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      Influenza and respiratory syncytial virus during the COVID‐19 pandemic: Time for a new paradigm?

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          Abstract

          Seasonal epidemics of influenza and the respiratory syncytial virus (RSV) are the cause of substantial morbidity and mortality among children. During the global coronavirus disease 2019 (COVID‐19) pandemic, the epidemiology of these viruses seems to have changed dramatically. In Australia and New Zealand, a significant decrease in both influenza and bronchiolitis have been noticed during usual peak seasons. Data from early months of winter seasons in Europe are showing similar trends. This current scenario imposes a reconsideration of the paradigm that toddlers and young schoolchildren are the main drivers of seasonal RSV outbreaks and respiratory epidemics in general. In this article, we summarize current literature, address current knowledge or role of adults in the RSV epidemiology, describe the lessons learned from pertussis epidemics and call the international community to better understand the community transmission dynamics of respiratory infections in all age groups. This can allow the establishment of better and more affordable preventive measures in the whole population level, which can ultimately save millions of child lives.

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          Most cited references25

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          COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

          Summary Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
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            Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults : A Systematic Review and Meta-analysis

            The degree to which children and adolescents are infected by and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The role of children and adolescents in transmission of SARS-CoV-2 is dependent on susceptibility, symptoms, viral load, social contact patterns, and behavior.
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              Respiratory syncytial virus and parainfluenza virus.

              C Hall (2001)
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                Author and article information

                Contributors
                danilobuonsenso@gmail.com
                Journal
                Pediatr Pulmonol
                Pediatr Pulmonol
                10.1002/(ISSN)1099-0496
                PPUL
                Pediatric Pulmonology
                John Wiley and Sons Inc. (Hoboken )
                8755-6863
                1099-0496
                13 October 2021
                January 2022
                13 October 2021
                : 57
                : 1 ( doiID: 10.1002/ppul.v57.1 )
                : 38-42
                Affiliations
                [ 1 ] Department of Paediatrics Christchurch Hospital Christchurch New Zealand
                [ 2 ] Alder Hey Children's Hospital Liverpool UK
                [ 3 ] General Paediatrics/Neonates London UK
                [ 4 ] Cliniques Universitaires Saint‐Luc Brussels Belgium
                [ 5 ] Department of Paediatrics and Adolescent Medicine, Klinik Ottakring Vienna Healthcare Group Vienna Austria
                [ 6 ] Children's Intensive Care Unit KK Women's and Children's Hospital Singapore Singapore
                [ 7 ] Department of Paediatrics, Institute of Biomedicine and Clinical Microbiology University of Turku and Turku University Hospital Turku Finland
                [ 8 ] Department of Paediatrics Centre Hospitalier de Mayotte Mayotte France
                [ 9 ] Paediatric Department Children Health Ireland Dublin Ireland
                [ 10 ] Paediatric Department Hospital Raja Permaisuri Bainun Ipoh Malaysia
                [ 11 ] Paediatric Department Muzu Central Hospital, Ministry of Health Muzu Malawi
                [ 12 ] Paediatric Department Sri Ramachandra Medical College & RI Chennai Tamil Nadu India
                [ 13 ] Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit Sant Joan de Déu Hospital Research Foundation Barcelona Spain
                [ 14 ] Department of Woman and Child Health and Public Health Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
                [ 15 ] Dipartimento di Scienze di Laboratorio e Infettivologiche Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
                [ 16 ] Global Health Research Institute, Istituto di Igiene Università Cattolica del Sacro Cuore Rome Italy
                Author notes
                [*] [* ] Correspondence Danilo Buonsenso, MD, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy.

                Email: danilobuonsenso@ 123456gmail.com

                Author information
                http://orcid.org/0000-0001-8567-2639
                Article
                PPUL25719
                10.1002/ppul.25719
                8662286
                34644459
                8fdf4d1d-f755-4edb-b5db-b349a0447f79
                © 2021 Wiley Periodicals LLC

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 23 July 2021
                : 03 June 2021
                : 02 October 2021
                Page count
                Figures: 0, Tables: 0, Pages: 5, Words: 3046
                Categories
                Commentary
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                Custom metadata
                2.0
                January 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.9 mode:remove_FC converted:10.12.2021

                Pediatrics
                covid‐19,influenza,respiratory syncytial virus,sars‐cov‐2
                Pediatrics
                covid‐19, influenza, respiratory syncytial virus, sars‐cov‐2

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