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      Epidemiology and clinical features of respiratory syncytial virus (RSV) infection in hospitalized children during the COVID‐19 pandemic in Gorgan, Iran

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          Abstract

          Background and Aims

          Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection in infants and young children. Given the altered circulation patterns of respiratory viruses during the coronavirus disease pandemic‐2019 (COVID‐19), the study aimed to evaluate epidemiology and clinical features of RSV infections in hospitalized children during the COVID‐19 pandemic in Gorgan, northeastern Iran. Molecular epidemiology studies on respiratory viral infections are necessary to monitor circulating viruses, disease severity, and clinical symptoms, in addition to early warning of new outbreaks.

          Methods

          Overall, 411 respiratory swab samples from hospitalized children from October 2021 to March 2022 were collected at Taleghani Children's Hospital, Gorgan, Iran. The incidence of RSV, as well as the circulating subgroups and genotypes, were investigated and confirmed using PCR methods. Additionally, all samples tested for severe acute respiratory syndrome‐associated coronavirus 2 (SARS‐CoV‐2) and influenza, and demographic and clinical data were analyzed using SPSS software.

          Results

          The share of RSV, SARS‐CoV‐2, and influenza among hospitalized children with acute lower respiratory infections (ALRI) were 27%, 16.5%, and 4.1%, respectively. The RSV subgroup A (genotype ON1) was dominant over subgroup B (genotype BA9), with more severe clinical symptoms. Compared with the prepandemic era there were high numbers of hospitalized SARS‐CoV‐2 positive children and low numbers of other respiratory viruses. Despite this, the prevalence of ALRI‐related RSV‐disease among hospitalized children in our specialized pediatric center was higher than COVID‐19 disease in the same cohort.

          Conclusions

          Studying the epidemiology of respiratory viruses and determining the circulating strains can contribute to effective infection control and treatment strategies.

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          Most cited references50

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          Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study

          Summary Background We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. Methods We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. Findings We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6–50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7–3·8) hospital admissions, and 59 600 (48 000–74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2–1·7) hospital admissions, and 27 300 (UR 20 700–36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600–149 400). Incidence and mortality varied substantially from year to year in any given population. Interpretation Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group. Funding The Bill & Melinda Gates Foundation.
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            Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens

            This study describes the prevalence of SARS-CoV-2 co-infection with noncoronavirus respiratory pathogens in a sample of symptomatic patients undergoing PCR testing in March 2020.
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              Defining the Epidemiology and Burden of Severe Respiratory Syncytial Virus Infection Among Infants and Children in Western Countries

              Introduction The REGAL (RSV [respiratory syncytial virus] Evidence—a Geographical Archive of the Literature) series provides a comprehensive review of the published evidence in the field of RSV in Western countries over the last 20 years. This first of seven publications covers the epidemiology and burden of RSV infection. Methods A systematic review was undertaken for articles published between Jan 1, 1995 and Dec 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov. Studies reporting data for hospital visits/admissions for RSV infection among children (≤18 years of age), as well as studies reporting RSV-associated morbidity, mortality, and risk factors were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. Result 2315 studies were identified of which 98 were included. RSV was associated with 12–63% of all acute respiratory infections (ARIs) and 19–81% of all viral ARIs causing hospitalizations in children (high SOE). Annual RSV hospitalization (RSVH) rates increased with decreasing age and varied by a factor of 2–3 across seasons (high SOE). Studies were conflicting on whether the incidence of RSVH has increased, decreased, or remained stable over the last 20 years (moderate SOE). Length of hospital stay ranged from 2 to 11 days, with 2–12% of cases requiring intensive care unit admission (moderate SOE). Case-fatality rates were <0.5% (moderate SOE). Risk factors associated with RSVH included: male sex; age <6 months; birth during the first half of the RSV season; crowding/siblings; and day-care exposure (high SOE). Conclusion RSV infection remains a major burden on Western healthcare systems and has been associated with significant morbidity. Further studies focusing on the epidemiology of RSV infection (particularly in the outpatient setting), the impact of co-infection, better estimates of case-fatality rates and associated risk factors (all currently moderate/low SOE) are needed to determine the true burden of disease. Funding Abbvie. Electronic supplementary material The online version of this article (doi:10.1007/s40121-016-0123-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Alireza.tmn@gmail.com
                Journal
                Health Sci Rep
                Health Sci Rep
                10.1002/(ISSN)2398-8835
                HSR2
                Health Science Reports
                John Wiley and Sons Inc. (Hoboken )
                2398-8835
                03 January 2024
                January 2024
                : 7
                : 1 ( doiID: 10.1002/hsr2.v7.1 )
                : e1787
                Affiliations
                [ 1 ] Infectious Diseases Research Center Golestan University of Medical Sciences Gorgan Iran
                [ 2 ] Department of Microbiology, School of Medicine Golestan University of Medical Sciences Gorgan Iran
                [ 3 ] Department of Virology, School of Public Health Tehran University of Medical Sciences Tehran Iran
                [ 4 ] Department of Pediatrics, School of Medicine, Taleghani Children's Hospital Golestan University of Medical Sciences Gorgan Iran
                [ 5 ] Department of Pediatric and Adolescent Health University of Botswana Gaborone Botswana
                [ 6 ] Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
                Author notes
                [*] [* ] Correspondence Alireza Tahamtan, Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran.

                Email: Alireza.tmn@ 123456gmail.com and dr.tahamtan.goums.ac.ir

                Author information
                http://orcid.org/0000-0001-7680-5698
                Article
                HSR21787
                10.1002/hsr2.1787
                10764657
                38186938
                f8e2a368-74ee-45ea-b7b8-cd3900042759
                © 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 November 2023
                : 21 September 2023
                : 12 December 2023
                Page count
                Figures: 2, Tables: 3, Pages: 9, Words: 5628
                Funding
                Funded by: Golestan Medical University
                Award ID: 112519
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                January 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.6 mode:remove_FC converted:03.01.2024

                covid‐19,influenza,polymerase chain reaction,respiratory syncytial virus

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