Decreased Pediatric Viral Burden and Increased Rhinovirus Infection During The COVID-19 Pandemic

Öz

Objective: Primary preventive nonpharmaceutical interventions were introduced to reduce viral transmission and disease spread at the beginning of the COVID-19 pandemic. Therefore, herein, we aimed to determine and assess the impact of the nonpharmaceutical interventions on bronchiolitis and varicella infection rates in the pediatric population during the pandemic compared to the previous four years. We also aimed to evaluate which viruses cause viral respiratory tract infections during the pandemic period.

Material and Methods: Diagnosis and laboratory data of the patients who were one month to 18 years of age were retrospectively retrieved from hospital records. The distribution of the number of patients with bronchiolitis and chickenpox diagnoses was shown monthly between January 2016 and December 2020. Viral agents detected by polymerase chain reaction (PCR) in the nasopharyngeal aspirate samples obtained at the first application of the patients during the pandemic period were investigated.

Results: The data of 2.254.877 pediatric patients admitted to our hospital from January 2016 to December 2020 were examined. There were 38.458 bronchiolitis and 954 chickenpox cases reported both as inpatients and outpatients. There was a 85.6% decrease in the rate of bronchiolitis compared to previous years, and chickenpox peak was not observed in the pandemic period. Rhinovirus was found to be the most common etiologic agent of bronchiolitis during the pandemic period and Respiratory Syncytial Virus (RSV) came second. A significant decrease in the frequency of influenza was also observed.

Conclusion: Our study reveals that the measures which curtail social life and prioritize social distancing prevent the spread of viral infections. It has also shown that there is an increase in the frequency of Rhinovirus infection during the pandemic period.

Anahtar Kelimeler

• bronchiolitis
• chickenpox
• COVID-19
• Rhinovirus

COVİD-19 Pandemisi Sırasında Azalan Pediatrik Viral Yük ve Artan Rinovirüs Enfeksiyonu

Öz

Amaç: COVID-19 pandemisinin başlangıcından itibaren viral bulaşı ve hastalık yayılmasını azaltmak ve engellemek amacıyla dünya genelinde olduğu gibi ülkemizde de medikal olmayan birincil önlemler alındı. Çalışmamızda bu önlemlerin çocuk hastalarda önceki dört yıla göre bronşiolit ve suçiçeği oranlarına etkisini belirlemeyi ve değerlendirmeyi, ayrıca pandemi döneminde viral solunum yolu enfeksiyonlarına hangi etkenlerin sebep olduğunu değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Bir ay ile 18 yaş arasındaki hastaların tanı ve laboratuvar verileri geriye dönük olarak hastane bilgi sisteminden alındı. Bronşiolit ve suçiçeği tanılı hasta sayılarının Ocak 2016’ dan Aralık 2020’ ye kadar olan aylara göre dağılımı gösterildi. Pandemi döneminde, hastaların ilk başvurusunda alınan nazofaringeal aspirat örneklerinde polimeraz zincir reaksiyonu (polymerase chain reaction, PCR) yöntemiyle saptanan viral etkenler araştırıldı.

Bulgular: Ocak 2016-Aralık 2020 tarihleri arasında hastanemize başvuran 2.254.877 çocuk hastanın verileri incelendi. Toplamda 38.458 bronşiolit ve 954 suçiçeği tanılı hasta vardı. Pandemi döneminde bronşiolit vakalarında önceki yıllara göre %85.6 oranında azalma görüldü ve önceki yıllarda görülen suçiçeği piklerinin hiçbiri görülmedi. Pandemi döneminde bronşiolit hastalarında en sık etkenin Rhinovirüs olduğu bulundu. Respiratuvar Sinsitiyal Virüs (RSV) ikinci sırada yer aldı. İnfluenza sıklığında da önemli bir azalma gözlendi.

Sonuç: Çalışmamız, sosyal hayatı kısıtlayan ve sosyal mesafeyi ön planda tutan önlemlerin viral enfeksiyonların yayılmasını engellediğini ortaya koymuştur. Ayrıca pandemi döneminde Rhinovirüs enfeksiyonu sıklığında artış olduğunu göstermiştir. Anahtar Sözcükler: Bronşiolit, Suçiçeği, COVID-19, Rhinovirus

Anahtar Kelimeler

• bronşiolit
• suçiçeği
• COVID-19
• Rhinovirus

Kaynakça

1. 1. Coronavirus disease (COVID-19) [Internet]. [cited 2020 Dec 23]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
2. 2. Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments | CDC [Internet]. [cited 2021 Jun 9]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html
3. 3. Friedman JN, Rieder MJ, Walton JM, Chauvin-Kimoff L, Chevalier I, Farrell CA, et al. Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age. Paediatr Child Heal [Internet]. 2014 Nov 1 [cited 2021 Jun 9];19(9):485. Available from: /pmc/articles/PMC4235450/
4. 4. Leung J, Harpaz R, Baughman AL, Heath K, Loparev V, Vázquez M, et al. Evaluation of laboratory methods for diagnosis of varicella. Clin Infect Dis [Internet]. 2010 Jul 1 [cited 2021 Jun 9];51(1):23–32. Available from: https://pubmed.ncbi.nlm.nih.gov/20504232/
5. 5. Aykaç K, Karadağ-öncel E, Bayhan C, Tanır-Başaranoğlu S, Akın MŞ, Özsürekci Y, et al. Prevalence and seasonal distribution of viral etiology of respiratory tract infections in inpatients and outpatients of the pediatric population: 10 year follow-up. Turk J Pediatr [Internet]. 2018 [cited 2021 Jun 9];60(6):642–52. Available from: https://pubmed.ncbi.nlm.nih.gov/31365200/
6. 6. Barker J, Stevens D, Bloomfield SF. Spread and prevention of some common viral infections in community facilities and domestic homes [Internet]. Vol. 91, Journal of Applied Microbiology. J Appl Microbiol; 2001 [cited 2021 Jun 9]. p. 7–21. Available from: https://pubmed.ncbi.nlm.nih.gov/11442709/
7. 7. Furuse Y, Oshitani H. Mechanisms of replacement of circulating viruses by seasonal and pandemic influenza A viruses. Int J Infect Dis. 2016 Oct 1;51:6–14.
8. 8. Angoulvant F, Ouldali N, Yang DD, Filser M, Gajdos V, Rybak A, et al. Coronavirus Disease 2019 Pandemic: Impact Caused by School Closure and National Lockdown on Pediatric Visits and Admissions for Viral and Nonviral Infections - A Time Series Analysis. Clin Infect Dis [Internet]. 2021 Jan 15 [cited 2021 Jun 9];72(2):319–22. Available from: https://academic.oup.com/cid/article/72/2/319/5850910

9. 9. Nascimento MS, Baggio DM, Fascina LP, do Prado C. Impact of social isolation due to COVID-19 on the seasonality of pediatric respiratory diseases. PLoS One [Internet]. 2020 Dec 1 [cited 2021 Jun 9];15(12 December). Available from: https://pubmed.ncbi.nlm.nih.gov/33306735/
10. 10. Wilder JL, Parsons CR, Growdon AS, Toomey SL, Mansbach JM. Pediatric Hospitalizations During the COVID-19 Pandemic. Pediatrics. 2020;146(6).
11. 11. Belingheri M, Paladino ME, Piacenti S, Riva MA. Effects of COVID-19 lockdown on epidemic diseases of childhood [Internet]. Vol. 93, Journal of Medical Virology. John Wiley and Sons Inc; 2021 [cited 2021 Jun 9]. p. 153–4. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.26253
12. 12. Wu D, Liu Q, Wu T, Wang D, Lu J. The impact of COVID-19 control measures on the morbidity of varicella, herpes zoster, rubella and measles in Guangzhou, China [Internet]. Vol. 8, Immunity, Inflammation and Disease. Wiley-Blackwell; 2020 [cited 2021 Jun 9]. p. 844–6. Available from: https://doi.org/10.1002/iid3.352
13. 13. Kanık A, Eliaçık K, Koyun B, İnce OT, Derici YK, Yılmaz NÖ, et al. Viral etiology of acute bronchiolitis in hospitalized infants and the effect on clinical course. Cocuk Enfeksiyon Derg. 2016 Sep 1;10(3):93–8.
14. 14. Pelit S, Bayraktar B, Bulut ME, Karabulut ND, Nuhoğlu A. Investigation of viral agents in lower respiratory tract infections of children by immunofluorescent and immunochromatographic methods. SiSli Etfal Hastan Tip Bul / Med Bull Sisli Hosp. 2015 Jun 26;118–21.
15. 15. Azkur D, Ozaydin E, Dibek-Misirlioglu E, Vezir E, Tombuloglu D, Kose G, et al. Viral etiology in infants hospitalized for acute bronchiolitis. 2014 [cited 2021 Jul 16]; Available from: http://acikerisim.mu.edu.tr/xmlui/handle/20.500.12809/3371
16. 16. E K, E B, Ş Ş, E C, MY Ç, M D, et al. Distribution of spreading viruses during COVID-19 pandemic: Effect of mitigation strategies. Am J Infect Control [Internet]. 2021 Jun [cited 2021 Jul 16]; Available from: https://pubmed.ncbi.nlm.nih.gov/34116082/
17. 17. Takashita E, Kawakami C, Momoki T, Saikusa M, Shimizu K, Ozawa H, et al. Increased risk of rhinovirus infection in children during the coronavirus disease-19 pandemic. Influenza Other Respi Viruses [Internet]. 2021 Jul 1 [cited 2021 Jul 16];15(4):488–94. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12854
18. 18. C S-K, T K, ML S-T, A A, T Z, M R, et al. Single treatment with ethanol hand rub is ineffective against human rhinovirus--hand washing with soap and water removes the virus efficiently. J Med Virol [Internet]. 2012 Mar [cited 2021 Jul 16];84(3):543–7. Available from: https://pubmed.ncbi.nlm.nih.gov/22246844/
19. 19. B W, K M, K A, JR R, JO H. Environmental contamination with rhinovirus and transfer to fingers of healthy individuals by daily life activity. J Med Virol [Internet]. 2007 Oct [cited 2021 Jul 16];79(10):1606–10. Available from: https://pubmed.ncbi.nlm.nih.gov/17705174/
20. 20. Vafadar S, Shahdoust M, Kalirad A, Zakeri P, Sadeghi M. Competitive exclusion during co-infection as a strategy to prevent the spread of a virus: A computational perspective. PLoS One [Internet]. 2021 Feb 1 [cited 2021 Jul 16];16(2). Available from: /pmc/articles/PMC7904198/
21. 21. Hassanin A, Tu VT, Curaudeau M, Csorba and G. The Ecological Niche of SARS-CoV-2-like Viruses in Bats, as Inferred from Phylogeographic Analyses of Rhinolophus Species. 2021 Mar 16 [cited 2021 Jul 16]; Available from: https://www.preprints.org/manuscript/202103.0409/v1