Evaluation of disease severity and prediction of severe cases in children hospitalized with influenza A (H1N1) infection during the post-COVID-19 era: a multicenter retrospective study.

BACKGROUND: The rebound of influenza A (H1N1) infection in post-COVID-19 era recently attracted enormous attention due the rapidly increased number of pediatric hospitalizations and the changed characteristics compared to classical H1N1 infection in pre-COVID-19 era. This study aimed to evaluate the clinical characteristics and severity of children hospitalized with H1N1 infection during post-COVID-19 period, and to construct a novel prediction model for severe H1N1 infection. METHODS: A total of 757 pediatric H1N1 inpatients from nine tertiary public hospitals in Yunnan and Shanghai, China, were retrospectively included, of which 431 patients diagnosed between February 2023 and July 2023 were divided into post-COVID-19 group, while the remaining 326 patients diagnosed between November 2018 and April 2019 were divided into pre-COVID-19 group. A 1:1 propensity-score matching (PSM) was adopted to balance demographic differences between pre- and post-COVID-19 groups, and then compared the severity across these two groups based on clinical and laboratory indicators. Additionally, a subgroup analysis in the original post-COVID-19 group (without PSM) was performed to investigate the independent risk factors for severe H1N1 infection in post-COIVD-19 era. Specifically, Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select candidate predictors, and logistic regression was used to further identify independent risk factors, thus establishing a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were utilized to assess discriminative capability and accuracy of the model, while decision curve analysis (DCA) was used to determine the clinical usefulness of the model. RESULTS: After PSM, the post-COVID-19 group showed longer fever duration, higher fever peak, more frequent cough and seizures, as well as higher levels of C-reactive protein (CRP), interleukin 6 (IL-6), IL-10, creatine kinase-MB (CK-MB) and fibrinogen, higher mechanical ventilation rate, longer length of hospital stay (LOS), as well as higher proportion of severe H1N1 infection (all P < 0.05), compared to the pre-COVID-19 group. Moreover, age, BMI, fever duration, leucocyte count, lymphocyte proportion, proportion of CD3+ T cells, tumor necrosis factor α (TNF-α), and IL-10 were confirmed to be independently associated with severe H1N1 infection in post-COVID-19 era. A prediction model integrating these above eight variables was established, and this model had good discrimination, accuracy, and clinical practicability. CONCLUSIONS: Pediatric H1N1 infection during post-COVID-19 era showed a higher overall disease severity than the classical H1N1 infection in pre-COVID-19 period. Meanwhile, cough and seizures were more prominent in children with H1N1 infection during post-COVID-19 era. Clinicians should be aware of these changes in such patients in clinical work. Furthermore, a simple and practical prediction model was constructed and internally validated here, which showed a good performance for predicting severe H1N1 infection in post-COVID-19 era.

Residue behavior and risk assessment of mixed formulation of imidacloprid and chlorfenapyr in chieh-qua under field conditions.

A simple and rapid method based on high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was developed for the simultaneous determination of imidacloprid and chlorfenapyr residues in chieh-qua. Field trials were designed to investigate the dissipation and terminal residue behavior of the mixed formulation of imidacloprid and chlorfenapyr in chieh-qua in Guangzhou and Nanning areas. Risk assessment was performed by calculating the risk quotient (RQ) values. The developed analytical method exhibited recoveries of 89.9-110.3% with relative standard deviations (RSDs) of 2.8-12.5% at the spiked levels of 0.01, 0.10, and 1.00 mg/kg. The limit of detection (LOD) was 0.003 mg/kg, and the limit of quantification (LOQ) was 0.01 mg/kg for both imidacloprid and chlorfenapyr. It was found that the half-lives of imidacloprid in chieh-qua under field conditions were 3.3 and 3.5 days in Guangzhou and Nanning at a dose of 180 g ai/ha, while the half-lives of chlorfenapyr were 3.3 and 2.6 days, respectively. The terminal residues of imidacloprid and chlorfenapyr were from 0.01 to 0.21 mg/kg and from 0.01 to 0.46 mg/kg, respectively. Results of dietary exposure assessment showed that the RQ values were much lower than 1, indicating that the risk of imidacloprid and chlorfenapyr applied in chieh-qua was negligible to human health under recommended dosage and good agricultural practices. The proposed study would provide guidance for safe and reasonable use of imidacloprid and chlorfenapyr in chieh-qua cultivation in China.