| Section A:Epidemiological characteristics of respiratory syncytial virus pneumonia in children before and after the COVID-19 outbreak in Guangzhou Objective:The global pandemic of COVID-19 has dramatically changed the epidemiological characteristics of viral respiratory infections including respiratory syncytial virus(RSV).This study aimed to review the clinical data of children under 5 years old hospitalized with RSV pneumonia in our hospital from 2017 to 2022(i.e.,three years before and after COVID-19),and explore the impact of epidemic prevention and control measures on the epidemiological characteristics of children with RSV-related community-acquired pneumonia.Methods:A total of 616 children hospitalized with RSV pneumonia in our hospital from January 2017 to December 2022 were included in this study.The data of Demographic information,medical history,clinical manifestations,etiological examinations and prognosis(severe pneumonia,repeated wheezing)were retrospectively collected.Descriptive statistics were used to compare the annual and monthly changes in the number of hospitalized children with RSV pneumonia in the three years before and after COVID-19(2017-2019)and the three years after COVID-19(2020-2022).Chi-square test,independent sample T-test and rank sum test were used to compare the differences in clinical characteristics of children before and after COVID-19.Results:From 2017 to 2022,the number of hospitalized children with RSV pneumonia peaked 217 in 2018,followed by 144 in 2019 and 142 in 2017.However,after the outbreak of COVHD-19,the number of children admitted to hospital for RSV pneumonia dropped sharply,with only 77 children admitted in 2020,a decrease of 46.6%compared to 2019.Only 14 children with RSV pneumonia were admitted in 2021 and 22 in 2022.In addition,the outbreak also altered the seasonal distribution of RSV pneumonia.The epidemic peaks in both 2017 and 2018 occurred in summer,while the number of cases of RSV pneumonia in 2019 was concentrated in spring.However,the number of RSV pneumonia peaked in January and September in 2020,with few cases in the rest of the months.In 2021 and 2022,the number of children hospitalized with RSV pneumonia continued to be low,and no RSV pneumonia outbreak was observed.In addition,the proportion of male infants before COVID-19 was significantly higher than that after COVID-19,but the mean age of children before COVID-19 was significantly lower than that after COVID-19.Conclusion:A series of measures related to the prevention of the COVID-19 had significantly reduced the incidence of RSV pneumonia,and the alternations in the control policy of COVID-19 had greatly affected the epidemiological characteristics of RSV pneumonia.Section B:Risk factors for recurrent wheezing in hospitalized children with RSV pneumoniaObjective:Repeated wheezing may increase disability and mortality in children with RSV pneumonia.This study was based on the information of children under 5 years old admitted to our hospitalized children with RSV pneumonia from 2017 to 2022,to explore the risk factors of recurrent wheezing after RSV pneumonia,and to provide guidance for improving the prognosis of children.Method:Data from 514 children admitted to hospital with RSV pneumonia between January 2017 and December 2022 with no previous history of asthma or wheezing were included in this study.This includes demographic information,clinical presentations,past history,family history,laboratory tests,imaging examinations,ect.Multivariate Logistic regression was used to adjust confounding factors,and the independent risk factors for recurrent wheezing after RSV pneumonia were analyzed,with the calculation of the odds ratio(OR)and 95%confidence interval(Cl).Results:A total of 165 children with wheezing and 349 children without wheezing after RSV pneumonia were included in this study.The proportion of fever,eczema history,and mosaic sign on chest imaging were significantly higher than that in the non-wheezing group,and the EOS%in the wheezing group was significantly higher than that in the control group.However,after adjusting for confounding factors,only EOS%levels were independently associated with recurrent wheezing.Compared with children with EOS%levels between 0 and 0.65,the risk of recurrent wheezing increased 2.12 times(95%CI 1.06-4.28)in those with EOS%levels between 0.66 and 1.70,2.34 times(95%CI 1.18-4.68)in those with EOS%levels between 1.71 and 3.50,and 3.25 times(95%CI 1.65-6.38)in those with EOS%levels more than 3.50,respectively,suggesting that the risk of recurrent wheezing increased with the increase of EOS%level.Conclusion:EOS%is an independent risk factor for recurrent wheezing after RSV pneumonia.For children hospitalized with RSV pneumonia,paying more attention to the level of eosinophils,and taking appropriate measures to control infection and reduce airway hyperreactivity are beneficial to the prevention and treatment of recurrent wheezing and subsequent asthma.Section C:Risk factors for severe pneumonia in hospitalized children with RSV pneumoniaObjective:This study aims to explore the risk factors of severe RSV pneumonia based on the information of hospitalized children under 5 years old with RSV pneumonia from 2017 to 2022 in our hospital,and provide reference for clinical prevention and treatment.Methods:Data of 616 children with RSV-related community-acquired pneumonia admitted to our hospital from January 2017 to December 2022 were retrospectively collected.The data collection items and laboratory examination methods of children are the same as the second part.The diagnostic criteria for severe pneumonia refer to the guidelines for the Diagnosis and Treatment of community acquired pneumonia in Children(2019 edition).Baseline data of children with severe RSV pneumonia and those without severe RSV pneumonia were compared.Measurement data conforming to normal distribution were expressed as mean±standard deviation,and independent sample Student’s t test was used for comparison between groups.Measurement data inconsistent with normal distribution were expressed as median and quartile spacing,and rank-sum analysis was used for comparison between groups.Count data were expressed as frequency and percentage,and chi-square test was used for comparison between groups.For the correlation analysis of continuous variables and severe pneumonia,Pearson correlation analysis is used,with Point-biserial correlation coefficient calculated.For the correlation analysis between categorical variables and severe pneumonia,multivariate Logistic regression was used to correct confounding factors,and the odds ratio(OR)and 95%confidence interval(CI)were calculated.P<0.05 was considered statistically significant.Results:A total of 116 children with severe RSV pneumonia and 500 children with mild or common RSV pneumonia were included in this study.The age of RSV patients with severe pneumonia was significantly lower than that of those without severe pneumonia.The children in the severe pneumonia group were preterm infants,with co-infection,wheezing,polypnea,three concave sign,stridor,premature infants,history of wheezing,chest images showed large patchy shadows dominated by parenchymal infiltration of lung segments,mosaic sign,pulmonary edema and NEUT%were significantly higher than those in the control group.After adjusting for confounding factors,age≤1 year old,co-infection,polypnea,three concave sign and history of wheezing was independently associated with severe pneumonia.Conclusion:Young age,co-infection,polypnea,three concave sign and history of wheezing were independent risk factors for severe RSV pneumonia.For children with the above risk factors and clinical manifestations,timely preventive measures may be helpful to reduce the incidence of severe pneumonia. |
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