Impact of social distancing on the spread of common respiratory viruses during the coronavirus disease outbreak

Impact of the CAPTURE COPD Screening Tool in US Primary Care: A Cluster Randomized Trial

Rationale: The impact of COPD screening on US primary care clinician behavior and patient outcomes is unclear. Objectives: Assess the impact of receiving CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening scores on clinical and patient outcomes. Methods: Cluster randomized trial included 49 usual care (COPD education only) and 51 intervention (COPD and CAPTURE education plus screening scores) primary care practices. Twelve-month medical record and patient survey outcome data were collected in patients with elevated screening scores or study spirometric abnormalities. Measurements and Main Results: Among 387 CAPTURE+ patients, no significant difference was noted between usual care and intervention practices in the primary composite outcome of: 1) spirometry referral/completion, 2) new COPD diagnosis, 3) newly prescribed inhaled long-acting respiratory medication, 4) referral to a respiratory specialist, or 5) pulmonary rehabilitation referral/completion, 45.9% versus 41.9% (+4.0%, 95% CI -6.9, +15.0, p=0.47). Only spirometry referral/completion was higher in the intervention group (+10.4%, 95% CI +0.1, +20.7, p = 0.0465). No differences were noted for secondary outcomes, composite components, change in COPD Assessment Test scores, rates of respiratory illnesses, or hospitalizations. For the 1,028 screen-negative (CAPTURE-) patients, composite primary and all secondary outcomes were similar in the two arms. In secondary and post hoc analyses evaluating the potential impact of the pandemic, intervention group differences in clinician and patient outcomes were noted for CAPTURE+ and CAPTURE- patients in the pre-pandemic period that diminished during the pandemic. Conclusions: Within these US primary care practices, COPD and CAPTURE education plus receipt of CAPTURE screening scores did not change clinician COPD assessment or care or patient outcomes for CAPTURE+ patients. However, in the pre-pandemic period CAPTURE+ patients were more likely to undergo spirometry referral completion while for CAPTURE- patients clinicians were significantly less likely to assess for COPD suggesting that the intervention resulted in a more appropriate use of healthcare resources.

Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality

BACKGROUND

Influenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia.

METHODS

This was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality.

RESULTS

During the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality.

CONCLUSIONS

Influenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

Impact of the coronavirus disease 2019 pandemic on hospital admissions for idiopathic pulmonary fibrosis: a nationwide population-based study

BACKGROUND

Previous studies have consistently reported a decrease in hospital admissions for respiratory diseases during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on idiopathic pulmonary fibrosis (IPF) admissions remains unknown.

METHODS

This study used data from the Korean National Health Insurance Service database. IPF was defined based on the International Classification of Diseases 10th Revision (ICD-10) and rare intractable disease (RID) codes. The rate of IPF admissions was calculated by dividing the number of IPF admissions by the prevalence of IPF. The rate of IPF admissions during the COVID-19 pandemic (2020-2021) was compared with the mean rate of admissions during the prepandemic period (2017-2019) and presented as the rate ratio (RR). A sensitivity analysis was conducted on patients treated with systemic corticosteroids during IPF admission.

RESULTS

In patients with IPF defined based on the ICD-10 (analysis 1), the RRs significantly decreased from March in 2020 to December 2021, except for June and September in 2020. Similarly, in patients with IPF defined based on the ICD-10 and RID (analysis 2), the RRs significantly decreased from March 2020 to December 2021, except for June and September 2020. In the sensitivity analysis of analysis 1, the RR significantly decreased in 2020 (0.93; 95%CI: 0.88-0.99; P = 0.029), whereas the RR in 2021 was not significantly different. The RRs in the sensitivity analysis of analysis 2 significantly decreased to 0.85 (0.79-0.92; P < 0.001) in 2020 and 0.82 (0.76-0.88; P < 0.001) in 2021. In the subgroup analysis, the rates of IPF admissions significantly decreased in 2020 and 2021 across both sexes, patients aged ≥ 60 years, and all household income groups.

CONCLUSIONS

The rate of IPF admissions significantly decreased during the COVID-19 pandemic. This result indicates that preventive measures against COVID-19 may effectively mitigate IPF exacerbation. Therefore, it is assumed that there is a close relationship between respiratory viral infections and IPF exacerbations.

Risk of COVID-19 in pediatric population and the effects of COVID-19 vaccination: A retrospective cohort study

OBJECTIVE

Prior studies have demonstrated the adverse effects of upper respiratory infections on the pediatric population, such as increased risk for acute otitis media (AOM). Other studies have noted decreased otitis media complaints during the COVID-19 pandemic. This project aims to identify whether individuals who tested positive for COVID-19 at the Emergency Department (ED) visit had an increased risk of developing severe complications. Additionally, we will study whether vaccination helped decrease following COVID-19 complications.

METHODS

Utilizing the TriNetX database, we obtained de-identified electronic medical records for children under five and 6-10 years old from 2020-2023 in the United States. The study population was propensity-matched for gender, index age, and comorbidities. Complications within eight weeks of the ED visit were compared between COVID-19 vaccinated and unvaccinated children. Risk ratio was used to measure associations between our groups. A p-value less than or equal to 0.05 was considered significant.

RESULTS

After propensity matching, a total of 211,138 children were identified. Within eight weeks after the ED visit, unvaccinated children <5 years old who tested negative for COVID-19 had a 30 % relative risk reduction for AOM, 52 % for sinusitis, 76 % for multisystem inflammatory system (MIS), 17 % for acute respiratory failure, and 37 % for septic shock when compared to those with a positive COVID-19 result (p ≤ 0.05). Unvaccinated 6-10 years old children who tested negative for COVID-19 had an 18 % risk reduction for AOM, 44 % reduction for sinusitis, 63 % reduction for MIS, and 42 % for acute respiratory failure (p ≤ 0.05) compared to those that tested positive for COVID-19. Vaccinated children with positive COVID-19 results have no significant risk of AOM or acute respiratory failure. Additionally, children 6-10 years old with positive COVID-19 results did not have a substantial risk of sinusitis.

CONCLUSION

COVID-19's effects require continued investigation in children. This study showed that there are some increased risks of severe complications following this viral infection.

Impact of the coronavirus disease 2019 pandemic on the incidence of other infectious diseases in the hematology hospital in Korea

BACKGROUND/AIMS

Since the coronavirus disease 2019 (COVID-19) outbreak, hospitals have implemented infection control measures to minimize the spread of the virus within facilities. This study aimed to investigate the impact of COVID-19 on the incidence of healthcare-associated infections (HCAIs) and common respiratory virus (cRV) infections in hematology units.

METHODS

This retrospective study included all patients hospitalized in Catholic Hematology Hospital between 2019 and 2020. Patients infected with vancomycin-resistant Enterococci (VRE), carbapenemase-producing Enterobacterales (CPE), Clostridium difficile infection (CDI), and cRV were analyzed. The incidence rate ratio (IRR) methods and interrupted time series analyses were performed to compare the incidence rates before and after the pandemic.

RESULTS

The incidence rates of CPE and VRE did not differ between the two periods. However, the incidence of CDI increased significantly (IRR: 1.41 [p = 0.002]) after the COVID-19 pandemic. The incidence of cRV infection decreased by 76% after the COVID-19 outbreak (IRR: 0.240 [p < 0.001]). The incidence of adenovirus, parainfluenza virus, and rhinovirus infection significantly decreased in the COVID-19 period (IRRs: 0.087 [p = 0.003], 0.031 [p < 0.001], and 0.149 [p < 0.001], respectively).

CONCLUSION

The implementation of COVID-19 infection control measures reduced the incidence of cRV infection. However, CDI increased significantly and incidence rates of CPE and VRE remained unchanged in hematological patients after the pandemic. Infection control measures suitable for each type of HCAI, such as stringent hand washing for CDI and enough isolation capacities, should be implemented and maintained in future pandemics, especially in immunocompromised patients.

Transmission of Viruses from Restroom Use: A Quantitative Microbial Risk Assessment

Restroom use has been implicated in a number of viral outbreaks. In this study, we apply quantitative microbial risk assessment to quantify the risk of viral transmission by contaminated restroom fomites. We estimate risk from high-touch fomite surfaces (entrance/exit door, toilet seat) for three viruses of interest (SARS-CoV-2, adenovirus, norovirus) through eight exposure scenarios involving differing user behaviors, and the use of hand sanitizer following each scenario. We assessed the impacts of several sequences of fomite contacts in the restroom, reflecting the variability of human behavior, on infection risks for these viruses. Touching of the toilet seat was assumed to model adjustment of the seat (open vs. closed), a common touch point in single-user restrooms (home, small business, hospital). A Monte Carlo simulation was conducted for each exposure scenario (10,000 simulations each). Norovirus resulted in the highest probability of infection for all exposure scenarios with fomite surfaces. Post-restroom automatic-dispensing hand sanitizer use reduced the probability of infection for each virus by up to 99.75%. Handwashing within the restroom, an important risk-reduction intervention, was not found to be as effective as use of a non-touch hand sanitizer dispenser for reducing risk to near or below 1/1,000,000, a commonly used risk threshold for comparison.

Increased population susceptibility to seasonal influenza during the COVID-19 pandemic in China and the United States

To the best of our knowledge, no previous study has quantitatively estimated the dynamics and cumulative susceptibility to influenza infections after the widespread lifting of COVID-19 public health measures. We constructed an imitated stochastic susceptible-infected-removed model using particle-filtered Markov Chain Monte Carlo sampling to estimate the time-dependent reproduction number of influenza based on influenza surveillance data in southern China, northern China, and the United States during the 2022-2023 season. We compared these estimates to those from 2011 to 2019 seasons without strong social distancing interventions to determine cumulative susceptibility during COVID-19 restrictions. Compared to the 2011-2019 seasons without a strong intervention with social measures, the 2022-2023 influenza season length was 45.0%, 47.1%, and 57.1% shorter in southern China, northern China, and the United States, respectively, corresponding to an 140.1%, 74.8%, and 50.9% increase in scale of influenza infections, and a 60.3%, 72.9%, and 45.1% increase in population susceptibility to influenza. Large and high-intensity influenza epidemics occurred in China and the United States in 2022-2023. Population susceptibility increased in 2019-2022, especially in China. We recommend promoting influenza vaccination, taking personal prevention actions on at-risk populations, and monitoring changes in the dynamic levels of influenza and other respiratory infections to prevent potential outbreaks in the coming influenza season.

Dynamics of respiratory viruses other than SARS-CoV-2 during the COVID-19 pandemic in Madrid, Spain

The COVID-19 pandemic and the implemented control measures have impacted the circulation of respiratory-transmitted pathogens. In this report, we present data from a retrospective study that included 17,883 specimens conducted between 2018 and 2022 in our facility, describing the dynamics of circulation of the main respiratory viruses. We observed a significant decrease in all viral detections (other than SARS-CoV-2) starting from March 2020. However, rhinovirus maintained comparable levels to the pre-pandemic period. Additionally, influenza viruses were not detected during the 2020-2021 season, and respiratory syncytial virus (RSV) exhibited a shift in its seasonality, with an epidemic peak occurring in the summer of 2021.

Antimicrobial Resistance and Antimicrobial Stewardship: Before, during and after the COVID-19 Pandemic

Antimicrobial resistance (AMR) is an ongoing phenomenon. It is a significant public health issue that has existed long before the coronavirus disease of 2019 (COVID-19) pandemic. It develops as microorganisms undergo genetic mutations that allow them to survive despite antimicrobial treatment. This process is highly associated with excessive and often unnecessary antimicrobial pharmacotherapy, which was often discussed during the COVID-19 pandemic. This article explores how the pandemic has affected antimicrobial stewardship by shifting the focus away from antimicrobial resistance, as well as the impact of enhanced antibiotic usage and measures such as lockdowns, mandatory testing and vaccination on antimicrobial resistance. Although these measures were regarded as successful in terms of limiting the pandemic, they have significantly contributed to an already escalating AMR issue. Outpatient methods in primary care and intensive care units aiming to prevent severe COVID-19 disease have contributed to the spread of multidrug-resistant bacteria, while laboratories burdened with COVID-19 testing have indirectly interrupted the detection of these bacteria. In this review, we summarize the pathogens whose AMRe has been greatly affected by COVID-19 measures and emphasize the importance of efficient antimicrobial stewardship in future pandemic and non-pandemic states to promote the responsible use of antibiotics and minimize AMR.

Phylogenetic analysis of HA and NA genes of influenza A viruses in immunosuppressed inpatients in Beijing during the 2018-2020 influenza seasons

BACKGROUND

Influenza A viruses have undergone rapid evolution with virulent; however, complete and comprehensive data on gene evolution and amino acid variation of HA and NA in immunosuppressed patients was few. In this study, we analysed molecular epidemiology and evolution of influenza A viruses in immunosuppressed population, and immunocompetent population were used as controls.

METHODS

Full sequences of HA and NA of A(H1N1)pdm09 and A(H3N2) were acquired through reverse transcription-polymerase chain reaction (RT-PCR). HA and NA genes were sequenced using the Sanger method and phylogenetically analysed using ClustalW 2.10 and MEGA software version 11.0.

RESULTS

During the 2018-2020 influenza seasons, 54 immunosuppressed and 46 immunocompetent inpatients screened positive for influenza A viruses by using the quantitative real-time PCR (qRT-PCR) were enrolled. 27 immunosuppressed and 23 immunocompetent nasal swab or bronchoalveolar lavage fluid samples were randomly selected and sequenced using the Sanger method. A(H1N1)pdm09 were detected in 15 samples and the remaining 35 samples were A(H3N2) positive. By analyzing the HA and NA gene sequences of these virus strains, we found that all A(H1N1)pdm09 viruses shared high similarities to each other and the HA and NA genes of these viruses exclusively belonged to subclade 6B.1A.1. Some NA genes of A(H3N2) viruses were not in the same clade as those of A/Singapore/INFIMH-16-0019/2016 and A/Kansas/14/2017, which may have led to A(H3N2) being the dominant strain in the 2019-2020 influenza season. Both A(H1N1)pdm09 and A(H3N2) viruses showed similar evolutionary lineages patterns of HA and NA between immunosuppressed and immunocompetent patients. Compared with the vaccine strains, there were no statistically significant of HA and NA genes and amino acid sequences of influenza A viruses in immunosuppressed and immunocompetent patients. However, the oseltamivir resistance substitution of NA-H275Y and R292K have been observed in immunosuppressed patients.

CONCLUSIONS

A(H1N1)pdm09 and A(H3N2) viruses showed similar evolutionary lineages patterns of HA and NA between immunosuppressed and immunocompetent patients. Both immunocompetent and immunosuppressed patients have some key substitutions, which should be of note monitored, especially those with potential to affect the viral antigen.

Efforts and expectations of pregnant women against the impact of the COVID-19 pandemic: a phenomenological study

BACKGROUND

COVID-19 is a global threat that directly impacts people's mental health and physical well-being. This study explored the efforts and expectations of pregnant women against the impact of the COVID-19 pandemic.

METHODS

This study was a qualitative study that used a phenomenological approach. The informants of this study were pregnant women (n = 20). Data analysis used content analysis with software assistance (Nvivo Release 1.5).

RESULTS

The results of this study identified three themes which were: 1) causative factors of pregnant women's anxiety regarding the impact of COVID-19 including lack of knowledge regarding the impact of the COVID-19 virus and perceived susceptibility; 2) Efforts to reduce anxiety during the COVID-19 pandemic including a spiritual approach, the role of family and COVID-19 prevention; and 3) Expectation regarding healthcare services during COVID-19 including virtual based Antenatal Care (ANC) Services and Private ANC Services.

CONCLUSION

A spiritual approach, the role of family, and COVID-19 prevention will help pregnant women reduce their anxiety about being infected with the COVID-19 virus. Furthermore, virtual-based ANC Services, and private ANC services, such as home visits and dividing ANC services and general services into two different tracks as a protective mechanism from being infected with the COVID-19 virus, would assist pregnant women feel safer and secure.

Clinical Outcomes Associated with SARS-CoV-2 Co-Infection with Rhinovirus and Adenovirus in Adults-A Retrospective Matched Cohort Study

(1) Background: Respiratory co-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other viruses are common, but data on clinical outcomes and laboratory biomarkers indicative of disease severity are limited. We aimed to compare clinical outcomes and laboratory biomarkers of patients with SARS-CoV-2 alone to those of patients with SARS-CoV-2 and either rhinovirus or adenovirus. (2) Methods: Hospitalized patients co-infected with SARS-CoV-2 and rhinovirus and patients co-infected with SARS-CoV-2 and adenovirus were matched to patients infected with SARS-CoV-2 alone. Outcomes of interest were the cumulative incidences of mechanical ventilation use, intensive care unit (ICU) admission, 30-day all-cause mortality, and 30-day all-cause readmission from the day of discharge. We also assessed differences in laboratory biomarkers from the day of specimen collection. (3) Results: Patients co-infected with SARS-CoV-2 and rhinovirus, compared with patients infected with SARS-CoV-2, had significantly greater 30-day all-cause mortality (8/23 (34.8%) vs. 8/69 (11.6%), p = 0.02). Additionally, median alanine transaminase (13 IU/L vs. 24 IU/L, p = 0.03), aspartate transaminase (25 IU/L vs. 36 IU/L, p = 0.04), and C-reactive protein (34.86 mg/L vs. 94.68 mg/L, p = 0.02) on day of specimen collection were significantly lower in patients co-infected with SARS-CoV-2 and rhinovirus in comparison to patients infected with SARS-CoV-2 alone. Clinical outcomes and laboratory markers did not differ significantly between patients with SARS-CoV-2 and adenovirus co-infection and patients with SARS-CoV-2 mono-infection. (4) Conclusion: SARS-CoV-2 and rhinovirus co-infection, compared with SARS-CoV-2 mono-infection alone, is positively associated with 30-day all-cause mortality among hospitalized patients. However, our lack of significant findings in our analysis of patients with SARS-CoV-2 and adenovirus co-infection may suggest that SARS-CoV-2 co-infections have variable significance, and further study is warranted.

Multimodal surveillance of SARS-CoV-2 at a university enables development of a robust outbreak response framework

BACKGROUND

Universities are vulnerable to infectious disease outbreaks, making them ideal environments to study transmission dynamics and evaluate mitigation and surveillance measures. Here, we analyze multimodal COVID-19-associated data collected during the 2020-2021 academic year at Colorado Mesa University and introduce a SARS-CoV-2 surveillance and response framework.

METHODS

We analyzed epidemiological and sociobehavioral data (demographics, contact tracing, and WiFi-based co-location data) alongside pathogen surveillance data (wastewater and diagnostic testing, and viral genomic sequencing of wastewater and clinical specimens) to characterize outbreak dynamics and inform policy. We applied relative risk, multiple linear regression, and social network assortativity to identify attributes or behaviors associated with contracting SARS-CoV-2. To characterize SARS-CoV-2 transmission, we used viral sequencing, phylogenomic tools, and functional assays.

FINDINGS

Athletes, particularly those on high-contact teams, had the highest risk of testing positive. On average, individuals who tested positive had more contacts and longer interaction durations than individuals who never tested positive. The distribution of contacts per individual was overdispersed, although not as overdispersed as the distribution of phylogenomic descendants. Corroboration via technical replicates was essential for identification of wastewater mutations.

CONCLUSIONS

Based on our findings, we formulate a framework that combines tools into an integrated disease surveillance program that can be implemented in other congregate settings with limited resources.

FUNDING

This work was supported by the National Science Foundation, the Hertz Foundation, the National Institutes of Health, the Centers for Disease Control and Prevention, the Massachusetts Consortium on Pathogen Readiness, the Howard Hughes Medical Institute, the Flu Lab, and the Audacious Project.

COVID-19 Prevention Guidance and the Incidence of Febrile Neutropenia in Patients with Breast Cancer Receiving TAC Chemotherapy with Prophylactic Pegfilgrastim

Chemotherapy-induced febrile neutropenia (FN) is a medical emergency that causes severe adverse effects and death. Respiratory infections are one of the main causes of fever in patients with FN. We studied whether infection prevention and control (IPC) guidance for coronavirus 2019 disease reduced the incidence of FN. We reviewed female patients with breast cancer treated with adjuvant docetaxel, doxorubicin, and cyclophosphamide with prophylactic pegfilgrastim between 2019 and 2021. IPC guidance was implemented in April 2020. There was no difference in the incidence of chemotherapy-induced neutropenia between patients with and without IPC. In patients with IPC, the incidence of FN (9.5%) was lower than that of patients without IPC (27.9%). The hospitalization duration (0.7 ± 1.5 days) and total hospital cost (279.6 ± 42.6 USD) of the IPC group were significantly lower than that of the non-IPC group (2.0 ± 3.8 days and 364.7 ± 271.6 USD, respectively). IPC guidance should be implemented to prevent FN in high-risk patients with breast cancer.

Association Between College Course Delivery Model and Rates of Psychological Distress During the COVID-19 Pandemic

IMPORTANCE

College students in the US have been heavily affected by the COVID-19 pandemic. In addition to increased rates of depression and anxiety, college students have faced unprecedented stressors, such as geographic relocation and abrupt conversion from in-person classes to online classes.

OBJECTIVE

To study the association between course delivery model and psychological distress among US college students.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional analysis used national data from the American College Health Association-National College Health Assessment III data set. Data were gathered from a web-based survey administered from January to early June 2021 to full-time US college students attending 4-year programs.

EXPOSURE

Course delivery model was self-reported.

MAIN OUTCOMES AND MEASURES

Psychological distress was measured using the Kessler Screening Scale for Psychological Distress.

RESULTS

This study evaluated 59 250 full-time undergraduate students (68.1% women; 51.5% White students; mean [SD] age, 21.2 [4.3] years); 3.5% attended fully in-person classes, 61.2% attended fully online classes, and 35.3% attended a mixed format of in-person and online classes. Students who attended classes fully online reported higher levels of psychological distress than those who attended a mix of online and in-person classes (b = 0.76 [99% CI, 0.64-0.88]; P < .001). This association remained significant after controlling for geographic region, year in school, gender, race and ethnicity, food security, current anxiety and/or depressive disorders, COVID-19 concerns, and residence (living on campus, off campus with family, or other off-campus arrangements) (b = 0.18 [99% CI, 0.04-0.31]; P = .001), as well as time spent socializing with friends (b = 0.13 [99% CI, 0.002-0.26]; P = .009).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that mental health professionals may wish to consider the association of course delivery models with mental health outcomes when working with college students. Colleges should be aware of the mental health burden associated with attending fully online classes and consider possible in-person components and supports for students.

Diagnosis and clinical significance of Human bocavirus 1 in children hospitalized for lower acute respiratory infection: molecular detection in respiratory secretions and serum

Introduction. Human bocavirus 1 (HBoV1) infection occurs with viral genome presence in respiratory secretions (RS) and serum, and therefore both samples can be used for diagnosis.

Gap statement. The diagnostic sensitivity of HBoV1 DNA detection in serum and the duration of DNAaemia in severe clinical cases have not been elucidated.

Aim. To determine HBoV1 DNA in serum and RS of paediatric patients hospitalized for lower acute respiratory infection (LARI) and to analyse the clinical–epidemiological features of positive cases.

Methodology. This was a prospective, transverse study. Physicians selected the clinical situations and obtained paired clinical samples (RS and serum) that were tested by PCR/qPCR for HBoV1. Positive cases were analysed considering time of specimen collection, co-detection, clinical manifestations and viral load; statistical significant level was set at α=0.05.

Results. HBoV1 was detected in 98 of 402 cases included (24 %); 18/98 (18 %) patients had the virus detectable in serum and 91/98 (93 %) in RS (P<0.001). Positivity rates were not significantly different in patients with RS and serum collected within or beyond 24 h of admission. Single HBoV1 infection was identified in 39/98 patients (40 %), three patients had HBoV1 in both clinical samples (3/39, 8 %) and 32 (32/39, 82 %) only in RS, 22 of them (69 %) with both clinical samples within 24 h of admission. Cough (P=0.001) and rhinitis (P=0.003) were significantly frequent among them and most patients were diagnosed with bronchiolitis (22/39, 56 %) and pneumonia (9/39, 23 %), which was more frequent compared to cases with co-infection (P=0.04). No significant differences were identified among patients with high, medium or low viral load of HBoV1 regarding rate of positivity in both clinical samples, the time of collection of RS and serum, co-detection, first episode of LARI, clinical manifestations, comorbidity or requirement for assisted ventilation. Intensive care unit (ICU) patients had a significantly higher frequency of detection (P<0.001) and co-detection (P=0.001) compared to patients on standard care.

Conclusions. HBoV1 is prevalent among infant patients hospitalized for LARI and including it in the standard testing can add to the aetiological diagnosis in these cases, especially for patients admitted to the ICU. HBoV1 detection in serum did not contribute significantly to the diagnosis as compared to detection in respiratory secretions.

A retrospective analysis of respiratory virus transmission before and during the COVID-19 pandemic in Pune the western region of India

BACKGROUND

SARS-CoV-2 was first reported in China in December 2019 and quickly spread across the world. Non-pharmaceutical interventions (NPIs) are the key to control the transmission of respiratory viruses. To stop the spread, NPI is widely recommended and is still followed by most countries.

METHODS

At the National Influenza Center of the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), the surveillance of severe acute respiratory illness and acute respiratory illness cases for influenza and other respiratory viruses is in place. In this study, we analyzed surveillance data on respiratory viruses and/or SARS-CoV-2 testing from January 2017 to December 2021. Multiplex real-time PCR was used to detect the respiratory viruses.

RESULTS

Our findings indicate that during the pandemic, the positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and human coronavirus declined significantly.

CONCLUSION

The annual distinct seasonal outbreaks of influenza, RSV, and other respiratory viruses as observed during the pre-COVID-19 period were not observed during the COVID-19 pandemic in years 2020 and 21. Social distancing, lock-downs, and non-pharmaceutical interventions may play an important role in the reduction of respiratory viruses. Understanding the seasonal respiratory virus decline could help public health experts prepare for future respiratory virus pandemics.

Epidemiological changes in infectious diseases during the coronavirus disease 2019 pandemic in Korea: a systematic review

In the era of the coronavirus disease 2019 (COVID-19) pandemic, countries worldwide have implemented several nonpharmaceutical interventions (NPIs) to contain its spread before vaccines and treatments were developed. NPIs included social distancing, mask wearing, intensive contact tracing and isolation, and sanitization. In addition to their effectiveness at preventing the rapid spread of COVID-19, NPIs have caused secondary changes in the epidemiology of other infectious diseases. In Korea, various NPI stages have been implemented since the first confirmed case of COVID-19 on January 20, 2020. This review, based on a PubMed database search, shows the impact of NPIs on several infectious diseases other than severe acute respiratory syndrome coronavirus 2 in the COVID-19 pandemic era in Korea.

Rhinovirus Incidence Rates Indicate We Are Tired of Non-pharmacological Interventions Against Coronavirus Disease 2019

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, the incidence of rhinovirus (RV) is inversely related to the intensity of non-pharmacological interventions (NPIs), such as universal mask wearing and physical distancing.

METHODS

Using RV surveillance data, changes in the effect of NPIs were investigated in South Korea during the pandemic. The time to the first visible effect of NPIs after the onset of NPIs (T1), time to the maximum effect (T2), and duration of the maximum effect (T3) were measured for each surge. For each week, the RVdiff [(RV incidence during the pandemic) - (RV incidence within 5 years before the pandemic)] was calculated, and number of weeks for RVdiff to be below zero after NPIs (time to RVdiff ≤ 0) and number of weeks RVdiff remains below zero after NPIs (duration of RVdiff ≤ 0) were measured for each surge.

RESULTS

During the study period, four surges of COVID-19 were reported. As the pandemic progressed, T1 and T2 increased, but T3 decreased. Additionally, the "time to RVdiff of ≤ 0" increased and "duration of RVdiff of ≤ 0" decreased. These changes became more pronounced during the third surge (mid-November 2020), before the introduction of the COVID-19 vaccine, and from the emergence of the delta variant.

CONCLUSION

The effect of NPIs appears slower, the duration of the effect becomes shorter, and the intensity also decreases less than a year after the onset of the pandemic owing to people's exhaustion in implementing NPIs. These findings suggest that the COVID-19 response strategy must be completely overhauled.

Changes in the Epidemiology and Causative Pathogens of Meningitis in Children After the Outbreak of the Coronavirus Disease 2019: A Multicenter Database Study

BACKGROUND

With the outbreak of the COVID-19 pandemic, non-pharmaceutical interventions such as social distancing have been implemented worldwide, and a decrease in other infectious diseases has been reported as an unexpected benefit. However, to date, studies are lacking regarding the effects of the COVID-19 pandemic on neuroinfectious diseases; therefore, we aimed to determine the effects of the COVID-19 pandemic on the incidence of meningitis, which is the most common infectious disease in children.

METHODS

This retrospective study used electronic medical record data from five university hospitals located in the metropolitan cities in Korea. This study included patients aged <18 years who were diagnosed with meningitis between January 2017 and December 2020. We analyzed the clinical characteristics of patients with meningitis and changes in the incidence and causative pathogens of meningitis before and after the COVID-19 outbreak.

RESULTS

The study included 677 patients with meningitis. Following the outbreak of COVID-19 in Korea in January 2020, the incidence of childhood meningitis significantly decreased and seasonal changes noted yearly disappeared. There was a difference in the age distribution of patients with meningitis. The incidence of meningitis decreased significantly in children aged >5 years, and the incidence in children <5 years of age relatively increased (p < 0.001). In addition, there was a notable decrease in the cases of suspected meningitis (p < 0.001). The incidence of enteroviral meningitis, the most common cause of meningitis, significantly decreased.

CONCLUSION

After the COVID-19 outbreak, the incidence of childhood meningitis significantly decreased with the implementation of non-pharmaceutical interventions. Absence of enteroviral meningitis and decrease in the proportion of patients aged ≥5 years with meningitis having mild symptoms were noted. Consequently, it can be concluded that the non-pharmaceutical interventions (NPIs) instituted to prevent the spread of COVID-19 had some effect on reducing the incidence of meningitis.

Circulation of Respiratory Viruses in Hospitalized Adults before and during the COVID-19 Pandemic in Brescia, Italy: A Retrospective Study

Different preventive public health measures were adopted globally to limit the spread of SARS-CoV-2, such as hand hygiene and the use of masks, travel restrictions, social distance actions such as the closure of schools and workplaces, case and contact tracing, quarantine and lockdown. These measures, in particular physical distancing and the use of masks, might have contributed to containing the spread of other respiratory viruses that occurs principally by contact and droplet routes. The aim of this study was to evaluate the prevalence of different respiratory viruses (influenza viruses A and B, respiratory syncytial virus, parainfluenza viruses 1, 2, 3 and 4, rhinovirus, adenovirus, metapneumovirus and human coronaviruses) after one year of the pandemic. Furthermore, another aim was to evaluate the possible impact of these non-pharmaceutical measures on the circulation of seasonal respiratory viruses. This single center study was conducted between January 2017-February 2020 (pre-pandemic period) and March 2020-May 2021 (pandemic period). All adults >18 years with respiratory symptoms and tested for respiratory pathogens were included in the study. Nucleic acid detection of all respiratory viruses was performed by multiplex real time PCR. Our results show that the test positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus and human coronaviruses decreased with statistical significance during the pandemic. Contrary to this, for adenovirus the decrease was not statistically significant. Conversely, a statistically significant increase was detected for rhinovirus. Coinfections between different respiratory viruses were observed during the pre-pandemic period, while the only coinfection detected during pandemic was between SARS-CoV-2 and rhinovirus. To understand how the preventive strategies against SARS-CoV-2 might alter the transmission dynamics and epidemic patterns of respiratory viruses is fundamental to guide future preventive recommendations.

Social distancing and preventive practices of government employees in response to COVID-19 in Ethiopia

Public health and social interventions are critical to mitigate the spread of the coronavirus disease 2019 (COVID-19) pandemic. Ethiopia has implemented a variety of public health and social measures to control the pandemic. This study aimed to assess social distancing and public health preventive practices of government employees in response to COVID-19. A cross-sectional study was conducted among 1,573 government employees selected from 46 public institutions located in Addis Ababa. Data were collected from 8th to 19th June 2020 using a paper-based self-administered questionnaire and analyzed using SPSS version 23.0. Descriptive statistics were used to summarize the data. Binary logistic regression analyses were used to identify factors associated with outcome variables (perceived effectiveness of facemask wearing to prevent coronavirus infection, and COVID-19 testing). Majority of the participants reported facemask wearing (96%), avoiding close contact with people including handshaking (94.8%), consistently followed government recommendations (95.6%), frequent handwashing (94.5%), practiced physical distancing (89.5%), avoided mass gatherings and crowded places (88.1%), restricting movement and travelling (71.8%), and stayed home (35.6%). More than 80% of the participants perceived that consistently wearing a facemask is highly effective in preventing coronavirus infection. Respondents from Oromia perceived less about the effectiveness of wearing facemask in preventing coronavirus infection (adjusted OR = 0.27, 95% CI:0.17-0.45). About 19% of the respondents reported that they had ever tested for COVID-19. Respondents between 40-49 years old (adjusted OR = 0.41, 95% CI:0.22-0.76) and 50-66 years (adjusted OR = 0.43, 95% CI:0.19-0.95) were less likely tested for coronavirus than the younger age groups. Similarly, respondents from Oromia were less likely to test for coronavirus (adjusted OR = 0.26, 95% CI:0.12-0.56) than those from national level. Participants who were sure about the availability of COVID-19 testing were more likely to test for coronavirus. About 57% of the respondents perceived that the policy measures in response to the pandemic were inadequate. The findings showed higher social distancing and preventive practices among the government employees in response to COVID-19. Rules and regulations imposed by the government should be enforced and people should properly apply wearing facemasks, frequent handwashing, social and physical distancing measures as a comprehensive package of COVID-19 prevention and control strategies.