A multicentre study on the incidence of respiratory viruses in children with community-acquired pneumonia requiring hospitalization in the setting of the zero-COVID policy in China

Abstract

Background Stringent nonpharmaceutical interventions (NPIs) have been implemented worldwide to combat the COVID-19 pandemic, and the circulation and seasonality of common respiratory viruses have subsequently changed. There have been few multicentre studies or comparisons of the prevalence of respiratory viruses accounting for community-acquired pneumonia (CAP) in hospitalized children between the pre-COVID period and the period after community and school reopening in the setting of the zero-COVID policy. Methods We included 1543 children with CAP who required hospitalization from November 1, 2020 to April 30, 2021 (period 1), and 629 children with the same conditions from November 1, 2018, to April 30, 2019 (period 2), in our study. All respiratory samples from these patients were screened for six respiratory viruses (respiratory syncytial virus [RSV], adenovirus [ADV], influenza A virus [Flu A], influenza B virus [Flu B], parainfluenza virus type 1 [PIV1], and parainfluenza virus type 3 [PIV3]) using a multiplex real-time PCR assay. Results and conclusions The median ages of the enrolled patients at the time of diagnosis were 1.5 years and 1.0 years for period 1 and period 2, respectively. In period 1, viral pathogens were detected in 50.3% (776/1543) of the enrolled patients. The most frequently identified viral pathogen was RSV (35.9%, 554/1543), followed by PIV3 (9.6%, 148/1543), PIV1 (3.6%, 56/1543), ADV (3.4%, 52/1543), Flu A (1.0%, 16/1543), and Flu B (0.8%, 13/1543). The total detection rates of these six viruses in the peak season of CAP were at the pre-COVID level. The prevalence of Flu A decreased dramatically, and circulation activity was low compared to pre-COVID levels, while the incidence of PIV3 increased significantly. There were no significant differences in the detection rates of RSV, ADV, Flu B, and PIV1 between the two periods. Our results showed that respiratory viruses accounted for CAP in hospitalized children at pre-COVID levels as communities and schools reopened within the zero-COVID policy, although the prevalence aetiology spectrum varied.

Impact of SARS‐CoV‐2 Pandemic on Emergency Hospitalizations for Acute Respiratory Infections: The Experience of a Paediatric Tertiary Care Hospital in Italy

“…Other viruses related to hospitalizations were enteroviruses, rhinovirus and coronavirus other than SARS‐CoV‐2, all of which were disrupted in various ways by the pandemic [ 33 , 34 , 35 , 36 , 37 , 38 ].…”

Challenges and Opportunities Associated with Lifting the Zero COVID-19 Policy in China

“…12 It is likely that China and other countries may experience a similar “tripledmic.” Indeed, RSV has been the most frequently detected virus among children with community-acquired pneumonia, which required hospitalization in China during the “Zero COVID-19” policy period, followed by adenovirus (a pathogen of common cold) and influenza A virus. 13 The RSV positive rate was approximately 35.7% and 35.9% of these children, before and after adopting the “Zero COVID-19” policy, respectively. 13 Strikingly, influenza A had a higher positive rate before the “Zero COVID-19” policy was adopted, when compared to the rate after the policy was adopted (4.5% vs. 1.0%), 13 suggesting the possible rise in influenza A cases/positive rates after lifting the “Zero COVID-19” policy.…”

“… 13 The RSV positive rate was approximately 35.7% and 35.9% of these children, before and after adopting the “Zero COVID-19” policy, respectively. 13 Strikingly, influenza A had a higher positive rate before the “Zero COVID-19” policy was adopted, when compared to the rate after the policy was adopted (4.5% vs. 1.0%), 13 suggesting the possible rise in influenza A cases/positive rates after lifting the “Zero COVID-19” policy. Another study in Beijing revealed that the implementation of non-pharmaceutical interventions (NPIs) reduced the incidence of RSV from 31.9% to 4.4% in children.…”