背景:在后COVID-19大流行时期因急性呼吸道感染(ARTI)住院的儿童中,呼吸道病毒感染的负担和特征尚不清楚。我们分析了杭州地区常见呼吸道病毒感染住院患儿非药物干预前后的流行病学和临床特征,中国和评估六板呼吸道病原体检测系统的诊断价值。
方法:通过多重实时定量聚合酶链反应(RT-qPCR)从可疑ARTI儿童的呼吸道样本中检测六种呼吸道病毒。病毒检测率的变化以及流行病学和临床特征,从电子健康记录中获得,进行了分析。采用二元logistic回归分析呼吸道感染的危险因素。在随机样本中比较多重RT-qPCR和靶向下一代测序结果。
结果:在11,056例儿科样本中,3228对六种常见呼吸道病原体中的一种或多种检测呈阳性。RSV和PIV-3的检出率在各年龄组之间存在显著差异(均P<0.001),在年幼的孩子中更为常见。PIV-1在婴儿中更常见,幼儿,和学龄前儿童比学龄儿童(P<0.001)。FluB主要在学龄儿童中检测(P<0.001)。RSV-,ADV-,2022年PIV-1阳性率高于2023年。季节性病毒模式因年份而异。RSV(或9.156。95%CI5.905-14.195)和PIV-3(OR1.683,95%CI1.133-2.501)是下呼吸道感染的危险因素。RSV阳性与重症肺炎相关(P=0.044)。PIV-3(OR0.391,95%CI0.170-0.899),夏季(OR1.982,95%CI1.117-3.519),和年龄较小(OR0.938,95%CI0.893-0.986)影响肺炎严重程度。多重RT-qPCR显示出良好的诊断性能。
结论:在COVID-19预防和控制策略发生变化后,6种儿童常见呼吸道病毒在2022-2023年流行,具有不同的季节流行特征和年龄倾向.RSV和PIV-3引起降低,和FluA,FluB,ADV更典型地引起上呼吸道感染。婴儿期和夏季影响重症肺炎的风险。多重RT-qPCR对于准确、及时地检测儿童呼吸道病毒具有重要意义,这便于管理,治疗,预防ARTI。
BACKGROUND: The burden and characteristics of respiratory viral infections in children hospitalized for acute respiratory tract infections (ARTIs) during the post-COVID-19 pandemic era are unclear. We analyzed the epidemiological and clinical characteristics of pediatric patients hospitalized with common respiratory virus infections before and after relaxation of non-pharmaceutical interventions in Hangzhou, China and evaluated the diagnostic value of the six-panel respiratory pathogen detection system.
METHODS: Six types of respiratory viruses were detected in respiratory samples from children with suspected ARTIs by multiplex real-time quantitative polymerase chain reaction (RT-qPCR). Changes in virus detection rates and epidemiological and clinical characteristics, obtained from electronic health records, were analyzed. Binary logistic regression was used to identify respiratory tract infections risk factors. Multiplex RT-qPCR and targeted next-generation sequencing results were compared in random samples.
RESULTS: Among the 11,056 pediatric samples, 3228 tested positive for one or more of six common respiratory pathogens. RSV and PIV-3 detection rates differed significantly across age groups (both P < 0.001), and were more common in younger children. PIV-1 was more common in infants, toddlers, and preschoolers than in school-age children (P < 0.001). FluB was predominantly detected in school-age children (P < 0.001). RSV-, ADV-, and PIV-1-positivity rates were higher in 2022 than in 2023. Seasonal viral patterns differed across years. RSV (OR 9.156. 95% CI 5.905-14.195) and PIV-3 (OR 1.683, 95% CI 1.133-2.501) were risk factors for lower respiratory tract infections. RSV-positivity was associated with severe pneumonia (P = 0.044). PIV-3 (OR 0.391, 95% CI 0.170-0.899), summer season (OR 1.982, 95% CI 1.117-3.519), and younger age (OR 0.938, 95% CI 0.893-0.986) influenced pneumonia severity. Multiplex RT-qPCR showed good diagnostic performance.
CONCLUSIONS: After changes in COVID-19 prevention and control strategies, six common respiratory viruses in children were prevalent in 2022-2023, with different seasonal epidemic characteristics and age proclivities. RSV and PIV-3 cause lower, and FluA, FluB, and ADV more typically cause upper respiratory tract infections. Infancy and summer season influence severe pneumonia risk. Multiplex RT-qPCR is valuable for accurate and timely detection of respiratory viruses in children, which facilitates management, treatment, and prevention of ARTIs.