Avaliação epidemiológica de SARS-CoV-2 e a ocorrência de outros vírus respiratórios em crianças pneumopatas
Data
2024-12-02
Autores
Conte, Danielle Dias 
Orientadores
Bellei, Nancy Cristina Junqueira
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Avaliar os aspectos epidemiológicos e virológicos do Betacoronavírus pandêmico (SARS-CoV-2), em crianças com doenças pulmonares crônicas, como fibrose cística e outras pneumopatias atendidas nos ambulatórios de pneumologia pediátrica do Complexo Hospital São Paulo/UNIFESP. Avaliar esses mesmos aspectos em crianças sem comorbidades atendidas no ambulatório de pediatria geral, Núcleo de apoio a família ou atendidas na Unidade de pronto atendimento para estabelecer possíveis comparações. O objetivo secundário, analisar a ocorrência de outros vírus respiratórios diante no cenário pandêmico e pós pandêmico. Metodologia: No período de janeiro de 2021 a julho de 2024, amostras de Swab de nasofaringe e orofaringe foram coletadas de crianças com 0 a 12 anos, crianças com doença pulmonar crônica assintomáticas (PNA) ou crianças com doença pulmonar crônica sintomáticos (PNS) para infecção respiratória aguda e de um grupo controle (GC) de crianças sintomáticas e sem comorbidades. Foram realizados teste rápido de detecção de anticorpo contra SARS-CoV-2, além de detecção genômica do SARS-CoV-2 e outros vírus respiratórios utilizando a técnica de reação em cadeia da polimerase precedida por transcrição reversa (RT-PCR). A comparação entre os grupos considerou dados temporais e estatísticos, considerando intervalo de confiança de 95% e p<0,05. Resultados: A detecção de anticorpos contra o SARS-CoV-2 foi realizada em 185 crianças, sendo 26,48% (49) reagentes para o anticorpo IgG contra COVID-19. Nenhuma dessas crianças havia sido vacinada contra a COVID-19. No grupo crianças com doença pulmonar crônica (PN) foi de 21.89% (37/169), sendo a faixa etária com maior detecção as crianças maiores de 5 anos, com 45.94% (17/37) dos casos, já no GC foram em 75% (12/16) dos casos. A positividade geral por RT-PCR foi 28,33% de vírus respiratórios, desses a COVID-19 foi detectada apenas em 3,33% e os outros vírus respiratórios com 25% de detecção. As análises das amostras dos grupos sintomáticos no mesmo período, demonstrou uma diferença significante entre os grupos. No PNA, houve apenas uma detecção viral, correspondendo a 1% (1/100) dos casos, com identificação do rinovírus (HRV) em uma criança de 2 < 5 anos, no ano de 2022. A detecção viral no PNS foi de 30,88% (21/68) e o grupo controle foi em 56% (56/100), nessa comparação houve diferença significante (p=0,002, OR= 2,78, IC 95% (1,45– 5,31), demonstrando que as crianças do grupo controle têm 2,78 vezes mais chances de detecção viral. A faixa etária com maior detecção viral forma os menores de 1 ano e a menor detecção viral entre 2 < 5 anos. A avaliação de detecção viral geral anual mostrou uma diferença significante indicando que a detecção viral em 2023 foi 36 vezes maior do que no ano de 2021 (p = 0,001; OR = 36,66; IC 95%: 10,10 – 133,09). Analisando os dois grupos com amostras coletadas no mesmo período as crianças com doenças pulmonares crônicas sintomáticas apresentaram 30,88% (21/68) de detecção viral. Já no grupo controle a detecção viral foi de 56% (56/100). Houve diferença significante entres esses grupos, (p=0,002, OR= 2,78, IC 95% (1,45– 5,31), demonstrando que as crianças do grupo controle têm 2,78 vezes mais chances de detecção viral. A distribuição viral ao longo do estudo demonstrou que o SARS-CoV-2, teve a maior prevalência registrada no ano de 2024, com 60% dos casos nas faixas etárias de 2< 5 anos e maiores de 5 anos apresentaram quantidades semelhantes de detecção. Na análise de ocorrência de outros vírus, os mais frequentes foram o HRV 8,33%, influenza (FLUA)/(H1N1/H2N2) e vírus sincicial respiratório (HRSV), ambos com 4,33%. Os únicos vírus respiratorios que apresentarem ocorrência anual foram o HRV e o parainfluenza com 2,33% dos casos. A taxa de codetecção foi de 1,66%. Outro dado relevante refere-se à vacinação: entre as crianças com doenças pulmonares crônicas, apenas 49 eram elegíveis para a vacinação contra a COVID-19, das quais 51% (25 crianças) foram vacinadas. Em relação à vacinação contra a influenza, 49% (98) das crianças foram vacinadas. Todas as crianças do grupo controle eram elegíveis para a vacinação contra a COVID-19, mas apenas 75% (66) receberam a vacina. Quanto à vacinação contra a influenza, apenas 57 crianças eram elegíveis, das quais 57,89% (33) foram vacinadas. Conclusão: Essas conclusões destacam a importância de políticas de saúde pública voltadas, especialmente, para crianças menores 1 anos que foi a faixa etária com maior deteção viral e a baixa adesão vacinal, principalmente em crianças com doença pulmonar crônica. É necessário traçar estratégias frequentes de controle da transmissão viral, uma maior abrangência da vigilância genômica dos vírus respiratórios mais prevalentes em crianças. implementação de medidas mais rigorosas eficácia das de vacinação. Tais ações são essenciais para mitigar os impactos da COVID-19 e de outras doenças respiratórias.
Objectives: Evaluate the epidemiological and virological aspects of the pandemic Betacoronavirus (SARS-CoV-2) in children with lung diseases such as cystic fibrosis and other pneumopathies treated in pediatric pulmonology outpatient clinics at the São Paulo Hospital Complex/UNIFESP. To establish possible comparisons, assess the same aspects in children without comorbidities seen in general pediatrics outpatient clinics, Family Support Centers, or emergency care units. The secondary objective is to analyze the occurrence of other respiratory viruses during the pandemic and post-pandemic scenarios. Methodology: From January 2021 to July 2024, nasopharyngeal and oropharyngeal swab samples were collected from children aged 0 to 12 years, including asymptomatic children with chronic lung disease (PNA), symptomatic children with chronic lung disease (PNS) with acute respiratory infections and a control group (CG) of symptomatic children without comorbidities. Rapid antibody detection tests for SARS-CoV-2 were conducted, as well as genomic detection of SARS-CoV-2 and other respiratory viruses using reverse transcription polymerase chain reaction (RT-PCR). Group comparisons included temporal and statistical data with a confidence interval of 95% and p<0.05. Results: Antibody detection for SARS-CoV-2 was conducted on 185 children, of whom 26.48% (49) tested positive for COVID-19 IgG antibodies. None of these children had been vaccinated against COVID-19. In the chronic lung disease group (PN), 21.89% (37/169) tested positive, with the highest detection rate among children older than 5 years, accounting for 45.94% (17/37) of cases. In the control group, 75% (12/16) tested positive. The overall positivity for respiratory viruses by RT-PCR was 28.33%, COVID-19 detected in only 3.33% of cases, and other respiratory viruses in 25%. Analysis of symptomatic groups during the same period showed significant differences between groups. In the PNA group, there was only one viral detection, corresponding to 1% (1/100) of cases, identifying rhinovirus (HRV) in a child aged 2 to <5 years in 2022. Viral detection in the PNS group was 30.88% (21/68), while in the control group, it was 56% (56/100), a significant difference (p=0.002, OR=2.78, 95% CI: 1.45–5.31), showing that children in the control group were 2.78 times more likely to have viral detection. The age group with the highest viral detection was infants under 1 year, while the lowest detection was among children aged 2 to <5 years. Annual general viral detection showed a significant increase in 2023, being 36 times higher than in 2021 (p=0.001; OR=36.66; 95% CI: 10.10–133.09). Analysis of both groups during the same period revealed that symptomatic pneumopathy children had 30.88% (21/68) viral detection, whereas in the control group, viral detection was 56% (56/100). There was a significant difference between these groups (p=0.002, OR=2.78, 95% CI: 1.45–5.31), again indicating that children in the control group were 2.78 times more likely to have viral detection. The viral distribution throughout the study showed that SARS-CoV-2 had the highest prevalence in 2024, with 60% of cases occurring in children aged 2 to <5 years and older than 5 years, showing similar detection rates. Among other viruses, the most frequent were HRV at 8.33%, influenza (FLUA)/(H1N1/H2N2), and respiratory syncytial virus (HRSV), each at 4.33%. HRV and parainfluenza were the only respiratory viruses with annual occurrence, accounting for 2.33% of cases. The co-detection rate was 1.66%. Another relevant finding relates to vaccination: among children with lung disease, only 49 were eligible for COVID-19 vaccination, of whom 51% (25 children) were vaccinated. Regarding influenza vaccination, 49% (98) of children were vaccinated. All children in the control group were eligible for COVID-19 vaccination, but only 75% (66) received the vaccine. Only 57 children were eligible for influenza vaccination, of whom 57.89% (33) were vaccinated. Conclusion: These findings highlight the importance of public health policies focused particularly on children under 1 year, the age group with the highest viral detection, and on addressing low vaccination adherence, especially among children with chronic lung disease. It is necessary to establish frequent strategies for controlling viral transmission, expanding genomic surveillance for the most prevalent respiratory viruses in children, and implementing more rigorous and effective vaccination measures. These actions are essential to mitigate the impacts of COVID-19 and other respiratory diseases. To evaluate the epidemiological and virological aspects of the pandemic Betacoronavirus (SARS-CoV-2) in children with cystic fibrosis and other pulmonary diseases treated at the pediatric pulmonology outpatient clinics of the São Paulo Hospital Complex/UNIFESP. To assess these same aspects in children without comorbidities treated at the general pediatric outpatient clinic, Family Support Center (NASF), or at the Emergency Care Unit (UPA) to establish possible comparisons. The secondary objective is to analyze the occurrence of other respiratory viruses in the pandemic and post-pandemic scenario. Methodology: From January 2021 to July 2024, nasopharyngeal and oropharyngeal swab samples were collected from children aged 0 to 12 years, either asymptomatic or symptomatic for acute respiratory infection, and from a control group of symptomatic children without comorbidities. Rapid antibody detection tests for SARS-CoV-2 were performed, as well as genomic detection of SARS-CoV-2 and other respiratory viruses using the RT-PCR technique. Comparisons between the groups considered temporal and statistical data, with a 95% confidence interval and p<0.05. Results: The detection of antibodies against SARS-CoV-2 was performed in 185 children, with 26.48% (49) testing positive for COVID-19 IgG antibodies. None of these children had been vaccinated against COVID-19. In the PN group, the positivity rate was 21.89% (37/169), with the highest detection among children older than 5 years, accounting for 45.94% (17/37) of cases. In the GC group, 75% (12/16) of cases tested positive. The overall positivity for respiratory viruses by RT-PCR was 28.33%, with COVID-19 detected in only 3.33% of cases and other respiratory viruses in 25% of cases. Analysis of samples from symptomatic groups during the same period showed a significant difference between the groups. In the PNA, there was only one viral detection, corresponding to 1% (1/100) of cases, with HRV identified in a child aged 2 to < 5 years in 2022. In the PN group, the detection rate was 21.89% (37/169), with the highest detection among children older than 5 years, accounting for 45.94% (17/37) of cases. In the GC group, 75% (12/16) of cases were detected. Overall RT-PCR positivity for respiratory viruses was 28.33%, with COVID-19 detected in only 3.33% of cases and other respiratory viruses in 25%. Analysis of samples from symptomatic groups during the same period showed a significant difference between groups. Viral detection in the PNS group was 30.88% (21/68), and in the control group, it was 56% (56/100), showing a significant difference (p=0.002, OR=2.78, 95% CI: 1.45–5.31), indicating that children in the control group were 2.78 times more likely to have viral detection. The age group with the highest viral detection was under 1 year, while the lowest detection was in children aged 2 to <5 years. Annual viral detection analysis revealed a significant difference, indicating that viral detection in 2023 was 36 times higher than in 2021 (p=0.001; OR=36.66; 95% CI: 10.10–133.09). In samples collected in the same period, symptomatic pneumopathy children showed 30.88% (21/68) viral detection, while the control group had 56% (56/100), with a significant difference (p=0.002, OR=2.78, 95% CI: 1.45–5.31), indicating that children in the control group were 2.78 times more likely to have viral detection. Viral distribution throughout the study showed that SARS-CoV-2 had the highest prevalence in 2024, with 60% of cases in children aged 2 to <5 years and those older than 5 years having similar detection rates. Analysis of other viruses showed that the most frequent were HRV at 8.33%, FLUA (H1N1/H2N2), and HRSV, both at 4.33%. The only viruses with annual occurrence were HRV and parainfluenza, each accounting for 2.33% of cases. The co-detection rate was 1.66%. Another relevant finding was vaccination: among pneumopathy children, only 49 were eligible for COVID-19 vaccination, and 51% (25 children) were vaccinated. For influenza vaccination, 49% (98) of children were vaccinated. All children in the control group were eligible for COVID-19 vaccination, but only 75% (66) were vaccinated. Regarding influenza vaccination, only 57 children were eligible, and 57.89% (33) were vaccinated. Conclusion: These findings underscore the importance of public health policies, especially for children under 1 year, emphasizing frequent viral transmission control strategies, broader genomic surveillance of prevalent respiratory viruses in children, and stricter vaccination measures. Such actions are essential to mitigate the impact of COVID-19 and other respiratory diseases in these groups.
Objectives: Evaluate the epidemiological and virological aspects of the pandemic Betacoronavirus (SARS-CoV-2) in children with lung diseases such as cystic fibrosis and other pneumopathies treated in pediatric pulmonology outpatient clinics at the São Paulo Hospital Complex/UNIFESP. To establish possible comparisons, assess the same aspects in children without comorbidities seen in general pediatrics outpatient clinics, Family Support Centers, or emergency care units. The secondary objective is to analyze the occurrence of other respiratory viruses during the pandemic and post-pandemic scenarios. Methodology: From January 2021 to July 2024, nasopharyngeal and oropharyngeal swab samples were collected from children aged 0 to 12 years, including asymptomatic children with chronic lung disease (PNA), symptomatic children with chronic lung disease (PNS) with acute respiratory infections and a control group (CG) of symptomatic children without comorbidities. Rapid antibody detection tests for SARS-CoV-2 were conducted, as well as genomic detection of SARS-CoV-2 and other respiratory viruses using reverse transcription polymerase chain reaction (RT-PCR). Group comparisons included temporal and statistical data with a confidence interval of 95% and p<0.05. Results: Antibody detection for SARS-CoV-2 was conducted on 185 children, of whom 26.48% (49) tested positive for COVID-19 IgG antibodies. None of these children had been vaccinated against COVID-19. In the chronic lung disease group (PN), 21.89% (37/169) tested positive, with the highest detection rate among children older than 5 years, accounting for 45.94% (17/37) of cases. In the control group, 75% (12/16) tested positive. The overall positivity for respiratory viruses by RT-PCR was 28.33%, COVID-19 detected in only 3.33% of cases, and other respiratory viruses in 25%. Analysis of symptomatic groups during the same period showed significant differences between groups. In the PNA group, there was only one viral detection, corresponding to 1% (1/100) of cases, identifying rhinovirus (HRV) in a child aged 2 to <5 years in 2022. Viral detection in the PNS group was 30.88% (21/68), while in the control group, it was 56% (56/100), a significant difference (p=0.002, OR=2.78, 95% CI: 1.45–5.31), showing that children in the control group were 2.78 times more likely to have viral detection. The age group with the highest viral detection was infants under 1 year, while the lowest detection was among children aged 2 to <5 years. Annual general viral detection showed a significant increase in 2023, being 36 times higher than in 2021 (p=0.001; OR=36.66; 95% CI: 10.10–133.09). Analysis of both groups during the same period revealed that symptomatic pneumopathy children had 30.88% (21/68) viral detection, whereas in the control group, viral detection was 56% (56/100). There was a significant difference between these groups (p=0.002, OR=2.78, 95% CI: 1.45–5.31), again indicating that children in the control group were 2.78 times more likely to have viral detection. The viral distribution throughout the study showed that SARS-CoV-2 had the highest prevalence in 2024, with 60% of cases occurring in children aged 2 to <5 years and older than 5 years, showing similar detection rates. Among other viruses, the most frequent were HRV at 8.33%, influenza (FLUA)/(H1N1/H2N2), and respiratory syncytial virus (HRSV), each at 4.33%. HRV and parainfluenza were the only respiratory viruses with annual occurrence, accounting for 2.33% of cases. The co-detection rate was 1.66%. Another relevant finding relates to vaccination: among children with lung disease, only 49 were eligible for COVID-19 vaccination, of whom 51% (25 children) were vaccinated. Regarding influenza vaccination, 49% (98) of children were vaccinated. All children in the control group were eligible for COVID-19 vaccination, but only 75% (66) received the vaccine. Only 57 children were eligible for influenza vaccination, of whom 57.89% (33) were vaccinated. Conclusion: These findings highlight the importance of public health policies focused particularly on children under 1 year, the age group with the highest viral detection, and on addressing low vaccination adherence, especially among children with chronic lung disease. It is necessary to establish frequent strategies for controlling viral transmission, expanding genomic surveillance for the most prevalent respiratory viruses in children, and implementing more rigorous and effective vaccination measures. These actions are essential to mitigate the impacts of COVID-19 and other respiratory diseases. To evaluate the epidemiological and virological aspects of the pandemic Betacoronavirus (SARS-CoV-2) in children with cystic fibrosis and other pulmonary diseases treated at the pediatric pulmonology outpatient clinics of the São Paulo Hospital Complex/UNIFESP. To assess these same aspects in children without comorbidities treated at the general pediatric outpatient clinic, Family Support Center (NASF), or at the Emergency Care Unit (UPA) to establish possible comparisons. The secondary objective is to analyze the occurrence of other respiratory viruses in the pandemic and post-pandemic scenario. Methodology: From January 2021 to July 2024, nasopharyngeal and oropharyngeal swab samples were collected from children aged 0 to 12 years, either asymptomatic or symptomatic for acute respiratory infection, and from a control group of symptomatic children without comorbidities. Rapid antibody detection tests for SARS-CoV-2 were performed, as well as genomic detection of SARS-CoV-2 and other respiratory viruses using the RT-PCR technique. Comparisons between the groups considered temporal and statistical data, with a 95% confidence interval and p<0.05. Results: The detection of antibodies against SARS-CoV-2 was performed in 185 children, with 26.48% (49) testing positive for COVID-19 IgG antibodies. None of these children had been vaccinated against COVID-19. In the PN group, the positivity rate was 21.89% (37/169), with the highest detection among children older than 5 years, accounting for 45.94% (17/37) of cases. In the GC group, 75% (12/16) of cases tested positive. The overall positivity for respiratory viruses by RT-PCR was 28.33%, with COVID-19 detected in only 3.33% of cases and other respiratory viruses in 25% of cases. Analysis of samples from symptomatic groups during the same period showed a significant difference between the groups. In the PNA, there was only one viral detection, corresponding to 1% (1/100) of cases, with HRV identified in a child aged 2 to < 5 years in 2022. In the PN group, the detection rate was 21.89% (37/169), with the highest detection among children older than 5 years, accounting for 45.94% (17/37) of cases. In the GC group, 75% (12/16) of cases were detected. Overall RT-PCR positivity for respiratory viruses was 28.33%, with COVID-19 detected in only 3.33% of cases and other respiratory viruses in 25%. Analysis of samples from symptomatic groups during the same period showed a significant difference between groups. Viral detection in the PNS group was 30.88% (21/68), and in the control group, it was 56% (56/100), showing a significant difference (p=0.002, OR=2.78, 95% CI: 1.45–5.31), indicating that children in the control group were 2.78 times more likely to have viral detection. The age group with the highest viral detection was under 1 year, while the lowest detection was in children aged 2 to <5 years. Annual viral detection analysis revealed a significant difference, indicating that viral detection in 2023 was 36 times higher than in 2021 (p=0.001; OR=36.66; 95% CI: 10.10–133.09). In samples collected in the same period, symptomatic pneumopathy children showed 30.88% (21/68) viral detection, while the control group had 56% (56/100), with a significant difference (p=0.002, OR=2.78, 95% CI: 1.45–5.31), indicating that children in the control group were 2.78 times more likely to have viral detection. Viral distribution throughout the study showed that SARS-CoV-2 had the highest prevalence in 2024, with 60% of cases in children aged 2 to <5 years and those older than 5 years having similar detection rates. Analysis of other viruses showed that the most frequent were HRV at 8.33%, FLUA (H1N1/H2N2), and HRSV, both at 4.33%. The only viruses with annual occurrence were HRV and parainfluenza, each accounting for 2.33% of cases. The co-detection rate was 1.66%. Another relevant finding was vaccination: among pneumopathy children, only 49 were eligible for COVID-19 vaccination, and 51% (25 children) were vaccinated. For influenza vaccination, 49% (98) of children were vaccinated. All children in the control group were eligible for COVID-19 vaccination, but only 75% (66) were vaccinated. Regarding influenza vaccination, only 57 children were eligible, and 57.89% (33) were vaccinated. Conclusion: These findings underscore the importance of public health policies, especially for children under 1 year, emphasizing frequent viral transmission control strategies, broader genomic surveillance of prevalent respiratory viruses in children, and stricter vaccination measures. Such actions are essential to mitigate the impact of COVID-19 and other respiratory diseases in these groups.
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CONTE, Danielle Dias. Avaliação epidemiológica de SARS-CoV-2 e a ocorrência de outros vírus respiratórios em crianças pneumopatas. 2024. 86 f. Tese (Doutorado em Infectologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.