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China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.
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Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) and hospitalizations in infants under 1 year of age, seriously jeopardizing infants′ health.Most hospitalizations (up to 80%) due to RSV-LRTI occur in otherwise healthy infants born at term.At present, no effective treatment and preventative measure against RSV is available domestically.Passive immunization with fully human long-acting monoclonal antibody Nirsevimab offers immediate protection for all infants experiencing their first RSV season with one shot, thus ushering in a new era of prevention of RSV infection among infants.
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Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.
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Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.
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Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.
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Respiratory syncytial virus (RSV) is the most important viral pathogen causing acute lower respiratory tract infections (ALRTI) in children under 5 years worldwide.RSV is also the primary viral factor leading to ALRTI hospitalization in infants under 1 year.Children are generally susceptible to RSV, and 90% of infants have been infected with RSV before 2 years, which seriously endangers children′s health.Since the discovery of RSV in 1950s, a large number of experiments and explorations on RSV vaccine have been conducted at home and abroad.Nevertheless, there is still no approved RSV vaccine.A breakthrough progress has been made on biological products for the prevention of RSV infection (maternal antibody vaccine, prophylactic monoclonal antibody, etc.), and some of them have entered phase 3 clinical trials.Therefore, it is expected to have effective interventions for preventing RSV infection via passive immune in the next 5-10 years.The Strategic Advisory Group of Experts on Immunization of the World Health Organization reviewed the development of two passive immune agents (maternal antibody vaccine and monoclonal antibody for prevention) in April 2016 to guide the follow-up research.This study systematically reviews the history of passive immunization for the prevention of infectious diseases and the progress in RSV preventive immunization, and summarizes the evidence-based evidence of passive immunity used to prevent RSV infection-related diseases.
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Objective:To analyze the dominant genotypes and epidemic characteristics of human rhinovirus (HRV) in pediatric community-acquired pneumonia (CAP) in China.Methods:Between June 2017 to December 2019, throat swabs or nasopharyngeal aspirates were collected from pediatric CAP patients hospitalized in 6 medical institutions in Southern and Northern China (bounded by Qinling and Huaihe River), respectively.A total of 16 species of common respiratory viruses were screened using respiratory pathogen detection kits.Samples with positive HRV were genotyped for further epidemiological analysis.Results:The total detection rate of HRV in pediatric CAP (2 913 cases) was 12.2%(356 cases) in this study, which was 10.3%(145/1 410 cases) and 14.0%(211/1 503 cases) in Northern and Southern China, respectively.The detection rate of HRV in the Southern region was significantly higher than that in the Northern region, the difference was statistically significant( χ2=9.562, P=0.002). Epidemiological analysis showed that the distribution of HRV-positive cases in the Northern region was similar in all age groups, while 90.5% of positive cases in the Southern region were infants under 3 years.Classified by seasonal distribution, HRV-positive cases in the Northern region were mainly distributed in summer and autumn, while those in the Southern region were mainly distributed in spring and autumn.The coinfection rate of HRV and other pathogens was 40.7%, which was significantly higher in the Southern region than that of Northern region (49.0% vs.28.0%), the difference was statistically significant( χ2=15.801, P<0.001). The most common pathogens mixed with HRV were respiratory syncytial virus (RSV), human boca virus (HBOV) and parainfluenza virus type Ⅲ (PIV3) in the Northern region, with the mixed infection rate of 5.0%, 5.0% and 4.0%, respectively, which were RSV, PIV3 and human metapneumovirus (HMPV) in the Southern region, with the mixed infection rate of 9.0%, 7.0% and 6.0%, respectively.The genotyping results showed that all three HRV genotypes were detected.HRV-A (118/220 cases) was the dominant genotype, followed by HRV-C(82/220 cases). Conclusions:The detection rate of HRV in pediatric CAP cases is 12.2% in this study.There are significant differences in age and seasonal distribution of HRV-positive cases in the Southern and Northern regions.Coinfection of HRV and other pathogens is detected.The coinfection rate is significantly higher in the Southern region than that in the Northern region.HRV-A is the dominant genotype, followed by HRV-C.
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Respiratory tract infection is a common infectious disease in children, which seriously threatens children′s health.The level of diagnosis and treatment of children′s respiratory virus infection has been significantly improved in China, but the diagnosis and treatment of children′s respiratory virus infection still face many challenges.This paper analyzes the challenges faced by children′s respiratory virus infection from the aspects of the harm of respiratory virus infection to children′s health, novel and recurrent respiratory virus infection, the infectivity of respiratory virus infection, vaccines and specific antiviral drugs, molecular diagnosis of respiratory virus infection and cytokine storm.
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Acute necrotizing encephalopathy (ANE) is a rare but distinctive acute encephalopathy with global distribution.It usually begins with a virus-associated febrile illness, which deteriorates rapidly, and leading to convulsion, unconsciousness and even coma.The neuroradiologic features of ANE are multi-focal and symmetrical brain lesions, involving bilateral thalamus.ANE has no specific treatment method at present.The majority of ANE patients are accompanied with varying degrees of neurological sequelae, and even death.In this review, we summarized the epidemiology, diagnosis and prognosis of this rare but fatal disease in children.
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Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still worldwide.As a vulnerable group, severe and dead pediatric cases are also reported.Under this severe epidemic situation, children should be well protected.With the widespread vaccination of SARS-CoV-2 vaccine in adults, the infection rate have decreased.Therefore, SARS-CoV-2 vaccine inoculation for children groups step by step is of great significance to the protection of children and the prevention and control of corona virus disease 2019(COVID-19) as a whole.But the safety of children vaccinated with SARS-CoV-2 vaccine is a main concern of parents.Therefore, in order to ensure the safety of vaccination and the implementation of vaccination work, National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health and the Society of Pediatrics, Chinese Medical Association organized experts to interpret the main issue of parents about SARS-CoV-2 vaccine for children, in order to answer the doubts of parents.
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At present, severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still rampant worldwide.As of September 10, 2021, there were about 222 million confirmed cases of corona virus disease 2019(COVID-19)and more than 4.6 million deaths worldwide.With the development of COVID-19 vaccines and the gradual vaccination worldwide, the increasing number of cases in children and unvaccinated young people has drawn attention.According to World Health Organization surveillance data, the proportion of COVID-19 infection cases in children gradually increased, and the proportion of cases in the age groups of under 5 years and 5-14 years increased from 1.0% and 2.5% in January 2020 to 2.0% and 8.7% in July 2021, respectively.At present, billions of adults have been vaccinated with various COVID-19 vaccines worldwide, and their protective effects including reducing infection and transmission, reducing severe disease and hospitalization, and reducing death, as well as high safety have been confirmed.Canada, the United States, Europe and other countries have approved the emergency COVID-19 vaccination in children and adolescents aged 12 to 17 years, and China has also approved the phased vaccination of COVID-19 vaccination in children and adolescents aged 3 to 17 years. For smooth advancement and implementation of COVID-19 vaccination in children, academic institutions, including National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health, and The Society of Pediatrics, Chinese Medical Association organized relevant experts to reach this consensus on COVID-19 vaccination in children.
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Influenza virus infection mainly mediates pathology in respiratory tract, but recent years it has drawn widespread attention by its extrapulmonary complications.Among all the complications, influenza associated encephalo-pathy/encephalitis (IAE), which has high morbidity and mortality, is the most lethal one that causes death in critically ill cases, and even those patients who are cured commonly suffer from neurological sequelae.However, there is little knowledge about IAE in the international society.In this paper, the research progress in IAE would be reviewed from such aspects as clinical manifestations, epidemiologic data, risk factors, classification, treatment, prognosis and mechanism, for the purpose of deepening the comprehension of this disease.
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Objective:To understand the profile type of serum Epstein-Barr virus (EBV) antibodies in children with infectious mononucleosis (IM), and to analyze the significance of viral capsid antigen (VCA) IgG antibody affinity in the diagnosis of IM.Methods:Retrospective analysis was performed on the results of the serum anti-EBV antibody profile and plasma EBV nucleic acid test of 150 hospitalized children with IM diagnosed in Beijing Children′s Hospital, Capital Medical University, from May 2016 to May 2019.Anti-EBV antibody profiles, including anti-VCA-IgG, anti-VCA-IgM, anti-early antigen (EA) IgA, anti-EBV nuclear antigen (EBNA) IgG, and anti-VCA-IgG affinity, were detected by enzyme-linked immunosorbent assay (ELISA). Plasma EBV nucleic acids were detected by real-time quantitative PCR.Results:There were mainly two types of anti-EBV antibody profiles in 150 children with IM: (1)130 cases who were positive for anti-VCA-IgM/IgG, negative for anti-EBNA-IgG and positive for anti-VCA-IgG antibodies with low affinity, accounting for 86.7% (130/150 cases), of which 50 cases were positive for anti-early antigen IgA; (2)18 cases who were negative for anti-VCA-IgM, positive for anti-VCA-IgG, negative for anti-EBNA-IgG and positive for anti-VCA-IgG antibody with low affinity, accounting for 12.0% (18/150 cases), of which 5 cases were positive for anti-EA IgA.EBV DNA was measured in 132 children, with a posi-tive rate of 37.9% (50/132 cases).Conclusions:There were several types of serum EBV antibody profiles in children with IM, 12.0% of patients with IM in this study were negative for anti-VCA-IgM, and the diagnosis of IM was confirmed by the affinity of anti-VCA IgG.
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2019 novel coronavirus(2019-nCoV) outbreak is one of the public health emergency of international concern.Since the 2019-nCoV outbreak, China has been adopting strict prevention and control measures, and has achieved remarkable results in the initial stage of prevention and control.However, some imported cases and sporadic regional cases have been found, and even short-term regional epidemics have occurred, indicating that the preventing and control against the epidemic remains grim.With the change of the incidence proportion and the number of cases in children under 18 years old, some new special symptoms and complications have appeared in children patients.In addition, with the occurrence of virus mutation, it has not only attracted attention from all parties, but also proposed a new topic for the prevention and treatment of 2019-nCoV infection in children of China.Based on the second edition, the present consensus further summarizes the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of treatment of 2019-nCoV infection in children.
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Human adenoviruses (HAdVs) are a group of non-enveloped double-stranded DNA viruses, including seven groups (A-G) and more than 80 serotypes/genotypes. HAdVs, mainly including HAdV-B, HAdV-C and HAdV-E, are one of the important pathogens of respiratory tract infections. China has a vast territory, and the predominant genotypes of HAdVs vary in different regions. In this article, I review the prevalence of different types of HAdVs that cause respiratory diseases, meanwhile, summarize and analyze the predominant circulating types and newly discovered types of HAdVs in different regions of China.
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Epstein-Bar virus (EBV) infection is widespread within the human population with over 95% of adults being infected. In response to primary EBV infection, the host mounts an antiviral immune response comprising both innate and adaptive immune system. In healthy populations, the immune system can control EBV infection to a large extent. However, the virus cannot be cleared. Instead, EBV establishes a persistent latent infection in B lymphocytes characterized by limited viral gene expression. To establish a persistent infection efficiently, EBV have evolved a number of strategies to avoid immune elimination. In this review, we focus on the immune evasion mechanisms of EBV encoded immune-evasion proteins, microRNA and host exosome pathway.
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Objective To analyze the relationship between the level of serum ferritin (SF)and the severity of community acquired pneumonia (CAP)in children,and to explore the timing of glucocorticoid therapy for children with CAP.Methods Retrospective analysis was performed on the clinical data of 738 children with CAP who were hospitalized at the Department of Respiratory,Beijing Children's Hospital,Capital Medical University from January 2014 to December 2015.All patients were divided into a mild group and a severe group based on the severity of CAP,and the levels of SF,C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC) and D-dimer were compared between the 2 groups.In addition,the analysis of receiver operating characteristic (ROC) curve was performed to study the usefulness of SF as severity indicators for CAP,and to learn the relationship between the level of SF and the glucocorticoid therapy in children with CAP.Simultaneous analysis of SF and CRP,WBC,ESR,D-dimer was made at the same time.Results (1) There were all 738 children enrolled into this study.There were 442 children in the mild group and 296 children in the severe group.There was no significant difference in age and sex between the mild group and the severe group(all P ＞ 0.05).(2)Comparisons between the mild group and the severe group were as follows:days of hospitalization [10.0 (9.0,13.0) days],duration of fever [10.0 (7.0,10.0) days] and heat peak [39.9 ℃ (39.1 ℃,40.1 ℃)] in the severe group,which had significant differences than those in the mild group [days of hospitalization 7.0 (6.0,9.0) days,duration of fever 7.0 (5.0,10.0) days and heat peak 39.3 ℃ (39.0 ℃,39.8 ℃)] (all P ＜ 0.05).The levels of SF [229.0 (150.0,436.2) μg/L],CRP [30.00 (9.84,78.20) mg/L],WBC [8.44 (5.91,12.6) × 109/L],ESR [30.5 (16.0,49.0) mm/1 h] and D-dimer [0.871 (0.317,2.532) μg/L] in the severe group were significantly higher than those in the mild group [SF:98.0 (68.2,136.1)μg/L,CRP:11.50 (5.77,11.50) mg/L,WBC:7.59 (5.87,10.1) × 109/L,ESR:23.0 (13.0,36.3) mm/1 h and D-dimer 0.232 (0.159,0.407) μg/L],and the differences were statistically significant (all P ＜ 0.05).(3) The levels of SF [258.5 (177.8,404.9) μg/L] and CRP [8.0 (8.0,16.5) mg/L] in CAP children in the recovery phase were significantly lower than those in the acute phase [SF:912.1 (418.7,1 380.3) μg/L,CRP:47.4 (18.8,105.8)mg/L].(4)The level of SF had significantly positive correlations with CRP,ESR,D-dimer (r =0.485,0.286,0.611,all P ＜ 0.05).(5) The cutoff value for SF,D-dimer for diagnosing severe pneumonia was 168.0 μg/L (sensitivity 70.6％,specificity 86.2％),and 0.616 μg/L (sensitivity 58.1％,specificity 87.1％).(6) There were 17.2％ cases (76/442 cases) in the mild group and 52.7％ cases (159/296 cases) in the severe group who received systemic glucocorticoid therapy.Conclusion The level of SF was correlated with the severity of CAP in children,and the level of SF in patients in recovery phase was significantly lower than that in the acute phase.When SF ≥ 168.0 μg/L,D-dimer ≥0.616 μg/L,attention should be paid to the possibility of severe CAP,regarding the indication for systemic steroid therapy for CAP in children.
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Objective To describe the clinical characteristics of acute lower respiratory tract infection (ALRTI)caused by human coronavirus (HCoV)in children.Methods Three thousand five hundred and three hospi-talized children diagnosed with ALRTI in Beijing Children′s Hospital from March 2007 to February 201 3 were re-viewed.Nasopharyngeal aspirate(NPA)specimen was collected from each patient.Reverse transcription (RT)-poly-merase chain reaction(PCR)methods were applied to detect common respiratory viruses including respiratory syncytial virus (RSV),rhinovirus (RV),parainfluenza virus (PIV)type 1 -4,influenza virus type A and B (IFA,IFB),adeno-virus (AdV),enterovirus (EV),HCoV,human metapneumovirus (hMPV)and human bocavirus (HBoV).Serum anti-bodies of mycoplasma and sputum bacterial culture were also detected.Only HCoV positive patients were analyzed in this study.Results Eleven of 3 503 patients were proved as HCoV -positive in NPA specimens.Of the 1 1 children,8 cases were male and 3 cases were female (2.71 .0).The median age was 3 months.The clinical symptoms of HCoV infection included cough (1 1 /1 1 cases,1 00.0%),wheezing (1 0 /1 1 cases,90.9%),fever (6 /1 1 cases,54.5%)and poor appetite (7 /1 1 cases,63.6%).Wheezing (8 /1 1 cases,72.7%)and moist rale in inspiratory phase (5 /1 1 ca-ses,45.4%)could be heard.Most patient′s chest X -ray showed bronchopneumonia.Full blood count displayed that leukocyte was in the normal range.Conclusions Respiratory tract infection with HCoV -positive will be easier to spread to ALRTI,especially in infants less than 1 year old.The symptoms include fever,cough and wheezing,but poor appetite and diarrhea can also be detected.
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The Epstein-Barr virus (EBV) is a gamma herpes virus associated with several types of malignancies. The EBV encodes viral microRNAs (miRNAs) that can target genes within cells. The EBV participates in signal transduction as well as the proliferation and differentiation of cells. How the target genes and functions of EBV-encoded miRNAs contribute to the pathogenesis of EBV is an important research topic. Some target genes have been validated since EBV-encoded miRNAs were discovered and, in this article, we summarize them and their functions.
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Animals , Humans , Epstein-Barr Virus Infections , Genetics , Metabolism , Virology , Herpesvirus 4, Human , Genetics , Physiology , MicroRNAs , Genetics , Metabolism , RNA, Viral , Genetics , MetabolismABSTRACT
The respiratory syncytial virus (RSV) belongs to the family Paramyxoviridae and subfamily Pneumovirinae. The RSV can cause acute infections of the lower respiratory tract in infants. The F gene of the RSV is a conservative gene and varies only slightly in its expression. Few studies focusing on the variability of the F gene have been carried out. F protein (fusion glycoprotein) is a transmembrane glycoprotein that mediates fusion and penetration between the virus and host cells. Neutralizing antibody against the F protein can protect against infection by RSV subtypes A and B. Hence, F protein has become the main target for the development of a monoclonal antibody and vaccine against the RSV. An effective vaccine is not available, so a monoclonal antibody against F protein is now the most important method to reduce the morbidity and severity associated with RSV infection in high-risk children. However, a monoclonal antibody can lead to the production of drug-resistant strains of the RSV. This review focuses on genetic variation of the F gene of the RSV as well as progress in the development of a monoclonal antibody against F protein and a vaccine in the last decade.
