后COVID-19时代儿童呼吸道合胞病毒感染的特征

Q4 Immunology and Microbiology Revista Romana de Boli Infectioase Pub Date : 2023-03-31 DOI:10.37897/rjid.2023.1.2
G. Jugulete, M. Merișescu, Bianca Borcoș, M. Luminos
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引用次数: 0

摘要

儿童呼吸道合胞病毒(RSV)感染是一个主要的公共卫生问题,尤其是在0-1岁年龄组,这种疾病的临床形式可能会严重发展,并伴有危及生命的并发症。在2020-2022年期间,由于针对新冠肺炎疫情采取的流行病学措施(防护口罩、在线教学活动、保持社交距离),我们看到儿童呼吸道合胞病毒感染病例数量大幅下降。随着预防措施的解除和寒冷季节的到来,我们看到儿科病房中被诊断为呼吸道病毒的入院人数有所增加。本文旨在分析2022-2023年儿童呼吸道合胞病毒感染的临床、进化和流行病学特征。我们对2022年10月至2023年3月期间入住国家传染病研究所儿科传染病临床部的呼吸道合胞病毒感染病例“Matei Bals教授博士”进行了回顾性临床研究。在此期间,我们登记了195例儿童呼吸道合胞病毒感染病例,占儿童住院病毒学疾病总数(195/3012)的6.47%。我们病房收治的所有儿童呼吸道合胞病毒感染病例进展顺利;我们没有任何死亡记录。从流行病学角度来看,儿童呼吸道合胞病毒感染的高峰发生在12月(98例)。该疾病最常见的临床形式是中度,但严重形式占31.8%。在并发症中,最常见的是呼吸系统(急性呼吸衰竭、肺炎/支气管肺炎)、血液系统(感染内和缺乏性贫血、白细胞减少症、血小板减少症),消化系统(腹泻病、肝细胞溶解综合征)和与水电解和酸碱紊乱相关的急性脱水综合征。严重并发症比前几个季节更频繁,与不良后果的风险相关:急性呼吸衰竭和神经系统并发症(抽搐、脑炎)。我们还观察到,2022年至2023年季节的急性呼吸道合胞病毒感染的特点是合并感染(病毒、细菌和真菌)比往年(22.5%)更频繁。最常见的合并感染是细菌(重叠感染-肺炎/支气管肺炎),可能是由于最近反复发作的病毒导致宿主免疫抑制传染值得注意的是,与其他合并感染相关的呼吸道合胞病毒感染发展得更严重,住院时间更长,并发症更多。总之,我们可以说,与前几个季节相比,2022年至2023年季节的呼吸道合胞病毒感染在儿童中进化得更严重,因为在新冠肺炎大流行的过去3年中,呼吸道类病毒病例非常少,因此人群没有自然免疫,尤其是0至4岁年龄组。此外,放弃对呼吸道疾病的具体保护措施,使儿科人群,尤其是儿童的呼吸道疾病数量“激增”。
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Features of respiratory syncytial virus infection in children in the post-COVID 19 era
Respiratory syncytial virus (RSV) infection in children is a major public health problem, especially in the 0-1 year age group where clinical forms of the disease can evolve severely with life-threatening complications. In the period 2020 – 2022, as a result of epidemiological measures specific to the COVI-19 pandemic (protective mask, online teaching activity, social distancing) we have witnessed a considerable decrease in the number of cases of RSV infection in children. With the lifting of prophylactic measures and the onset of the cold season, we have seen an increase in the number of admissions with a diagnosis of respiratory virus in pediatric wards. In this article, we aim to analyze the clinical, evolutionary and epidemiological features of respiratory syncytial virus infection in children in the 2022 - 2023 season. We conducted a retrospective clinical study of RSV infection cases admitted to the Pediatric Infectious Diseases Clinical Departments of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” in the period October 2022 - March 2023. During this period, we registered 195 cases of RSV infection in children, which represents 6.47% of the total number of hospitalized virologic illnesses in children (195/3012). All pediatric RSV infection cases admitted to our wards have progressed favorably; we have not recorded any deaths. From an epidemiological point of view, the peak incidence of RSV infection in children occurred in December (98 cases). The most frequent clinical form of the disease was the medium form, but severe forms represented 31.8%. Among the complications, the most common were respiratory (acute respiratory failure, pneumonia/bronchopneumonia), hematological (intrainfectious and deficiency anemia, leukopenia, thrombocytopenia), digestive (diarrheal disease, hepatic cytolysis syndrome) and acute dehydration syndrome associated with hydro electrolytic and acid-base disturbances. Severe complications were more frequent than in previous seasons, being associated with a risk of an unfavorable outcome: acute respiratory failure and neurological complications (convulsions, encephalitis). We also observed that acute RSV infection in the 2022 - 2023 season is characterized by the association of co-infections (viral, bacterial and fungal) more frequent than in previous years (22.5%). The most frequent co-infections were bacterial (superinfections - pneumonia/bronchopneumonia) probably due to the immunosuppression of the hosts as a result of repeated recent episodes of viral infections. Of note, RSV infection associated with other coinfections evolved more severely, with prolonged hospitalization and more complications. In conclusion we can say that RSV infection in the 2022 - 2023 season evolved more severely in children compared to previous seasons because in the last 3 years during the COVID-19 pandemic there were very few cases of respiratory viroids, thus the population was not naturally immunized, especially the age group 0 - 4 years. In addition, the abandonment of specific protective measures for respiratory diseases has “exploded” the number of respiratory illnesses in the pediatric population, especially in children.
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0.10
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发文量
11
审稿时长
4 weeks
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