.
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Affiliation(s)
- Ya-Li Hu
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 8, Chung Shan S. Rd., Taipei, 10041, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University and Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan
| | - Chiu-Mei Chen
- Epidemic Intelligence Center, Centers for Disease Control, No. 6, Linsen S. Rd., Taipei, 10050, Taiwan
| | - En-Tzu Wang
- Epidemic Intelligence Center, Centers for Disease Control, No. 6, Linsen S. Rd., Taipei, 10050, Taiwan
| | - Hung-Wei Kuo
- Epidemic Intelligence Center, Centers for Disease Control, No. 6, Linsen S. Rd., Taipei, 10050, Taiwan
| | - Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University and Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University and Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan
| | - Ding-Ping Liu
- Epidemic Intelligence Center, Centers for Disease Control, No. 6, Linsen S. Rd., Taipei, 10050, Taiwan.
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 8, Chung Shan S. Rd., Taipei, 10041, Taiwan.
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Hoseinyazdi M, Esmaeilian S, Jahankhah R, Teimouri A, Sherbaf FG, Rafiee F, Jalli R, Hooshmandi S. Clinical, laboratory, and chest CT features of severe versus non-severe pediatric patients with COVID-19 infection among different age groups. BMC Infect Dis 2021; 21:560. [PMID: 34118894 PMCID: PMC8196295 DOI: 10.1186/s12879-021-06283-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Background This study was performed with the intention of comparing the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups composed of pediatric patients with confirmed COVID-19. Method This study was carried out on a total of 53 confirmed COVID-19 pediatric patients who were hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. The patients were divided into two severe (n = 27) and non-severe (n = 28) groups as well as into other three groups in terms of their age: aged less than two years, aged 3–12 years and 13–17 years. It should be noted that CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution. Result Fever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis, while the non-severe ones did not (P = 0.03). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3–12 and 13–17 years (P = 0.01). It was shown also that O2 saturation experienced a significant increase as did patients’ age (P = 0.01). Severe patients had significantly higher CT abnormalities than non-severe patients (48.0% compared to 17.9%, respectively) (P = 0.02). Conclusion Lymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased.
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Affiliation(s)
- Meisam Hoseinyazdi
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Esmaeilian
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jahankhah
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Teimouri
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Faranak Rafiee
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedighe Hooshmandi
- Medical Imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
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Bao N, Lu Y, Huang K, Gao X, Gui SY, Hu CY, Jiang ZX. Association between short-term exposure to ambient nitrogen dioxide and the risk of conjunctivitis in Hefei, China: A time-series analysis. ENVIRONMENTAL RESEARCH 2021; 195:110807. [PMID: 33515578 DOI: 10.1016/j.envres.2021.110807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Conjunctivitis, one of the most common ocular surface diseases, can be caused by many contributors. However, the important role of air pollution has been inadequately evaluated, particularly in countries with poor air quality. This study aims to explore the possible association of short-term ambient nitrogen dioxide (NO2) exposure with the risk of outpatient visits for conjunctivitis. METHODS A total of 43,462 conjunctivitis patients from January 1, 2014 to December 31, 2018 were identified from the Department of Ophthalmology of The Second Affiliated Hospital of Anhui Medical University, Hefei, China. Such data were linked to the daily mean concentration of NO2 at ten fixed air quality monitoring stations. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear regression model was employed to assess the association between NO2 exposure and the risk of outpatient visits for conjunctivitis. Stratified analyses were also performed on the basis of gender, age group and season. RESULTS The association of NO2 exposure with the risk of outpatient visits for conjunctivitis was statistically significant. In the single-day lags (lag 0 to lag 11) analysis, the largest effect estimates were observed at lag 0. In the moving average exposure lags (lag 0-1 to lag 0-11) analysis, the cumulative effects were stronger than the single-day lag effects. The stratified analyses suggested that the effect of NO2 exposure was more pronounced in females and patients aged 19-65 years and in the cold season. CONCLUSIONS This study confirms the evidence that short-term NO2 exposure is associated with an increased risk of conjunctivitis outpatient visits. Our research encourages individuals to avoid outdoor activities on severe air pollution days and the government is obliged to adopt more stringent environmental policies to alleviate the effects of air pollution on human health, particularly for individuals at risk of developing conjunctivitis.
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Affiliation(s)
- Ning Bao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China
| | - Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiang Gao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Si-Yu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China; Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China.
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Kuitunen I, Artama M, Mäkelä L, Backman K, Heiskanen-Kosma T, Renko M. Effect of Social Distancing Due to the COVID-19 Pandemic on the Incidence of Viral Respiratory Tract Infections in Children in Finland During Early 2020. Pediatr Infect Dis J 2020; 39:e423-e427. [PMID: 32773660 DOI: 10.1097/inf.0000000000002845] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social distancing measures are used to reduce the spreading of infection. Our aim was to assess the immediate effects of national lockdown orders due to coronavirus disease 2019 (COVID-19) on pediatric emergency room (ER) visits and respiratory tract infections in hospitals and nationwide in Finland. METHODS This register-based study used hospital patient information systems and the Finnish national infectious disease register. The participants were all patients visiting pediatric ER in 2 Finnish hospitals (Kuopio University Hospital, Mikkeli Central Hospital) covering 1/5th of the Finnish children population, 4 weeks before and 4 weeks after the start of the nationwide lockdown on March 16, 2020. Nationwide weekly numbers of influenza (A + B) and respiratory syncytial virus (RSV) in children were assessed from the infectious disease register from 2015 to 2020. RESULTS A major decrease in the rate of daily median pediatric ER visits was detected in both hospitals in the study during the nationwide lockdown compared with the study period before the lockdown (Mikkeli, 19 vs. 7, P < 0.001; Kuopio, 9 vs. 2,5, P < 0.001). The influenza season was shorter (8 weeks from peak to no cases), and the weekly rate of new cases decreased faster compared with the previous 4 influenza seasons (previously 15-20 weeks from peak to no cases). A similar decrease was also seen in RSV cases. No pediatric cases of COVID-19 were found in participating hospitals during the study period. CONCLUSION These results strongly suggest that social distancing and other lockdown strategies are effective to slow down the spreading of common respiratory viral diseases and decreasing the need for hospitalization among children.
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Affiliation(s)
- Ilari Kuitunen
- From the University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211, Kuopio.,Mikkeli Central Hospital, Department of Pediatrics, Porrassalmenkatu 35-37, 50100, Mikkeli
| | - Miia Artama
- Finnish Institute of Health and Welfare, FinnMedi 1, Biokatu 6, 33540, Tampere.,Tampere University, Faculty of Social Sciences, Arvo Ylpön Katu 34, 33520, Tampere
| | - Lotta Mäkelä
- Mikkeli Central Hospital, Department of Pediatrics, Porrassalmenkatu 35-37, 50100, Mikkeli
| | - Katri Backman
- Kuopio University Hospital, Department of Pediatrics, Puijonlaaksontie 2, 70210, Kuopio
| | - Tarja Heiskanen-Kosma
- Kuopio University Hospital, Department of Pediatrics, Puijonlaaksontie 2, 70210, Kuopio
| | - Marjo Renko
- From the University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211, Kuopio.,Kuopio University Hospital, Department of Pediatrics, Puijonlaaksontie 2, 70210, Kuopio.,University of Oulu, PEDEGO Research Unit, Kajaanintie 50, 90220 Oulu, Finland
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12
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Sim JY, Chang LY, Chang TH, Chen JM, Lee PI, Huang LM, Lu CY. Pediatric parapneumonic effusion before and after national pneumococcal vaccination programs in Taiwan. J Formos Med Assoc 2020; 119:1608-1618. [PMID: 32747171 DOI: 10.1016/j.jfma.2020.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Reports on the effectiveness of pneumococcal conjugate vaccines (PCVs) on pediatric parapneumonic effusion are limited. We report the changes in cases and etiologies of pediatric parapneumonic effusion in a children's hospital before and after national PCV13 vaccination programs. METHODS We screened medical records of children 0-18 years admitted to the National Taiwan University Hospital with diagnoses of lobar pneumonia and parapneumonic effusion between 2008 and 2017. Patients with effusion analyses were included. Results of blood, pleural fluid, and respiratory specimens surveyed as standard care were analyzed. RESULTS Diagnostic testing revealed at least a pathogen in 85% of 202 children with lobar pneumonia and parapneumonic effusion. After national PCV13 immunization, pneumococcal empyema decreased by 72% among 2- to 5-year olds. Mycoplasma pneumoniae was the second most common etiology. There were marked differences in effusion characteristics, metabolic, and respiratory parameters between children infected with pneumococcus and M. pneumoniae. CONCLUSION The effectiveness of the national PCV13 immunization programs on pneumococcal empyema was evident and remained substantial after 4 years in Taiwan. Continuous surveillance is important to monitor the emergence of other pathogens including non-PCV serotypes and M. pneumoniae.
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Affiliation(s)
- Jun Yi Sim
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 71004, Taiwan
| | - Jong-Min Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan.
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13
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Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and meta-analysis. J Formos Med Assoc 2020; 119:982-989. [PMID: 32307322 PMCID: PMC7161491 DOI: 10.1016/j.jfma.2020.04.007] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/PURPOSE Current studies on pediatric coronavirus disease 2019 (COVID-19) are rare. The clinical characteristics and spectrum are still unknown. Facing this unknown and emerging pathogen, we aimed to collect current evidence about COVID-19 in children. METHODS We performed a systematic review in PubMed and Embase to find relevant case series. Because some reports were published in Chinese journals, the journals and publications of the Chinese Medical Association related to COVID-19 were completely reviewed. A random effects model was used to pool clinical data in the meta-analysis. RESULTS Nine case series were included. In the pooled data, most of patients (75%) had a household contact history. The disease severity was mainly mild to moderate (98%). Only 2 children (2%) received intensive care. Fever occurred in 59% of the patients, while cough in 46%. Gastrointestinal symptoms (12%) were uncommon. There are 26% children are asymptomatic. The most common radiographic finding was ground glass opacities (48%). Currently, there is no evidence of vertical transmission to neonates born to mothers with COVID-19. Compared with the most relevant virus, SARS-CoV, SARS-CoV-2 causes less severe disease. CONCLUSION COVID-19 has distinct features in children. The disease severity is mild. Current diagnosis is based mainly on typical ground glass opacities on chest CT, epidemiological suspicion and contact tracing.
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14
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Hu YL, Chang LY. Current status of enterovirus D68 worldwide and in Taiwan. Pediatr Neonatol 2020; 61:9-15. [PMID: 31706947 DOI: 10.1016/j.pedneo.2019.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/09/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022] Open
Abstract
Enterovirus D68 was first identified in 1962 and caused a worldwide outbreak starting from the North America in 2014. Enterovirus D68 has been in continuous circulation among many countries recently, including Taiwan. Reports also reveal high seroprevalence, which indicates that the disease burden of enterovirus D68 may be underestimated via viral culture or polymerase chain reaction results. Although most infected cases have mild respiratory illness, severe complications including acute flaccid myelitis and acute respiratory distress syndrome have also been reported. In the position of an emerging pathogen, enterovirus D68 poses a threat to public health and may cause devastating diseases. Diverse severity of neurological sequelae remains inevitable among acute flaccid myelitis patients, but no curable treatment is available currently. According to the management suggestions of the American Centers of Disease Control, uses of corticosteroids and plasmapheresis are either preferred or avoided and intravenous immunoglobulin also has no clear indication in the treatment for acute flaccid myelitis. In this review article, we provide information about the epidemiology, clinical recognition and treatment strategy of enterovirus D68. Better understanding of this disease is the foothold for advanced investigation and monitoring in the future.
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Affiliation(s)
- Ya-Li Hu
- Department of Pediatrics, New Taipei City Hospital, New Taipei City, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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15
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Manifestations of enterovirus D68 and high seroconversion among children attending a kindergarten. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:858-864. [DOI: 10.1016/j.jmii.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 01/28/2023]
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16
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Ison MG, Hirsch HH. Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs. Clin Microbiol Rev 2019; 32:e00042-19. [PMID: 31511250 PMCID: PMC7399564 DOI: 10.1128/cmr.00042-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.
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Affiliation(s)
- Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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17
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A multimodal intervention to improve hand hygiene compliance via social cognitive influences among kindergarten teachers in China. PLoS One 2019; 14:e0215824. [PMID: 31086379 PMCID: PMC6516664 DOI: 10.1371/journal.pone.0215824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/07/2019] [Indexed: 11/29/2022] Open
Abstract
Children attending kindergarten are at high risk for contracting infections, for which hand hygiene (HH) has been recognized as the most cost-effective prevention measure globally. Kindergarten teachers’ HH behavior plays a vital role in encouraging favorable hygiene techniques and environment. This study aims to evaluate the effectiveness of a multimodal intervention at changing kindergarten teachers’ HH behavior and social cognitive factors that influences HH behavior in China. The intervention named “Clean Hands, Happy Life” includes HH products with refills, reminders and cues for action, a kick-off event with awards, and training programs. We evaluated the intervention using a self-administrative questionnaire with a stratified random sample of 12 kindergartens. Two surveys was completed by 176 teachers at baseline and 185 after the 6-month intervention. Compared with the baseline scores, there was a significant improvement in the overall self-reported HH compliance of teachers (9.38 vs. 9.68 out of 10, p = 0.006), as well as teachers’ perceived disease susceptibility, disease severity and behavioral control after the intervention (p<0.05). We found that teachers’ HH compliance was likely to be higher among those who have better HH guideline awareness (β = 0.48, p<0.01) and perceived behavioral control (β = 0.26, p = 0.01), which explained 24.2% of the variance of self-reported compliance of teachers at baseline. The assessed intervention may provide Chinese kindergarten teachers with behavioral skills and cognitions that associated with the compliance of HH behavior. We thus recommend future intervention studies consider our HH behavior change techniques, address multiple social cognitive determinants of HH behavior and include the change of targeted influences in the impact evaluation.
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Gosert R, Naegele K, Hirsch HH. Comparing the Cobas Liat Influenza A/B and respiratory syncytial virus assay with multiplex nucleic acid testing. J Med Virol 2018; 91:582-587. [PMID: 30345524 PMCID: PMC7166997 DOI: 10.1002/jmv.25344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/13/2018] [Indexed: 01/21/2023]
Abstract
Influenza virus and respiratory syncytial virus (RSV) detection with short turn‐around‐time (TAT) is pivotal for rapid decisions regarding treatment and infection control. However, negative rapid testing results may come from poor assay sensitivity or from influenza‐like illnesses caused by other community‐acquired respiratory viruses (CARVs). We prospectively compared the performance of Cobas Liat Influenza A/B and RSV assay (LIAT) with our routine multiplexNAT‐1 (xTAG Respiratory Pathogen Panel; Luminex) and multiplexNAT‐2 (ePlex‐RPP; GenMark Diagnostics) using 194 consecutive nasopharyngeal swabs from patients with influenza‐like illness during winter 2017/2018. Discordant results were reanalyzed by specific in‐house quantitative nucleic acid amplification testing (NAT). LIAT was positive for influenza virus‐A, ‐B, and RSV in 18 (9.3%), 13 (6.7%), and 55 (28.4%) samples, and negative in 108 samples. Other CARVs were detected by multiplexNAT in 66 (34.0%) samples. Concordant results for influenza and RSV were seen in 190 (97.9%), discordant results in 4 (2.1%), which showed low‐level RSV (<40 000 copies/mL). Sensitivity and specificity of LIAT for influenza‐A, ‐B, and RSV were 100%, 100% and 100%, and 100%, 99.5% and 100%, respectively. The average TAT of LIAT was 20 minutes compared to 6 hours and 2 hours for the multiplexNAT‐1 and ‐2, respectively. Thus, LIAT demonstrated excellent sensitivity and specificity for influenza and RSV, which together with the simple sample processing and short TAT renders this assay suitable for near‐patient testing. Cobas Liat is highly sensitive and specific for Influenza and RSV in 86/194 children Other CARVs were detected by multiplex NAT in 66/196 children Simple processing and TAT of 20 min suitable for near‐patient testing LIAT assay shows excellent sensitivity and specificity for influenza and RSV Simple sample processing and short turn‐around‐time of 20 min render the assay suitable for near‐patient testing Barcode reading and direct transfer of results into the laboratory information system
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Affiliation(s)
- Rainer Gosert
- Division of Infection Diagnostics, Department Biomedicine, Haus Petersplatz, University of Basel, Basel, Switzerland
| | - Klaudia Naegele
- Division of Infection Diagnostics, Department Biomedicine, Haus Petersplatz, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infection Diagnostics, Department Biomedicine, Haus Petersplatz, University of Basel, Basel, Switzerland.,Transplantation and Clinical Virology, Department Biomedicine, Haus Petersplatz, University of Basel, Basel, Switzerland.,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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19
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Lin GL, Lu CY, Chen JM, Lee PI, Ho SY, Weng KC, Huang LM, Chang LY. Molecular epidemiology and clinical features of adenovirus infection in Taiwanese children, 2014. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:215-224. [PMID: 30172758 DOI: 10.1016/j.jmii.2018.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSES Human adenovirus (HAdV) infection is prevalent and has an important clinical impact on children. We aim to investigate the molecular epidemiology of HAdV infection and discover the correlations between clinical features and HAdV species in an HAdV outbreak of 2014. METHODS This is a retrospective study, enrolling patients under 19 years of age with HAdV infection at the National Taiwan University Hospital in 2014. We gathered the demographic and clinical data, carried out molecular typing and constructed a phylogenetic tree. Statistical analyses were performed in terms of HAdV species and hospitalization. RESULTS A total of 531 patients with HAdV infection were identified. HAdV-B accounted for the largest proportion (n = 387, 73%). On average, patients infected with HAdV-E were oldest, whereas those with HAdV-C infection were youngest (p < 0.001). Patients with HAdV-B (HAdV-3) infection were associated with a lower incidence of co-infection with other viruses (p < 0.001). Complications occurred in 203 (38%) patients. There were 149 (28%) patients requiring hospitalization. The risk factors for hospitalization included underlying neurological abnormalities, prematurity and the diagnosis of pneumonia. Five patients (1%) had severe HAdV infection requiring intensive care; all of them fully recovered. The phylogenetic study showed that the partial hexon genes of HAdV-1, HAdV-3, HAdV-4 and HAdV-5 remain stable over time. CONCLUSION We established the molecular epidemiology of HAdV infection and demonstrated the relationship between clinical features and HAdV species.
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Affiliation(s)
- Gu-Lung Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jong-Min Chen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Yuan Ho
- Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-Chen Weng
- Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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