Linking digital surveillance and in-depth virology to study clinical patterns of viral respiratory infections in vulnerable patient populations

To improve the identification and management of viral respiratory infections, we established a clinical and virologic surveillance program for pediatric patients fulfilling pre-defined case criteria of influenza-like illness and viral respiratory infections. The program resulted in a cohort comprising 6,073 patients (56% male, median age 1.6 years, range 0–18.8 years), where every patient was assessed with a validated disease severity score at the point-of-care using the ViVI ScoreApp. We used machine learning and agnostic feature selection to identify characteristic clinical patterns. We tested all patients for human adenoviruses, 571 (9%) were positive. Adenovirus infections were particularly common and mild in children ≥1 month of age but rare and potentially severe in neonates: with lower airway involvement, disseminated disease, and a 50% mortality rate (n = 2/4). In one fatal case, we discovered a novel virus: HAdV-80. Standardized surveillance leveraging digital technology helps to identify characteristic clinical patterns, risk factors, and emerging pathogens.Peer Reviewe

Virological Surveillance and Molecular Characterization of Human Parainfluenzavirus Infection in Children with Acute Respiratory Illness: Germany, 2015–2019

Human parainfluenza viruses (HPIVs) are important causes of respiratory illness, especially in young children. However, surveillance for HPIV is rarely performed continuously, and national-level epidemiologic and genetic data are scarce. Within the German sentinel system, to monitor acute respiratory infections (ARI), 4463 respiratory specimens collected from outpatients < 5 years of age between October 2015 and September 2019 were retrospectively screened for HPIV 1–4 using real-time PCR. HPIV was identified in 459 (10%) samples. HPIV-3 was the most common HPIV-type, with 234 detections, followed by HPIV-1 (113), HPIV-4 (61), and HPIV-2 (49). HPIV-3 was more frequently associated with age < 2 years, and HPIV-4 was more frequently associated with pneumonia compared to other HPIV types. HPIV circulation displayed distinct seasonal patterns, which appeared to vary by type. Phylogenetic characterization clustered HPIV-1 in Clades 2 and 3. Reclassification was performed for HPIV-2, provisionally assigning two distinct HPIV-2 groups and six clades, with German HPIV-2s clustering in Clade 2.4. HPIV-3 clustered in C1, C3, C5, and, interestingly, in A. HPIV-4 clustered in Clades 2.1 and 2.2. The results of this study may serve to inform future approaches to diagnose and prevent HPIV infections, which contribute substantially to ARI in young children in Germany.Peer Reviewe

Sensitive on-site detection of SARS-CoV-2 by ID NOW COVID-19

Point of care detection of SARS-CoV-2 is one pillar in a containment strategy and important to break infection chains. Here we report the sensitive, specific and robust detection of SARS-CoV-2 and respective variants of concern by the ID NOW COVID-19 device.Peer Reviewe

Respiratory infections in children and adolescents in Germany during the COVID-19 pandemic

Background: Before the COVID-19 pandemic, acute respiratory infections (ARIs) in children were mainly characterised by three pathogens: respiratory syncytial viruses (RSV), influenza viruses and rhinoviruses. The impact of the COVID-19 pandemic and the measures taken in Germany (especially until the end of 2021) on the incidence of ARI in children and adolescents aged 0 to 14 years and the pathogens causing them has not yet been comprehensively analysed. Methods: The evaluation is based on data from population-based, virological and hospital-based surveillance instruments up to the end of 2022. Results: After the onset of the COVID-19 pandemic in early 2020, ARI rates remained almost consistently below pre-pandemic levels until autumn 2021, with only rhinoviruses continuously continuing to cause ARI. Only when the Omicron variant became predominant in 2022, there were measurable COVID-19 rates at population level in children, although COVID-19 hospitalisation rates remained comparatively low. RSV and influenza waves were initially absent and then occurred ‘out of season’, but were more severe than usual. Conclusions: While the measures taken were effective in inhibiting the number of respiratory infections for almost 1.5 years, moderately frequent but rather mild COVID-19 cases occurred when measures were lifted. When Omicron emerged in 2022 COVID-19 became moderately frequent but led predominantly to mild illnesses. For RSV and influenza, the measures resulted in changes in their annual timing and intensity

Diagnostic Approach for the Differentiation of the Pandemic Influenza A(H1N1)v Virus from Recent Human Influenza Viruses by Real-Time PCR

BACKGROUND: The current spread of pandemic influenza A(H1N1)v virus necessitates an intensified surveillance of influenza virus infections worldwide. So far, in many laboratories routine diagnostics were limited to generic influenza virus detection only. To provide interested laboratories with real-time PCR assays for type and subtype identification, we present a bundle of PCR assays with which any human influenza A and B virus can be easily identified, including assays for the detection of the pandemic A(H1N1)v virus. PRINCIPAL FINDINGS: The assays show optimal performance characteristics in their validation on plasmids containing the respective assay target sequences. All assays have furthermore been applied to several thousand clinical samples since 2007 (assays for seasonal influenza) and April 2009 (pandemic influenza assays), respectively, and showed excellent results also on clinical material. CONCLUSIONS: We consider the presented assays to be well suited for the detection and subtyping of circulating influenza viruses

Atemwegsinfektionen bei Kindern und Jugendlichen in Deutschland während der COVID-19-Pandemie

Hintergrund: Akute respiratorische Erkrankungen (ARE) im Kindesalter waren vor der COVID-19-Pandemie vor allem durch die drei Erreger Respiratorische Synzytialviren (RSV), Grippe-(Influenza-) und Rhinoviren geprägt. Die Auswirkungen der COVID-19-Pandemie und der getroffenen Maßnahmen (vor allem bis Ende 2021) in Deutschland auf die Häufigkeit von ARE bei Kindern und Jugendlichen im Alter von 0 – 14 Jahren sowie die sie auslösenden Erreger wurden bisher nicht umfassend analysiert. Methode: Ausgewertet wurden Daten aus bevölkerungs-, virologischen und Krankenhaus-basierten Erhebungsinstrumenten bis Jahresende 2022. Ergebnisse: Nach dem Beginn der COVID-19-Pandemie zu Jahresbeginn 2020 blieben die ARE-Raten bis zum Herbst 2021 fast durchgehend unterhalb des vorpandemischen Niveaus, nur Rhinoviren führten kontinuierlich weiterhin zu ARE. Erst mit der Dominanz der Omikron-Variante ab 2022 kam es auf Bevölkerungsebene zu messbaren COVID-19-Raten bei Kindern, wobei die COVID-19-Hospitalisierungsraten vergleichsweise niedrig blieben. RSV- und Influenzawellen fielen zunächst aus und traten dann zu ungewöhnlichen Jahreszeiten, dann aber heftiger als üblich auf. Schlussfolgerungen: Während die getroffenen Maßnahmen die Zahl der Atemwegsinfekte über fast 1,5 Jahre wirksam zu hemmen vermochten, kam es mit der zunehmenden Rücknahme von Maßnahmen und im Rahmen des Auftretens der Omikron-Variante im Jahr 2022 zu moderat häufigen, jedoch eher leichten COVID-19-Erkrankungen. Bei RSV und Influenza führten die Maßnahmen zu Wellenrhythmus- und Intensitätsveränderungen

Influenza-Wochenbericht 44

Die Aktivität der akuten Atemwegserkrankungen (ARE) ist in der 44. Kalenderwoche (KW) 2018 bundesweit relativ stabil geblieben, die Werte des Praxisindex lagen in der 44. KW insgesamt im Bereich der AREHintergrund- Aktivität. Die Werte der Konsultationsinzidenz sind im Vergleich zur Vorwoche gesunken. Im Nationalen Referenzzentrum für Influenza (NRZ) wurden in der 44. KW 2018 in 16 (28 %) von 57 Sentinelproben respiratorische Viren identifiziert. Dabei handelt es sich hauptsächlich um Rhinoviren. In der 44. Meldewoche (MW) wurden nach Infektionsschutzgesetz (IfSG) bislang 27 labordiagnostisch bestätigte Influenzafälle an das Robert Koch-Institut (RKI) übermittelt (Datenstand: 06.11.2018)

Todesfall eines Kindes im Rahmen eines Influenza-Ausbruchs in einem Kindergarten

Im Epidemiologischen Bulletin 22/2018 wird ein Ausbruchsgeschehen durch Influenza-A(H1N1)pdm09-Virus in einer Kita und deren sozialer Umgebung analysiert. Die Mehrheit der involvierten Personen war nicht gegen Influenza immunisiert. Die Variation der Symptome bei den Erkrankten von leichtem Husten bis hin zu respiratorischem Versagen infolge Pneumonie bei diesem Influenza-Ausbruch mit genetisch, innerhalb des Kerngeschehens, unverändertem Virus zeigt, dass die Influenza auf individueller Ebene unterschiedliche Verläufe nehmen kann, die nicht vorhersagbar sind.Peer Reviewe