Clinical and epidemiological characteristics and effectiveness of antiviral therapy for COVID-19 in children: The experience of the first year of the pandemic

Background. The use of antiviral agents can shorten the duration of the viral infection. The aim: to study the clinical and epidemiological features and the effectiveness of antiviral therapy for new coronavirus infection (COVID-19) in outpatient children.Materials and methods. From April 2020 to March 2021, 9334 outpatient children aged from 0 months to 17 years were randomly tested for new coronavirus infection. SARS-CoV-2 RNA was detected in oropharyngeal and nasal material by PCR. Patients with confirmed new coronavirus infection were prescribed interferon-alpha (IFN-α) intranasally, antiviral agents of systemic action. The control group consisted of children with COVID-19 who did not receive treatment.Results. When examining clinically healthy contact children, SARS-CoV-2 RNA was detected in 7.4 % of cases. In the structure of ARI, the specific weight of COVID-19 was 12.3 % with the peak incidence in April-May (up to 22.8 %) and NovemberDecember (up to 30.0 %). In half of the cases, children became infected in the family, and usually adults were the index patient. In 47.7 % of cases, an asymptomatic form of COVID-19 was registered without significant differences in patients of different ages. In one third of children with concomitant pathology, the disease was asymptomatic, in half it was mild, in other cases moderate severity was diagnosed. The clinical picture of COVID-19 did not differ from other ARIs. Anosmia (9.4 %) in half of the cases was combined with ageusia (4.4 %) and was significantly more common in boys. The duration of clinical manifestations in children of the control group and those who received antiviral therapy did not statistically significantly differ in mild and severity of the disease. Also, various antiviral therapy options did not significantly affect the duration of SARS-CoV-2 detection in children with various forms of COVID-19.Conclusion. In the first year of the pandemic, the novel coronavirus infection did not dominate the pattern of respiratory diseases in outpatient children. Further research is required to develop pediatric guidelines for the treatment of COVID-19 at the outpatient stage.

Epidemiological characteristics and genetic diversity of norovirus infections among outpatient children with diarrhea under 5 years of age in Beijing, China, 2011–2018

Background Human noroviruses are the leading cause of sporadic cases and outbreaks of viral acute gastroenteritis in all age groups worldwide. Methods Epidemiological data and fecal specimens were collected between January 2011 and December 2018 from 4911 children < 5 years of age with diarrhea in three districts of Beijing. From 2011 to 2013, One-Step Reverse Transcription Polymerase Chain Reaction (RT-PCR) was used to detect noroviruses, and from January 2014 to December 2018, norovirus GI and GII were screened using duplex quantitative real-time RT-PCR (qRT-PCR). One-Step RT-PCR and RT-seminested PCR were performed to amplify the RNA-dependent polymerase and capsid genes of noroviruses in positive sample. Amplified products were sequenced directly; norovirus was typed using the online Norovirus Genotyping Tool v2.0 and phylogenetic analyses were conducted using MEGA-X. Results From 2011 to 2018, noroviruses were detected in 16.5% of specimens from children with diarrhea. The highest prevalence was observed in children aged 12 to 23 months (22.4%, 319/1421), followed by children aged 6 to 11 months (17.6%, 253/1441). The highest prevalence of norovirus infections occurred in autumn followed by winter, spring, and summer. From 2011 to 2018, the most prevalent dual types (genotype and polymerase type) were GII.4 Sydney[P31] (51.6%, 239/463), followed by GII.3[P12] (24.0%, 111/463), GII.4 2006b[P4 2006b] (7.3%, 34/463), GII.2[P16] (5.0%, 23/463), GII.17[P17] (2.6%, 12/463) and GII.6[P7] (2.6%, 12/463). GII.4 2006b[P4 2006b] predominated in 2011 and 2012. GII.4 Sydney[P31] predominated from 2013 to 2018. In total, 15 genotypes, 15 P-types and 19 dual types were detected in this study, reflecting the genetic diversity. Conclusions There were significant epidemiological characteristics and genetic diversity among outpatient children with norovirus infections < 5 years of age in Beijing from 2011 to 2018. These characteristics differ from those of norovirus outbreaks in Beijing. The complete genome sequences of each genotype are needed to better understand norovirus evolutionary mechanisms.

Analysis of quality control group of departments on improving effect of PICC maintenance quality in outpatient children with tumor

To explore the clinical effect of quality control group of departments on improving PICC maintenance quality in outpatient children with tumor. Methods: A total of 4100 children with tumor who were treated in our outpatient department of intravenous therapy from January to December 2020 were divided into observation group (July to December 2020: after the establishment of quality control department) and control group (January to June 2020: before the establishment of quality control group of departments). In the control group, conventional PICC treatment management and maintenance measures were used. In the observation group, quality control group was used to manage, and moreover, the PICC maintenance quality, the incidence rate of PICC-related risk events and the level of PICC maintenance knowledge and satisfaction evaluation were compared between the two groups. Results: (1) Comparing the PICC maintenance quality between the two groups, the rate of absence of PICC maintenance during the course of tumor management in the observation group (1.14%) was significantly lower than that in the control group (4.00%), and there was significant difference in the PICC maintenance quality between the two groups (P<0.05). (2) Comparing the relative indexes of children with tumor: Before intervention, there was no significant difference in the relative indexes of children with tumor (PICC maintenance knowledge level) between the two groups (P>0.05), but after intervention, the relative indexes of children with tumor (PICC maintenance knowledge level, and service evaluation recognition degree) in the observation group were significantly higher than that in the control group (P<0.05). (3) Comparing the probability of PICC-related risk events between the two groups: In the course of tumor management, PICC-related complications were observed in the observation group (3.59%, 3.18%), which were significantly lower than those in the control group (11.95%, 11.37%) (P<0.05). Conclusion: The application of quality control group of departments in the management of PICC in outpatient children with tumor has obvious clinical effect. It can effectively improve the level of maintenance knowledge and service satisfaction of family members, optimize the quality of maintenance, reduce the rate of lack of maintenance and risk related to PICC, and is worthy of being popularized in clinical practice.

Development of antibiotic associated dysbiosis in children of early age with acute intestinal infections in Azerbaijan

Objective. To study microbiological peculiarities of intestinal microflora in children of early age with acute intestinal infections.Material and methods. The scientists carried out the bacteriological examination of 338 children with acute intestinal infections, who were on inpatient and outpatient treatment. The age structure of patients on inpatient treatment from 0 to 6 month – 52 (29,1%), 7–12 month – 57 (31,8%), 1–3 years – 70 (39,1%). The distribution of children on outpatient treatment: from 0 to 6 month – 59 (37,0%), 7–12 month – 35 (22,0%), 1–3 years – 65 (41,0%).Results. It was determined that absence of Escherichia coli (55,7%) and bifidobacterium (81,2%) prevailed in patients on inpatient treatment while in patients on outpatient treatment there was the reduction of these bacteria (67,3% and 36,5% accordingly). Among the representatives of opportunistic microflora, the leading place was occupied by Candida albicans, which was diagnosed in 50% of both inpatient and outpatient children. Only 12,8% cases there were diagnosed with Staphylococcus aureus, Proteus, one patient was diagnosed with Klebsiella, and 5 (9,6%) patients were diagnosed with Salmonellaenteritidis.

Long-Term Persistence of Anti-SARS-CoV-2 Antibodies in a Pediatric Population

Background: Antibody dynamics over time after SARS-CoV-2 infection are still unclear, and data regarding children are scarce. Methods: A prospective cohort study was performed including children infected by SARS-CoV-2 between March and May 2020. Patients were categorized into 3 groups: children admitted with COVID-19; outpatient children with mild COVID-19; and seropositive children participating in a seroprevalence study among cohabitants of infected healthcare workers (HCWs). Six months after the infection, a new serological control was performed. Results: A total of 58 children were included, 50% male (median age 8.3 [IQR 2.8–13.5] years). The median time between the two serological studies was 186 (IQR 176–192) days, and 86% (48/56) of the children maintained positive IgG six months after the infection. This percentage was 100% in admitted patients and 78% among the rest of the included children (p = 0.022). The diagnoses of lower respiratory tract infection and multisystemic inflammatory syndrome were associated with persistence of IgG (p = 0.035). The children of HCWs in the seroprevalence study lost antibodies more often (p = 0.017). Initial IgG titers of the children who remained positive six months after the infection were significantly higher (p = 0.008). Conclusions: Most children infected by SARS-CoV-2 maintain a positive serological response six months after the infection. Those children who lost their IgG titer were more frequently asymptomatic or mildly symptomatic, presenting with low antibody titers after the infection.

Blow pinwheels improve oxygen saturation of preschool children with post pneumonia in outpatient pediatric departement

This study aimed to recognize the Pursed Lips Breathing (PLB) modification effect by blowing pinwheel to the oxygen saturation of preschool children with post pneumonia. Also, to analyze the oxygen saturation value of the preschool children with pneumonia on the intervention group and the control group and to recognize the differences. This study design was quasi experimental pre-posttest with control group design. The participants were 30 preschool children with post pneumonia (15 children were in the intervention group, 15 were in the control group) and were chosen by consecutive sampling. This study showed significant differences on oxygen saturation between the intervention group and control group (p=0.018<0.05). Blowing pinwheel affected the oxygen saturation of the preschool age with pneumonia on the intervention group but none on the control group. The results of this study can be used as the basis and reference for the hospital in making policies, as founded that blowing pinwheel affected the oxygen saturation escalation of the preschool children with pneumonia after several exercises. This activity was recommended to be implemented at the hospital as the treatment for the outpatient children with pneumonia and to be carried on at home for the preschool children who were able to perform independently. The recommendation for the further study was to use a true experiment with a larger sample and was not limited to PLB but also to measure the ability to blow.

Performance of RT-PCR on saliva specimens compared to nasopharyngeal swabs for the detection of SARS-CoV-2 in children: A prospective comparative clinical trial

Background: Saliva RT-PCR is an attractive alternative for the detection of SARS-CoV-2 in adults with much less known in children. Methods: Children and adolescents with symptoms suggestive of COVID-19 were prospectively enrolled in a comparative clinical trial of saliva and nasopharyngeal (NP) RT-PCR between November and December 2020. Detection rates and sensitivities of saliva and NP RT-PCR were compared. Participants with discordant NP and saliva RT-PCR results including viral load (VL) were also analyzed. Result: Out of 405 patients enrolled, 397 patients had two tests performed. Mean age was 12.7 years (range 1.2-17.9). Detection rates were 22.9% (95%CI 18.8-27.1%) by saliva RT-PCR, 25.4% (21.2-29.7%) by NP RT-PCR, and 26.7% (22.4-31.1%) by any test. The sensitivity of saliva was 85.2% (78.2-92.1%) when using NP as the gold standard; in contrast, when saliva was considered the gold standard, the sensitivity of NP was 94.5% (89.8-99.2%).For a NP RT-PCR VL threshold of ≥103 and ≥104 copies/ml, sensitivity of saliva increases to 88.7% and 95.2% respectively. Sensitivity of saliva and NP swabs was respectively 89.5% and 95.3% in patient with symptoms less than 4 days (p=0.249) and 70.0% and 95.0% in those with symptoms ≥ 4 to 7 days (p=0.096). The 15 patients who had an isolated positive NP RT-PCR were significantly younger (p=0.034), had a lower NP VL (median 5.6x103 vs 3.9x107, p<0.001), and were not able to drool saliva at the end of the sampling (p=0.002). VLs were significantly lower with saliva PCR than with NP RT-PCR (median 8.7 cp/ml x104; IQR 1.2x104-5.2x105; vs median 4.0x107cp/ml; IQR 8.6x105-1.x108; p<0.001). Conclusion: Saliva PCR shows diagnostic performances close to NP RT-PCR for SARS-CoV2 detection in most symptomatic outpatient children and adolescents.