The Influence of Age, Gender, and Race on Pediatric Upper Respiratory Infections of COVID-19 and RSV in Mississippi
Authors: Dhaliwal Neha , Wichman Thomas , Kota Sai , Saleem Khunsa , Wright-Sexton Laura , Horwitz Bruce , Glover Sarah 
Published: November 2023

Abstract

Background
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Respiratory Syncytial Virus (RSV) are significant respiratory viruses that adversely affect pediatric patients in Mississippi. SARS- CoV-2, a positive-strand RNA virus, causes COVID-19, a contagious respiratory disease that carries profound morbidity and mortality. Infection with RSV, a negative-strand RNA virus, has recently experienced increased inter-seasonal activity in the Southern US, particularly in Mississippi. Symptoms of COVID-19 and RSV commonly overlap within pediatric patients and include clinical manifestations of fever, cough, sore throat, and shortness of breath. Both viruses are spread person-to-person via aerosol penetration into the upper respiratory tract and lungs via inhalation. Of the two viruses, RSV has previously been shown to impact children more frequently. However, the emergence of SARS-CoV-2 has led to a resurgence of interest in upper respiratory viruses within pediatric patients.

Methods
Nasopharyngeal and buccal samples were collected from pediatric patients at the University of Mississippi Medical Center, a large tertiary referral hospital, from May 2021 to November 2022. The cohort was prospectively enrolled and consisted of 132 patients who reported upper respiratory symptoms such as cough, fever, wheezing, dyspnea, and nasal congestion. Ultimately, 72% of these symptomatic patients tested positive for a viral respiratory infection of RSV or SARS-CoV-2.

Results
The data showed three specific trends in: age, gender, and race. First, a higher prevalence of certain respiratory viruses was demonstrated amongst specific age groups. In the age cohort of 0-2 years old, there were fewer cases of SARS-CoV-2 and an increased number of cases of RSV. In the age cohort of 7-12 years old, there were an increased number of cases of both SARS-CoV-2 and RSV. Furthermore, the age cohort of 13-17 years old demonstrated an increased number of cases of SARS-CoV-2 and a reduced number of cases of RSV. A two-tailed t-test indicated a significant difference between the mean age of patients infected with RSV verses SARS-CoV-2 (t=2.05, p=.04). Secondly, while analyzing gender and race, black males were disproportionately represented by increased positive viral results, comprising 46% of the positive viral detection results, while only making up 29% of the total patient cohort. Conversely, white females comprised 29% of the total patient cohort, but only 14% of the positive viral testing results.
Figure 1: Illustration of the processing of nasopharyngeal swabs utilizing single-cell RNA sequencing.

Conclusions
This data potentially points to differences in immunologic makeup of different groups within the pediatric population that would protect one age group or racial group from a certain respiratory illness but make them more susceptible to another. Additionally, the collected nasopharyngeal and buccal samples are being further characterized using single cell RNA sequencing. While many efforts to blunt the effects of these viruses in pediatric populations rely on prevention strategies and public awareness, this empirical information could allow scientists to better target the presence of these viruses within high-risk populations.