简介为了应对2019年冠状病毒病(COVID-19)大流行,州和地方政府实施了缓解战略,包括封锁,从而避免了典型的2020年秋季/冬季毛细支气管炎季节,并减少了呼吸道病毒的发病率,如呼吸道合胞病毒(RSV)。佛罗里达州从2020年4月1日至2020年4月30日实施了严格的封锁。2020年9月25日取消了封锁预防措施,随后在2021年4月出现了非典型的反季节毛细支气管炎。有趣的是,这种激增似乎与多病毒共感染增加和疾病严重程度有关.目的确定细支气管炎季节外激增是否与历史季节性病例模式不同。方法采用国际疾病分类法,对儿科重症监护病房(PICU)的入院进行单中心回顾性队列研究,毛细支气管炎第十次修订(ICD-10)代码,从2019年12月9日至2020年2月29日(12周,预锁定组或PreLD),与2021年3月29日相比,2021年6月19日(12周,锁定后小组或PostLD)。用于比较的变量是性别,种族,年龄,病毒共感染,检测到的病毒,PICU住院时间,住院时间,死亡率,所需的最大呼吸支持,机械通气天数,体外生命支持(ECLS)日,通过小儿Logistic器官功能障碍-2(PELOD-2)和小儿序贯器官衰竭评估(pSOFA)测量疾病的严重程度。分类数据使用Fisher精确检验进行分析,连续变量采用t检验。双侧p<0.05被认为是显著的。结果两组共分析了135名受试者。在PostLD阶段收治了更多患者(87vs.48).PostLD组入院时年龄较高(11.2±12.3vs.6.6±7.5,p=0.0075),但性别或种族/民族没有差异。PostLD组的RSV感染比例也较高(73vs.16,p<0.0001)和多病毒感染(p<0.0001)。较高的冠状病毒OC43(9vs.0,p=0.0263)和副流感病毒1-4型(人副流感病毒(HPIV))(19vs.1,p=0.0017)检测,人类偏肺病毒(HMPV)检测次数较少(0vs.4,p=0.0147),在LD后观察到。住院时间没有差异,PICU住院时间,死亡率,机械通气天数,ECLS天,或基于PELOD-2或pSOFA评分的疾病严重程度评分。结论在毛细支气管炎的反季节激增中,PICU的入院人数有所增加.那些病人年龄较大,更有可能患有RSV,以及与冠状病毒OC43或HPIV的合并感染,但不太可能有HMPV。没有显示出住院时间或疾病严重程度的差异。
Introduction In response to the coronavirus disease 2019 (COVID-19) pandemic, state and local governments implemented mitigation strategies, including lockdowns, thereby averting the typical fall/winter 2020 bronchiolitis season and reducing the incidence of respiratory viruses, such as respiratory syncytial virus (RSV). Florida implemented a strict lockdown from April 1, 2020, to April 30, 2020. The removal of lockdown precautions on September 25, 2020, was followed by an atypical out-of-season surge of bronchiolitis in April 2021. Anecdotally, this surge appeared to be associated with both increased poly-viral coinfections and disease severity. Objective To determine if the bronchiolitis out-of-season surge differed from historical seasonal case patterns. Methods A single-center retrospective cohort study of admissions to the pediatric intensive care unit (PICU) with International Classification of Diseases, Tenth Revision (ICD-10) codes of bronchiolitis, from December 9, 2019, to February 29, 2020 (12 weeks, pre-lockdown group or PreLD), was compared to March 29, 2021, to June 19, 2021 (12 weeks, post-lockdown group or PostLD). Variables used for comparison were gender, ethnicity, age, viral coinfections, viruses detected, PICU length of stay, hospital length of stay, mortality, maximum respiratory support needed, mechanical ventilation days, extracorporeal life support (ECLS) days, and severity of disease measured by Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and Pediatric Sequential Organ Failure Assessment (pSOFA). Categorical data were analyzed using Fisher\'s exact test, and a t-test was used for continuous variables. A two-sided p < 0.05 was considered significant. Results A total of 135 subjects were analyzed from the two cohorts. More patients were admitted during the PostLD phase (87 vs. 48). The PostLD group had a higher age at admission (11.2 ± 12.3 vs. 6.6 ± 7.5, p = 0.0075), but there were no differences in gender or race/ethnicity. The PostLD group also exhibited a higher proportion of RSV infections (73 vs. 16, p < 0.0001) and poly-viral infections (p < 0.0001). Higher coronavirus OC43 (9 vs. 0, p = 0.0263) and parainfluenza types 1-4 (human parainfluenza virus (HPIV)) (19 vs. 1, p = 0.0017) detections, yet fewer human metapneumovirus (HMPV) detections (0 vs. 4, p = 0.0147), were observed PostLD. No differences were found in hospital length of stay, PICU length of stay, mortality, mechanical ventilation days, ECLS days, or severity of illness scores based on PELOD-2 or pSOFA scores. Conclusion In the bronchiolitis out-of-season surge, there were an increased number of admissions to the PICU. Those patients were older, and more likely to have RSV, as well as a coinfection with coronavirus OC43 or HPIV, yet less likely to have HMPV. No difference in length of stay or disease severity was demonstrated.