In European countries, pediatric respiratory infections are responsible for 30% of all hospital admissions and they represent the 60% of causes of pediatric consultation. Among respiratory diseases, in infants, acute bronchiolitis is the most common lower respiratory tract infections and the leading cause of hospitalization in infants less than 12 months of age. It is mainly caused by Respiratory Syncytial Virus (RSV) but other respiratory viruses can often be involved. Notably, emerging viral infectious diseases originate from (wild) animal reservoirs: among them, respiratory tract viral infections pose great threats worldwide, as exemplified by the ongoing pandemic caused by SARS-CoV-2. Diseases related to these emerging infectious agents can have major consequences in terms of public health. There is an urgent need for integrated knowledge from a multidisciplinary research approach, including all expertise from the different health specialties (paediatrics, virology and epidemiology) in order to face present and future infectious threats. In this scenario, we hypothesize that respiratory viruses infections are influenced by the emergence of SARS-CoV-2 and/or by the behavioural and social interventions adopted to contain the outbreak of the virus. We propose a study on children attending ER with respiratory symptoms with the aims of: establishing the influence of SARS-CoV-2 infection and/or physical distancing on respiratory viruses epidemiology; giving insights into the epidemiology of respiratory viral infections in children; and identifying factors involved in determining children susceptibility to viral infections. The demonstration of the impact of Sars-Cov-2 pandemic would improve the understanding of respiratory infections epidemiology and would inform policy decisions on the containing effects of these strategies.
This project will be mainly focused on studying the epidemiology of 15 respiratory viruses in children, to evaluate how the novel spread of SARS-CoV-2,along with the new rules of social distancing, is able to modify the epidemiology of the viral respiratory infections in children.
The most innovative part of the research is aimed to determine if the epidemiology of the respiratory infection changes over the enrollment period. In fact it is well known that most respiratory viruses and in particular RSV have a seasonality, with peaks during cold months (Obando-Pacheco P, et al. J infect dis 2018; 217: 1356-64), but little is known about the new SARS-CoV-2 course of infections, especially in children, when the new autumn-winter epidemic season will start. In the previous epidemics caused by emerging coronavirus outbreaks (SARS-CoV-1 and MERS) the frequency of children infected was very low, with less than 50 cases reported in literature (Hon, K et al. Pediatr Pulmonol 2020; 55: 1584¿ 1591), and the clinical presentation was milder than in adults. What emerged from the recent manuscripts published on SARS-CoV-2 is that children aged less than 18 years have a milder clinical presentation, with less percentage of symptomatic forms and lower need of intensive care assistance (around 2%). What we would like to establish is whether the co-infection with other viruses or predisposing factors are involved in the clinical presentation of respiratory infections.
A potential application of the whole project is to evaluate if the preventive measures that have been applied worldwide (e.g. physical distancing, use of face masks and gloves) for COVID-19 infection are able to reduce the spread of the viruses infection during winter months, or at least cause a less severe clinical presentation in respiratory infections. Another important point is to evaluate the prevalence of the new SARS-CoV-2 infection among the children attending the ER for an acute respiratory infection.
This epidemiologic surveillance has important implications since starting from 2003, new coronavirus outbreak has been observed every around ten years, but only the SARS-CoV2 has been able to provoke a pandemic of such magnitude. The main aim of this project is to know as much as possible about the course of this pandemic, in order to be able to cope with the spread of viruses in any new epidemics and to implement the preventive strategies that have proved most effective.