Health authorities worldwide have
adopted measures of social distancing
and movement restrictions, in addition
to other public health measures to reduce
exposure and to suppress interhuman
SARS-CoV-
2 transmission. In Italy, a
national lockdown with school closure
was introduced from March to May 2020.
From November 2020, Italy has been
divided into zones according to regional
epidemiological data, with primary
schools reopened, associated with the
mandatory use of face masks and different
levels of social distance measures. For
children with symptoms suggestive of
COVID-19, the surveillance mechanism
for the control of SARS-CoV-
2 infection
is based on the performance of a real-time
PCR on a nasopharyngeal swab. A
diagnostic test has been introduced at the
tertiary-level
university hospital, Institute
for Maternal and Child Health, IRCCS
\u201cBurlo Garofolo\u201d of Trieste, consisting of
a multiple nucleic acid amplification assay
for 13 common viral respiratory pathogens
on nasopharyngeal swab (Respiratory
Flow Chip assay (Vitro, Sevilla,
Spain), including SARS-CoV-
2, influenza
A and B, adenovirus, other coronaviruses,
parainfluenza virus 1\u20134, enteroviruses,
bocavirus, metapneumovirus, respiratory
syncytial virus (RSV), rhinoviruses, Bordetella
pertussis, Bordetella parapertussis
and Mycoplasma pneumoniae. Before
routine utilisation, international standard
quality control samples for each pathogen
were used for test validation, and no
cross-detection
was found between the
different pathogens. Criteria for testing
referral did not change during the study
period. Weekly variability of the number
of total tests performed was due to the
normal variations of acute illness. During
the last winter season, from September
2020 (week 39) to February 2021 (week
7), 1138 nasopharyngeal swabs were
tested for patients younger than 17 years
old (figure 1). No influenza A or B nor
RSV was detected during this period.
The most common pathogen was rhinovirus
(n=505), followed by adenoviruses
(n=131), other coronaviruses (n=101)
and SARS-CoV-
2 (n=57). Our data show
that common winter pathogens circulation
changed, and influenza virus and RSV
did not produce a seasonal epidemic in
the 2020\u20132021 winter season. These data
suggest that social distancing measures
and mask wearing profoundly changed
the seasonality of winter paediatric respiratory
infections that are mainly spread
by respiratory droplets. The reasons why
rhinovirus remains the main pathogen
despite social distancing and face mask
use are still a matter of debate. Similar
data showing a decrease of common viral
respiratory infections during the winter
season have recently been reported in the
southern hemisphere.1\u20134 Our data refer
to a single institute, covering paediatric
population of the Trieste Province (about
230 000 inhabitants), limiting the generalisation
of our findings. However, our
results highlight the need for continuing
surveillance for the delayed spread of such
viruses during spring and summer
