scholarly journals Epidemiology and Clinical Symptoms Related to Seasonal Coronavirus Identified in Patients with Acute Respiratory Infections Consulting in Primary Care over Six Influenza Seasons (2014–2020) in France

Viruses ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 630
Author(s):  
Shirley Masse ◽  
Lisandru Capai ◽  
Natacha Villechenaud ◽  
Thierry Blanchon ◽  
Rémi Charrel ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Features ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Epidemiological Data ◽  
Influenza Surveillance ◽  
Respiratory Pathogens ◽  
Detection Rates ◽  
Representative Samples

There is currently debate about human coronavirus (HCoV) seasonality and pathogenicity, as epidemiological data are scarce. Here, we provide epidemiological and clinical features of HCoV patients with acute respiratory infection (ARI) examined in primary care general practice. We also describe HCoV seasonality over six influenza surveillance seasons (week 40 to 15 of each season) from the period 2014/2015 to 2019/2020 in Corsica (France). A sample of patients of all ages presenting for consultation for influenza-like illness (ILI) or ARI was included by physicians of the French Sentinelles Network during this period. Nasopharyngeal samples were tested for the presence of 21 respiratory pathogens by real-time RT-PCR. Among the 1389 ILI/ARI patients, 105 were positive for at least one HCoV (7.5%). On an annual basis, HCoVs circulated from week 48 (November) to weeks 14–15 (May) and peaked in week 6 (February). Overall, among the HCoV-positive patients detected in this study, HCoV-OC43 was the most commonly detected virus, followed by HCoV-NL63, HCoV-HKU1, and HCoV-229E. The HCoV detection rates varied significantly with age (p = 0.00005), with the age group 0–14 years accounting for 28.6% (n = 30) of HCoV-positive patients. Fever and malaise were less frequent in HCoV patients than in influenza patients, while sore throat, dyspnoea, rhinorrhoea, and conjunctivitis were more associated with HCoV positivity. In conclusion, this study demonstrates that HCoV subtypes appear in ARI/ILI patients seen in general practice, with characteristic outbreak patterns primarily in winter. This study also identified symptoms associated with HCoVs in patients with ARI/ILI. Further studies with representative samples should be conducted to provide additional insights into the epidemiology and clinical features of HCoVs.

scholarly journals OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19

2021 ◽  
pp. BJGP.2021.0380
Author(s):  
Helen J Curtis ◽  
Brian MacKenna ◽  
Richard Croker ◽  
Peter Inglesby ◽  
Alex J Walker ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Respiratory Disease ◽  
Laboratory Tests ◽  
Respiratory Infections ◽  
Seasonal Pattern ◽  
Substantial Reduction ◽  
Chronic Obstructive ◽  
Clinical Activity ◽  
Ratio Test

BackgroundThe COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.AimTo describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples.Design and settingWorking on behalf of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY.MethodActivity using Clinical Terms Version 3 codes and keyword searches from January 2019 to September 2020 are described.ResultsActivity recorded in general practice declined during the pandemic, but largely recovered by September. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was the international normalised ratio test, with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 6.9). The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as ‘no change’. Respiratory infections exhibited a sustained drop, not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, whereas chronic obstructive pulmonary disease reviews remained below baseline.ConclusionAn open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected and recording of respiratory disease codes was mixed.

scholarly journals COVID-19, COPD, and AECOPD: Immunological, Epidemiological, and Clinical Aspects

2021 ◽  
Vol 7 ◽  
Author(s):  
Francesca Polverino ◽  
Farrah Kheradmand
Keyword(s):  
Cigarette Smoke ◽  
Clinical Features ◽  
Respiratory Infections ◽  
Severe Disease ◽  
Epidemiological Data ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Obstructive Pulmonary Disease ◽  
Ultimate Cause

The newly identified severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) causes several heterogeneous clinical conditions collectively known as Coronavirus disease-19 (COVID-19). Older patients with significant cardiovascular conditions and chronic obstructive pulmonary disease (COPD) are predisposed to a more severe disease complicated with acute respiratory distress syndrome (ARDS), which is associated with high morbidity and mortality. COPD is associated with increased susceptibility to respiratory infections, and viruses are among the top causes of acute exacerbations of COPD (AECOPD). Thus, COVID-19 could represent the ultimate cause of AECOPD. This review will examine the pathobiological processes underlying SARS-CoV-2 infection, including the effects of cigarette smoke and COPD on the immune system and vascular endothelium, and the known effects of cigarette smoke on the onset and progression of COVID-19. We will also review the epidemiological data on COVID-19 prevalence and outcome in patients with COPD and analyze the pathobiological and clinical features of SARS-CoV-2 infection in the context of other known viral causes of AECOPD. Overall, SARS-CoV-2 shares common pathobiological and clinical features with other viral agents responsible for increased morbidity, thus representing a novel cause of AECOPD with the potential for a more long-term adverse impact. Longitudinal studies aimed at COPD patients surviving COVID-19 are needed to identify therapeutic targets for SARS-CoV2 and prevent the disease's burden in this vulnerable population.

scholarly journals Declining influenza activity in Europe while public concern over SARS has not increased general practice consultations for influenza-like illness or acute respiratory infections

2003 ◽  
Vol 7 (16) ◽  
Author(s):  
W J Paget ◽  
M Zambon ◽  
H Upphoff ◽  
A I M Bartelds
Keyword(s):  
General Practice ◽  
Respiratory Infections ◽  
Influenza Surveillance ◽  
Clinical Activity ◽  
Acute Respiratory Infections ◽  
Public Concern ◽  
Influenza Like Illness ◽  
Influenza Activity ◽  
Baseline Levels ◽  
Surveillance Scheme

Influenza activity in the 22 networks (19 countries) that participate in the European Influenza Surveillance Scheme (EISS, http://www.eiss.org/) in the week ending 6 April 2003 (week 14/2003) was regional in Italy, local in nine networks and sporadic in eight networks (1). One network – Portugal – reported no influenza activity, indicating that the overall level of clinical activity was at baseline levels. Compared to week 13/2003, clinical morbidity rates declined in thirteen networks and remained stable in two (France and Slovenia).

scholarly journals Respiratory Syncytial Virus: New Challenges for Molecular Epidemiology Surveillance and Vaccination Strategy in Patients with ILI/SARI

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1334
Author(s):  
Fabio Tramuto ◽  
Carmelo Massimo Maida ◽  
Daniela Di Naro ◽  
Giulia Randazzo ◽  
Francesco Vitale ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Respiratory Infections ◽  
Age Groups ◽  
Hospital Setting ◽  
Community Setting ◽  
Vaccination Strategy ◽  
Influenza Surveillance ◽  
Valuable Insight ◽  
Respiratory Pathogens ◽  
Syncytial Virus

Several respiratory pathogens are responsible for influenza-like illness (ILI) and severe respiratory infections (SARI), among which human respiratory syncytial virus (hRSV) represents one of the most common aetiologies. We analysed the hRSV prevalence among subjects with ILI or SARI during the five influenza seasons before the emergence of SARS-CoV-2 epidemic in Sicily (Italy). Respiratory specimens from ILI outpatients and SARI inpatients were collected in the framework of the Italian Network for the Influenza Surveillance and molecularly tested for hRSV-A and hRSV-B. Overall, 8.1% of patients resulted positive for hRSV. Prevalence peaked in the age-groups <5 years old (range: 17.6–19.1%) and ≥50 years old (range: 4.8–5.1%). While the two subgroups co-circulated throughout the study period, hRSV-B was slightly predominant over hRSV-A, except for the season 2019–2020 when hRSV-A strongly prevailed (82.9%). In the community setting, the distribution of hRSV subgroups was balanced (47.8% vs. 49.7% for hRSV-A and hRSV-B, respectively), while most infections identified in the hospital setting were caused by hRSV-B (69.5%); also, this latter one was more represented among hRSV cases with underlying diseases, as well as among those who developed a respiratory complication. The molecular surveillance of hRSV infections may provide a valuable insight into the epidemiological features of ILI/SARI. Our findings add new evidence to the existing knowledge on viral aetiology of ILI and SARI in support of public health strategies and may help to define high-risk categories that could benefit from currently available and future vaccines.

scholarly journals Prevalence and clinical features of 2019 novel coronavirus disease (COVID-19) in the Fever Clinic of a teaching hospital in Beijing: a single-center, retrospective study

2020 ◽  
Author(s):  
Ying Liang ◽  
Jingjin Liang ◽  
Qingtao Zhou ◽  
Xiaoguang Li ◽  
Fei Lin ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Features ◽  
Respiratory Infections ◽  
Panel Discussion ◽  
Epidemiological Data ◽  
Hubei Province ◽  
Single Center ◽  
Peking University ◽  
Novel Coronavirus ◽  
Lung Ct

AbstractBackgroundWith the spread of COVID-19 from Wuhan, Hubei Province to other areas of the country, medical staff in Fever Clinics faced the challenge of identifying suspected cases among febrile patients with acute respiratory infections. We aimed to describe the prevalence and clinical features of COVID-19 as compared to pneumonias of other etiologies in a Fever Clinic in Beijing.MethodsIn this single-center, retrospective study, 342 cases of pneumonia were diagnosed in Fever Clinic in Peking University Third Hospital between January 21 to February 15, 2020. From these patients, 88 were reviewed by panel discussion as possible or probable cases of COVID-19, and received 2019-nCoV detection by RT-PCR. COVID-19 was confirmed by positive 2019-nCoV in 19 cases, and by epidemiological, clinical and CT features in 2 cases (the COVID-19 Group, n=21), while the remaining 67 cases served as the non-COVID-19 group. Demographic and epidemiological data, symptoms, laboratory and lung CT findings were collected, and compared between the two groups.FindingsThe prevalence of COVID-19 in all pneumonia patients during the study period was 6.14% (21/342). Compared with the non-COVID-19 group, more patients with COVID-19 had an identified epidemiological history (90.5% versus 32.8%, P<0.001). The COVID-19 group had lower WBC [5.19×109/L (±1.47) versus 7.21×109/L (±2.94), P<0.001] and neutrophil counts [3.39×109/L (±1.48) versus 5.38×109/L (±2.85), P<0.001] in peripheral blood. However, the count of lymphocytes was not different. On lung CT scans, involvement of 4 or more lobes was more common in the COVID-19 group (45% versus 16.4%, P=0.008).InterpretationIn the period of COVID-19 epidemic outside Hubei Province, the prevalence of COVID-19 in patients with pneumonia visiting our Fever Clinic in Beijing was 6.14%. Epidemiological evidence was important for prompt case finding, and lower blood WBC and neutrophil counts may be useful for differentiation from pneumonia of other etiologies.FundingNone.

scholarly journals Rapid Molecular Tests for Detecting Respiratory Pathogens Reduced the Use of Antibiotics in Children

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 283
Author(s):  
Yu Kyung Kim ◽  
Jong Ho Lee ◽  
Sae Yoon Kim ◽  
Ji Young Ahn ◽  
Kwang Hae Choi ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Turnaround Time ◽  
University Hospital ◽  
Respiratory Pathogens ◽  
Detection Rates ◽  
Molecular Tests ◽  
Specificity And Sensitivity

Multiplex polymerase chain reaction (mPCR) is increasingly being used to diagnose infections caused by respiratory pathogens in pediatric inpatient facilities. mPCR assays detect a broader array of viruses, with higher specificity and sensitivity and faster turnaround than previous assays. We adapted the FilmArray Respiratory Panel (FA-RP) for diagnosing respiratory infections. FA-RP is an in vitro mPCR assay that simultaneously and rapidly (in about 1 h) detects 20 pathogens directly from respiratory specimens. Here, we studied the clinical efficacy of FA-RP in children who underwent testing for respiratory pathogens at Yeungnam University Hospital from November 2015 to August 2018. From November 2015 to June 2016, routine mPCR testing was performed on nasopharyngeal swabs using the routine mPCR kit. From November 2016 to July 2018, mPCR testing was performed using FA-RP. A total of 321 tests by routine mPCR and 594 tests by FA-RP were included. The positive detection rates for routine mPCR and FA-RP were 71.3% and 83.3%, respectively. FA-RP reduced the lead time, waiting time, turnaround time, intravenous (IV) antibiotic use, and length of hospital stay for pediatric patients. The decreased use of antibiotics is expected to reduce antibiotic resistance in children.

scholarly journals Using influenza surveillance networks to estimate state-specific case detection rates and forecast SARS-CoV-2 spread in the United States

2020 ◽  
Author(s):  
Justin D. Silverman ◽  
Nathaniel Hupert ◽  
Alex D. Washburne
Keyword(s):  
Detection Rate ◽  
Clinical Symptoms ◽  
Large Population ◽  
The United States ◽  
Influenza Surveillance ◽  
Case Detection ◽  
Rt Pcr ◽  
Detection Rates ◽  
Seroprevalence Data ◽  
The Us

AbstractDetection of SARS-CoV-2 infections to date has relied on RT-PCR testing. However, a failure to identify early cases imported to a country, bottlenecks in RT-PCR testing, and the existence of infections which are asymptomatic, sub-clinical, or with an alternative presentation than the standard cough and fever have resulted in an under-counting of the true prevalence of SARS-CoV-2. Here, we show how publicly available CDC influenza-like illness (ILI) outpatient surveillance data can be repurposed to estimate the detection rate of symptomatic SARS-CoV-2 infections. We find a surge of non-influenza ILI above the seasonal average and show that this surge is correlated with COVID case counts across states. By quantifying the number of excess ILI patients in March relative to previous years and comparing excess ILI to confirmed COVID case counts, we estimate the syndromic case detection rate of SARS-CoV-2 in the US to be less than 13%. If only 1/3 of patients infected with SARS-CoV-2 sought care, the ILI surge would correspond to more than 8.7 million new SARS-CoV-2 infections across the US during the three week period from March 8 to March 28. Combining excess ILI counts with the date of onset of community transmission in the US, we also show that the early epidemic in the US was unlikely to be doubling slower than every 4 days. Together these results suggest a conceptual model for the COVID epidemic in the US in which rapid spread across the US are combined with a large population of infected patients with presumably mild-to-moderate clinical symptoms. We emphasize the importance of testing these findings with seroprevalence data, and discuss the broader potential to use syndromic time series for early detection and understanding of emerging infectious diseases.

scholarly journals COVID-19 Pandemic Impact on Respiratory Infectious Diseases in Primary Care Practice in Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Ravinder Kaur ◽  
Steven Schulz ◽  
Naoko Fuji ◽  
Michael Pichichero
Keyword(s):  
Primary Care ◽  
Infectious Diseases ◽  
Respiratory Infections ◽  
New York State ◽  
Acute Otitis Media ◽  
Care Practice ◽  
Respiratory Pathogens ◽  
Nasopharyngeal Colonization ◽  
Respiratory Infectious Diseases ◽  
The Impact

Background: The coronavirus disease 2019 (COVID-19) pandemic led to day care and school closures and children staying home for several months. When they gradually returned, aggressive regulations were implemented in New York State to reduce viral transmission.Method: An ongoing prospective study occurring in the Rochester, NY region, focused on early childhood respiratory infectious diseases, afforded an opportunity to assess the impact of the pandemic on the incidence of these illnesses in a primary care outpatient setting. Physician-diagnosed, medically attended infection visits were assessed in two child cohorts, age 6–36 months old: from March 15 to December 31, 2020 (the pandemic period) compared to the same months in 2019 (prepandemic). Nasopharyngeal colonization by potential otopathogens during healthy/well-child and acute otitis media (AOM) visits was evaluated.Results: One hundred and forty-four children were included in the pandemic cohort and 215 in the prepandemic cohort. The pandemic cohort of children experienced 1.8-fold less frequent infectious disease visits during the pandemic (p &lt; 0.0001). Specifically, visits for AOM were 3.7-fold lower (p &lt; 0.0001), viral upper respiratory infections (URI) 3.8-fold lower (p &lt; 0.0001), croup 27.5-fold lower (p &lt; 0.0001), and bronchiolitis 7.4-fold lower (p = 0.04) than the prepandemic cohort. Streptococcus pneumoniae (p = 0.03), Haemophilus influenzae (p &lt; 0.0001), and Moraxella catarrhalis (p &lt; 0.0001) nasopharyngeal colonization occurred less frequently among children during the pandemic.Conclusion: In primary care pediatric practice, during the first 9 months of the COVID-19 pandemic, significant decreases in the frequency of multiple respiratory infections and nasopharyngeal colonization by potential bacterial respiratory pathogens occurred in children age 6–36 months old.

Clinical symptoms cannot predict influenza infection during the 2013 influenza season in Bavaria, Germany

2015 ◽  
Vol 144 (5) ◽  
pp. 1045-1051 ◽  
Author(s):  
H. CAMPE ◽  
S. HEINZINGER ◽  
C. HARTBERGER ◽  
A. SING
Keyword(s):  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Influenza Season ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Case Definitions ◽  
Laboratory Confirmation

SUMMARYFor influenza surveillance and diagnosis typical clinical symptoms are traditionally used to discriminate influenza virus infections from infections by other pathogens. During the 2013 influenza season we performed a multiplex assay for 16 different viruses in 665 swabs from patients with acute respiratory infections (ARIs) to display the variety of different pathogens causing ARI and to test the diagnostic value of both the commonly used case definitions [ARI, and influenza like illness (ILI)] as well as the clinical judgement of physicians, respectively, to achieve a laboratory-confirmed influenza diagnosis. Fourteen different viruses were identified as causing ARI/ILI. Influenza diagnosis based on clinical signs overestimated the number of laboratory-confirmed influenza cases and misclassified cases. Furthermore, ILI case definition and physicians agreed in only 287/651 (44%) cases with laboratory confirmation. Influenza case management has to be supported by laboratory confirmation to allow evidence-based decisions. Epidemiological syndromic surveillance data should be supported by laboratory confirmation for reasonable interpretation.

scholarly journals Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study

2019 ◽  
Vol 23 (11) ◽  
pp. 1-70 ◽  
Author(s):  
Martin C Gulliford ◽  
Dorota Juszczyk ◽  
A Toby Prevost ◽  
Jamie Soames ◽  
Lisa McDermott ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Respiratory Infections ◽  
Antibiotic Prescribing ◽  
Intervention Trial ◽  
Health Records ◽  
Multicomponent Intervention ◽  
General Practices ◽  
Electronically Delivered

BackgroundUnnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance.ObjectivesTo develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs).InterventionsA multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing.DesignA parallel-group, cluster randomised controlled trial.SettingThe trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD).ParticipantsAll registered patients were included.Main outcome measuresThe primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period.Cohort studyA separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014.ResultsThere were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99;p = 0.040]. There was no evidence of effect in children aged < 15 years (RR 0.96, 95% CI 0.82 to 1.12) or adults aged ≥ 85 years (RR 0.97, 95% CI 0.79 to 1.18). Antibiotic prescribing was reduced in adults aged between 15 and 84 years (RR 0.84, 95% CI 0.75 to 0.95), that is, one antibiotic prescription was avoided for every 62 patients (95% CI 40 to 200 patients) aged 15–84 years per year. Analysis of trial data for 12 safety outcomes, including pneumonia and peritonsillar abscess, showed no evidence that these outcomes might be increased as a result of the intervention. The analysis of data from non-trial practices showed that if a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices.LimitationsThe research was based on electronic health records that may not always provide complete data. The number of practices included in the trial was smaller than initially intended.ConclusionsThis study found evidence that, overall, general practice antibiotic prescribing for RTIs was reduced by this electronically delivered intervention. Antibiotic prescribing rates were reduced for adults aged 15–84 years, but not for children or the senior elderly.Future workStrategies for antimicrobial stewardship should employ stratified interventions that are tailored to specific age groups. Further research into the safety of reduced antibiotic prescribing is also needed.Trial registrationCurrent Controlled Trials ISRCTN95232781.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 11. See the NIHR Journals Library website for further project information.

Sign in / Sign up

Export Citation Format

Share Document