Medically Attended Outpatient Coronavirus Infections in Ecuadorean Children During the 20 Months Preceding Countrywide Lockdown Related to the SARS-CoV-2 Pandemic of 2020

Abstract

Background: Human coronaviruses (HCoVs) cause respiratory tract infections during childhood manifesting as common colds, bronchiolitis, croup and pneumonia. In temperate geographies, HCoV activity peaks between December and March. The epidemiology and manifestations of HCoV infections have not been previously reported from Ecuador. Methods: Children <5 years who presented with ≥2 symptoms consistent with an acute respiratory tract infection were eligible for enrollment. After obtaining informed consent, demographic data and details regarding the acute illness were recorded. Secretions collected with a nasopharyngeal swab underwent diagnostic testing using multiplex polymerase chain reaction. Results: A total of 850 subjects were enrolled. A total of 677 (80%) tested positive for at least 1 pathogen, including 49 (7.2%) who tested positive for ≥1 HCoV type. HCoV-NL63 was the most frequent type detected (39%), followed by HCoV-OC43 (27%), 229E (22%) and HKU1 (12%). Nearly all subjects who tested positive for HCoV had nasal congestion or secretions (47/49; 96%). The most frequent syndromic diagnosis was common cold (41%), followed by bronchiolitis (27%). We found no association between the infecting HCoV type and subject’s syndromic diagnosis (P > 0.05) or anatomic location of infection (upper vs. lower respiratory tract; P > 0.05). The 2018–2019 peak HCoV activity occurred from October to November; the 2019–2020 peak occurred from January to February. Conclusions: HCoVs were detected in ~7% of outpatient Ecuadorean children <5 years of age with symptoms of acute respiratory tract infection. The most frequently detected HCoV types, and the period of peak HCoV activity differed for the 2018–2019 and 2019–2020 seasons.

Etiologies of outpatient medically attended acute respiratory infections among young Ecuadorian children prior to the start of the 2020 SARS‐CoV‐2 pandemic

“…The clinical and demographic distribution of children testing positive for detection of seasonal coronaviruses has been previously published. 18 …”

“…Adenoviruses, hMPV, and seasonal coronaviruses each accounted for 10% or less of the pathogens detected from nasopharyngeal samples (Table 1), yet collectively, they accounted for 59 of the 238 (25%) cases of bronchiolitis. The clinical and demographic distribution of children testing positive for detection of seasonal coronaviruses has been previously published 18 …”

“…Eligibility for inclusion and recruitment logistics were previously described. 18 Briefly, children < 5 years of age presenting to a study‐designated ambulatory clinic with a suspected ARTI are eligible. For study purposes, an ARTI is defined as the presence or parental report of two or more of the following for fewer than 8 days: temperature ≥ 38°C, nasal congestion/discharge, cough, tachypnea, wheezing, rales, hypoxia, or apnea.…”

“…Eligibility for inclusion and recruitment logistics were previously described 18 . Briefly, children < 5 years of age presenting to a study‐designated ambulatory clinic with a suspected ARTI are eligible.…”

The deadly impact of COVID-19 among children from Latin America: The case of Ecuador

“…The burden of COVID-19 among children is significantly lower than adults and the elderly. In terms of symptomatology and severity, milder cases are often compared to common endemic viral infections of childhood such as those caused by adenovirus or respiratory syncytial virus (34,35). The reasons behind differences in severity and prognosis between children and adults could be explained by several factors (21).…”