Sentinelni nadzor nad akutnim respiratornim infekcijama i distribucija SARS-CoV-2, virusa gripa tipa A i B i respiratornog sincicijalnog virusa u post-COVID-19 periodu
Sažetak
Uvod/Cilj. Akutne respiratorne infekcije (ARI) i dalje predstavljaju značajan globalni zdravstveni problem. Cilj rada bio je da se analiziraju epidemiološke i kliničke karakteristike ARI i detektuje distribucija koronavirusa 2 izazivača teškog akutnog respiratornog sindroma (severe acute respiratory syndrome coronavirus 2 - SARS-CoV-2), virusa gripa tipa A, virusa gripa tipa B i respiratornog sincicijalnog virusa (RSV) među ambulantno lečenim bolesnicima tokom sezona 2023/24 i 2024/25. Metode. Sprovedena je prospektivna studija putem sentinelnog nadzora, a obuhvaćeni su samo bolesnici sa simptomima/znacima ARI. Identifikacija jednog od četiri virusa izvršena je korišćenjem brzog kombinovanog testa CerTest SARS-CoV-2 + Flu A + Flu B + RSV. Rezultati. U sezoni 2023/24, 26,57% uzoraka bilo je pozitivno na najmanje jedan virus, dok je u sezoni 2024/25 zabeležen pad pozitivnosti ispitivanih virusa na 14,24%. Infekcije virusom gripa A dominirale su tokom sezone 2023/24, dok je učestalost virusa gripa B porasla početkom 2025. godine, dostižući vrhunac krajem februara. SARS-CoV-2 pokazao je umerene fluktuacije tokom studijskog perioda, sa izraženim pikom u septembru 2024, dok je aktivnost RSV ostala niska tokom obe sezone. Uzrasna distribucija bolesnika je varirala: u sezoni 2023/24, RSV i virus gripa B najčešće su registrovani kod dece uzrasta 0–4 godine, virus gripa A kod dece uzrasta 0–4 i 5–14 godina, dok je SARS-CoV-2 bio najzastupljeniji među odraslima uzrasta 30–64 godine. U sezoni 2024/25, RSV i virus gripa A najčešće su dijagnostikovani kod dece uzrasta 0–4 godine, virus gripa B kod dece uzrasta 5–14 godina, a SARS-CoV-2 kod osoba starijih od 30 godina. Povišena telesna temperatura bila je najčešći simptom bez obzira na vrstu dokazane virusne infekcije, ali je bila značajno ređe prisutna kod infekcija SARS-CoV-2 u poređenju sa ostalim virusima. Zaključak. Rezultati ove studije ukazuju na promenu u dominaciji virusnih uzročnika između posmatranih sezona, pri čemu je virus gripa A bio dominantan u 2023/24, dok je u sezoni 2024/25 zabeležen porast učestalosti virusa gripa B. SARS-CoV-2 cirkulisao je kontinuirano, ali na niskom nivou, dok je uticaj RSV bio minimalan u obe sezone.
Reference
GBD 2021 Upper Respiratory Infections Otitis Media Collaborators. Global, regional, and national burden of upper respiratory in-fections and otitis media, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Infect Dis 2025; 25(1): 36–51. Erratum in: Lancet Infect Dis 2025; 25(1): e13.
Duan KI, Birger M, Au DH, Spece LJ, Feemster LC, Dieleman JL. Health Care Spending on Respiratory Diseases in the United States, 1996-2016. Am J Respir Crit Care Med 2023; 207(2): 183–92.
Palin V, Mölter A, Belmonte M, Ashcroft DM, White A, Welfare W, et al. Antibiotic prescribing for common infections in UK general practice: variability and drivers. J Antimicrob Chemother 2019; 74(8): 2440–50.
Derbyshire EJ, Calder PC. Respiratory Tract Infections and An-tibiotic Resistance: A Protective Role for Vitamin D? Front Nutr 2021; 8: 652469.
Luštrek M, Cesar Z, Suljič A, Kogoj R, Knap N, Virant MJ, et al. Influenza A, Influenza B, human respiratory syncytial virus and SARSCoV-2 molecular diagnostics and epidemiology in the post COVID-19 era. Respir Res 2024; 25(1): 234.
Burki TK. Circulation of influenza, RSV, and SARS-CoV-2: an uncertain season ahead. Lancet Respir Med 2021; 9(10): e103.
Almeida T, Guimarães JT, Rebelo S. Epidemiological Changes in Respiratory Viral Infections in Children: The Influence of the COVID-19 Pandemic. Viruses 2023; 15(9): 1880.
Zhou H, Tsou JH, Chinthalapally M, Liu H, Jiang F. Detection and Differentiation of SARS-CoV-2, Influenza, and Respira-tory Syncytial Viruses by CRISPR. Diagnostics (Basel) 2021; 11(5): 823.
Nunes MC, Chauvel C, Raboni SM, López-Labrador FX, Andrew MK, Badar N, et al. The Global Influenza Hospital Surveil-lance Network: A Multicountry Public Health Collaboration. Influenza Other Respir Viruses 2025; 19(3): e70091.
Moriyama M, Hugentobler WJ, Iwasaki A. Seasonality of Respir-atory Viral Infections. Annu Rev Virol 2020; 7(1): 83–101.
Statistical Office of the Republic of Serbia. Census of population, households and dwellings in the Republic of Serbia [Internet]. Belgrade: Statistical Office of the Republic of Serbia; 2025 [cited 2025 March 9; accessed 2025 June 4]. Available from: https://www.stat.gov.rs/en-us/oblasti/popis/
CERTEST Rapid Test. SARS-CoV-2 + Flu A+ Flu B [Inter-net]. Zaragoza: CERTEST; 2025 [cited 2025 March 10; ac-cessed 2025 June 4]. Available from: https://www.certest.es/products
/sars-cov-2-flu-a-flu-b/
Institute for Public Health of Vojvodina. Influenza Sentinel Sur-veillance Report [Internet]. 2025; [cited 2025 June 4; accessed 2025 June 5]. Available from: https://izjzv.org.rs/?lng=lat&cir=0&
link=2-6 (Serbian)
Guadalupe-Fernández V, Martínez-Solanas E, Sabrià-Sunyé A, Ferrer-Mikoly C, Martínez-Mateo A, Ciruela-Navas P, et al. In-vestigating epidemiological distribution (temporality and in-tensity) of respiratory pathogens following COVID-19 de-escalation process in Catalonia, September 2016-June 2021: Analysis of regional surveillance data. PLoS One 2024; 19(2): e0285892.
Stamm P, Sagoschen I, Weise K, Plachter B, Münzel T, Gori T, et al. Influenza and RSV incidence during COVID-19 pandemic-an observational study from in-hospital point-of-care testing. Med Microbiol Immunol 2021; 210(5–6): 277–82.
Petersen E, Koopmans M, Go U, Hamer DH, Petrosillo N, Castelli F, et al. Comparing SARS-CoV-2 with SARS-CoV and influ-enza pandemics. Lancet Infect Dis 2020; 20(9): e238–44.
Rankin DA, Spieker AJ, Perez A, Stahl AL, Rahman HK, Stew-art LS, et al. Circulation of Rhinoviruses and/or Enterovirus-es in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6(2): e2254909.
Lin Q, Lim JYC, Xue K, Yew PYM, Owh C, Chee PL, et al. San-itizing agents for virus inactivation and disinfection. View (Beijing) 2020; 1(2): e16.
Ursic T, Kogoj R, Erzar K, Virant MJ, Petrovec M. Respiratory viruses in hospitalized patients before and after SARS-CoV-2. J Biomed Res Environ Sci 2022; 23(6): 703–11.
European Centre for Disease Prevention and Control. SURVEIL-LANCE REPORT - Seasonal influenza, 2023−2024. Annual Epidemiological Report for 2023 [Internet]. Stockholm: ECDC; 2024 [cited 2025 March 13; accessed 2025 June 4]. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/seasonal-influenza-annual-epidemiological-report-2023-2024.pdf
European Centre for Disease Prevention and Control. Communica-ble disease threats report, 1-7 March 2025, week 10 [Internet]. Stockholm: ECDC; 2025 [cited 2025 March 13; accessed 2025 June 4]. Available from: https://www.ecdc.europa.eu/
en/publications-data/communicable-disease-threats-report-1-7-march-2025-week-10
Nørgaard SK, Nielsen J, Nordholm AC, Richter L, Chalupka A, Sierra NB, et al. Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024. Euro Surveill 2024; 29(15): 2400178.
Begley KM, Leis AM, Petrie JG, Truscon R, Johnson E, Lamerato LE, et al. Epidemiology of Respiratory Syncytial Virus in Adults and Children With Medically Attended Acute Respira-tory Illness Over Three Seasons. Clin Infect Dis 2024; 79(4): 1039–45.
Jackson ML, Scott E, Kuypers J, Nalla AK, Roychoudury P, Chu HY. Epidemiology of Respiratory Syncytial Virus Across Five Influenza Seasons Among Adults and Children One Year of Age and Older-Washington State, 2011/2012-2015/2016. J Infect Dis 2021; 223(1): 147–56.
Brigadoi G, Demarin GC, Boracchini R, Pierantoni L, Rossin S, Barbieri E, et al. Comparison between the Viral Illness Caused by SARS-CoV-2, Influenza Virus, Respiratory Syncytial Virus and Other Respiratory Viruses in Pediatrics. Viruses 2024; 16(2): 199.