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\begin{document}

\title{Changing pattern of respiratory virus detections among school-aged
children in a small community -- Dane County, Wisconsin,
September-December 2022}



\author[1]{Jonathan Temte}%
\author[1]{Maureen Goss}%
\author[1]{Cristalyne Bell}%
\author[1]{Shari Barlow}%
\author[1]{Emily Temte}%
\author[2]{Allen Bateman}%
\author[3]{Amra Uzicanin}%
\affil[1]{University of Wisconsin-Madison School of Medicine and Public Health}%
\affil[2]{University of Wisconsin-Madison Wisconsin State Laboratory of Hygiene}%
\affil[3]{Centers for Disease Control and Prevention}%


\vspace{-1em}



  
  \date{May 23, 2024}


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\selectlanguage{english}
\begin{abstract}
Widespread school closures and other non-pharmaceutical interventions
(NPIs), used to limit the spread of SARS-CoV-2, significantly disrupted
transmission patterns of seasonal respiratory viruses. As NPIs were
relaxed, populations were vulnerable to resurgence. This study within a
small community assessed acute respiratory illness among kindergarten
through grade 12 students as they returned to public schools from
September through December 2022 without masking and distancing
requirements. The 277 specimens collected demonstrated a shift from
rhinovirus to influenza. With continued circulation of SARS-CoV-2 and
return of seasonal respiratory viruses, understanding evolving
transmission patterns will play an important role in reducing disease
burden.%
\end{abstract}%



\sloppy


\textbf{Changing pattern of respiratory virus detections among
school-aged children in a small community -- Dane County, Wisconsin,
September-December 2022}

Short Title: Changing pattern of respiratory viruses in 2022

Authors:

Jonathan L. Temte, MD, PhD\textsuperscript{1}, Maureen Goss,
MPH\textsuperscript{1}, Cristalyne Bell, BS\textsuperscript{1}, Shari
Barlow, BS\textsuperscript{1}, Emily Temte, BA\textsuperscript{1}, Allen
Bateman, MPH, PhD\textsuperscript{2}, Amra Uzicanin, MD,
MPH\textsuperscript{3}

Affiliations:

\textsuperscript{1}University of Wisconsin School of Medicine and Public
Health. Madison, WI

\textsuperscript{2}Wisconsin State Laboratory of Hygiene. Madison, WI

\textsuperscript{3}U.S. Centers for Disease Control and Prevention.
Atlanta, GA

Corresponding Author:

Jonathan L. Temte, MD,PhD

Associate Dean for Public Health and Community Engagement

University of Wisconsin School of Medicine and Public Health

Email: jon.temte@fammed.wisc.edu

Acknowledgment:

This research would not be possible without our other dedicated ORCHARDS
team members including Cecilia He, Carly Hamer, Kelly Johnson, Sarah
Walters, Alea Sabry, and our colleagues at the Wisconsin State
Laboratory of Hygiene including Rich Griesser and Erika Hanson. We
appreciate the ongoing support of the administration, staff, and
families of the Oregon School District, Oregon, WI. This study has been
supported by CDC through cooperative agreement \# 5U01CK000542-02-00.
The findings and conclusions in this study are those of the authors and
do not necessarily represent the official position of the Centers for
Disease Control and Prevention. None of the authors have any conflicts
of interest to report.

Abstract

Widespread school closures and other non-pharmaceutical interventions
(NPIs), used to limit the spread of SARS-CoV-2, significantly disrupted
transmission patterns of seasonal respiratory viruses. As NPIs were
relaxed, populations were vulnerable to resurgence. This study within a
small community assessed acute respiratory illness among kindergarten
through grade 12 students as they returned to public schools from
September through December 2022 without masking and distancing
requirements. The 277 specimens collected demonstrated a shift from
rhinovirus to influenza. With continued circulation of SARS-CoV-2 and
return of seasonal respiratory viruses, understanding evolving
transmission patterns will play an important role in reducing disease
burden.

\textbf{Introduction:} Acute respiratory infections (ARI) in school-aged
children serve as a bellwether for pattens of ARI in the broader
community.{[}1,2{]} Prolonged, widespread use of nonpharmaceutical
interventions (NPIs) to mitigate the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) pandemic significantly altered usual
circulation of all respiratory viruses.{[}3,4{]} As NPIs were relaxed,
however, opportunities for respiratory pathogen resurgence increased.
Subsequently, theoretical concerns regarding possibly significant,
convergent impacts of respiratory syncytial virus (RSV) and influenza
virus, along with SARS-CoV-2, became a reality in late 2022.{[}5{]}

We used an ongoing community-based, laboratory-supported study of ARI in
school-aged children in a small community to characterize occurrences of
respiratory viruses in the late SARS-CoV-2 pandemic period (September --
December 2022), as children returned to public schools in the absence of
masking and distancing.

\textbf{Methods:} The ORegon CHild Absenteeism due to Respiratory
Disease Study {[}ORCHARDS; Oregon School District (OSD), Oregon, WI;
enrollment \textasciitilde{} 4,100 in 7 schools){]} is a prospective,
community-based observational study enrolling 4-year-old kindergarten
through 12\textsuperscript{th} grade (4K-12; 4-18 years-old) children
with ARI after parental consent. ORCHARDS has afforded continuous
collection of data and respiratory specimens since January 2015; study
design and methods are described in detail elsewhere (Protocol 2013-1357
approved by University of Wisconsin Health Sciences-IRB).{[}6{]} Since
March 2020, ORCHARDS has utilized participant-collected respiratory
specimens. Specimens are evaluated for SARS-CoV-2 and influenza A and B
using reverse transcription polymerase chain reaction and for 14
additional viruses using a multiplexed respiratory pathogen panel at the
Wisconsin State Laboratory of Hygiene.{[}6{]}

The 2022-2023 academic year began on September 1, with winter break
commencing on December 22. The OSD did not employ masking or distancing
requirements during this observation period. We present the number of
detections of respiratory viruses as well as the percent of detections
by week over 16-weeks, from September 5 through December 25, 2022.
Absenteeism is expressed as the average daily number of students absent
due to illness for each week.

\textbf{Results:} During the 16-week period, we received 277 participant
specimens. Of these, 229 (82.7\%) had positive virus detection,
including 28 dual virus detections (10.1\%) and two triple virus
detections (0.7\%). Participants per week mirrored OSD illness-related
absenteeism (figure 1) and was highly correlated with it (r=0.902;
p\textless{}0.001). SARS-CoV-2 detections were relatively stable over
the observation period (mean \selectlanguage{ngerman}± SD: 1.3±1.3 detections/week; figure 2a
and figure 2b). Rhinovirus/enterovirus (R/E) cases predominated in the
first eight weeks (n=45; 66.2\% of detections) declining to 12.4\%
(n=24) in the second eight weeks; influenza A was initially detected on
November 1 and comprised 56.0\% (n=108) of detections in the second
eight weeks, the majority (75.9\%; n=82) being H3 viruses.

A wide variety of other respiratory viruses were detected including RSVA
(n=18), coronavirus-HKU1 (CoV-HKU1: 14), human metapneumovirus (hMPV:
7), parainfluenza 4 (PIV4: 7), adenovirus (Ad: 6), RSVB (4), PIV1 (3),
CoV-OC43 (2), and PIV3 (2).

\textbf{Discussion:} During autumn 2022, as children returned to school
without NPIs, a wide variety of respiratory viruses was detected in a
small community setting, along with a steady, but low level of
SARS-CoV-2. Initial dominance of R/E subsided as influenza A virus
activity increased in this community. RSV activity was noted throughout,
declining as influenza virus increased.

This study's generalizability is limited by the small geographical study
area and the possibility of selection bias by participants' willingness
to enroll. Conversely, use of a long-standing laboratory-supported,
community-based, participatory platform {[}4,6{]} and previous findings
that illness absenteeism mirrors detections of respiratory viruses in
this study setting {[}2{]} reinforce the present findings.

As SARS-CoV-2 transitions into endemicity and NPI use subsides, other
respiratory viruses are returning to prominence in communities calling
for better understanding of respiratory virus patterns.

\textbf{References}

1. Temte JL, Meiman JG, Gangnon RE. School sessions are correlated with
seasonal outbreaks of medically attended respiratory infections:
electronic health record time series analysis, Wisconsin
2004-2011.\emph{Epidemiol Infect} . 2019;147:e127.
doi:10.1017/S0950268818003424

2. Temte JL, Barlow S, Goss M, et al. Cause-specific student absenteeism
monitoring in K-12 schools for detection of increased influenza activity
in the surrounding community-Dane County, Wisconsin,
2014-2020.\emph{PLoS One} . 2022;17(4):e0267111. Published 2022 Apr 19.

3. Lepak AJ, Taylor LN, Stone CA, et al. Association of changes in
seasonal respiratory virus activity and ambulatory antibiotic
prescriptions with the COVID-19 pandemic. \emph{JAMA Intern Med} .
2021;181(10):1399-1402. doi:10.1001/jamainternmed.2021.2621

4. Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on
community respiratory virus activity {[}published online ahead of print,
2022 Oct 17{]}. \emph{Nat Rev Microbiol.} 2022;1-16.
doi:10.1038/s41579-022-00807-9

5. Furlow B. Triple-demic overwhelms paediatric units in US hospitals
{[}published online ahead of print, 2022 Dec 15{]}. \emph{Lancet Child
Adolesc Health} . 2022;S2352-4642(22)00372-8.
doi:10.1016/S2352-4642(22)00372-8

6. Temte JL, Barlow S, Goss M, et al. The Oregon Child Absenteeism Due
to Respiratory Disease Study (ORCHARDS): Rationale, objectives, and
design. \emph{Influenza Other Respir Viruses} . 2022;16(2):340-350.
doi:10.1111/irv.12920

\textbf{Figures}

\textbf{Figure 1.} Number of 4K through 12\textsuperscript{th} grade
participants providing respiratory specimens per week (narrow red bars)
and average daily illness-associated absenteeism each week from the
Oregon School District (Oregon, WI: wide blue bars) for period from
September 5 through December 25, 2022.

\textbf{Figure 2a} Number of detections of respiratory viruses* per week
from participants in the ORegon CHild Absenteeism due to Respiratory
Infection Study (ORCHARDS, Oregon, WI) from September 5 through December
25, 2022.

\textbf{Figure 2b.} Percent of detections by virus type* and week.

*AH1 = influenza A(H1); AH3 = influenza A(H3); Au = influenza A
unsubtypable; R/E = rhinovirus/enterovirus; SARS-CoV-2 = severe acute
respiratory syndrome coronavirus 2; RSV = respiratory syncytial virus
type A and B; PIV = parainfluenza virus type 1, 2 and 4; Ad =
adenovirus; hMPV = human metapneumovirus; sCoV = seasonal coronavirus
HKU1 and OC43.\selectlanguage{english}
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