Acute Respiratory Tract Disease Research Articles

Faktor-Faktor yang Berhubungan dengan Kelengkapan Vaksinasi Covid-19 pada Masyarakat di Wilayah Kerja Puskesmas Kenali Besar Kota Jambi

The Covid-19 pandemic caused by the Sars Cov-2 virus has the effect of triggering mild to severe acute respiratory tract disease with symptoms namely fever, shortness of breath, cough, fatigue, runny nose, sore throat, diarrhea, loss of the ability to smell and taste on the tongue and can cause death. Indonesia is the country with the most new cases and deaths in Southeast Asia as of 24-30 October 2022 with 19,661 new cases or 7.2 new cases per 100,000 population, even though the previous week there were 14,093 cases. This means that the addition occurred as much as 40%. This type of research is quantitative with a cross sectional design. The population of this study was all people aged > 17 years in the working area of the Puskesmas Iknew Besar, totaling 42,796 people with a sample of 172 respondents. The sampling technique used multistage random sampling. Data were collected using questionnaires and observation sheets, then univariate data analysis using the chi-square test. The results of the multivariate analysis show that there is a relationship between the completeness of the Covid-19 vaccination and attitudes, history of Covid-19, history of non-communicable diseases, perception of Covid-19 risk, family support and health information among the community in the working area of the Puskesmas Kenali Besar, Jambi City in 2022.

A novel live attenuated vaccine candidate protects chickens against subtype B avian metapneumovirus

Avian metapneumovirus (aMPV) is a highly contagious pathogen that causes acute upper respiratory tract diseases in chickens and turkeys, resulting in serious economic losses. Subtype B aMPV has recently become the dominant epidemic strain in China. We developed an attenuated aMPV subtype B strain by serial passaging in Vero cells and evaluated its safety and efficacy as a vaccine candidate. The safety test showed that after the 30th passage, the LN16-A strain was fully attenuated, as clinical signs of infection and histological lesions were absent after inoculation. The LN16-A strain did not revert to a virulent strain after five serial passages in chickens. The genomic sequence of LN16-A differed from that of the parent wild-type LN16 (wtLN16) strain and had nine amino acid mutations. In chickens, a single immunization with LN16-A induced robust humoral and cellular immune responses, including the abundant production of neutralizing antibodies, CD4+ T lymphocytes, and the Th1 (IFN-γ) and Th2 (IL-4 and IL-6) cytokines. We also confirmed that LN16-A provided 100% protection against subtype B aMPV and significantly reduced viral shedding and turbinate inflammation. Our findings suggest that the LN16-A strain is a promising live attenuated vaccine candidate that can prevent infection with subtype B aMPV.

Cardisoma guanhumi as a Therapeutic Candidate: Assessing Hypo-lipidemic and Histological Effects in Bordetella pertussis Infected Swiss Mice

Background: Bordetella pertussis is the causative organism of an acute human respiratory tract disease known as pertussis – an endemic disease globally with reported cases in both developing and developed countries. This study evaluated the hypo-lipidaemic and histological effects of the crab specie Cardisoma guanhumi extracts on bordetela pertussis infected Swiss mice.
 Methods: One hundred and twenty-two (122) animals were divided into five groups in the study. Groups 1 and 2 were the normal and negative controls respectively, while groups 3 and 4 received (300mg/kg and 600mg/kg) of the extract and group 5 received 4000mg/70kg (57.14 mg/kg) of erythromycin. Blood and kidney samples were collected on days 0, 6, 12 and 18for lipid profile analysis and kidney histological examination.
 Results: The result shows that Animals exposed to B. pertussis inoculum dose (5.0x105cfu/ml) without treatment caused a decrease in the plasma level of high density lipo-protein cholesterol (HDL) and an increase in the plasma levels of total cholesterol, triglycerides and low density lipo-protein cholesterol (LDL). However, treatment with Cardisoma guanhumi extract reversed the observed effect thereby producing a gradual increase in HDL levels and decrease in triglycerides, cholesterol and LDL levels with no adverse effect on the kidney histology.
 Conclusion: The study reveals significant lipid profile alterations caused by B. pertussis infection in Swiss mice, highlights the potential lipid-lowering effects of Cardisoma guanhumi extract, and indicates the absence of apparent kidney damage from the infection.

Clinical characterization of human bocavirus 1 infection in infants hospitalized in an intensive care unit for severe acute respiratory tract disease

Acute respiratory infections represent the leading cause of morbimortality in children and viruses are the main etiological agents. Here we describe the clinical characteristics and evolution of infants admitted to intensive care unit with severe acute respiratory infection (SARI) due to Human Bocavirus 1 mono-infection in patients without previous comorbidity. We also compared them with respiratory syncytial virus (RSV) cases. Of 141 cases included (age 5.43 ± 4.54 months, 52% male), 80% had at least 1 virus detected. RSV was the most frequent in the series (71.6%) followed by HBoV1 (28%). Five cases of HBoV1 mono-detection were identified. Pediatric acute respiratory distress syndrome was present in both groups, HBoV1 and RSV. The clinical presentation and evolution of HBoV1 single infection was similar to RSV. HBoV1 should be included among the agents investigated in cases of SARI in infants.

Hypo-Lipidaemic and Histological Effects of Goniopsis pelli in Bordetella pertussis Infected Swiss Mice

Background: Bordetella pertussis is the causative organism of an acute human respiratory tract disease known as pertussis – an endemic disease globally with reported cases in both developing and developed countries. This study evaluated the anti-bacterial potentials of the crab specie (Goniopsis pelli) extract on bordetela pertussis in Swiss mice. Methods: One hundred and twenty-two (122) animals (Swiss mice) were divided into five groups for the curative treatment study. Groups 1 and 2 were the normal and negative controls respectively, while groups 3 and 5 received (300mg/kg and 600mg/kg) of the extract and group 5 received 4000mg/70kg of erythromycin. Blood and kidney samples were collected on 0, 6th, 12th and 18thday for lipid profile analysis and kidney histological examination. Result: The result shows that Animals exposed to B. pertussis inoculum dose (5.0x105cfu/ml) without treatment caused a decrease in the plasma level of high density lipoprotein cholesterol (HDL) and an increase in the concentration of total cholesterol, triglycerides and low density lipoprotein cholesterol (LDL). However, treatment with Goniopsis pelli extracts reversed the observed effect thereby producing a gradual increase in HDL levels and decrease in triglycerides, cholesterol and LDL levels with no adverse effect on the kidney histology. Conclusion: Goniopsis pelli has the potentials of ameliorating lipid abnormalities and plays a therapeutic role in improving lipid profiles associated with the bacterial infection.

Unveiling the antiviral activity of interferon epsilon in respiratory infections

Abstract Type I interferons (IFN-I), including IFN-α and IFN-β, have demonstrated efficacy in treatments against some viral infections but with a considerable amount of undesirable side effects. IFN-ɛ, a recently discovered member of the IFN-I family, has been found to be expressed constitutively in several tissues, including the lung. However, the antiviral effect of IFN-ɛ against respiratory viral infections is largely unknown. Human respiratory syncytial virus (RSV) is the most important agent responsible for acute lower respiratory tract diseases in infants worldwide. Each year in the United States, RSV leads to approximately 2.1 million outpatient (non-hospitalization) visits among children younger than five years old, with a considerable number of hospitalizations among children younger than five years old and adults 65 years and older. Currently, no vaccine is available to prevent this respiratory tract infections, and new strategies are necessary to treat patients. Therefore, in this study, we aimed to investigate the antiviral effect of IFN-ɛ against respiratory viruses, such as RSV. Using a human epithelial cell line, we assessed the expression, susceptibility, and antiviral effect of IFN-ɛ on RSV infection. Our results demonstrate that RSV is capable of inducing IFN-ɛ. Moreover, RSV is susceptible to the antiviral activity of the rhIFN-ɛ, reducing the number of infected cells as well as the viral replication. That effect is due to the induction of the expression of ISGs with a low inflammatory profile. Overall, our findings demonstrate that RSV is susceptible to the effect of IFN-ɛ, suggesting a potential therapeutic effect of this novel member of the IFN-I family to treat respiratory viral infections. This work was funded in part by a Louisiana State University School of Veterinary Medicine Competitive Research Program Award

Evidence That Increasing Serum 25(OH)D Concentrations to 30 ng/mL in the Kingdom of Saudi Arabia and the United Arab Emirates Could Greatly Improve Health Outcomes

Accumulating evidence supports the potential protective effects of vitamin D against chronic diseases such as Alzheimer's disease, autoimmune diseases, cancers, cardiovascular disease (ischaemic heart disease and stroke), type 2 diabetes, hypertension, chronic kidney disease, stroke, and infectious diseases such as acute respiratory tract diseases, COVID-19, influenza, and pneumonia, as well as adverse pregnancy outcomes. The respective evidence is based on ecological and observational studies, randomized controlled trials, mechanistic studies, and Mendelian randomization studies. However, randomized controlled trials on vitamin D supplementation have largely failed to show benefits, probably due to poor design and analysis. In this work, we aim to use the best available evidence on the potential beneficial effects of vitamin D to estimate the expected reduction in incidence and mortality rates of vitamin D-related diseases in the Kingdom of Saudi Arabia and the United Arab Emirates if minimum serum 25(OH)D concentrations were to be raised to 30 ng/mL. Estimated reductions by 25% for myocardial infarction incidence, 35% for stroke incidence, 20 to 35% for cardiovascular disease mortality, and 35% for cancer mortality rates depicted a promising potential for raising serum 25(OH)D. Methods to increase serum 25(OH)D concentrations at the population level could include food fortification with vitamin D3, vitamin D supplementation, improved dietary vitamin D intake, and sensible sun exposure.

Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults

BackgroundRespiratory syncytial virus (RSV) is an important cause of acute respiratory infection, lower respiratory tract disease, clinical complications, and death in older adults. There is currently no licensed vaccine against RSV infection.MethodsIn an ongoing, international, placebo-controlled, phase 3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive a single dose of an AS01E-adjuvanted RSV prefusion F protein–based candidate vaccine (RSVPreF3 OA) or placebo before the RSV season. The primary objective was to show vaccine efficacy of one dose of the RSVPreF3 OA vaccine against RSV-related lower respiratory tract disease, confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), during one RSV season. The criterion for meeting the primary objective was a lower limit of the confidence interval around the efficacy estimate of more than 20%. Efficacy against severe RSV-related lower respiratory tract disease and RSV-related acute respiratory infection was assessed, and analyses according to RSV subtype (A and B) were performed. Safety was evaluated.ResultsA total of 24,966 participants received one dose of the RSVPreF3 OA vaccine (12,467 participants) or placebo (12,499). Over a median follow-up of 6.7 months, vaccine efficacy against RT-PCR–confirmed RSV-related lower respiratory tract disease was 82.6% (96.95% confidence interval [CI], 57.9 to 94.1), with 7 cases (1.0 per 1000 participant-years) in the vaccine group and 40 cases (5.8 per 1000 participant-years) in the placebo group. Vaccine efficacy was 94.1% (95% CI, 62.4 to 99.9) against severe RSV-related lower respiratory tract disease (assessed on the basis of clinical signs or by the investigator) and 71.7% (95% CI, 56.2 to 82.3) against RSV-related acute respiratory infection. Vaccine efficacy was similar against the RSV A and B subtypes (for RSV-related lower respiratory tract disease: 84.6% and 80.9%, respectively; for RSV-related acute respiratory infection: 71.9% and 70.6%, respectively). High vaccine efficacy was observed in various age groups and in participants with coexisting conditions. The RSVPreF3 OA vaccine was more reactogenic than placebo, but most adverse events for which reports were solicited were transient, with mild-to-moderate severity. The incidences of serious adverse events and potential immune-mediated diseases were similar in the two groups.ConclusionsA single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related acute respiratory infection and lower respiratory tract disease and severe RSV-related lower respiratory tract disease in adults 60 years of age or older, regardless of RSV subtype and the presence of underlying coexisting conditions. (Funded by GlaxoSmithKline Biologicals; AReSVi-006 ClinicalTrials.gov number, NCT04886596.)

Severity of Omicron (B.1.1.529) and Delta (B.1.617.2) SARS-CoV-2 infection among hospitalised adults: A prospective cohort study in Bristol, United Kingdom.

There is an urgent public health need to evaluate disease severity in adults hospitalised with Delta and Omicron SARS-CoV-2 variant infections. However, limited data exist assessing severity of disease in adults hospitalised with Omicron SARS-CoV-2 infections, and to what extent patient-factors, including vaccination, age, frailty and pre-existing disease, affect variant-dependent disease severity. A prospective cohort study of adults (≥18 years of age) hospitalised with acute lower respiratory tract disease at acute care hospitals in Bristol, UK conducted over 10-months. Delta or Omicron SARS-CoV-2 infection was defined by positive SARS-CoV-2 PCR and variant identification or inferred by dominant circulating variant. We constructed adjusted regression analyses to assess disease severity using three different measures: FiO2 >28% (fraction inspired oxygen), World Health Organization (WHO) outcome score >5 (assessing need for ventilatory support), and hospital length of stay (LOS) >3 days following admission for Omicron or Delta infection. Independent of other variables, including vaccination, Omicron variant infection in hospitalised adults was associated with lower severity than Delta. Risk reductions were 58%, 67%, and 16% for supplementary oxygen with >28% FiO2 [Relative Risk (RR)=0.42 (95%CI: 0.34-0.52), P<0.001], WHO outcome score >5 [RR=0.33 (95%CI: 0.21-0.50), P<0.001], and to have had a LOS > 3 days [RR=0.84 (95%CI: 0.76-0.92), P<0.001]. Younger age and vaccination with two or three doses were also independently associated with lower COVID-19 severity. We provide reassuring evidence that Omicron infection results in less serious adverse outcomes than Delta in hospitalised patients. Despite lower severity relative to Delta, Omicron infection still resulted in substantial patient and public health burden and an increased admission rate of older patients with Omicron which counteracts some of the benefit arising from less severe disease. AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.

Avon Community-Acquired Pneumonia (AvonCAP) Surveillance Study: A Pan-pandemic Acute Lower Respiratory Tract Disease Surveillance Study, and the linked records of the participants in the Avon Longitudinal Study of Parents and Children (ALSPAC)

This data note describes the linking of records of the Avon Community-Acquired Pneumonia (AvonCAP) Surveillance Study – A Pan-pandemic Acute Lower Respiratory Tract Disease Surveillance Study (ISRCTN: 17354061), with the participants of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’). These records were obtained from a database created specifically by AvonCAP operating within the two acute care NHS Trusts in Bristol, which is the centre of the ALSPAC study catchment area. These two trusts are the (a) North Bristol NHS Trust (NBT) based at Southmead Hospital (SMH) and (b) the University Hospitals Bristol and Weston NHS Foundation Trust (UHBWT) based at Bristol Royal Infirmary (BRI). The AvonCAP database was updated by staff using a combination of clinical records and self-reporting by the participant, which was unable to be independently verified. Data was collected using the REDCap (Research Electronic Data Capture) software program. Software code was created to transform the original files into a single data base which was reviewed for data-completeness and for its potential value as a research resource. The AvonCAP records provide a contemporaneous record of a subset of the ALSPAC cohort who experienced Lower Respiratory Tract Disease. It is available for research and may be used in conjunction with other ALSPAC data.

In vitro antiviral effect of silver nanoparticles against SARS-CoV-2

Introduction: COVID-19 is an acute respiratory tract disease caused by the emerging coronavirus SARS-CoV-2. Although several options for chemoprophylaxis are under development, effective treatment for COVID-19 is not yet available. Objective: To investigate the antiviral properties of synthesized silver nanoparticles (AgNPs) against SARS-CoV-2 using in vitro models. Materials and methods: This work synthesized AgNPs using an electrochemical method and characterized them using physico-chemical techniques (ICP-OES, ultraviolet-visible spectroscopy, and transmission electron microscopy). AgNPs with diameter sizes ranging between 2.6 to 30 nm and an average size of 6.2 nm were obtained by the electrochemical method. The cytotoxic effect and the antiviral activity of prepared AgNPs against SARS-CoV-2 were evaluated in vitro using Vero E6 cells. Cell viability was evaluated by MTT assay in the presence of serial dilutions of AgNPs. The antiviral effect of AgNPs was evaluated before and after the infection of Vero E6 cells by plaque assay. Results: Cytotoxic effect was observed at concentrations above 0.07 ppm. AgNPs exhibit a significant reduction of SARS-CoV-2 viral titer after a pre-post treatment strategy with inhibition of 96.5%, 64.13%, and 74.72% at 0.03, 0.017, and 0.008 ppm, respectively. Conclusion: Our results suggest that AgNPs could reduce SARS-CoV-2 replication with a low cytotoxic effect. Still, additional in vitro and in vivo studies are required to define its potential therapeutic application in humans.

Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study.

SummaryBackgroundThe emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail.MethodsWe conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis.Findings12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7–10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8–16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5–5.5] admissions per 100,000 adults per week).InterpretationWhile COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high.FundingAvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.

Factors Associated with Unscheduled Emergency Department Revisits in Children with Acute Lower Respiratory Tract Diseases.

PurposeTo identify factors associated with unscheduled emergency department (ED) revisits within 72 hours in children with acute dyspnea from lower respiratory tract diseases.Patients and MethodsThis retrospective cohort study included pediatric patients (age group: one month to 15 years old) who visited the ED with acute lower respiratory tract diseases between January 1st, 2017 and February 28th, 2019. The medical records were reviewed and discharged patients were dichotomized into revisit and non-revisit groups, based on whether the patients needed a revisit or not. Baseline characteristics, vital signs, diagnosis, treatment, pediatrician consultation, ED length of stay, and primary doctor of both groups were compared. Univariate and multivariate analyses by logistic regression were used to determine the significant factors associated with the revisits.ResultsMedical records of 918 eligible pediatric patients (1417 visits) were reviewed. Factors significantly associated with the revisits were history of asthma or current controller use (odds ratio [OR]: 3.08: 95% confidence interval [CI]: 1.86–5.1). Not prescribing systemic corticosteroids (P < 0.001), or prescribing them upon discharge without first dose in the ED (P = 0.022) were significantly associated with revisits.ConclusionNo prescription of systemic corticosteroids or prescription upon discharge, without an immediate dose at the ED, in children with history of asthma or current controller use were associated with revisits.

Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

ObjectivesTo determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.SettingSingle-centre,...

Immunization with a mucosal, post-fusion F/G protein-based polyanhydride nanovaccine protects against BRSV infection in neonatal calves

Abstract Human respiratory syncytial virus (HRSV) is a leading cause of severe acute lower respiratory tract (LRT) disease in young children worldwide. Currently, there is no approved vaccine for HRSV. Bovine RSV (BRSV) is closely related to HRSV and is the cause of severe acute LRT disease in young cattle. A neonatal calf model presents an opportunity to test HRSV vaccines and study a naturally susceptible host-pathogen interaction similar to HRSV infection. We tested the efficacy of a polyanhydride nanoparticle-vaccine (nanovaccine) encapsulating the post-fusion F and G proteins from BRSV and CpG adjuvant in neonatal calves with maternally-derived antibodies (MDA). A prime-boost immunization of neonatal calves with the BRSV post-fusion F/G CpG nanovaccine induced clinical protection in the presence of MDA. Vaccinated calves developed moderate or no clinical symptoms and were mostly protected from virus-associated lung pathology compared to unvaccinated controls. Calves that received a mucosal/systemic nanovaccine immunization had complete virological protection against BRSV infection in the lungs, which correlated with BRSV-specific immune responses in the bronchoalveolar lavage. Vaccination with the nanovaccine induced anamnestic BRSV-specific IgA titers in the lungs and systemic T cell responses with BRSV-specific CD4+ T cell proliferation and antigen-specific IL-17 and IFNγ secretion. Overall, the BRSV post-fusion F/G CpG nanovaccine is a promising candidate for further studies to protect neonatal calves and infants from RSV infection.

Altered cytokine and chemokine profiles in the lungs of vitamin A deficient mice with respiratory syncytial virus infection

Abstract Human respiratory syncytial virus (RSV) is a leading cause of severe acute lower respiratory tract disease worldwide in infants and young children. Epidemiologically, low levels of vitamin A (VA) are known to increase susceptibility to severe respiratory infection. However, little is known regarding how VA impacts lung immune function, specifically during RSV infection. Here, we investigated the impact of VA deficiency (VAD) on innate immunity in the lungs following RSV infection using a BALB/c mouse model. Groups of VA sufficient (VAS) and VAD, 6 to 8-week-old mice were intranasally infected with RSV, and lung tissues were collected at 3, 4, and 8 days post-infection for evaluation of vitamin A status, flow cytometry for innate immune populations, and Luminex bead-based multiplex assays for inflammatory cytokines. Acute RSV infection negatively impacted lung VA status in vitamin-replete mice. Although no differences in morbidity were observed between treatment groups, VAD mice had more neutrophils recruited to the lungs. VAD also altered the phenotype of γδ T cell populations in the lung, resulting in significantly increased frequencies of CD27+ γδ T cells, and fewer CD27 negative γδ T cells compared to VAS mice. Moreover, cytokine and chemokine production was altered in the lung of VAD animals after RSV infection, with reduced production of IL-1β, IL-6, IL-17, and KC (CXCL1). These results suggest that VAD alters the inflammatory environment in the lung, which may contribute to disease susceptibility. Future experiments will focus on further changes to the innate and adaptive immune systems in the lungs during VAD after RSV infection. Supported by Roy J. Carver Charitable Trust Grant #20-5306

The impact of COVID-19 and control measures on public health in Thailand, 2020.

BackgroundThe COVID-19 virus has been an emerging disease causing global outbreaks for over a year. In Thailand, transmission may be controlled by strict measures that could positively and negatively impact physical health and suicidal behavior.MethodsThe incidence of COVID-19 was retrieved from the Department of Disease Control (DDC). The impact of viral diseases was retrieved from the open-source of the DDC and King Chulalongkorn Memorial Hospital. The road accidents data were from the Thai Ministry of Transport. The suicidal behavior data were obtained from the Department of Mental Health. We compared data from the year 2019 with the pandemic COVID-19 outbreak period in 2020, before lockdown, during lockdown, easing, and new wave period using unpaired t-test and least-squares linear regression. We compared the impact of the outbreak on various data records in 2020 with corresponding non-outbreak from 2019.ResultsThere was a significant decline in cases of influenza (p < 0.001) and norovirus (p = 0.01). However, there was no significant difference in RSV cases (p = 0.17). There was a dramatic increase in attempt to suicides and suicides (p < 0.001). There was no impact on roadside accidents and outpatient department visits.DiscussionThe extensive intervention measures during lockdown during the first wave positively impacted total cases for each period for acute respiratory and gastrointestinal tract diseases, car accidents, and injuries and negatively impacted indicators of suicidal behavior. The data support government policies that would be effective against the next outbreak by promoting the “new normal” lifestyle.

Delayed respiratory syncytial virus outbreak in 2020 in Taiwan was correlated with two novel RSV-A genotype ON1 variants.

BackgroundHuman respiratory syncytial virus (RSV) is a leading pathogen of acute respiratory tract disease among infants and young children. Compared with previous seasons, RSV outbreaks in Taiwan during the 2020–2021 season were delayed because of COVID‐19 mitigation measures. We conducted this study to determine the association of viral factors with clinical characteristics of preschool children with RSV infection.MethodsWe performed a molecular epidemiology analysis of RSV among inpatient preschool children in Taiwan. In 80 nasopharyngeal samples positive for RSV, we sequenced and analyzed viral genotypes according to patient data. Patients' clinical data were obtained from medical files, and their clinical profiles were compared with those of RSV cases recorded during the 2014–2017 seasons.ResultsPhylogenetic analysis revealed that among the RSV‐positive samples, all RSV strains identified during the 2020–2021 season belonged to the ON1 genotype. Most of the Taiwan ON1 strains were categorized into two well‐supported clusters with distinct G protein amino acid substitution patterns that had never been demonstrated previously. Furthermore, the proportion of cases among children aged >24 months increased (P < 0.001). Compared with patients infected during the 2014–2017 seasons, patients infected during the 2020–2021 season were hospitalized for shorter days from hospital admission to dereference (P = 0.004) and had a greater need for oxygen supplements (P = 0.021) and systemic steroid therapy (P = 0.026).ConclusionThe delayed 2020–2021 RSV outbreak in Taiwan was caused by two novel RSV ON1.1 variants. How the change in RSV epidemiology affects future RSV outbreaks warrants exploration.

A novel approach to calculate disease incidence for hospital-based health events in England

BackgroundDisease incidence is a key indicator for the assessment of population health and to guide public health policies. Defining accurate population denominators is challenging for incidence studies of hospital-based events, for which hospital catchment areas depend on patient choice and geographic proximity and often do not match established town or city boundaries. We describe a new method to accurately define a hospital's population denominator, which we developed for a study designed to estimate the incidence of hospitalisation for adult acute lower respiratory tract disease in Bristol, UK. MethodsWe examined hospital data for adult acute lower respiratory tract disease to identify general practitioner (GP) practices (n=82) whose patients were treated for adult acute lower respiratory tract disease at study hospitals and confirmed that nearly all patients (9230 [94·5%] of 9764) were registered with practices within the National Health Service's Bristol, North Somerset, and South Gloucestershire Clinical Commissioning Group (CCG). Hospital admission data were linked to aggregated GP practice patient registration data within this CCG for April 1, 2017, to March 31, 2020. The proportion of GP practices' patients who were hospitalised for adult acute lower respiratory tract disease that occurred at a specific study hospital was multiplied by their patient registration count for six age groups to obtain the practices' contribution to that hospital's denominator (eg, if 50% of GP practice admissions were at a specific study hospital among patients aged 50–64 years, the practice contributed half of their patients aged 50–64 years to the denominator). Alternate denominators were calculated using population census data matched to 20-minute drivetime estimates for study hospitals (the method used to define hospital catchment for local health service purposes). FindingsThe percentage of admissions at study hospitals varied substantially by GP practice (0–100%). 231 342 (86·3%) of 268 093 of the CCG's GP practice registrants aged 18–34 years received treatment at study hospitals (compared with 19 229 [80%] of 23 938 registrants aged or older than 85 years); some received treatment at another local hospital to the south. With 20-minute drivetime as an estimate measure, hospital catchment would be 550 155 (66·5%) of 827 304 individuals in the CCG population. InterpretationUsing health-care data stratified by local CCG enables the estimation of local population denominators to support accurate incidence ascertainment within hospital-based surveillance studies. FundingThis work was funded by Pfizer.

Association of Sinusitis and Upper Respiratory Tract Diseases With Incident Rheumatoid Arthritis: A Case-control Study.

We aimed to determine whether specific respiratory tract diseases are associated with increased rheumatoid arthritis (RA) risk. This case-control study within the Mass General Brigham Biobank matched newly diagnosed RA cases to 3 controls on age, sex, and electronic health record history. We identified RA using a validated algorithm and confirmed by medical record review. Respiratory tract disease exposure required 1 inpatient or 2 outpatient codes at least 2 years before the index date of RA clinical diagnosis or matched date. Logistic regression models calculated ORs for RA with 95% CIs, adjusting for confounders. We then stratified by serostatus ("seropositive" was positive rheumatoid factor and/or anticitrullinated protein antibodies) and smoking. We identified 741 RA cases and 2223 controls (both median age 55, 76% female). Acute sinusitis (OR 1.61, 95% CI 1.05-2.45), chronic sinusitis (OR 2.16, 95% CI 1.39-3.35), and asthma (OR 1.39, 95% CI 1.03-1.87) were associated with increased risk of RA. Acute respiratory tract disease burden during the preindex exposure period was also associated with increased RA risk (OR 1.30 per 10 codes, 95% CI 1.08-1.55). Acute pharyngitis was associated with seronegative (OR 1.68, 95% CI 1.02-2.74) but not seropositive RA; chronic rhinitis/pharyngitis was associated with seropositive (OR 2.46, 95% CI 1.01-5.99) but not seronegative RA. Respiratory tract diseases tended towards higher associations in smokers, especially > 10 pack-years (OR 1.52, 95% CI 1.02-2.27, P = 0.10 for interaction). Acute and chronic sinusitis, pharyngitis, and acute respiratory burden increased RA risk. The mucosal paradigm of RA pathogenesis may involve the upper respiratory tract.