Acute Respiratory Infections Research Articles

АНАЛИЗ ОБЪЕМА ПРОДАЖ КОМБИНИРОВАННЫХ ПРЕПАРАТОВ ДЛЯ СИМПТОМАТИЧЕСКОЙ ТЕРАПИИ ОСТРЫХ РЕСПИРАТОРНЫХ ВИРУСНЫХ ИНФЕКЦИЙ И ПРОРАБОТКА АССОРТИМЕНТА АНТИГРИППИНА НА ПРИМЕРЕ АПТЕКИ ГОРОДА КАЗАНИ

There is strong competition between pharmacy providers. The abundance of advertising allows the public to be relatively informed in the variety of medicines offered by suppliers. All of the above, including high rent for inventory storage space, emphasizes the problem of the need for rational assortment formation. Only a properly created assortment of goods will allow the pharmacy to compete in the eyes of consumers, not to lose regular customers and to acquire new ones. With effective management of the product assortment can increase the income of the pharmacy due to the lack of unsatisfied demand. It is also possible to reduce the number of sales lost due to lack of goods, to accelerate the turnover of goods, to reduce the cost of storing medicines. Currently, there is a variety of combination medicines offered by suppliers to combat several symptoms of acute respiratory viral infections. The article presents the results of ABC-analysis, XYZ-analysis and their combination on the example of the assortment of dosage forms of antigrippin of the pharmacy of the state network of the city of Kazan. The distribution of antigrippin assortment into groups is shown and recommendations on the strategy of the pharmacy manager in relation to each of the groups are offered. The fact that these are seasonally consumed commodities with medium forecasting capabilities makes it difficult to plan the procurement of combination medicines to control several symptoms of acute respiratory viral infections. After combining the results of ABC XYZ analysis, it was found that antigrippin pharmacy-made antigrippin and antigrippin effervescent tablets are commodity items with a low share of turnover and number of sales units. They showed a medium degree of forecast reliability due to unstable demand. Antigrippin express powder, antigrippin - ANVI capsules and Vicks Antigripp Max powder made up the majority of the assortment, a small share of the turnover of antigrippin dosage forms and the number of sales units. These products showed low forecast reliability due to non-constant demand and generated little profit. This could be due to the fact that the consumer did not have sufficient information about these products.

ОЦЕНКА БЕЗОПАСНОСТИ И ВЛИЯНИЯ ПНЕВМОКОККОВОЙ ВАКЦИНЫ «ПРЕВЕНАР-13» НА ПОКАЗАТЕЛИ ЗАБОЛЕВАЕМОСТИ ПНЕВМОНИЕЙ И ОТИТОВ У ДЕТЕЙ ПЕРВЫХ ПЯТИ ЛЕТ ЖИЗНИ

The scientific article presents an assessment of the clinical effectiveness and safety of the use of the pneumococcal conjugate 13-valent vaccine (PCV13, PCV 13) «Prevenar 13» in children from 0 to 5 years old, observed in the children's department of the State Budgetary Institution of Healthcare of the Secondary Educational Institution «SGKP N 15» in the city Samara. The study included 590 children, who were divided into 2 groups. The first (main, group PC-13) group included children born in 2018 - 2020 and vaccinated with the Prevenar 13 vaccine according to the «2 + 1» (n=490), the second (control) group included children born in 2013 and not vaccinated with a vaccine against pneumococcal infection, including Prevenar 13 (n=100). The study revealed that during the 2nd year of life in children of the first group, the incidence rate after vaccination decreased by 2 times. The incidence rate of pneumonia in the group of vaccinated children also decreased in all age periods, and the incidence rate of otitis media during the entire observation period in the second group of children (unvaccinated) was higher. Based on the data presented, we can conclude that vaccination with Prevenar-13 is a safe and effective measure in the prevention of ARI (acute respiratory infections) in children.

How AI Could Help Us in the Epidemiology and Diagnosis of Acute Respiratory Infections?

Acute respiratory infections (ARIs) represent a significant global health burden, contributing to high morbidity and mortality rates, particularly in vulnerable populations. Traditional methods for diagnosing and tracking ARIs often face limitations in terms of speed, accuracy, and scalability. The advent of artificial intelligence (AI) has the potential to revolutionize these processes by enhancing early detection, precise diagnosis, and effective epidemiological tracking. This review explores the integration of AI in the epidemiology and diagnosis of ARIs, highlighting its capabilities, current applications, and future prospects. By examining recent advancements and existing studies, this paper provides a comprehensive understanding of how AI can improve ARI management, offering insights into its practical applications and the challenges that must be addressed to realize its full potential.

Emergency Department admissions for Acute Respiratory Infections: a retrospective analysis

Abstract Background Acute Respiratory Infections (ARIs) have a relevant impact on public health in terms of prevalence and costs associated with the diseases. The COVID-19 pandemic highlighted the need to adopt accurate surveillance systems to respond to new emergencies and meet the demand for access to care. The aim of our work is to describe the accesses at the Emergency Departement (ED) of the Pisa University Hospital (AOUP), Italy, for ARIs, from 2017 to 2021. Methods A retrospective analysis of electronic medical records from the AOUP was conducted from January 2017 to December 2021. The analysis focused on ED admissions and positive lab test results, examining their correlation with ED visits caused by ARI. Multiple linear regression models were used to understand the influence of viral laboratory results on ARI-related ED admissions, adjusting the results for age. The study also assessed the contribution of each virus incausing ARI within different age groups. Results 33,101 (annual average 5,520) ARI admissions in ED were registered, resulting in 7,426 hospital admissions (22.8%, annual average 1,163) with a seasonal pattern between week 42 of each year and week 17 of the following year. The reduction in emergency room admissions in 2020 (weekly average of 78.2, compared to 144.3 in 2017-2019) may be due to the restrictions implemented for the COVID-19 pandemic. Nevertheless, the average weekly rate of ED admissions caused by ARI was 30.8% in 2020, as compared with 21.7% in 2017-2019. Analysis by age group showed a peak of accesses in the last weeks of 2021 for the <1 and 1-4 years old age groups. Conclusions Data on ARI-related admissions provide valuable insights into the dynamic patterns of seasonal air-borne infections and age-related vulnerabilities. This could be useful in directing health policies to identify indicators of future epidemic waves, contributing to the ongoing efforts to enhance preparedness and response strategies for respiratory infections. Key messages • It is important to create an integrated surveillance system to monitor and respond to ARIs. • Strategies should prioritise vaccination campaigns, particularly for RSV and influenza.

Effects of airway clearance in hospitalized children with neurologic impairment.

Airway clearance therapies (ACT) are often used to optimize respiratory function for children with neurologic impairment (CNI) hospitalized with acute respiratory infections (ARI). In a five-center retrospective cohort study of CNI aged 1-18 years hospitalized between 2013 and 2015 with ARI, we assessed the association of admission ACT with hospital outcomes (days to return to baseline respiratory support and length of stay [LOS]). Generalized estimated equation (GEE) models examined the association between ACT and outcomes, while accounting for clustering. Propensity scores estimating the likelihood of receiving ACT were included in the GEE models as inverse probability of treatment weights to account for confounding. In adjusted analyses, children receiving admission ACT required similar time to return to respiratory baseline (adjusted risk ratio [aRR] 1.24, 95%CI: 0.95,1.62) and had similar LOS (aRR 1.08, 95%CI: 0.88,1.32) compared with children not receiving ACT. Future studies should seek to identify subpopulations of CNI who benefit most from ACT.

Rapid health technology assessment to inform policy: a case study with respiratory syncytial virus

Abstract Background Respiratory syncytial virus (RSV) can cause severe acute respiratory tract infection in infants and older adults. However, until recently, no immunisation interventions were available to reduce the burden of RSV disease in the general population. New health technologies have now been authorised in Europe for infants (a long-acting monoclonal antibody (nirsevimab) and a maternal vaccine (RSVpreF)), and two vaccines for adults aged ≥60 years (RSVPreF3 and RSVpreF). A rapid health technology assessment (HTA) was requested by the Irish Department of Health to support an interim decision on RSV immunisation. Methods The rapid HTA commenced in January 2024, and comprised description of technology, a summary of international practice, national and international epidemiology and burden of disease, and a costing analysis. The summary of international practice (including underpinning evidence) was undertaken rather than a systematic review of effectiveness and safety due to the rapidly changing evidence base and short timeline within which information was required. Results While new recommendations regarding immunisation against RSV are emerging internationally in response to recently authorised technologies, implementation and funding strategies are not currently widespread. Compared with a full HTA, a rapid HTA enabled an efficient and flexible approach to producing a high quality evidence synthesis to inform a temporary policy decision, taking approximately 6 months to complete rather than 12 months or longer. A full HTA is planned to inform long-term decision-making on this topic, but would not have been feasible to inform an interim decision. Conclusions This rapid HTA will inform a temporary decision on immunisation policy for a single RSV season in Ireland. Conducting a rapid HTA prior to a full HTA has enabled timely decision-making, with implications for Ireland’s national healthcare system and people at risk of severe RSV-related disease. Key messages • Innovations in immunisation against RSV are leading to changes in policy across Europe. • Rapid HTA can support timely, evidence-based public health decision-making in a fast-evolving field.

Influenza vaccine effectiveness in Ireland during two influenza seasons, 2022/23 and 2023/24

Abstract Background Live Attenuated Influenza Vaccine (LAIV) is recommended in Ireland for all children aged 2-17 years. Quadrivalent influenza vaccine is recommended for all others eligible for vaccination, including those aged ≥18 years with underlying medical conditions and all aged ≥65 years. We aimed to estimate influenza vaccine effectiveness (IVE) against Acute Respiratory Infection (ARI) presentations to primary care due to influenza over two influenza seasons in Ireland, to inform vaccination recommendations and communication campaigns. Methods We undertook a test-negative design case control study within the national sentinel surveillance General Practice network, as part of the European Vaccine Effectiveness Burden and Impact Studies (VEBIS) network. We compared influenza vaccination status among influenza Polymerase Chain Reaction (PCR) positive cases with influenza PCR negative controls, amongst patients consulting with ARI. We verified vaccination status using the national influenza vaccination database. We estimated end of season IVE for 2022/23, and mid-season IVE (up to 7th April 2024) for 2023/24, using multivariable logistic regression and adjusting for age, onset time, medical condition, and sex. Results In 2022/23, there were 288 cases and 765 controls. In 2023/24 there were 515 cases and 1,482 controls. Overall vaccination coverage was 23% in both seasons. Coverage in 2-17 year-olds was 10% in 2022/23 and 12% in 2023/24. In 2022/23, overall IVE was 42% (95%CI 9-54) and 50% (95%CI -30-83) in 2-17 year-olds. Overall IVE in 2023/24 was 37% (95%CI 16-54) and was 67% (95%CI 28-87) in 2-17 year-olds. Conclusions Influenza vaccination reduced medical attendance to primary care with ARI due to influenza, demonstrating benefits of vaccination, particularly among children. Influenza vaccination should continue to be offered and promoted to recommended groups, including children. Key messages • This study suggests that influenza vaccination protected population health and the health service from medical attendance to primary care with acute respiratory infection due to influenza. • Higher influenza vaccine effectiveness was observed in children aged 2-17 years. These findings can inform influenza vaccination programmes with LAIV for children in Ireland and internationally.

Vaccination status and long COVID symptoms among patients hospitalized with COVID-19: the WHF COVID-19 Long-term Study

Abstract Background COVID-19 vaccinations have been found to be effective in reducing the severity of COVID-19 infection and in-hospital deaths; however, insufficient evidence exists about the effect of vaccination on long term morbidity and mortality after hospitalization in patients from low- and middle-income countries. Methods The global WHF COVID-19 Long-Term Follow-up Study recruited 2,504 COVID-19 hospitalized patients from 26 collaborating sites in 16 countries between January 2022 - June 2023. Patients were followed up , at 1, 3, 6, and 9-12 months post-discharge to examine short- and long-term physical and psycho-social outcomes. A standardised questionnaire was used to collect data on demographics, pre-existing comorbidities, COVID-19 symptoms on admission, vaccination status, and outcomes at discharge, including persisting symptoms, new onset hypertension or diabetes, major adverse cardiovascular events (MACE), and mortality. We compared persistent long COVID symptoms, MACE, and mortality outcomes up to one year by COVID-19 vaccination status. Results The majority of study participants were Asians (78%), males (56%) with a mean (SD) age of 59.2 (19.9) years and from low- and middle-income (65%), upper middle-income (20%) and high-income (15%) countries. The most commonly reported comorbidities were hypertension: 54% and diabetes: 38%. Approximately two-thirds of the patients had received at least one dose of COVID-19 vaccination prior to hospitalization. Unvaccinated patients were more likely to present with dyspnea (60% vs 53%, p-value<0.001) and acute respiratory infection (15% vs 9%, p-value<0.001) during hospitalization. Unvaccinated patients also had twice the in-hospital mortality rate, compared with vaccinated patients (6% vs 3%, p-value<0.001). Unvaccinated patients had a greater incidence of MACE (23% vs 18%, p-value=0.016) during hospitalization and across all follow-up visits. Unvaccinated patients also had a higher mortality rate across all follow-up visits (mortality at one year post-discharge 14% vs 10%, p<0.001). At the 9-12 month follow-up, about a quarter of the patients had at least one long COVID symptom, but unvaccinated patients had a higher rate of long COVID symptoms, including fatigue (23% vs 14%, p<0.001), palpitations (17% to 7%, p-value<0.001), and anxiety (13% to 7%, p=0.002). Conclusions Our data highlight the long-term protective effect of COVID-19 vaccination on reducing morbidity and mortality among COVID-19 patients after hospital discharge. However, a substantial proportion of COVID-19 vaccinated patients still showed persistent long COVID symptoms (22%) and mortality (10%). Future research is needed to investigate individual- and health system-level factors contributing to poor health outcomes post-COVID-19 infection.

COVID-19 vaccine effectiveness and hybrid immunity in the respiratory season of 2022-23 in Hungary

Abstract Background There has been an increase in COVID-19 vaccine hesitancy among the general population, accompanied by a decline in confidence that vaccines provide adequate protection. We estimated the effectiveness of the COVID-19 vaccines (CVE) and hybrid immunity against medically attended COVID-19 during the 2022-2023 respiratory season in Hungary. Methods We conducted a test-negative design study involving 68 GPs. Patients aged ≥18 years presenting with acute respiratory infection were swabbed. Cases and controls were patients testing positive and negative for SARS-CoV-2 by RT-PCR, respectively. Exposure was defined as having received at least one COVID-19 booster dose, taking into account the time since the last vaccination. CVE was estimated using logistic regression, adjusted for symptom onset date, age, chronic condition and sex. Results We included 247 cases and 1073 controls in the analysis. 196 samples were sequenced, and Omicron BA.5, BQ.1 and XBB.1 were the most frequent sub-variants. The CVE was 52.9% (95% CI: 15.2-73.9%), and 72.3% (95% CI: 32.0-88.7%) in the 18-59, and 60+-year-old population who received the final dose within the past year, respectively. Self-reported COVID-19 in the previous 60-365 days did not confer protection against reinfection, however, when combined with booster vaccination, it reduced the risk of COVID-19 by 63.0% (95% CI: −28.0-89.3%) and 87.6% (95% CI: 26.4-97.9%) among the 18-59 and 60+ age groups, respectively. Conclusions Booster vaccination within one year after the last dose confers significant protection against symptomatic infection, particularly among the elderly. Those who have previously been infected with SARS-CoV-2 may also benefit from booster vaccinations. Key messages • COVID-19 booster campaigns must be intensified, focusing mainly on the elderly. • Providing clear guidance on the timing and target groups of vaccination and emphasising the benefits of vaccination can help to achieve higher coverage.

The circulating characteristics of common respiratory pathogens in Ningbo, China, both before and following the cessation of COVID-19 containment measures

To assess the circulating characteristics of common respiratory pathogens following the complete relaxation of non-pharmaceutical interventions (NPIs) and the cessation of the dynamic zero-COVID policy. The retrospective analysis was conducted from 14,412 patients with acute respiratory infections (ARIs) from January 24, 2020, to December 31, 2023, including Influenza A virus (IFV-A), Influenza B virus (IFV-B), Respiratory Syncytial Virus (RSV), Human Rhinovirus (HRV), Human Parainfluenza Virus (HPIV), Human Metapneumovirus (HMPV), Human Coronavirus (HCoV), Human Bocavirus (HBoV), Human Adenovirus (HAdV), and Mycoplasma pneumoniae (MP). Compared with 2020–2022, Joinpoint analysis indicated a monthly increase in overall pathogen activity in 2023, rising from an average of 43.05% to an average of 68.46%. The positive rates of IFV-A, IFV-B, HMPV, HPIV, HCoV, and MP increased, while those of HRV and RSV decreased, and no differences in HAdV and HBoV. The outbreak of IFV-A and MP was observed, the positive rate of MP has surpassed pre-COVID-19 pandemic levels and the spread of RSV was interrupted by IFV-A. Infants and toddlers were primarily infected by HRV and RSV, Children and adolescents exhibited a higher prevalence of infections with MP, IFV-A, and HRV, whereas Adults and the elderly were primarily infected by IFV-A. The incidence of co-infections rose from 4.25 to 13.73%. Restricted cubic spline models showed that the susceptible age ranges for multiple pathogens expanded. These changes serve as a reminder to stay alert in the future and offer clinicians a useful guide for diagnosing and treating.

The effects of weather and mobility on respiratory viruses before and during the COVID-19 pandemic

Abstract Background The flu season is caused by a combination of different pathogens, including influenza viruses, which cause the flu, and non-influenza respiratory viruses, that cause common colds or influenza-like illness. These viruses exhibit similar dynamics and, given that outbreaks occur mostly in the winter and there is almost no circulation during the summer, in temperate regions, meteorological conditions have historically been regarded as a principal modulator of their epidemiology. However, after the emergence of SARS-CoV2, in late 2019, the dynamics of these respiratory viruses were strongly perturbed worldwide: some infections displayed near-eradication, while others experienced temporal shifts or occurred “off-season”. This disruption raised questions regarding the dominant role of weather while also providing an unique opportunity to investigate the roles of other determinants in their epidemiological dynamics. Methods Weather, mobility and epidemiological surveillance data was collected for Influenza, RSV, hCOV and hMPV, from Canada and the USA, from 2016 to 2023. Statistical analysis and modeling were employed to test the effects of weather and mobility on viral dynamics, before and during the COVID-19 pandemic. Results Using Beta Regressions, we found that whereas in the pre-COVID-19 pandemic period, weather had a strong effect, in the pandemic period, this effect was strongly reduced post-pandemic with mobility playing a more significant role. Conclusions These results, together with previous studies, dispute the general belief that respiratory viral dynamics are mostly dictated by weather and indicate that behavioral changes resulting from the non-pharmacological interventions implemented to control SARS-CoV2, played a key role. This disruption of past dynamical equilibrium raises important questions regarding the factors that modulate them, particularly in a context of climate change. Key messages • We took advantage of the disruption caused by COVID-19 to study dynamics of other respiratory viruses and to disentangle the effects of weather from those of human behavior. • While before 2020 cold temperatures were highly correlated with incidence, afterwards cold weather was no longer a necessary condition and human mobility became central.

Analysis of the mpox outbreak in Europe in 2022: vaccination rollout in the most affected countries

Abstract Background The mpox virus spreads through contact with infected material and causes flu-like symptoms and skin lesions. Common in Central and West Africa, a global rise in mpox cases in 2022 was observed, affecting mainly men who have sex with men. Methods The study analysed vaccination policies in the most affected WHO-EURO countries during the mpox outbreak, including the Netherlands, France, UK, Spain, Germany, Belgium, Portugal, and Switzerland. Epidemiological data from May to October 2022 (first wave) were compared. Additionally, the role of EU health institutions in assisting member states in controlling virus spread across the region was examined. Results By the end of May 2022, three countries (The Netherlands, France, and UK) initiated post-exposure vaccination shortly after the first case identification. Portugal, one of the most affected countries, implemented pre-exposure prophylaxis for high-risk groups by September, followed by Switzerland in November. Vaccination access for non-exposed priority groups varied, with France not requiring a medical prescription. EU cooperation in health was pivotal during the outbreak, with vaccines distributed through the EU4Health program budget via HERA to ensure preparedness. However, detailed information remains limited. Conclusions Countries’ responses to the mpox virus outbreak varied significantly, with discrepancies not always aligning with epidemiological data. These differences could stem from various factors, such as behavioural patterns, prior immunisation rates, and neighbouring countries’ policies. However, the unequal access to vaccines across the region underscores existing health disparities, particularly affecting stigmatised populations. Data on immunisation records were notably scarce in most countries, hindering thorough analysis of policy implementation and effectiveness. Additionally, further exploration is warranted into the role of LGBT associations and evidence of stigma surrounding the outbreak. Key messages • The mpox 2022 outbreak in Europe provides an important picture of cross-border health policies and public health responses for future emergences in a European cooperative environment. • Most national authorities provided limited information during the mpox 2022 outbreak; data on immunisation records and vaccine access is pivotal to assess countries’ health policies.

Exploring the Clinical Characteristics and Outcomes of Rhinovirus Infection in Hospitalized Children Compared with Other Respiratory Viruses

Background: Acute viral respiratory tract infections constitute a significant challenge in pediatric healthcare globally, with rhinovirus representing one of the primary etiological agents. In this context, we conducted a study with the objective of identifying the clinical characteristics and outcomes of rhinovirus infection in comparison with other respiratory viruses in children hospitalized in one of the largest pediatric hospitals in the capital of Romania. Methods: We conducted a retrospective study among children hospitalized for influenza-like illness symptoms and who were tested by multiplex RT-PCR with a nasopharyngeal swab between May 2020 and December 2021. Results: A total of 496 children were eligible for inclusion in the study, and the positivity rate for at least one virus was 58.5%. The rhinovirus was identified in 138 patients (median age 12.5 months), representing 27.8% of all children tested and 49.3% of all positive samples. Although the clinical features of children with rhinovirus were dominated by cough (63.7%) and dyspnea (51.6%), no symptoms were identified that were strongly associated with rhinovirus infection in comparison to other respiratory viruses. The probability of receiving an antibiotic prescription was 1.92 times lower (p = 0.011) in children who tested positive for rhinovirus compared to children with negative RT-PCR results. The incidence of acute bronchiolitis or acute bronchitis, acute respiratory failure, and acute otitis media was higher among rhinovirus-positive children than among those who tested negative via RT-PCR. However, the incidence of these conditions was similar among children who tested positive for other respiratory viruses. Conclusions: Rhinovirus was the most prevalent virus identified in children hospitalized with influenza-like illness symptoms. The utilization of multiplex RT-PCR molecular tests is instrumental in elucidating etiology with precision and implementation of these advanced diagnostic methods, which can bring significant benefits in practice. A positive result for rhinovirus helps to reduce the unnecessary administration of antibiotics and optimizes patient management, thus decreasing the risk of severe complications such as acute respiratory failure and acute otitis media.

Housing tenure and acute lower respiratory tract infection admissions in two Scottish birth cohorts

Abstract Introduction Early-life acute lower respiratory tract infections (LRTI) have been associated with increased morbidity and mortality. Despite young children spending much of their time at home, the contribution of home ownership status, on LRTI hospital admissions is unknown. Objectives To estimate the association between housing tenure and the odds of LRTI hospitalization in children <2 years in two birth cohorts. Methods De-identified Scottish birth records were linked to maternal Census data (2001 and 2011) and to hospital admission data to construct two birth cohorts (Cohort 1 (C1), born 2000-2002; Cohort 2 (C2), 2010-2012). Using logistic regression we estimated the association of housing tenure (owned, social rented, private rented, rent-free) with the odds of LRTI hospital admission, before and after adjustment for maternal age, residential area, and maternal qualification level. Results Over the 2-year follow-up, there were 14,833 LRTI admissions in 12,527 children (10,832 children had 1 LRTI admission and 1,695 >1 LRTI admission). 75.6 % of all LRTI admissions were due to bronchiolitis. In C1 and C2, 4.0% and 5.3% children, respectively, had one or more LRTI admission. Compared to children living in owned housing, the odds of LRTI admission were higher in children living in social rented housing (C1: Odds ratio=1.40, 95% confidence interval: 1.31-1.49; C2: 1.23, 1.16-1.31), private rented (C1:1.24, 1.11,1.39; C2: 1.14, 1.06-1.21), and rent-free housing (C1: 1.53, 1.35,1.74; C2: 1.04, 0.80-1.36) after confounder adjustment. Conclusions We found an association between non-owned housing and higher odds of LRTI admission which was more marked in C1 than in C2. Further research is warranted to unpick the mechanisms underlying the association between housing tenure and LRTI admission. Interventions to prevent LRTI admissions could usefully target children living in non-owned housing. Key messages • This study demonstrates the value of administrative and health data linkage in improving our understanding of how socio-environmental factors might impact children’s respiratory health. • Children living in social and private rented housing (compared to owned housing) have a higher risk of LRTI hospital admission and could benefit the most from LRTI-lowering interventions.

Epidemiology and genetic diversity of human respiratory syncytial virus in Belgium between 2011 and 2019

BackgroundHuman respiratory syncytial virus (HRSV) is worldwide one of the leading causes of acute respiratory tract infections in young children and the elderly population. Two distinct subtypes of HRSV (A and B) and a multitude of genotypes have been described. The laboratory of Clinical and Epidemiological Virology (KU Leuven/University Hospitals Leuven) has a long-standing history of HRSV surveillance in Belgium.MethodsIn this study, the seasonal circulation of HRSV in Belgium was monitored during 8 consecutive seasons prior to the SARS-CoV-2 pandemic (2011–2012 until 2018–2019). By use of a multiplex quantitative real time PCR panel, 27,386 respiratory samples were tested for HRSV. Further subtyping and sequencing of the HRSV positive samples was performed by PCR and Sanger sequencing. The prevalence and positivity rate were estimated in 4 distinct age groups and the circulating strains of each subtype were situated in a global context and in reference to the described genotypes in literature.ResultsHRSV circulated in Belgium in a yearly re-occurring pattern during the winter months and both HRSV subtypes co-circulated simultaneously. All HRSV-B strains contained the 60 nt duplication in the HVR2 region of the G gene. Strains of subtype HRSV-A with a 72 nt duplication in the HVR2 region were first observed during the 2011–2012 season and replaced all other circulating strains from 2014 to 2015 onwards.

Main challenges and measures taken by public health institutions in response to war in Kyiv Region

Abstract Background The establishment of martial law due to Russia’s military aggression against Ukraine led to specific adjustments in the functioning of the Centers for Diseases Control and Prevention (СDС). The negative impact of hostilities is determined by the increased morbidity rate of communicable and non-communicable diseases, insufficient supply of safe drinking water and food to damaged sites, inadequate living conditions, etc. Objectives The purpose of the work was to create an effective system for responding to biological, chemical and radiation hazards and eliminating the consequences of an emergency situation in the realities of martial law. Methods We used the most common methods, namely descriptive, statistical, microbiological and сhemical laboratory tests. Results The activities of the CDC under martial law include daily monitoring studies of environmental objects. The epidemic situation of acute intestinal infection (AII) and other communicable diseases (CD) is constantly analyzed. The Kyiv Oblast CDC became the basic institution for the implementation of the ‘pilot project’ in the direction of sanitary and epidemic assessment and monitoring of environmetal objects in 188 de-occupied areas. The main public health risks were identified: providing the population with high-quality drinking water; low immunization rate of the population; sites for the location of internally displaced persons; natural foci of especially dangerous diseases, such as tularemia, leptospirosis, infection fevers, etc. In 2022, the overall level of CD in the Kyiv region decreased by 44.0% from 2021. The most common nosologies were acute respiratory viral infections and influenza (98.9%), AII (42.4%), tuberculosis (15.3%), Lyme disease (15.3%), and viral hepatitis (14.2%). Conclusions Based on the research conducted, mechanisms have been developed for responding to hazards of various origins by public health institutions, including risk assessmant and laboratory studies. Key messages • The main focus of the Centers for Diseases Control and Prevention is aimed at effective response to hazards of various origins in order to ensure public health under martial law. • Risk assessment in de-occupied territories has become an important tool for identifying correct approaches to prevent negative consequences for public health.

Integrated sentinel surveillance of influenza, SARS-CoV-2, RSV and respiratory viruses in Serbia

Abstract Introduction Integrated sentinel SARI surveillance of influenza, SARS -CoV-2 and RSV has been established in Serbia since 2021-2022 influenza season. Nine sentinel hospitals in 3 cities participated in the SARI surveillance system. The aim of this study is to provide a review of integrated sentinel surveillance of SARI in Serbia in 2023-2024 influenza season, from October 2023 to April 2024. Methods On a weekly basis, both epidemiological and virological data were collected. Surveillance is be conducted year-round. Specimens were tested for influenza, SARS-CoV-2,RSV and other respiratory viruses. Respiratory disease wards, intensive care units (ICUs) and pediatric wards were all represented. Real time polymerase chain reaction (RT-PCR) was used. Results From October 2023 to April 2024, a total of 1571 SARI cases were reported with 100% recorded age. Of these, 35% were 0-4 years old, 16% were 5-14, 6% were 15-29, 14% were 30-64, 18% were 65-79 and 11% were 80+. Among these cases, 1002 (64%) respiratory specimens were collected. The number of positive samples for influenza was 294 (29%). The positivity rate was 10% for SARS-CoV-2 and 19 % for RSV. The highest proportion of laboratory-confirmed influenza cases was 67% in week 04/2023. Then above 50% in week 05/2023 and 06/2023. Type A viruses was predominated, accounting for 97% of all influenza SARI detections. Activity was dominated by A(H3) with 42% positivity rate. Also, collected swabs were tested for rhinoviruses, positivity rate was 26%, for adenoviruses, 12%, for human metapneumovirus, 7% and for parainfluenza 3 viruses, 4%. Conclusions Sustaining and intensified effective integrated surveillance for influenza, SARS-CoV-2,RSV and other respiratory viruses in Serbia is the priority especially in the frame of International Health Regulations. In this way, we improve national capacity for preparedness and emergency response to national and cross-border public health threats. Key messages • Building and maintaining integrated respiratory surveillance that can rapidly integrate the surveillance of a new viruses is crucial. • Establishing well structured surveillance of severe acute respiratory infections, strengthening and expanding respiratory viral surveillance is one the base pillars preparation for future pandemics.

Respiratory Syncytial Virus Infection in Children with Bronchiolitis

Background: Respiratory Syncytial Virus (RSV) is the most common organism causing bronchiolitis. Bronchiolitis is almost always diagnosed clinically. As a result, the availability of bedside sensitive rapid RSV antigen tests is critical for timely RSV acute respiratory infection diagnosis. Methods and materials: This study was conducted to detect RSV antigen positivity and the sociodemographic profile of children with RSV antigen positive bronchiolitis. From October 2022 to March 2023, this observational study was conducted in the pediatrics department of Chattogram Medical College Hospital. Ninety-two nasopharyngeal swabs from children younger than two years, were tested for RSV antigen. The mean and standard deviation were used to express the demographic data. Chi-square analysis was used to examine differences in group proportions. Results: RSV antigen positivity was detected in 45.7% of the 92 cases, with a mean age of 4.18±3.08 months. Severe bronchiolitis cases were more common (22.8%) among antigen positive cases and had the longest hospital stay. During the months of November (42.4%) and December (29.3%), RSV infection levels peaked. This study describes that during the seasonal epidemics, RSV was the main concern, as the number of positive cases decreased in the months that followed. The signs and symptoms of RSV positive and negative cases were not significantly different. Conclusion: A simple, low-cost and bedside RSV test can be considered as a valuable diagnostic tool in a low resource setting. J Bangladesh Coll Phys Surg 2024; 42: 368-378

Autochthonous dengue outbreak in Lombardy, Italy: enhanced surveillance and vector control measures

Abstract Description of the problem On 18 August 2023, the first autochthonous case of dengue was registered in Lombardy, in a person living in a village in Lodi province. The case, a man with no history of travels prior to symptoms onset, developed flu-like symptoms on 3 August. After initial suspicion of WNV infection, he was confirmed to have a DENV-1 infection. Following the notification, measures to control the spread of the disease were activated, including alert of healthcare professionals, vector control activities, entomological monitoring and active case finding among household contacts and people living close to the case. Moreover, a serological screening was proposed to population of the entire municipality, along with a survey collecting data about travels abroad and symptoms. Results Forty-one confirmed and six probable autochthonous cases were identified. The last case developed symptoms on 20 October. Among confirmed cases, 24 were identified after admission to Emergency Department, 16 through community screening and one at the time of blood donation. 38/41 confirmed cases were symptomatic, with fever, rash and retro-orbital pain being the most common symptoms. Mean age was 55,5 years (3-88), while male: female ratio was 2:1. Hospitalisation was required for 7/41 cases. Community screening was offered from 25 August to 8 October and 416 individuals participated. Among them 10 tested positive for DENV IgG and 27 for DENV IgM (16 were subsequently confirmed as DENV cases, 6 remained probable and 5 were ruled out as non-cases). The primary case of the outbreak was not identified. Vector control activities and entomological monitoring were conducted on 21 August within 200-m radius area around the residence and places visited by index case. Subsequent interventions were conducted in all public areas and sensitive sites of the municipality. Lessons Enhancement of surveillance through community screening allowed identification of several additional autochthonous cases. Key messages • Strengthening of surveillance, vector control activities and entomological monitoring is crucial to prevent and control future outbreaks in non-endemic areas with stable presence of Aedes mosquitoes. • To minimize the risk of introduction and spread of dengue virus in non-endemic areas, it is essential to raise awareness among travellers and general population about preventive and control measures.

Epidemiological characteristics and meteorological factors of acute respiratory infections (ARIs) in hospitalized children in eastern Guangdong, China

Acute respiratory infections (ARIs) are the most common issue in pediatric clinical practice. They pose a significant public threat, with high morbidity and mortality rates worldwide. Aiming at understanding the epidemiological characteristics of respiratory pathogens and their risk factors among children in eastern Guangdong, China. Samples obtained from 15,993 children hospitalized with ARIs in eastern Guangdong Province were tested for 14 pathogens via multiplex polymerase chain reaction (PCR) from May 2019 to July 2023. The number of hospitalizations for ARIs was correlated with pathogens, age, meteorological parameters, and the pandemic of COVID-19. The data were analyzed by different statistical methods. Among all the samples, the positive rate with ARIs accounted for 68.94% (11,026/15,993) in hospitalized patients. Cytomegalovirus (CMV) (24.49%), Streptococcus pneumoniae (SP) (20.54%), and Respiratory Syncytial Virus (RSV) (14.16%) were the top three pathogens with the greatest infection rates. Among hospitalized patients, there were more single infections in pediatric patients (40.91%, P < 0.001). Compared with bacterial infection and mixed infection, the detection rate of virus infection was higher in pediatric (36.04%, P < 0.001). Age-related increases in Mycoplasma pneumoniae (MP) infection (r = 0.729, P < 0.001) and decreases in RSV infection were observed (r = 0.88, P < 0.001). The virus infection peaked at six months, and the bacterial infection and mixed infection peaked at 1–3 years. Viral pathogens are on the rise in the post-pandemic era. The prevalence of SP infection was more influenced by the Air Quality Index (AQI), RSV infections were more clearly influenced by temperature, and Influenza A virus (IAV) infections were more strongly correlated with both the AQI and relative humidity (P < 0.001). This study highlights the need of keeping an eye on monitoring meteorological factors in assessing hospitalizations for pediatric ARIs in eastern Guangdong, China, especially RSV- and SP-associated hospitalizations.