Nasopharyngeal Washes Research Articles

Эффективность применения Гроприносина в комплексной терапии гипертрофии глоточной миндалины и хронических аденоидитов у детей

Objective. Evaluation of the effectiveness of including the drug with immunostimulating and antiviral effects Groprinosin® in the combined treatment of children with hypertrophy of the pharyngeal tonsil (PHT) / chronic adenoiditis (DCA). Patients and methods. A comparative prospective study was conducted involving 355 children with PHT and DCA. 253 children received surgical treatment with the recommended basic therapy, 102 – the same, but with the addition of 2 courses of Groprinosin®. The children were observed for a year after surgery, and the frequency of episodes of acute respiratory infections (ARI) and relapses of HGM was assessed. Statistical analysis of the results was carried out using the Statistica 8 (USA) program. Results. In 81.4% of children with GGT/CA, DNA of lymphotropic herpes viruses with a significant predominance of the Epstein–Barr virus was found in the nasopharyngeal wash. In all groups after treatment, there was a statistically significant decrease in the frequency of ARI episodes: up to 2 (IQR 2–3) times a year with Groprinosin® treatment and up to 5 (IQR 2–4) without it, p = 0.023. In 29 children (8.2%) a relapse of HGM was observed: in one of the group treated with Groprinosin®, in 28 – without it. Conclusion. The high efficacy and safety of the drug Groprinosin® allows us to recommend its inclusion in the treatment protocol for children with clinically significant hypertrophy of the pharyngeal tonsil in combination with active Epstein–Barr viral infection after adenoidectomy. Key words: hypertrophy of the pharyngeal tonsil, chronic adenoiditis, treatment, relapses, inosine pranobex, children

Antigen Discovery for Next-Generation Pertussis Vaccines Using Immunoproteomics and Transposon-Directed Insertion Sequencing.

Despite high vaccination rates, the United States has experienced a resurgence in reported cases of pertussis after switching to the acellular pertussis vaccine, indicating a need for improved vaccines that enhance infection control. Bordetella pertussis antigens recognized by convalescent-baboon serum and nasopharyngeal wash were identified by immunoproteomics and their subcellular localization predicted. Genes essential or important for persistence in the baboon airway were identified by transposon-directed insertion-site sequencing (TraDIS) analysis. In total, 314 B. pertussis antigens were identified by convalescent baboon serum and 748 by nasopharyngeal wash. Thirteen antigens were identified as immunogenic in baboons, essential for persistence in the airway by TraDIS, and membrane-localized: BP0840 (OmpP), Pal, OmpA2, BP1485, BamA, Pcp, MlaA, YfgL, BP2197, BP1569, MlaD, ComL, and BP0183. The B. pertussis antigens identified as immunogenic, essential for persistence in the airway, and membrane-localized warrant further investigation for inclusion in vaccines designed to reduce or prevent carriage of bacteria in the airway of vaccinated individuals.

Parent tRNA Modification Status Determines the Induction of Functional tRNA-Derived RNA by Respiratory Syncytial Virus Infection.

tRNA-derived RNA fragments (tRFs) are a recently discovered family of small noncoding RNAs (sncRNAs). We previously reported that respiratory syncytial virus (RSV) infection induces functional tRFs, which are derived from a limited subset of parent tRNAs, in airway epithelial cells. Such induction is also observed in nasopharyngeal wash samples from RSV patients and correlates to RSV genome copies, suggesting a clinical significance of tRFs in RSV infection. This work also investigates whether the modification of parent tRNAs is changed by RSV to induce tRFs, using one of the most inducible tRFs as a model. We discovered that RSV infection changed the methylation modification of adenine at position 57 in tRNA glutamic acid, with a codon of CTC (tRNA-GluCTC), and the change is essential for its cleavage. AlkB homolog 1, a previously reported tRNA demethylase, appears to remove methyladenine from tRNA-GluCTC, prompting the subsequent production of tRFs from the 5'-end of tRNA-GluCTC, a regulator of RSV replication. This study demonstrates for the first time the importance of post-transcriptional modification of tRNAs in tRF biogenesis following RSV infection, providing critical insights for antiviral strategy development.

Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial.

Background Although great progress has been made over the past 2 years in the scientific understanding of the biology, epidemiology, and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), case morbidity and fatality rates remain a great concern and continue to challenge the healthcare resources worldwide as novel variants emerge. There is therefore an urgent need for affordable and readily available strategies to reduce viral transmission. Previous studies in non-COVID-19 patients have demonstrated that administration of low-salt (isotonic but 0.0375% Na) and isotonic saline (0.9% Na) solutions has been associated with an immediate, significant reduction in the microbial antigens and a related decline of microbial burden. The aim of the present study was to determine the effect of nasal washes with normal saline 0.9% on nasopharyngeal viral load and outcome in hospitalized patients with COVID-19 pneumonia. Methods We performed a prospective, randomized, pilot, controlled trial in 50 patients with confirmed COVID-19 disease. Patients were randomized into two groups, the normal saline group (received normal saline 0.9% solution for nasopharyngeal wash) and the control group (no treatment). In the normal saline group, nasopharyngeal wash was performed every 4 hours for a 16-hour period. Twenty-four hours after the baseline nasopharyngeal swab (and 8 hours after the last wash in the normal saline group), a second nasopharyngeal swab was collected for the semiquantitative estimation of the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values. Results In the normal saline group, mean N gene Ct values increased significantly 24 hours after the baseline measurement [ΔCtday2−day1 = 1.87 ± 3.11 cycles, p = 0.007 (95% CI: 0.55 to 3.18)], indicating a decline in SARS-CoV-2 nasopharyngeal viral load by 8.9%. A significant decrease in mean N gene Ct values was observed in the control group, indicating an increase in viral load [ΔCtday2-day1 = −2.12 ± 2.66, p < 0.001 (95% CI: −3.20 to −1.05)] by 9.7%. The difference between the two groups 24 hours after admission and nasopharyngeal wash was 3.09 cycles (p = 0.005, 95% CI: 0.97 to 5.20). Conclusion Nasal washes with normal saline effectively decreased the viral load during hospitalization and at follow-up.

Pandemic driven innovation: A pilot evaluation of an alternative respiratory pathogen collection device

BackgroundThe nasopharyngeal swab is the gold standard collection method for COVID-19, but is invasive and painful, subsequently resulting in poor patient acceptance. This investigation explores the process of developing and validating an alternative respiratory pathogen collection device that relies on a nasopharyngeal irrigation mechanic. The primary objective was to determine if sufficient pathological sampling can be achieved by mechanism of nasopharyngeal irrigation that is proportionate to the nasopharyngeal swab method. MethodsThe study device was designed using Shapr3D modeling software and fabricated on a fused deposition modeling printer. Fifteen participants were enrolled with each receiving a saline nasopharyngeal washing using the study device. Specimen adequacy was evaluated by two real-time reverse transcriptase polymerase chain reaction (PCR) testing methods to identify the presence of the human RNase P gene. Results were evaluated quantitatively through interpretation of the PCR cycle threshold (Ct). ResultsAll 15 specimens tested positive for the presence of RNaseP, demonstrating specimen cellularity, adequate extraction of nucleic acids, and the absence of inhibitors to amplification. The mean Ct value was 29.5 (Applied Biosystems TaqPath RT-qPCR) and 30.7 (NECoV19). All participants felt the study device irrigation procedure was faster than the nasopharyngeal swab, with none experiencing any discomfort from the irrigation mechanism. ConclusionThe importance of early diagnostic testing and its role in countermeasures for communicable diseases such as COVID-19 is well established in the literature. Innovation to bolster our testing infrastructure is more important now than ever. This study was successful in developing and validating an alternative nasopharyngeal respiratory pathogen collection device that utilizes fluid debridement as its core mechanic. Data from this pilot study demonstrated the study device was successful in producing high-quality specimens for PCR testing. Feedback from the study participants was also in favor of the study device when compared to the nasopharyngeal swab.

“A Journey of COVID 19 from Pathogenesis to Therapy”

The novel Corona virus has come up from China, the first outburst of this Pandemic disease was reported in Wuhan, China in December 2019. Hence it is named as Covid-19. The other forms such as SARS and MERS have already prevailed in the nature, but this Covid-19 is more lethal than the those. In this review the author wants to focus on the epidemiology, pathogenesis &amp; Current treatment scenario with little impact on Ayurveda used during this outbreak. The novel Corona virus is very contagious disease which propagates rapidly via droplets of saliva and other bodily fluids. Currently, confirmation of 2019-nCoV infection is performed at CDC using the CDC real-time RT-PCR assay for 2019-nCoV on respiratory specimens (which can include nasopharyngeal or oropharyngeal aspirates or washes, nasopharyngeal or oropharyngeal swabs, bronchioalveolar lavage, tracheal aspirates, or sputum) and serum. There are some new developing approaches, for example artificial learning (AI), and high throughput screenings can possibly accelerate the revelation of treatment. During this Outburst of Corona Virus, it is necessary &amp; need of time to form collaborations across the world to debacle this outbreak. The Researchers now re-emphasized importance in evolving the broad-spectrum Antiviral Drugs to battle the effects of this COVID-19 Virus. There are many antiViral drugs and vaccines which are under clinical trials. The rapid spread of disease permits intense surveillance and isolation protocols to prevent further transmission.

Sharp decline in rates of community respiratory viral detection among patients at the National Institutes of Health Clinical Center during the coronavirus disease 2019 (COVID-19) pandemic.

To analyze the frequency and rates of community respiratory virus infections detected in patients at the National Institutes of Health Clinical Center (NIHCC) between January 2015 and March 2021, comparing the trends before and during the coronavirus disease 2019 (COVID-19) pandemic. We conducted a retrospective study comparing frequency and rates of community respiratory viruses detected in NIHCC patients between January 2015 and March 2021. Test results from nasopharyngeal swabs and washes, bronchoalveolar lavages, and bronchial washes were included in this study. Results from viral-challenge studies and repeated positives were excluded. A quantitative data analysis was completed using cross tabulations. Comparisons were performed using mixed models, applying the Dunnett correction for multiplicity. Frequency of all respiratory pathogens declined from an annual range of 0.88%-1.97% between January 2015 and March 2020 to 0.29% between April 2020 and March 2021. Individual viral pathogens declined sharply in frequency during the same period, with no cases of influenza A/B orparainfluenza and 1 case of respiratory syncytial virus (RSV). Rhino/enterovirusdetection continued, but with a substantially lower frequency of 4.27% between April 2020 and March 2021, compared with an annual range of 8.65%-18.28% between January 2015 and March 2020. The decrease in viral respiratory infections detected in NIHCC patients during the pandemic was likely due to the layered COVID-19 prevention and mitigation measures implemented in the community and the hospital. Hospitals should consider continuing the use of nonpharmaceutical interventions in the future to prevent nosocomial transmission of respiratory viruses during times of high community viral load.

Association of Clinical Signs, Host Biomarkers and Etiology With Radiological Pneumonia in Bhutanese Children.

Diagnosing pneumonia and identifying those requiring antibiotherapy remain challenging. Chest radiographs (CXR) are often used as the reference standard. We aimed to describe clinical characteristics, host-response biomarkers and etiology, and assess their relationship to CXR findings in children with pneumonia in Thimphu, Bhutan. Children between 2 and 59 months hospitalized with WHO-defined pneumonia were prospectively enrolled and classified into radiological endpoint and non-endpoint pneumonia. Blood and nasopharyngeal washing were collected for microbiological analyses and plasma levels of 11 host-response biomarkers were measured. Among 149 children with readable CXR, 39 (26.2%) presented with endpoint pneumonia. Identification of respiratory viruses was common, with no significant differences by radiological outcomes. No clinical sign was suggestive of radiological pneumonia, but children with radiological pneumonia presented higher erythrocyte sedimentation rate, C-reactive protein and procalcitonin. Markers of endothelial and immune activation had little accuracy for the reliable identification of radiological pneumonia.

FM-aM Detection of the SARS-CoV-2 Antigen by Advanced Lateral Flow Immunoassay Based on Gold Nanospheres.

The SARS-CoV-2 global pandemic created an unprecedented need for rapid, sensitive, and inexpensive point-of-care (POC) diagnostic tests to treat and control the disease. Many POC SARS-CoV-2 lateral flow immunoassays (LFAs) have been developed and/or commercialized, but with only limited sensitivity (μM–fM). We created an advanced LFA based on gold nanospheres (GNSs) with comprehensive assay redesign for enhanced specific binding and thermal contrast amplification (TCA) on GNSs for signal amplification, which enabled fM–aM detection sensitivity for SARS-CoV-2 spike receptor-binding domain (RBD) proteins within 30 min. The advanced LFA can visually detect RBD proteins down to 3.6 and 28.6 aM in buffer and human nasopharyngeal wash, respectively. This is the first reported LFA achieving sensitivity comparable to that of the PCR (aM–zM) by visual reading, which was much more sensitive than traditional LFAs. We also developed a fast (<1 min) TCA reading algorithm, with results showing that this TCA could distinguish 26–32% visual false negatives for clinical commercial LFAs. When our advanced LFAs were applied with this TCA, the sensitivities were further improved by eightfold to 0.45 aM (in buffer) and 3.6 aM (in the human nasopharyngeal wash) with a semiquantitative readout. Our proposed advanced LFA with a TCA diagnostic platform can help control the current SARS-CoV-2 pandemic. Furthermore, the simplicity and speed with which this assay was assembled may also facilitate preparedness for future pandemics.

Screening of Asymptomatic Healthcare Workers for SARS-COV-2 for Occult Infections: A Cross-Sectional Study.

IntroductionThe SARS-CoV-2 illness (COVID-19) has spread around the world, primarily through person-to-person transmission, and is a serious public health concern. Based on the severity of illness symptoms, SARS-CoV-2 infection can be classified as either apparent or occult. To date, real-time reverse transcription polymerase chain reaction (RT-PCR) on respiratory specimens, particularly nasopharyngeal and oropharyngeal swabs, or nasopharyngeal wash or aspirate, has been the gold standard for the identification of COVID-19. A negative RT-PCR does not necessarily rule out SARS-CoV-2 infection. Occult COVID-19 infections could least be identified with RT-PCR.Aims and objectivesTo assess the prevalence of possible occult COVID-19 infection in healthcare personnel by RT-PCR and serology testing for SARS-CoV-2 virus.MethodsA cross-sectional study was conducted on health care workers at a tertiary care hospital in South India during the period from October 2020 to January 2021. None of the study participants were vaccinated against COVID-19 during the study period. Nasopharyngeal swabs collected for RT-PCR were tested using Cobas 480 platform (Roche, Basel, Switzerland). Peripheral blood venous sampling was performed to collect EDTA (ethylenediaminetetraacetic acid) and plain samples. SARS-CoV-2 IgG antibodies against spike proteins were estimated using ECI Vitros platform (Ortho Clinical Diagnostics, Raritan, USA).ResultsThe mean age of study participants was 34.78 years (SD±9.51) with an age range of 19-69 years. The study participants were stratified into age groups of 19-25 years, 26-40 years, 41-60 years, and above 60 years, gender, ABO and Rh blood groups, and occupational and further based on their area of work as Covid and Non-Covid for the purpose of statistical analysis. Total 190 samples from healthcare workers (HCWs) were tested for RT-PCR using nasopharyngeal swabs collected at the time of enrolment into the study, and all the 190 samples tested negative for RT-PCR. Among 190 HCW samples screened for SARS-CoV-2-IgG antibodies, 48 (25.3%) were found reactive for IgG antibodies while 142 (74.7%) were found non-reactive.ConclusionOur study findings suggested that using RT-PCR testing, which may only identify those with a prolonged viral shedding period and minimum viral loads, the proportion of asymptomatic/occult infections could be underestimated.

Nasopharyngeal bacterial and fungal microbiota in normal horses and horses with nasopharyngeal cicatrix syndrome.

BackgroundThe nasopharyngeal bacterial and fungal microbiota of normal horses and those with nasopharyngeal cicatrix syndrome (NCS) are unknown.Hypotheses/ObjectivesTo describe the microbiota from nasopharyngeal washes of healthy horses and of horses acutely affected with NCS.AnimalsTwenty‐six horses acutely affected with NCS horses and 14 unaffected horses.MethodsProspective, observational cohort study. Horses were recruited by investigators through personal communications in central Texas. Bacterial (16s RNA) and fungal (internal transcribed spacer) microbiota from nasopharyngeal washes were evaluated. Polymerase chain reaction for detection of Pythium insidiosum was performed.ResultsResults indicated that 6 fungal genera (Alternaria, Bipolaris, Microascus, Spegazzinia, Paraconiothyrium, Claviceps) and 1 bacterial genera (Staphylococcus) were significantly different between affected and unaffected horses. The fungal genus Bipolaris had increased abundance in NCS affected horses and on NCS affected farms. Pythium insidiosum was absent in the nasopharyngeal wash of all horses, irrespective of health status.Conclusion and Clinical ImportanceSignificant differences were identified in the fungal microbiota in horses affected with NCS and farms affected with NCS compared to those unaffected. Therefore, Bipolaris warrants further investigation.

Molecular typing and epidemiologic profiles of human metapneumovirus infection among children with severe acute respiratory infection in Huzhou, China

BackgroundHuman metapneumovirus (hMPV) is one of the important pathogens in infant respiratory tract infection. However, the molecular epidemiology of hMPV among children < 14 years of age hospitalized with severe acute respiratory infection (SARI) is unclear. We investigated the hMPV infection status and genotypes of children hospitalized with SARI from January 2016 to December 2020 in Huzhou, China.MethodsA nasopharyngeal flocked swab, nasal wash, or nasopharyngeal swab/or opharyngeal swab combination sample was collected from children with SARI in Huzhou from January 2016 to December 2020. Quantitative reverse transcription-polymerase chain reaction was performed to detect hMPV RNA. The hMPV F gene was amplified and sequenced, followed by analysis using MEGA software (ver. 7.0). Epidemiological data were analyzed using Microsoft Excel 2010 and SPSS (ver. 22.0) software.ResultsA total of 1133 children with SARI were recruited from 2016 to 2020. Among them, 56 (4.94%) were positive for hMPV-RNA. Children < 5 years of age accounted for 85.71% of the positive cases. The hMPV incidence was high in spring and winter, especially in December and January to March. Phylogenetic analysis of the F-gene sequences of 28 hMPV strains showed that the A1, B1, and B2 genotypes were prevalent in Huzhou, and the dominant hMPV genotype varied according to surveillance year.ConclusionsHMPV is an important respiratory pathogen in children in Huzhou, with a high incidence in winter and spring in children < 5 years of age. In this study, genotypes A1, B1, and B2 were the most prevalent.

Clinical fnd epidemiological features of measles by adults in modern period

Positive results have been achieved during the implementation of the measles elimination program in the Russian Federation and in the Northwestern Federal District (NWFD). However, measles remains an urgent problem for some regions due to the peculiarities of this infection.Purpose of the work: to characterize the clinical, epidemiological and molecular genetic characteristics of measles in adults during the period of increasing incidence in St. Petersburg.Materials and methods: the incidence of measles in the Northwestern Federal District was analyzed in 2006–2020, and the data of 30 patients of S.P. Botkin clinical infectious diseases hospital over 18 years old (2018). The diagnosis of measles is confirmed by enzyme immunoassay. Molecular genetic studies (PCR, sequencing) were carried out at the National Scientific and Methodological Center for the Surveillance of Measles and Rubella of G.N. Gabrichevsky Moscow Scientific Research Institute of Epidemiology and Microbiology, biological material was used (nasopharyngeal washings, urine).Results: there was an increase in morbidity in some regions of the Northwestern Federal District in conditions of high coverage of the population with measles vaccinations. In the age structure in 2018–2019 the proportion of adults was 65%. 74% of patients were not vaccinated against measles. A moderate-severe course (100%) was noted, regardless of the genotypes of the virus. Clinical manifestations were characterized by febrile, catarrhal and exanthema syndrome. Diarrhea was found in 36,7% of patients, hepatomegaly in 43.4%, and an increase in transaminases in 87%. 66,7% of patients traveled outside St. Petersburg. The genotypes of the virus were identified: B3 Kabul and B3 Dublin of African origin, D8 Girsomnath of Indian origin.Conclusions: measles remains an urgent problem, in recent years, adults prevail among patients, both local and imported cases are recorded. The clinical course of the disease may be accompanied by intestinal complications and other symptoms that make it difficult to diagnose at the prehospital stage. The use of molecular genetic methods makes it possible to identify the pathogen, assess the identity of viral isolates, and improve the epidemiological surveillance of the infection.

Infant rhesus macaques as a non-human primate model of Bordetella pertussis infection

BackgroundThe prevalent resurgence of pertussis has recently become a critical public health problem worldwide. To understand pertussis pathogenesis and the host response to both the pathogen and vaccines, a suitable pertussis animal model, particularly a non-human primate model, is necessary. Recently, a non-human primate pertussis model was successfully established with baboons. Rhesus macaques have been shown to be ideal animal models for several infectious diseases, but a model of infectious pertussis has not been established in these organisms. Studies on rhesus macaque models of pertussis were performed in the 1920s–1930s, but limited experimental details are available. Recent monkey pertussis models have not been successful because the typical clinical symptoms and transmission have not been achieved.MethodsIn the present study, infant rhesus macaques were challenged with Bordetella pertussis (B.p) using an aerosol method to evaluate the feasibility of this system as an animal model of pertussis.ResultsUpon aerosol infection, monkeys infected with the recently clinically isolated B.p strain 2016-CY-41 developed the typical whooping cough, leukocytosis, bacteria-positive nasopharyngeal wash (NPW), and interanimal transmission of pertussis. Both systemic and mucosal humoral responses were induced by B.p.ConclusionThese results demonstrate that a model of pertussis was successfully established in infant rhesus macaques. This model provides a valuable platform for research on pertussis pathogenesis and evaluation of vaccine candidates.

Mass Screening of COVID-19 Cases by Sputum Testing

SARS CoV 2 virus is detected in the respiratory tract by using nasal/oropharyngeal and nasal mid-turbinate swabs, nasopharyngeal wash and aspirate, and an oral aspirate. The anterior nares are the most common place to collect samples due to its ease and little invasiveness. Sample collection requires experienced hands, and if the appropriate technique isn't followed, it might lead to false negative results and alter the final conclusion. Because of its size and robustness, India's healthcare system has over 700 districts each running National Tuberculosis Elimination Program (NTEP) and experts in India have proposed modifying the CBNAAT machines used in NTEP program for COVID 19 testing by utilizing a new cartridge. After a second wave of COVID-19 cases, the number of cases in India is on the rise again. When dealing with a highly contagious disease, healthcare professionals are constrained by a lack of personal protective equipment, logistics, and infrastructure. The nasopharyngeal specimen and the procedure involved, make it a more difficult and riskier affair for healthcare practitioners to perform. If COVID-19 is combated with the NTEP's current infrastructure, human resources, and logistics, we believe that early detection of cases and overall containment will be maximized. Sputum samples can be self-collected in small plastic containers and sent to the nearest tuberculosis unit for CBNAAT analysis instead of using the professional technique of collecting nasopharyngeal swabs in Viral Transport Media. Sputum sample collection is a simple operation. Be it in urban tertiary care facilities or a rural subcentre. To collect sputum, healthcare staff can simply assist. In the current phase of the pandemic in India, where the majority of COVID-19 infections are asymptomatic, mass screening at the community level using effective testing specimens and methodologies becomes critical and the only choice. It would make sense to collect COVID-19 samples at the community level based on the scientific evidence in such a scenario, especially for a country with a population of over 1.3 billion people.

408. Evaluation of the negative predictive value of the SARS-CoV-2 PCR respiratory assays in asymptomatic children undergoing surgery

BackgroundUniversal pre-operative screening with SARS-CoV-2 PCR has been adopted by institutions to mitigate risk to healthcare workers (HCW) during aerosol-generating procedures such as intubation. However, there remains uncertainty regarding rates of false negative results and optimal sampling type. The objective was to determine the reliability of single, pre-operative SARS-CoV-2 testing from the nasopharynx in children undergoing general anesthesia.MethodsChildren < 18 years of age who underwent intubation for a procedure received pre-operative testing 24–48 hours prior with a nasopharyngeal (NP) swab or wash, in conjunction with intra-operative nasal wash (NW) and tracheal aspirate (TA) sampling. All paired samples underwent testing using the Simplexa DiaSorin platform or a modified Centers for Disease Control assay. Cohen’s Kappa was used for interrater reliability of each sample result. McNemar’s Test was used to compare result proportions by sample type. Positive and negative predictive values (PPV, NPV) were calculated based on the intraoperative NW as the reference standard. Analyses were conducted using SAS (v 9.4).ResultsWe collected full sample sets from 364 children from April 14 to May 15; 66% of pre-operative samples were NP swabs. The median age was 6 years (IQR 2,13), 55% were male, 68% were white and 41% of children had a high-risk comorbidity. Most surgeries were conducted by general surgery (23%), followed by orthopedics (19%). Only 2.5% of children had respiratory symptoms, and 4.8% had a documented fever within a week of the procedure. SARS-CoV-2 positive samples occurred in 4/364 (1%) of pre-operative samples, 8/363 (2.2%) of intra-operative samples, and 8/348 (2.3%) of TA samples. The pre-operative test had 100% PPV and 99% NPV, and the TA had 100% PPV and 98.6% NPV (Table 1). There was very good agreement (Figure) between pre- and intraoperative upper respiratory sampling, with a Kappa of 0.66, (95% CI 0.35–0.97). There was no statistical difference in results by sample type.Table 1. Comparison of intra-operative and pre-operative nasopharyngeal sample results, test characteristics and test concordance Table 2. Comparison of intra-operative nasopharyngeal and tracheal aspirate sample results, test characteristics and test concordance Figure 1 Percent agreement between pre-operative and intra-operative samples ConclusionThere is a high PPV and NPV of pre-operative SARS-CoV-2 PCR testing among children undergoing anesthesia. These data can help inform guidelines regarding appropriate precautions for HCW performing high risk procedures in asymptomatic pediatric patients.Disclosures Suchitra Rao, MD, BioFire (Grant/Research Support) Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)

Pneumococcal nasopharyngeal carriage among Bhutanese children hospitalized with clinical pneumonia: serotypes and viral co-infection

BackgroundPneumococcal nasopharyngeal colonization (PNC) generally precedes pneumococcal disease. The purpose of this study was to determine the prevalence of PNC and to identify the pneumococcal serotypes circulating among Bhutanese children under five years of age admitted with clinical pneumonia, before the introduction of pneumococcal conjugate vaccine (PCV13) in the country. We also aimed to contribute to the understanding of the interplay between PNC and viral co-infection among this population.MethodsThis was a prospective study conducted at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan over 12 consecutive months. Children aged 2 to 59 months admitted with WHO-defined clinical pneumonia were eligible for recruitment. We collected blood for bacterial culture and molecular identification of S. pneumoniae, and nasopharyngeal washing for screening of respiratory viruses, and for the detection and capsular typing of S. pneumoniae by real-time polymerase chain reaction (RT-PCR).ResultsOverall, 189 children were recruited, and PNC was tested in 121 of them (64.0%). PNC was found in 76/121 children (62.8%) and S. pneumoniae was identified in blood (both by culture and RT-PCR) in a single child. Respiratory viruses were detected in a similar proportion among children with (62/70; 88.6%) and without PNC (36/40; 90.0%; p = 1.000), but rhinovirus detection was less common among children with PNC (20/70; 28.6% versus 19/40; 47.5%; p = 0.046). Capsular typing identified 30 different serotypes. Thirty-nine children (51.3%) were colonised with two to five different serotypes. A third of the children presented with serotypes considered highly invasive. Over half of the children (44/76; 57.9%) were carrying at least one serotype included in PCV13.ConclusionsThis study provides baseline information on the status of PNC among Bhutanese children admitted with clinical pneumonia prior to the introduction of PCV13, which is valuable to monitor its potential impact. PCV13 could theoretically have averted up to 58% of the pneumococcal infections among the children in this study, suggesting a future role for the vaccine to significantly reduce the burden associated with S. pneumoniae in Bhutan.

Comparison of detection rate of 16 sampling methods for respiratory viruses: a Bayesian network meta-analysis of clinical data and systematic review

BackgroundRespiratory viruses (RVs) is a common cause of illness in people of all ages, at present, different types of sampling methods are available for respiratory viral diagnosis. However, the diversity...

Prevalence of Influenza Virus Type and Subtype at Siriraj Hospital, Bangkok, Thailand During 2013 - 2017

Background: Influenza A (pandemic and seasonal H1/H3) and influenza B viruses were the predominant circulating seasonal influenza strains. Following its massive outbreak in 2009 globally, including Thailand, influenza A (H1N1) pdm09 viruses have replaced the previous seasonal H1 strain and become one of the circulating strains ever since. Both influenza A and B viruses are highly contagious and potentially cause respiratory illness ranging from mild to severe.&#x0D; Objective: To determine the prevalence of types and subtypes of circulating influenza virus strains in Bangkok, Thailand during 2013 - 2017.&#x0D; Methods: The 4385 nasopharyngeal wash specimens were collected from patients presented with influenza-like illness from January 2013 to December 2017 at Siriraj Hospital, Bangkok, Thailand. Influenza virus types and subtypes were determined using real-time RT-PCR technique. Clinical characteristics of patients infected with influenza A viruses and influenza B virus were compared and analyzed.&#x0D; Results: Of 4385 nasopharyngeal wash specimens, the prevalence of influenza virus infection during 2013 - 2017 was 18.22% (n = 799). Of 799 influenza-positive samples, 608 (76.09%) and 191 (23.90%) samples were positive for influenza A and influenza B viruses, respectively. Most patients were presented with fever, cough, and runny nose; however, patients infected with influenza A virus generally had higher severity than those with influenza B virus infection (P &lt; .05).&#x0D; Conclusions: The findings provided the characteristics of influenza virus types and subtypes at Siriraj Hospital, Bangkok, Thailand during 2013 - 2017. Sporadic cases of influenza occurred all year round, but the incidence peaked in March 2014 and August 2017. The outcomes of this study are potentially useful for prevention, treatment, and disease monitoring.&#x0D;

Sensitivity of nasopharyngeal, oropharyngeal, and nasal wash specimens for SARS-CoV-2 detection in the setting of sampling device shortage

In the context of an unprecedented shortage of nasopharyngeal swabs (NPS) or sample transport media during the coronavirus disease 2019 (COVID-19) crisis, alternative methods for sample collection are needed. To address this need, we validated a cell culture medium as a viral transport medium, and compared the analytical sensitivity of SARS-CoV-2 RT-PCR in nasal wash (NW), oropharyngeal swab (OPS), and NPS specimens. Both the clinical and analytical sensitivity were comparable in these three sample types. OPS and NW specimens may therefore represent suitable alternatives to NPS for SARS-CoV-2 detection.