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Background: Nonpharmaceutical interventions (NPIs) targeted at SARS‐CoV‐2 have remarkably affected the circulation of other respiratory pathogens, including respiratory syncytial virus (RSV). This study aimed to assess the changes in epidemiological and clinical characteristics of RSV infections in hospitalized children before and during the pandemic in Suzhou, China. Methods: We prospectively enrolled children aged < 18 years who were hospitalized in Soochow University Affiliated Children's Hospital with acute lower respiratory infection (ALRIs) from January 2018 to July 2022. Changes in epidemiological and clinical characteristics of RSV infections were analyzed. Results: Compared with the same period in 2018–2019, the difference in the overall positive rate of RSV was not statistically significant in 2020, while it increased significantly in 2021 (11.8% [662/5621] vs. 20.8% [356/1711], p < 0.001) and 2022 (9.0% [308/3406] vs. 18.9% [129/684], p < 0.001). Specifically, the positive rates declined considerably from October to December 2020 but sharply increased during the summer of 2021. Compared to prepandemic period, RSV infections were more frequently observed in older children during the pandemic. RSV‐positive children exhibited milder clinical characteristics during the COVID‐19 pandemic, including decreased proportion of patients with hospital stay ≥ 11 days (10.3% vs. 6.7%, p < 0.05), less requirement for oxygen therapy (13.7% vs. 6.9%, p < 0.001), and fewer cases of polypnea (12.2% vs. 9.7%, p < 0.05) and wheeze (50.1% vs. 42.9%, p < 0.001). Conclusions: The implementation of multilayered NPIs targeted at COVID‐19 has affected the activity of RSV. Ongoing monitoring of RSV is warranted as the changing RSV epidemiology can provide valuable insights for future healthcare system planning. [ABSTRACT FROM AUTHOR]

Background: There is a limited amount of data in China on the disease burden of respiratory syncytial virus‐ (RSV) associated acute lower respiratory infection (ALRI) among young children. This study aimed to estimate the hospitalization rate of RSV‐associated ALRI (RSV‐ALRI) among children aged 0–59 months in Suzhou, China. Methods: All cases from children hospitalized with ALRI who were aged 0–59 months in Suzhou University Affiliated Children's Hospital during January 2010 to December 2014 were retrospectively identified. Detailed diagnosis and treatment data were collected by reviewing each individual's medical chart. In accordance with the World Health Organization (WHO) influenza disease burden estimation, the hospitalization rate of RSV‐ALRI among children aged 0–59 months in Suzhou, China, was then estimated. Results: Out of the 28,209 ALRI cases, 19,317 (68.5%) were tested for RSV, of which the RSV positive proportion was 21.3% (4107/19,317). The average hospitalization rate of RSV‐ALRI for children aged 0–59 months was 14 (95% confidence interval [CI]:14–14)/1000 children years, and that for children aged 0–5, 6–11, 12–23, and 24–59 months were 70 (95% CI: 67–73), 31 (95% CI: 29–33), 11 (95% CI: 10–12), and 3 (95% CI: 3–3)/1000 children years, respectively. Conclusion: A considerable degree of RSV‐ALRI hospitalization exists among children aged 0–59 months, particularly in those under 1 year of age. Therefore, an effective monoclonal antibody or vaccine is urgently needed to address the substantial hospitalization burden of RSV infection. [ABSTRACT FROM AUTHOR]

Background The disease burden of influenza among children in China has not been well described. Objective To estimate the influenza-associated excess hospitalization rate and compare the hospitalization length and costs between pneumonia and influenza (P&I) and other community-acquired diseases ( CAD) in Suzhou, China. Methods We retrospectively collected hospital discharge data on pediatric patients' discharge diagnosis, hospital costs, and length of hospital stay in Suzhou. P&I hospitalization was defined as a primary discharge diagnosis of pneumonia and influenza disease ( ICD-10 codes J09-J18). Other CAD were common community-acquired diseases among children. Negative binomial regression models were used to estimate the weekly P&I hospitalizations in Suzhou. Excess P&I hospitalizations due to influenza were calculated as the difference in P&I hospitalizations between the epidemic period and the baseline period. Baseline was defined as when the influenza-positive rates were <5% for two consecutive weeks. Results From October 2005 to September 2011, we identified a total of 180 091 all-cause hospitalizations among children <5 years of age in Suzhou City. The rates of P&I and influenza-associated excess hospitalizations were highest in the 2009-2010 pandemic and 2010-2011 post-pandemic seasons. Infants <6 months of age had the highest P&I hospitalization rates, the longest hospital stays (7.5-8.0 days), and the highest hospitalization costs for P&I. Compared with other CAD, children admitted for P&I had longer hospital stays and higher hospitalization costs. Conclusions The influenza-associated P&I hospitalization rates and economic burden were high among children. Targeted influenza prevention and control strategies for young children in Suzhou may reduce the influenza-associated hospitalizations in this age group. [ABSTRACT FROM AUTHOR]

In China, 13-valent pneumococcal conjugate vaccine (PCV13) has been available since 2017, but only via the private market with low uptake rate. We assessed the direct effectiveness of PCV13 against community acquired pneumonia (CAP) associated with PCV13 serotype carriage (VT-CAP). We conducted an observational cohort study of children born during 12-Dec-2016 to 30-Nov-2018 identified in the Suzhou Centers for Disease Control vaccine registry database, and who had at least one inpatient or outpatient record at the Suzhou University Affiliated Children's hospital (SCH) health-information-system (HIS) database. The vaccine registry cohort was followed through the HIS database through 30-Jun-2019 to identify hospitalized VT-CAP. Pneumococci were isolated from deep upper respiratory aspirates and serotyped with Quellung reactions. We included 139,127 children of whom 9024 (6.5%) received 1 + PCV13 doses (95.8% received 2 + doses). Within the total cohort, we identified 548 children hospitalized at SCH for VT-CAP, of whom 10 had received 2 + PCV13 doses. Adjusted for demographics, receipt of other childhood vaccines, and underlying medical conditions, the first visit vaccine effectiveness among children who had received 2 + PCV13 doses was 60.9% (95% CI: 25.8% to 79.4%) for VT-CAP and 17.9% (95% CI: 5.5% to 28.6%) for clinical CAP. Incidence rate reductions per 100,000 child-years of observation for all visits were 208 (95% CI: 118 to 298) for VT-CAP and 720 (95% CI: 304 to 1135) for clinical CAP. PCV13 was protective against hospitalized VT-CAP and clinical CAP with large associated incidence rate reductions among children living in Suzhou, China. [ABSTRACT FROM AUTHOR]

• We assessed economic burden of influenza in children <5 in Suzhou from 2011-2017. • Cost per illness episode was $161 for outpatient and $1426 for hospitalization. • Annual economic burden of influenza among children <5 in Suzhou was $7.4 million. • Indirect costs accounted for 22-36% of the total annual economic burden. • Influenza in children <5 in Suzhou results in a substantial annual economic burden. Data are limited on the economic burden of seasonal influenza in China. We estimated the cost due to influenza illness among children < 5-year-old in Suzhou, China. This study adopted a societal perspective to estimate direct medical cost, direct non-medical cost, and indirect cost related to lost productivity. Data to calculate costs and rates of three influenza illness outcomes (non-medically attended, outpatient and hospitalization) were collected from prospective community-based cohort studies and hospital-based enhanced laboratory-confirmed influenza surveillance in Suzhou during the 2011/12 to 2016/17 influenza seasons. We used mean cost-per-episode, annual incidence rates of episodes of each outcome, and annual population size to estimate the total annual economic burden of influenza illnesses among children < 5-year-old for Suzhou. All costs were reported in 2017 U.S. dollars. The mean cost-per-episode (standard deviation) was $9.92 (13.26) for non-medically attended influenza, $161.05 (176.98) for influenza outpatient illnesses, and $1425.95 (603.59) for influenza hospitalizations. By applying the annual incidence rates to the population size, we estimated an annual total of 4,919 episodes of non-medically attended influenza, 21,994 influenza outpatient, and 2,633 influenza hospitalization. Total annual economic burden of influenza to society among children < 5-year-old in Suzhou was $7.37 (95% confidence interval, 6.9–7.8) million, with estimated costs for non-medically attended influenza of $49,000 (46,000–52,000), influenza outpatients $3.5 (3.3–3.8) million, and influenza hospitalizations $3.8 (3.6–3.9) million. Among outpatients, the indirect cost was 36.3% ($1.3 million) of total economic burden, accounting for 21,994 days of lost productivity annually. Among inpatients, the indirect cost was 22.1% ($829,000), accounting for 18,431 days of lost productivity annually. Our findings show that influenza in children < 5-year-oldcauses substantial societal economic burden in Suzhou, China. Assessing the potential economic benefit of increasing influenza vaccination coverage in this population is warranted. [ABSTRACT FROM AUTHOR]

• Influenza vaccine averted influenza-associated illnesses even with low coverage. • Influenza vaccination prevented 6.2% influenza hospitalizations in Suzhou, China. • Influenza vaccination prevented 6.5% influenza illnesses in Suzhou, China. There are few estimates of vaccination-averted influenza-associated illnesses in China. We used a mathematical model and Monte Carlo algorithm to estimate numbers and 95% confidence intervals (CI) of influenza-associated outcomes (hospitalization, illness, and medically-attended (MA) illness) averted by vaccination among children aged 6–59 months in Suzhou from October 2011–September 2016. Influenza illnesses included non-hospitalized MA influenza illnesses and non-MA influenza illnesses. The numbers of influenza-associated outcomes averted by vaccination were the difference between the expected burden if there were no vaccination given and the observed burden with vaccination. The model incorporated the disease burden estimated based on surveillance data from Suzhou University Affiliated Children's Hospital (SCH) and data from health utilization surveys conducted in the catchment area of SCH, age-specific estimates of influenza vaccination coverage in Suzhou from the Expanded Program on Immunization database, and influenza vaccine effectiveness estimates from previous publications. Averted influenza estimations were presented as absolute numbers and in terms of the prevented fraction (PF). A hypothetical scenario with 50% coverage (but identical vaccine effectiveness) over the study period was also modeled. In ~250,000 children, influenza vaccination prevented an estimated 731 (CI: 549–960) influenza hospitalizations (PF: 6.2% of expected, CI: 5.8–6.6%) and 10,024 (7593–12,937) influenza illnesses (PF: 6.5%, 6.4–6.7%), of which 8342 (6338–10,768) were MA (PF: 6.6%, 6.4–6.7%) from 2011 to 2016. The PFs declined each year along with decreasing influenza vaccination coverage. If 50% of the study population had been vaccinated over time, the estimated numbers of averted cases during the study period would have been 4059 (3120–5762) influenza hospitalizations (PF: 27.2%, 26.4–27.9%) and 56,215 (42,925–78,849) influenza illnesses (PF: 28.5%, 28.3–28.7%), of which 46,596 (35,662–65,234) would be MA (PF: 28.5%, 28.3–28.7%). Influenza vaccination is estimated to have averted influenza-associated illness outcomes even with low coverage in children aged 6–59 months in Suzhou. Increasing influenza vaccination coverage in this population could further reduce illnesses and hospitalizations. [ABSTRACT FROM AUTHOR]

Background The effectiveness of influenza vaccine among nursery school children has not been systematically studied. We conducted a cohort study of children from 13 nursery schools in Suzhou, China, to estimate the effectiveness of influenza vaccine against laboratory-confirmed influenza during 2016–17. Methods Children aged 36–72 months were chosen from 13 nursery schools from 3 District in Suzhou. The surveillance started 2 weeks after vaccination during October 2016–February 2017. Class teachers reported the names of students with ILI (influenza-like illness) to study clinicians on each school day. Further, local physicians collected the student’s nasopharyngeal swab or throat swab, either at a study clinic or at the child’s home. The swabs were sent to the National Influenza Network Laboratory in Suzhou Center for Disease Control and Prevention for influenza testing by RT-PCR. Result A total of 4614 children were enrolled, of which 15 children (vaccinated: 2; unvaccinated: 13) were lost to follow-up. Of the remaining 4599 children, 558 swabs were collected. Among these swabs, 70 samples tested positive for influenza virus; 17 in the vaccinated group (B Victoria: 2; H3N2: 15) and 53 in the unvaccinated group (B Victoria: 14; A(H1N1)pdm09: 1; H3N2: 38). The overall influenza vaccine effectiveness (VE) during the influenza season of 2016–2017 was 20.6%. The incidence of developing ILI symptoms and healthcare seeking behavior through clinical visits was significantly lower in vaccinated children than in the unvaccinated group. Conclusion Influenza vaccine protection in vaccinated and unvaccinated children showed no statistical difference and the VE percentage varied for different virus subtypes. However, the incidence rate of developing ILI and healthcare seeking behavior was significant lower in the vaccinated group than in the unvaccinated children. Larger studies are required to estimate the VE according to the influenza type, subtype, and lineage during influenza seasons in China in the future. [ABSTRACT FROM AUTHOR]

Background Data on characteristics of invasive pneumococcal diseases (IPD) is limited in China. We aimed to understand the clinical features and explore the molecular characteristics of the pneumococcal isolates in China. Methods Since 2010, we prospectively collected the pneumococcal isolates and the IPD patients’ demographic and clinical information in Suzhou University Affiliated Children’s Hospital (SCH). The antibiotic susceptibility, serotypes, genotypes of Streptococcus pneumoniae strains were identified by E-test, quellung reaction and/or multiplex PCR, and multi-locus sequence typing, respectively. Results During the period from January 2010 to December 2015, a total of 80 IPD patients were identified. They were diagnosed as meningitis (31.3%), septicemia (27.5%), pneumonia (21.3%) and others (20.0%). About half of them required vancomycin treatment, 42.5% were admitted to ICUs, 36.2% had complications and 6.2% were hospitalized for over 1 year. The most common serotypes of the pneumococcal isolates were serotypes 6B and 14, the coverage of PCV13 was 92.5%, and CC236s and CC199s were the most common clone complexes. Conclusions Pediatric IPD patients had severe clinical symptoms, demanded intensive treatment, suffered poor prognosis and substantial burden. The pneumococcal isolates’ serotype coverage of PCV13 vaccine was high, which leads to implication of PCV vaccine usage among children in China. [ABSTRACT FROM AUTHOR]

Background Seasonal influenza infections among young children in China lead to substantial numbers of hospitalizations and financial burden. This study assessed the seasonal influenza vaccine effectiveness (VE) against laboratory confirmed medically attended influenza illness among children in Suzhou, China, from October 2011–September 2012. Methods We conducted a test-negative case–control study among children aged 6–59 months who sought care at Soochow University Affiliated Children's Hospital (SCH) from October 2011–September 2012. A case was defined as a child with influenza-like illness (ILI) or severe acute respiratory infection (SARI) with an influenza-positive nasopharyngeal swab by rRT-PCR. Controls were selected from children presenting with ILI or SARI without laboratory confirmed influenza. We conducted 1:1 matching by age and admission date. Vaccination status was verified from the citywide immunization system database. VE was calculated with conditional logistic regression: (1 − OR) × 100%. Result During the study period, 2634 children aged 6–59 months presented to SCH with ILI (1975) or SARI (659) and were tested for influenza. The vaccination records were available for 69% (1829; ILI: 1354, SARI: 475). Among those, 23% (427) tested positive for influenza, and were included as cases. Among influenza positive cases, the vaccination rates were 3.2% for SARI and 4.5% for ILI. Among controls, the vaccination rates were 13% for SARI, and 11% for ILI. The overall VE against lab-confirmed medically attended influenza virus infection was 67% (95% CI: 41–82). The VE for SARI was 75% (95% CI: 11–93) and for ILI was 64% (95% CI: 31–82). Conclusions The seasonal influenza vaccine was effective against medically attended lab-confirmed influenza infection in children aged 6–59 months in Suzhou, China in the 2011–12 influenza season. Increasing seasonal influenza vaccination among young children in Suzhou may decrease medically attended influenza-associated ILI and SARI cases in this population. [ABSTRACT FROM AUTHOR]