Mortality Time Trend for Major Viral Pathogens Causing Acute Respiratory Failure in Brazilian Children and Adolescents Before and During the SARS-Cov-2 Pandemic Mortality trend for major viral pathogens causing acute respiratory failure in Brazil
Main Article Content
Abstract
Background – Little is known about the time trend in mortality rates due to respiratory viruses other than SARS-CoV-2 and seasonal influenza among Brazilian children and adolescents.
Methods – Study outcomes were mortality rates due to influenza A, influenza B, respiratory syncytial virus, metapneumovirus, rhinovirus, parainfluenza, adenovirus, and bocavirus, for age groups <5, 5-9, and 10-19 years of age, in Brazil, over the 2009-2022 period. Secondary data from the Brazilian Ministry of Health were analyzed by interval regression, bounded between reported deaths and estimated upper limit of this number, which took into account the underestimation of deaths, the error in attributing its causes in official records, and the variation due to Poisson distribution.
Results - For all viruses, mortality varied little among the children under five years of age, and increased gradually among the 5-10 and 11-19-years old. The highest average mortality rates per million inhabitants over the 2009-2022 period were estimated for respiratory syncytial virus (1.04), with the lowest values for parainfluenza (0.54) and influenza B (0.55), and intermediate values in the range of 0.90 to 0.95 for influenza A, bocavirus, metapneumovirus, rhinovirus, adenovirus, and other respiratory viruses except SARS-Cov-2. Age groups of 5-9 and 10-19 years of age had similar mortality rates and were by far the largest contributors to the overall mortality rates for all viruses analyzed.
Conclusion - Schoolchildren mortality due to respiratory viruses in Brazil has been rising for at least five years before the COVID-19 pandemic, and remained elevated during the pandemic. In addition to SARS-CoV-2 and seasonal influenza, respiratory syncytial virus, metapneumovirus, rhinovirus, parainfluenza, adenovirus, and bocavirus, all showed a non-ignorable impact on mortality in this age group.
Keywords:
Mortality, Children, Adolescents, Respiratory Viruses, Brazil
Article Details
How to Cite
KUPEK, Emil; MARIANO, Tatiana Oliveira.
Mortality Time Trend for Major Viral Pathogens Causing Acute Respiratory Failure in Brazilian Children and Adolescents Before and During the SARS-Cov-2 Pandemic.
Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4082>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i7.1.4082.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Collaborators EM. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet (London, England). 2022;399(10334):1513-1536. doi:10.1016/S0140-6736(21)02796-3
2. Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130-137. doi:10.1038/s41586-022-05522-2
3. Brasil. Ministério da Saúde. Nota Técnica no 19/2022 - CGGRIPE/DEIDT/SVS/MS. Published 2022. https://www.gov.br/saude/pt-br/coronavirus/notas-tecnicas/2022/nota-tecnica-no-19-2022/view
4. Yunusa A, Cabral C, Anderson E. The impact of the Covid-19 pandemic on the uptake of routine maternal and infant vaccines globally: A systematic review. PLOS Glob Public Heal. 2022;2(10):e0000628. doi:10.1371/journal.pgph.0000628
5. SeyedAlinaghi SA, Karimi A, Mojdeganlou H, et al. Impact of COVID-19 pandemic on routine vaccination coverage of children and adolescents: A systematic review. Heal Sci Reports. 2022;5(2):1-12. doi:10.1002/hsr2.516
6. Chan PKS, Tam WWS, Lee TC, et al. Hospitalization incidence, mortality, and seasonality of common respiratory viruses over a period of 15 years in a developed subtropical city. Med (United States). 2015;94(46):e2024. doi:10.1097/MD.0000000000002024
7. Kuitunen I, Artama M, Haapanen M, Renko M. Respiratory virus circulation in children after relaxation of COVID-19 restrictions in fall 2021—A nationwide register study in Finland. J Med Virol. 2022;94(9):4528-4532. doi:10.1002/jmv.27857
8. Gordon A, Reingold A. The Burden of Influenza: a Complex Problem. Curr Epidemiol Reports. 2018;5(1):1-9. doi:10.1007/s40471-018-0136-1
9. Li Y, Wang X, Blau DM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047-2064. doi:10.1016/S0140-6736(22)00478-0
10. Alonso WJ, Laranjeira BJ, Pereira SAR, et al. Comparative dynamics, morbidity and mortality burden of pediatric viral respiratory infections in an equatorial city. Pediatr Infect Dis J. 2012;31(1):1-13. doi:10.1097/INF.0b013e31823883be
11. Sansone NMS, Boschiero MN, Marson FAL. Epidemiologic Profile of Severe Acute Respiratory Infection in Brazil During the COVID-19 Pandemic: An Epidemiological Study. Front Microbiol. 2022;13(July). doi:10.3389/fmicb.2022.911036
12. Ferone EA, Berezin EN, Durigon GS, et al. Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection. J Pediatr (Rio J). 2014;90(1):42-49. doi:10.1016/j.jped.2013.05.005
13. Costa LF, da Silveira HL, Queiróz DAO, Mantese OC, Yokosawa J. Respiratory virus infections in hospitalized and non-hospitalized children: Determinants of severe course of the disease. J Infect Dev Ctries. 2022;16(1):196-205. doi:10.3855/jidc.15117
14. Lamarão LM, Ramos FL, Mello WA, et al. Prevalence and clinical features of respiratory syncytial virus in children hospitalized for community-acquired pneumonia in northern Brazil. BMC Infect Dis. 2012;12:1-7. doi:10.1186/1471-2334-12-119
15. Santos RO, Borges IC, Souza ML, Bouzas ML, Nascimento-carvalho CM. Seasonality of distinct respiratory viruses in a tropical city : implications for prophylaxis. 2021;26(6):672-679. doi:10.1111/tmi.13571
16. Hivylla L, Ferreira S, Oliveira GS, et al. High incidence of rhinovirus infection in children with community ‐ acquired pneumonia from a city in the Brazilian pre ‐ Amazon region. 2019;(December 2018):1751-1758. doi:10.1002/jmv.25524
17. Kupek E. Low COVID-19 vaccination coverage and high COVID-19 mortality rates in Brazilian elderly. Rev Bras Epidemiol. 2021;24:1-11. doi:10.1590/1980-549720210041
18. João Guilherme Alves, Figueiroa JN, Urquia ML. Impact of COVID-19 on immunization of Brazilian infants. Int J Infect Dis. 2021;107(January):252-253. http://creativecommons.org/licenses/by-ncnd/4.0/
19. Mariangela F. Silveira, B CTT, C AGKM, et al. Missed childhood immunizations during the COVID-19 pandemic in Brazil: Analyses of routine statistics and of a national household survey. Vaccine. 2021;39(25, 8 June):3404-3409. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9756801/
20. Ministerio da Saúde D. Projeção da População das Unidades da Federação por sexo e grupos de idade: 2000-2030. Accessed January 11, 2023. https://datasus.saude.gov.br/populacao-residente
21. World Health Organization GESS for I. Global Influenza Programme. 2013. Accessed April 10, 2023. https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/case-definitions-for-ili-and-sari
22. Paes NA, Ferreira AMS, Moura L de A. Proposta metodológica para avaliação de registros de óbitos por COVID-19. Cad Saude Publica. 2023;39(1):e00096722. doi:10.1590/0102-311XPT096722
23. WH G. Econometric Analysis. 3rd ed. (International P-H, ed.).; 1997.
24. Cameron AC TP. Microeconometrics Using Stata. 2nd ed. (Station C, ed.). Stata Press; 2022.
25. Station C, ed. StataCorp. Stata: Release 17. Statistical Software. StataCorp LLC; 2021.
26. Alharbi S, Van Caeseele P, Consunji-Araneta R, et al. Epidemiology of severe pediatric adenovirus lower respiratory tract infections in Manitoba, Canada, 1991-2005. BMC Infect Dis. 2012;12(1):55. doi:10.1186/1471-2334-12-55
27. Barrero PR, Valinotto LE, Tittarelli E, Mistchenko AS. Molecular typing of adenoviruses in pediatric respiratory infections in Buenos Aires, Argentina (1999-2010). J Clin Virol. 2012;53(2):145-150. doi:10.1016/j.jcv.2011.11.001
28. Emukule GO, Spreeuwenberg P, Chaves SS, et al. Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013. PLoS One. 2017;12(7):2007-2013. doi:10.1371/journal.pone.0180890
29. Breiman RF, Cosmas L, Njenga MK, et al. Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007-2011. BMC Infect Dis. 2015;15(1):1-11. doi:10.1186/s12879-015-0827-x
30. Kenmoe S, Joel J, Fatawou A, et al. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19 . The COVID-19 resource centre is hosted on Elsevier Connect , the company ’ s public news and information . 2020;(January).
31. Nasrullah A, Gangu K, Garg I, et al. Trends in Hospitalization and Mortality for Influenza and Other Respiratory Viruses during the COVID-19 Pandemic in the United States. Vaccines. 2023;11(2):1-14. doi:10.3390/vaccines11020412
32. Haddadin Z, Schuster JE, Spieker AJ, et al. Pandemic : Prospective Multicenter Study. Pediatrics. 2021;148(2). doi:10.1542/peds.2021-051462.Acute
33. Olsen SJ, Winn AK, Budd AP, et al. Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic — United States, 2020–2021. MMWR Morb Mortal Wkly Rep. 2021;70(29):1013-1019. doi:10.15585/mmwr.mm7029a1
34. Ujiie M, Tsuzuki S, Nakamoto T, Iwamoto N, Ujiie M. Resurgence of respiratory syncytial virus infections during covid-19 pandemic, tokyo, japan. Emerg Infect Dis. 2021;27(11):2969-2970. doi:10.3201/eid2711.211565
35. van Summeren J, Meijer A, Aspelund G, et al. Low levels of respiratory syncytial virus activity in Europe during the 2020/21 season: what can we expect in the coming summer and autumn/winter? Eurosurveillance. 2021;26(29):1-6. doi:10.2807/1560-7917.es.2021.26.29.2100639
36. Foley DA, Phuong LK, Peplinski J, et al. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child. 2022;107(3):e7. doi:10.1136/archdischild-2021-322507
37. Varela FH, Scotta MC, Polese-Bonatto M, et al. Absence of detection of RSV and influenza during the COVID-19 pandemic in a Brazilian cohort: Likely role of lower transmission in the community. J Glob Health. 2021;11:1-5. doi:10.7189/jogh.11.05007
38. Alonso WJ, Viboud C, Simonsen L, Hirano EW, Daufenbach LZ, Miller MA. Seasonality of influenza in Brazil: A traveling wave from the amazon to the subtropics. Am J Epidemiol. 2007;165(12):1434-1442. doi:10.1093/aje/kwm012
39. Zheng X yan, Xu Y jun, Guan W jie, Lin L feng. Regional, age and respiratory-secretion-specific prevalence of respiratory viruses associated with asthma exacerbation: a literature review. Arch Virol. 2018;163(4):845-853. doi:10.1007/s00705-017-3700-y
40. Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545-1555. doi:10.1016/S0140-6736(10)60206-1
41. Jain S, Williams DJ, Arnold SR, et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children and for the Centers for Disease Control and Prevention (CDC) Etiology of Pneumonia in the Community (EPIC) Study Team. N Engl J Med. 2015;372(9):835-845. doi:10.1056/NEJMoa1405870.Community-Acquired
42. Walter JM, Wunderink RG. Severe Respiratory Viral Infections: New Evidence and Changing Paradigms. Infect Dis Clin North Am. 2017;31(3):455-474. doi:10.1016/j.idc.2017.05.004
43. Perez A, Lively JY, Curns A, Weinberg GA, Halasa NB, Staat MA. Respiratory Virus Surveillance Among Children with Acute Respiratory Illnesses — New Vaccine Surveillance Network , United States , 2016 – 2021. 2022;71(40):2016-2021.
44. Tempia S, Moyes J, Cohen AL, et al. The national burden of influenza-like illness and severe respiratory illness overall and associated with nine respiratory viruses in South Africa , 2013 – 2015. 2022;(December 2021):438-451. doi:10.1111/irv.12949
45. Freitas ARR, Donalisio MR. Respiratory syncytial virus seasonality in Brazil: Implications for the immunisation policy for at-risk populations. Mem Inst Oswaldo Cruz. 2016;111(5):294-301. doi:10.1590/0074-02760150341
46. Rebouças P, Goes E, Pescarini J, et al. Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies. Lancet Glob Heal. 2022;10(10):e1453-e1462. doi:10.1016/S2214-109X(22)00333-3
47. Greenberg SB. Respiratory consequences of rhinovirus infection. Arch Intern Med. 2003;163(3):278-284. doi:10.1001/archinte.163.3.278
48. Gu J, Ting S. Adenovirus diseases : a systematic review and meta ‑ analysis of 228 case reports. Infection. 2021;49(1):1-13. doi:10.1007/s15010-020-01484-7
49. Falahi S, Sayyadi H, Abdoli A, Kenarkoohi A, Mohammadi S. The prevalence of human bocavirus in < 2-year-old children with acute bronchiolitis. New Microbes New Infect. 2020;37:100736. doi:10.1016/j.nmni.2020.100736
50. Serra F, Rossana C, Cordeiro DA, Edna F, Moura A. The role of human bocavirus as an agent of community ‑ acquired pneumonia in children under 5 years of age in Fortaleza , Ceará ( Northeast Brazil ). Brazilian J Microbiol. Published online 2022:1915-1924. doi:10.1007/s42770-022-00806-1
51. Wang X, Li Y, Deloria-Knoll M, et al. Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study. Lancet Glob Heal. 2021;9(1):e33-e43. doi:10.1016/S2214-109X(20)30393-4
52. Our World in Data. Number of children under 5 years old: The total population under 5 years old, given as historic estimates and projections to 2100 based on the UN’s median fertility scenario.
53. Pilger DA, Cantarelli VV, Amantea SL, Leistner-segal S. Detection of human bocavirus and human metapneumovirus by real-time PCR from patients with respiratory symptoms in Southern Brazil. 2011;106(June 2010):56-60.
54. Fé MM, Monteiro AJ MF. Parainfluenza Virus Infections in a Tropical City : Clinical and Epidemiological Aspects. Braz J Infect Dis. 2008;12(3):192-197. doi:10.1590/s1413-86702008000300006
55. Guzman-Holst A, de Barros E, Rubio P, DeAntonio R, Cintra O, Abreu A. Impact after 10-year use of pneumococcal conjugate vaccine in the Brazilian national immunization program: an updated systematic literature review from 2015 to 2020. Hum Vaccines Immunother. 2022;18(1):1-17. doi:10.1080/21645515.2021.1879578
2. Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130-137. doi:10.1038/s41586-022-05522-2
3. Brasil. Ministério da Saúde. Nota Técnica no 19/2022 - CGGRIPE/DEIDT/SVS/MS. Published 2022. https://www.gov.br/saude/pt-br/coronavirus/notas-tecnicas/2022/nota-tecnica-no-19-2022/view
4. Yunusa A, Cabral C, Anderson E. The impact of the Covid-19 pandemic on the uptake of routine maternal and infant vaccines globally: A systematic review. PLOS Glob Public Heal. 2022;2(10):e0000628. doi:10.1371/journal.pgph.0000628
5. SeyedAlinaghi SA, Karimi A, Mojdeganlou H, et al. Impact of COVID-19 pandemic on routine vaccination coverage of children and adolescents: A systematic review. Heal Sci Reports. 2022;5(2):1-12. doi:10.1002/hsr2.516
6. Chan PKS, Tam WWS, Lee TC, et al. Hospitalization incidence, mortality, and seasonality of common respiratory viruses over a period of 15 years in a developed subtropical city. Med (United States). 2015;94(46):e2024. doi:10.1097/MD.0000000000002024
7. Kuitunen I, Artama M, Haapanen M, Renko M. Respiratory virus circulation in children after relaxation of COVID-19 restrictions in fall 2021—A nationwide register study in Finland. J Med Virol. 2022;94(9):4528-4532. doi:10.1002/jmv.27857
8. Gordon A, Reingold A. The Burden of Influenza: a Complex Problem. Curr Epidemiol Reports. 2018;5(1):1-9. doi:10.1007/s40471-018-0136-1
9. Li Y, Wang X, Blau DM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047-2064. doi:10.1016/S0140-6736(22)00478-0
10. Alonso WJ, Laranjeira BJ, Pereira SAR, et al. Comparative dynamics, morbidity and mortality burden of pediatric viral respiratory infections in an equatorial city. Pediatr Infect Dis J. 2012;31(1):1-13. doi:10.1097/INF.0b013e31823883be
11. Sansone NMS, Boschiero MN, Marson FAL. Epidemiologic Profile of Severe Acute Respiratory Infection in Brazil During the COVID-19 Pandemic: An Epidemiological Study. Front Microbiol. 2022;13(July). doi:10.3389/fmicb.2022.911036
12. Ferone EA, Berezin EN, Durigon GS, et al. Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection. J Pediatr (Rio J). 2014;90(1):42-49. doi:10.1016/j.jped.2013.05.005
13. Costa LF, da Silveira HL, Queiróz DAO, Mantese OC, Yokosawa J. Respiratory virus infections in hospitalized and non-hospitalized children: Determinants of severe course of the disease. J Infect Dev Ctries. 2022;16(1):196-205. doi:10.3855/jidc.15117
14. Lamarão LM, Ramos FL, Mello WA, et al. Prevalence and clinical features of respiratory syncytial virus in children hospitalized for community-acquired pneumonia in northern Brazil. BMC Infect Dis. 2012;12:1-7. doi:10.1186/1471-2334-12-119
15. Santos RO, Borges IC, Souza ML, Bouzas ML, Nascimento-carvalho CM. Seasonality of distinct respiratory viruses in a tropical city : implications for prophylaxis. 2021;26(6):672-679. doi:10.1111/tmi.13571
16. Hivylla L, Ferreira S, Oliveira GS, et al. High incidence of rhinovirus infection in children with community ‐ acquired pneumonia from a city in the Brazilian pre ‐ Amazon region. 2019;(December 2018):1751-1758. doi:10.1002/jmv.25524
17. Kupek E. Low COVID-19 vaccination coverage and high COVID-19 mortality rates in Brazilian elderly. Rev Bras Epidemiol. 2021;24:1-11. doi:10.1590/1980-549720210041
18. João Guilherme Alves, Figueiroa JN, Urquia ML. Impact of COVID-19 on immunization of Brazilian infants. Int J Infect Dis. 2021;107(January):252-253. http://creativecommons.org/licenses/by-ncnd/4.0/
19. Mariangela F. Silveira, B CTT, C AGKM, et al. Missed childhood immunizations during the COVID-19 pandemic in Brazil: Analyses of routine statistics and of a national household survey. Vaccine. 2021;39(25, 8 June):3404-3409. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9756801/
20. Ministerio da Saúde D. Projeção da População das Unidades da Federação por sexo e grupos de idade: 2000-2030. Accessed January 11, 2023. https://datasus.saude.gov.br/populacao-residente
21. World Health Organization GESS for I. Global Influenza Programme. 2013. Accessed April 10, 2023. https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/case-definitions-for-ili-and-sari
22. Paes NA, Ferreira AMS, Moura L de A. Proposta metodológica para avaliação de registros de óbitos por COVID-19. Cad Saude Publica. 2023;39(1):e00096722. doi:10.1590/0102-311XPT096722
23. WH G. Econometric Analysis. 3rd ed. (International P-H, ed.).; 1997.
24. Cameron AC TP. Microeconometrics Using Stata. 2nd ed. (Station C, ed.). Stata Press; 2022.
25. Station C, ed. StataCorp. Stata: Release 17. Statistical Software. StataCorp LLC; 2021.
26. Alharbi S, Van Caeseele P, Consunji-Araneta R, et al. Epidemiology of severe pediatric adenovirus lower respiratory tract infections in Manitoba, Canada, 1991-2005. BMC Infect Dis. 2012;12(1):55. doi:10.1186/1471-2334-12-55
27. Barrero PR, Valinotto LE, Tittarelli E, Mistchenko AS. Molecular typing of adenoviruses in pediatric respiratory infections in Buenos Aires, Argentina (1999-2010). J Clin Virol. 2012;53(2):145-150. doi:10.1016/j.jcv.2011.11.001
28. Emukule GO, Spreeuwenberg P, Chaves SS, et al. Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013. PLoS One. 2017;12(7):2007-2013. doi:10.1371/journal.pone.0180890
29. Breiman RF, Cosmas L, Njenga MK, et al. Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007-2011. BMC Infect Dis. 2015;15(1):1-11. doi:10.1186/s12879-015-0827-x
30. Kenmoe S, Joel J, Fatawou A, et al. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19 . The COVID-19 resource centre is hosted on Elsevier Connect , the company ’ s public news and information . 2020;(January).
31. Nasrullah A, Gangu K, Garg I, et al. Trends in Hospitalization and Mortality for Influenza and Other Respiratory Viruses during the COVID-19 Pandemic in the United States. Vaccines. 2023;11(2):1-14. doi:10.3390/vaccines11020412
32. Haddadin Z, Schuster JE, Spieker AJ, et al. Pandemic : Prospective Multicenter Study. Pediatrics. 2021;148(2). doi:10.1542/peds.2021-051462.Acute
33. Olsen SJ, Winn AK, Budd AP, et al. Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic — United States, 2020–2021. MMWR Morb Mortal Wkly Rep. 2021;70(29):1013-1019. doi:10.15585/mmwr.mm7029a1
34. Ujiie M, Tsuzuki S, Nakamoto T, Iwamoto N, Ujiie M. Resurgence of respiratory syncytial virus infections during covid-19 pandemic, tokyo, japan. Emerg Infect Dis. 2021;27(11):2969-2970. doi:10.3201/eid2711.211565
35. van Summeren J, Meijer A, Aspelund G, et al. Low levels of respiratory syncytial virus activity in Europe during the 2020/21 season: what can we expect in the coming summer and autumn/winter? Eurosurveillance. 2021;26(29):1-6. doi:10.2807/1560-7917.es.2021.26.29.2100639
36. Foley DA, Phuong LK, Peplinski J, et al. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child. 2022;107(3):e7. doi:10.1136/archdischild-2021-322507
37. Varela FH, Scotta MC, Polese-Bonatto M, et al. Absence of detection of RSV and influenza during the COVID-19 pandemic in a Brazilian cohort: Likely role of lower transmission in the community. J Glob Health. 2021;11:1-5. doi:10.7189/jogh.11.05007
38. Alonso WJ, Viboud C, Simonsen L, Hirano EW, Daufenbach LZ, Miller MA. Seasonality of influenza in Brazil: A traveling wave from the amazon to the subtropics. Am J Epidemiol. 2007;165(12):1434-1442. doi:10.1093/aje/kwm012
39. Zheng X yan, Xu Y jun, Guan W jie, Lin L feng. Regional, age and respiratory-secretion-specific prevalence of respiratory viruses associated with asthma exacerbation: a literature review. Arch Virol. 2018;163(4):845-853. doi:10.1007/s00705-017-3700-y
40. Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545-1555. doi:10.1016/S0140-6736(10)60206-1
41. Jain S, Williams DJ, Arnold SR, et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children and for the Centers for Disease Control and Prevention (CDC) Etiology of Pneumonia in the Community (EPIC) Study Team. N Engl J Med. 2015;372(9):835-845. doi:10.1056/NEJMoa1405870.Community-Acquired
42. Walter JM, Wunderink RG. Severe Respiratory Viral Infections: New Evidence and Changing Paradigms. Infect Dis Clin North Am. 2017;31(3):455-474. doi:10.1016/j.idc.2017.05.004
43. Perez A, Lively JY, Curns A, Weinberg GA, Halasa NB, Staat MA. Respiratory Virus Surveillance Among Children with Acute Respiratory Illnesses — New Vaccine Surveillance Network , United States , 2016 – 2021. 2022;71(40):2016-2021.
44. Tempia S, Moyes J, Cohen AL, et al. The national burden of influenza-like illness and severe respiratory illness overall and associated with nine respiratory viruses in South Africa , 2013 – 2015. 2022;(December 2021):438-451. doi:10.1111/irv.12949
45. Freitas ARR, Donalisio MR. Respiratory syncytial virus seasonality in Brazil: Implications for the immunisation policy for at-risk populations. Mem Inst Oswaldo Cruz. 2016;111(5):294-301. doi:10.1590/0074-02760150341
46. Rebouças P, Goes E, Pescarini J, et al. Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies. Lancet Glob Heal. 2022;10(10):e1453-e1462. doi:10.1016/S2214-109X(22)00333-3
47. Greenberg SB. Respiratory consequences of rhinovirus infection. Arch Intern Med. 2003;163(3):278-284. doi:10.1001/archinte.163.3.278
48. Gu J, Ting S. Adenovirus diseases : a systematic review and meta ‑ analysis of 228 case reports. Infection. 2021;49(1):1-13. doi:10.1007/s15010-020-01484-7
49. Falahi S, Sayyadi H, Abdoli A, Kenarkoohi A, Mohammadi S. The prevalence of human bocavirus in < 2-year-old children with acute bronchiolitis. New Microbes New Infect. 2020;37:100736. doi:10.1016/j.nmni.2020.100736
50. Serra F, Rossana C, Cordeiro DA, Edna F, Moura A. The role of human bocavirus as an agent of community ‑ acquired pneumonia in children under 5 years of age in Fortaleza , Ceará ( Northeast Brazil ). Brazilian J Microbiol. Published online 2022:1915-1924. doi:10.1007/s42770-022-00806-1
51. Wang X, Li Y, Deloria-Knoll M, et al. Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study. Lancet Glob Heal. 2021;9(1):e33-e43. doi:10.1016/S2214-109X(20)30393-4
52. Our World in Data. Number of children under 5 years old: The total population under 5 years old, given as historic estimates and projections to 2100 based on the UN’s median fertility scenario.
53. Pilger DA, Cantarelli VV, Amantea SL, Leistner-segal S. Detection of human bocavirus and human metapneumovirus by real-time PCR from patients with respiratory symptoms in Southern Brazil. 2011;106(June 2010):56-60.
54. Fé MM, Monteiro AJ MF. Parainfluenza Virus Infections in a Tropical City : Clinical and Epidemiological Aspects. Braz J Infect Dis. 2008;12(3):192-197. doi:10.1590/s1413-86702008000300006
55. Guzman-Holst A, de Barros E, Rubio P, DeAntonio R, Cintra O, Abreu A. Impact after 10-year use of pneumococcal conjugate vaccine in the Brazilian national immunization program: an updated systematic literature review from 2015 to 2020. Hum Vaccines Immunother. 2022;18(1):1-17. doi:10.1080/21645515.2021.1879578