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Introduction: Streptococcus pneumoniae colonization patterns are influenced by host and environmental factors, which may be related to Invasive Pneumococcal Disease (IPD). Interestingly, COVID-19 pandemic witnessed a decline in the incidence of IPDs. Investigations with diligent data collection on the prevalence of nasopharyngeal colonization and associated serotypes during this unique period can yield novel insights. The aim of the current study was to assess the prevalence of S. pneumoniae carriage among children and adults who have sought care at emergency departments with suspected COVID-19. Methods: In this cross-sectional study, adults and children presenting with signs and symptoms likely associated with COVID-19 in two outpatient clinics in Southern Brazil were invited to participate. RT-PCR with a comprehensive molecular panel for pneumococcal identification of the 21 most prevalent serotypes in Latin America was performed on all enrolled subjects. Prevalence of pneumococcal carriage was assessed in the age groups (< 2, ≥ 2–5, ≥ 5–11, ≥ 11–18, ≥ 18–60, ≥ 60). Results: A total of 1644 subjects were included in the study. Pneumococcal carriage was detected by PCR testing in 14.9% (245/1,644), and serotype identification occurred in 42.0% (103/245) of the participants, with a total frequency of 111. The most frequent serotype identified was 19A (25.2%, n = 28/111), followed by 6C/6D (17.1%, n = 19/111), and 23A (11.7%, n = 13/111), also highlighting the high frequency of non-vaccine serotypes found across all age groups. Discussion: 19A serotype, as well other most frequent serotypes identified are not covered by the PCV-10 in a community setting where PCV-10 is widely available. This finding reinforces the need for continuous surveillance to determine the impact of pneumococcal vaccination and guide public health decision-making. High 19A serotype prevalence is critical in the decision-making process for electing the best options for pneumococcal conjugate vaccines.

Objective: Changes in the epidemiology of respiratory infections during the restrictions imposed as a response to the coronavirus disease 2019 (COVID-19) pandemic have been reported elsewhere. The present study's aim was to describe the prevalence of a large array of respiratory pathogens in symptomatic children and adolescents during the pandemic in Southern Brazil. Methods: Hospitalized and outpatients aged 2 months to 18 years with signs and symptoms of acute COVID-19 were prospectively enrolled in the study from May to November 2020 in two hospitals in a large metropolitan area in a Brazilian city. All participants performed a real-time PCR panel assessing 20 respiratory pathogens (three bacteria and 17 viruses). Results: 436 participants were included, with 45 of these hospitalized. Rhinovirus was the most prevalent pathogen (216/436) followed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, 97/436), with a coinfection of these two viruses occurring in 31/436 participants. The remaining pathogens were found in 24 symptomatic participants (adenovirus, n = 6; Chlamydophila pneumoniae, n = 1; coronavirus NL63, n = 2; human enterovirus, n = 7; human metapneumovirus, n = 2; Mycoplasma pneumoniae, n = 6). Hospitalization was more common among infants (p = 0.004) and those with pathogens other than SARS-CoV-2 (p = 0.001). Conclusion: During the period of social distancing in response to COVID-19, the prevalence of most respiratory pathogens was unusually low. Rhinovirus remained as the main virus co-circulating with SARS-CoV-2. COVID-19 in symptomatic children was less associated with hospitalization than with other respiratory infections in children and adolescents.

Introdução: O Streptococcus pneumoniae é uma das principais bactérias associadas a coinfecções virais. Informações quanto à colonização pneumocócica e coinfecções são limitadas, incluindo uma possível associação com SARS-CoV-2. O objetivo deste estudo foi descrever as frequências de colonização de S. pneumoniae e identificação outros agentes respiratórios patogênicos comuns, durante o primeiro ano da pandemia de COVID-19. Métodos: Estudo observacional prospectivo em participantes com idade >10 anos, com sintomas respiratórios, entre maio e novembro/2020. Foi realizado um painel respiratório abrangente para detecção de agentes respiratórios por RT-PCR, e nos positivos para S. pneumoniae seguiu-se com a identificação de 21 sorotipos. Foram coletadas informações clínicas e dados sobre gravidade/hospitalização. Resultados: Foram incluídos 1.297 participantes; a idade mediana foi de 36,8 anos (IQR = 27,5-47,3). 134/1.297 (10,3%) participantes estavam colonizados por S. pneumoniae e 33/134 (26,4%) tiveram sorotipos identificados. O sorotipo 19A foi o mais prevalente (21,2%, 7/33), seguido por: 23A (15,2%, 5/33) e 6C/6D (12,1%, 4/33). Os principais patógenos respiratórios identificados foram SARS-CoV-2 (36,4%, 472/1.296), rinovírus (34,8%, 449/1.291), Mycoplasma pneumoniae (1,4%, 18/1.291), e em menor percentual coronavírus HKU1 e NL63, enterovírus, metapneumovírus, adenovírus, representando 1,9% (25/1.291). A detecção de rinovírus foi associada à não-colonização pneumocócica (p < 0,001), enquanto que nos outros patógenos detectados não houve associação significativa para colonização. Não foram detectados: Bordetella pertussis, bocavírus; coronavírus (229E e OC43); vírus influenza A (H1 e H3); vírus influenza B; vírus parainfluenza (1, 2 e 3); e vírus sincicial respiratório (A e B). Não houve associação entre gravidade clínica e colonização pneumocócica. 5,5% (71/1.297) indivíduos foram hospitalizados; 4% (46/1.297) precisaram de oxigênio suplementar e houve 1% (15/1.297) de óbitos. 14,3% (185/1.297) referiram uso de antibióticos na semana anterior à inclusão no estudo, sendo que 94% (173/185) não eram colonizados (p = 0,049). Conclusão: Não houve associação da colonização com patógenos respiratórios ou desfechos por hospitalização. O sorotipo 19A foi o mais prevalente nessa população, sendo um potencial agente de infecção invasiva. A avaliação da prevalência é fundamental para monitorar o cenário epidemiológico e orientar a tomada de decisões em saúde pública.

Introdução: Streptococcus pneumoniae é um importante colonizador nasofaríngeo, e potencial causador de infecções graves e invasivas em crianças. Desde 2010, a vacina pneumocócica conjugada 10 (PVC-10) está disponível pelo Programa Nacional de Imunizações. O objetivo deste estudo foi descrever a colonização de S. pneumoniae e identificar outros patógenos durante o primeiro ano da pandemia de COVID-19. Métodos: Foram recrutados em um estudo observacional prospectivo, crianças (≤10 anos) em dois hospitais do Sul do Brasil entre maio e novembro de 2020. A presença de sintomas respiratórios (dor de garganta, tosse e febre ≥37,8°C) foram critérios de inclusão dos participantes. Em todas as amostras coletadas foi realizado um painel para identificação de infecções respiratórias por RT-PCR. Nas amostras positivas para S. pneumoniae foi realizada a identificação dos 21 sorotipos mais prevalentes na América Latina. Foram coletadas informações clínicas e dados sobre vacinação. Resultados: Foram incluídos 347 participantes, com idade mediana de 3,6 anos (IQR: 1,5-7,2). Colonização pneumocócica foi identificada em 111 (32%) crianças. 43/111 (38.7%) tinham

ABSTRACT Objective: To evaluate the association between obesity and hospitalization in mild COVID-19 adult outpatients in Brazil. Subjects and methods: Adults with signs and symptoms suggestive of acute SARS-CoV-2 infection who sought treatment in two hospital (public and private) emergency departments were prospectively enrolled. Patients with confirmed COVID-19 at inclusion were followed by phone calls at days D7, D14 and D28. Multivariable logistic regression models were employed to explore the association between obesity and other potential predictors for hospitalization. Results: A total of 1,050 participants were screened, and 297 completed the 28-day follow-up and were diagnosed with COVID-19 by RT-PCR. The median age was 37.2 (IQR 29.7-44.6) years, and 179 (60.0%) were female. The duration of symptoms was 3.0 (IQR 2.0-5.0) days, and 10.0 (IQR 8.0-12.0) was the median number of symptoms at inclusion. Ninety-five (32.0%) individuals had obesity, and 233 (78.5%) had no previous medical conditions. Twenty-three participants (7.7%) required hospitalization during the follow-up period. After adjusting, obesity (BMI ≥ 30.0 kg/m2) (OR = 2.69, 95% CI 1.63-4.83, P < 0.001) and older age (OR = 1.05, 95% CI 1.01-1.09, P < 0.001) were significantly associated with higher risks of hospitalization. Conclusion: Obesity, followed by aging, was the main factor associated with hospital admission for COVID-19 in a young population in a low-middle income country. Our findings highlighted the need to promote additional protection for individuals with obesity, such as vaccination, and to encourage lifestyle changes.

Objective: to evaluate the accuracy of an antibody point-of-care lateral flow immunoassay (LFI - Wondfo Biotech Co., Guangzhou, China) in a pediatric population. Methods: children and adolescents (2 months to 18 years) with signs and symptoms suggestive of acute SARS-CoV-2 infection were prospectively investigated with nasopharyngeal RT-PCR and LFI at the emergency room. RT-PCR was performed at baseline, and LFI at the same time or scheduled for those with less than 7 days of the clinical picture. Overall accuracy, sensitivity and specificity were assessed, as well as according to the onset of symptoms (7-13 or ≥14 days) at the time of the LFI test. Results: In 175 children included, RT-PCR and LFI were positive in 51 (29.14%) and 36 (20.57%), respectively. The overall sensitivity, specificity, positive and negative predictive value was 70.6% (95%CI 56.2-82.5), 96.8% (95%CI 91.9-99.1), 90.0% (95%CI 77.2-96.0), and 88.9% (95%CI 83.9-92.5), respectively. At 7-13 and ≥14 days after the onset of symptoms, sensitivity was 60.0% (95%CI 26.2-87.8) and 73.2% (95%CI 57.1-85.8) and specificity was 97.9% (95%CI 88.7-99.9) and 96.1% (95%CI 89.0-99.2), respectively. Conclusion: Despite its high specificity, in the present study the sensitivity of LFI in children was lower (around 70%) than most reports in adults. Although a positive result is informative, a negative LFI test cannot rule out COVID-19 in children.

Introduction: Pneumococcal pneumonia is a leading cause of severe disease, leading to approximately 2.2 million hospital admissions in 2019 in Brazil. Since 2010, the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine was introduced in Brazil as part of the National Immunization Program (NIP) with free-for-all access, approaching coverage of 91.4% in 2019. Although studies from many countries are available, there is still a need to understand the effect of the vaccine introduction on the incidence of pneumonia hospitalizations in Brazil. Methodology: We accessed data on hospitalization associated with the diagnosis of pneumonia in the population assisted by the Brazilian Public Health system to fit a time series analysis testing the main hypothesis of the influence of vaccination on the trends for the incidence of pneumonia hospitalizations . Results: The post-vaccination period showed a negative trend, reducing 1.75, 0.16, and 0.11 cases per 100,000 inhabitants per month for the groups

Objective: To investigate the prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life in a sample of women in the first 24 h postpartum during the hospital stay. Methods: Cross-sectional study with data from screening phase of a birth cohort. The proportion of mothers who did not intend to breastfeed exclusively for 6 months (primary outcome) derived from a negative response to the question “Would you be willing to try to breastfeed exclusively for the first 6 months?”, in an interview conducted by previously trained interviewers. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals were obtained by Poisson regression with robust variance. Results: A total of 2964 postpartum women were interviewed. The overall prevalence of mothers who did not intend to breastfeed exclusively for 6 months was 17.8% (16.4−19.1%). After adjusting for maternal age and type of pregnancy (singleton or multiple), no intention to exclusively breastfeed was higher in mothers with a monthly household income < 3 minimum wages (PR, 1.64; 1.35−1.98) and in those who intended to smoke 4−7 days/week after delivery (PR, 1.42; 1.11−1.83). The presence of significant newborn morbidity (PR, 0.32; 0.19−0.54) and intention to breastfeed up to 12 months (PR, 0.46; 0.38−0.55) had a protective effect against not intending to breastfeed exclusively for 6 months. Conclusions: Approximately 1 in every 5 mothers did not intend to breastfeed exclusively for 6 months. Strategies aimed at promoting exclusive breastfeeding should focus attention on mothers from lower economic strata and smokers.

Children often show milder COVID-19 symptoms, but the underlying mechanistic insights are still lacking. Here the authors profile both pediatric and adult cohorts of COVID-19 patients in Brazil to find that children exhibit higher viral load but stronger and biased cellular immunity, thereby serving clues for the differential responses in children.

This is the third year of the SARS-CoV-2 pandemic, and yet most children remain unvaccinated. COVID-19 in children manifests as mostly mild or asymptomatic, however high viral titers and strong cellular and humoral responses are observed upon acute infection. It is still unclear how long these responses persist, and if they can protect from re-infection and/or disease severity. Here, we analyzed immune memory responses in a cohort of children and adults with COVID-19. Important differences between children and adults are evident in kinetics and profile of memory responses. Children develop early N-specific cytotoxic T cell responses, that rapidly expand and dominate their immune memory to the virus. Children’s anti-N, but not anti-S, antibody titers increase over time. Neutralization titers correlate with N-specific antibodies and CD8+T cells. However, antibodies generated by infection do not efficiently cross-neutralize variants Gamma or Delta. Our results indicate that mechanisms that protect from disease severity are possibly different from those that protect from reinfection, bringing novel insights for pediatric vaccine design. They also underline the importance of vaccination in children, who remain at risk for COVID-19 despite having been previously infected.

Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants’ status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.

Introdução/Objetivo: Os fatores associados ao risco de hospitalização por COVID19 não são completamente conhecidos. O objetivo deste estudo foi descrever o risco de hospitalização dos participantes ambulatoriais com diagnóstico exclusivo para rinovírus, SARS-CoV-2 e codetecção entre esses dois agentes, durante a pandemia no sul do Brasil. Métodos: Participantes ambulatoriais (> 18 anos) com sinais agudos de tosse, febre ou dor de garganta foram recrutados prospectivamente nas tendas de atendimento do Hospital Moinhos de Vento e Hospital Restinga e Extremo Sul, entre maio e novembro de 2020, e foram acompanhados por 28 dias através de entrevistas telefônicas. Para a detecção de SARS-CoV-2 bem como para o painel respiratório, foi utilizada a técnica de RT-PCR. Para detecção de SARS-CoV-2 foi utilizado kit TaqManTM 2019-nCoV Assay Kit v1 (genes S, N e ORF1ab) a partir de swabs orofaríngeo e nasofaríngeo bilateral. Em coleta de outro swab nasofaríngeo foi realizado painel respiratório para detecção de: Bordetella pertussis; Chlamydophila pneumoniae; Mycoplasma pneumoniae; adenovírus; bocavírus; coronavírus tipos HKU1, 229E, NL63 e OC43; vírus influenza A tipos H1 e H3; vírus influenza B; enterovírus humano; metapneumovírus humano; vírus parainfluenza tipos 1, 2 e 3; RSV tipos A e B; e rinovírus). Todas as amostras foram analisadas no Laboratório de Biologia Molecular do Hospital Moinhos de Vento. Resultados: Foram recrutados 609 participantes, com idade mediana de 36 anos, sendo a maioria mulheres (63,2%). 282 (46,4%) participantes tiveram detectado apenas rinovírus, seguido por 234 (38,4%) com SARS-CoV-2 exclusivamente. A codetecção entre estes dois agentes ocorreu em 93 (15,3%) dos 608 participantes. Deste total, 26 (4,3%) participantes necessitaram hospitalização após a busca por atendimento ambulatorial. Participantes com codetecção viral apresentaram maior proporção de hospitalização quando comparados aos participantes com SARS-CoV-2 e rinovírus detectados como agentes únicos (9,7% (9/93) vs 6,8% (16/234) vs 0,4% (1/282), p < 0.001). Entretanto, quando comparadas as proporções de coinfecção com SARS-CoV-2 (como agente único), a diferença não é significativa (9,7% (9/93) vs 6,8% (16/234), p = 0.373). Conclusão: O rinovírus foi o principal patógeno detectado em adultos, e apesar da alta prevalência não foi associado ao aumento na hospitalização, sendo o maior risco atribuído à detecção de SARS-CoV-2 nessa população.

Introdução/Objetivo: Apesar do predomínio do SARS-CoV-2 como etiologia das infecções virais em adultos durante o ano de 2020, outros agentes infecciosos podem fazer parte do diagnóstico diferencial. O objetivo deste estudo foi descrever a prevalência dos patógenos respiratórios em adultos internados em dois hospitais no sul do Brasil durante a pandemia e comparar os desfechos de gravidade na internação entre participantes com diagnóstico de COVID-19 comparado com outros agentes infecciosos. Métodos: Participantes adultos (> 18 anos) hospitalizados com sinais agudos de tosse, febre ou dor de garganta foram recrutados prospectivamente entre maio e novembro de 2020, e seguidos até o final da internação. A técnica de RT-PCR foi utilizada para detecção de SARS-CoV-2 e demais agentes infecciosos. Para SARS-CoV-2 foram coletados swabs oro e nasofaríngeo bilateral tendo como alvos os genes S, N e ORF1ab. Outro swab nasofaríngeo foi coletado para realização de painel respiratório através sondas de expressão gênica que avaliou a presença de: Bordetella pertussis; Chlamydophila pneumoniae; Mycoplasma pneumoniae; adenovírus; bocavírus; coronavírus tipos HKU1, 229E, NL63 e OC43; vírus influenza A tipos H1 e H3; vírus influenza B; enterovírus; metapneumovírus; vírus parainfluenza tipos 1, 2 e 3; RSV tipos A e B; e rinovírus. Todas as amostras foram analisadas no Laboratório de Biologia Molecular do Hospital Moinhos de Vento. Resultados: Foram incluídos 156 participantes, sendo a maioria homens (57,1%) com idade mediana de 58 anos. A mediana de dias de sintomas foi 8 dias. O SARS-CoV-2 foi o agente mais prevalente, sendo detectado exclusivamente em 101 (65.0%) de 156 participantes, seguido pela detecção única de rinovírus (4,0%, 6/154). A codetecção desses dois agentes ocorreu em 28 (18,0%) dos 154 participantes. Os demais patógenos (adenovírus, coronavírus HKU1 e enterovírus) foram detectados em 5 participantes. A comparação dos desfechos de gravidade (uso de oxigênio suplementar, ventilação mecânica invasiva e óbito) não apresentou diferença quanto à codetecção versus detecção exclusiva de SARS-CoV-2 (60,7% (17/28) vs 62,4% (63/101), P = 1,00; 21,4% (6/28) vs 15,8% (16/101), P = 0,57; 7,1% (2/28) vs 5,9% (6/101), P = 0,68). Conclusão: O SARS-CoV-2 foi o principal patógeno detectado seguido pelo rinovírus, com uma importante queda na detecção de outros patógenos. A detecção de rinovírus simultânea ao SARS-CoV-2 não foi associada a maior gravidade.

Although varicella is usually a mild and self-limited disease, complications can occur. In 1998, the World Health Organization recommended varicella vaccination for countries where the disease has a significant public health burden. Nonetheless, concerns about a shift in the disease to older groups, an increase in herpes zoster in the elderly and cost-effectiveness led many countries to postpone universal varicella vaccine introduction. In this review, we summarize the accumulating evidence, available mostly from high and middle-income countries supporting a high impact of universal vaccination in reductions of the incidence of the disease and hospitalizations and its cost-effectiveness. We have also observed the effect of herd immunity and noted that there is no definitive and consistent association between vaccination and the increase in herpes zoster incidence in the elderly.