Perfil clínico e epidemiológico das infecções por vírus respiratórios durante a pandemia de Covid-19 em um hospital pediátrico de referência na cidade de Belo Horizonte - MG

Abstract

INTRODUCTION: The Covid-19 pandemic appears to have impacted the epidemiology of respiratory infections in the pediatric population. Strategies to prevent the SARS-CoV-2 virus that causes COVID-19 may have changed the epidemiology of existing respiratory viruses and may have influenced the clinical severity of respiratory illnesses in children. The pandemic has dramatically demonstrated the unpredictability of virus behavior and how little we still know about them, but it has also provided an opportunity to understand them better. OBJECTIVE: Evaluate respiratory viral infections during the Covid-19 pandemic in pediatric patients admitted to Hospital Infantil João Paulo II who were reported to have Severe Acute Respiratory Syndrome (SARS) or Flu Syndrome (GS) throughout the years 2020, 2021 and 2022. METHODS: Retrospective cohort study carried out at Hospital Infantil João Paulo II, which included data collected from medical records of patients admitted and reported for SARS between the period from March 2020 to November 2022. The inclusion criterion in the study was any patient admitted to Hospital Infantil João Paulo II who has been reported for SARS or SG during the study period and who has had at least one respiratory virus identified through any viral research carried out in the service (Rapid tests for Respiratory syncytial virus, Covid-19 and Influenza, PCR for Covid-19 or viral panel). The exclusion criteria were: patients who do not present a record in the electronic medical record, patients without necessary information for the analysis proposed for the study, patients who present a viral test with inconclusive results without re-collection. RESULTS: data were collected from 1397 hospitalized children, 179 children in 2020, 574 in 2021 and 644 in 2022. There was a predominance of hospitalizations in the age group under 6 months of age (39.5%). The viral circulation curve during the years studied showed a general reduction in viral circulation in 2020, a change in the seasonality pattern of the respiratory syncytial virus in 2021, a low circulation of the influenza virus throughout the years studied and, on the other hand, the presence common occurrence of rhinovirus throughout the three years of study. The most prevalent clinical findings overall were cough (76.4%), respiratory discomfort (73.7%), oxygen saturation below 95% (64.7%) and tachypnea (60.7%) and the Covid-19 was more associated with gastrointestinal tract symptoms such as diarrhea and vomiting and rhinovirus with wheezing. The presence of comorbidities was associated with worse clinical outcomes such as death, ICU admission, need for orotracheal intubation and increased length of stay. The respiratory syncytial virus was the one most associated with the need for orotracheal intubation, but on the other hand, the virus most associated with death in the pediatric age group was Covid-19. CONCLUSION: The restrictive measures adopted to reduce the circulation of SARS-CoV-2 have had an impact on other respiratory viruses. The study also demonstrated that Covid-19 infection is more associated with death, while respiratory syncytial virus infection is more associated with the need for orotracheal intubation. Some signs and symptoms are more associated with some respiratory viruses than others, but it is still extremely difficult and complex to differentiate viral infection cases solely based on the signs and symptoms presented by patients. Understanding the seasonal variations of viruses is essential so that we can properly plan preventive strategies and control outbreaks in the future.