[COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey].
Identifieur interne : 000E68 ( Main/Corpus ); précédent : 000E67; suivant : 000E69[COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey].
Auteurs : A. Janda ; C. Schuetz ; M. Heeg ; K. Minden ; C M Hedrich ; T. Kallinich ; C. Hinze ; A. Schulz ; F. SpethSource :
- Zeitschrift fur Rheumatologie [ 1435-1250 ] ; 2020.
English descriptors
- KwdEn :
- Antirheumatic Agents (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Child (MeSH), Coronavirus Infections (drug therapy), Coronavirus Infections (therapy), Germany (MeSH), Humans (MeSH), Pandemics (MeSH), Pneumonia, Viral (therapy), Rheumatologists (MeSH), SARS-CoV-2 (MeSH), Surveys and Questionnaires (MeSH).
- MESH :
- chemical , therapeutic use : Antirheumatic Agents.
- geographic : Germany.
- drug therapy : Coronavirus Infections.
- therapy : Coronavirus Infections, Pneumonia, Viral.
- Betacoronavirus, COVID-19, Child, Humans, Pandemics, Rheumatologists, SARS-CoV-2, Surveys and Questionnaires.
Abstract
BACKGROUND
Reliable data on the course and treatment of pediatric COVID-19 ("corona virus disease 2019") in immunosuppressed patients with rheumatic diseases are missing.
AIM
Delineation of individual strategies of the members of the Society for Pediatric Rheumatology (GKJR) in cases of COVID-19.
METHODS
In May 2020 all GKJR members were invited to take part in an online survey. Opinion data regarding an approach using disease-modifying anti-rheumatic drugs (DMARD) in cases of COVID-19 as well as the readiness to use new therapeutic agents in patients in different stages of the disease were collected.
RESULTS
A total of 71 respondents (27.3% of all contacted pediatric rheumatologists) took part in the survey. Of these 28.2% had treated patients with COVID-19. Over 95% of the respondents did not support a preventive adaptation of the anti-rheumatic treatment during the SARS-CoV‑2 pandemic. In the case of outpatients under immunosuppression with proven COVID-19 more than 50% of the respondents would refrain from administering intravenous high-dose steroids, cyclophosphamide, anti-CD20 antibodies as well as BAFF, CTLA‑4 and TNF-alpha blockades. Conversely, >70% of the respondents would continue the treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine (HCQ), oral steroids, mycophenolate, IL‑1 blockade and immunoglobulins (Ig). In the case of inpatients 74.6% of respondents would consider targeted COVID-19 treatment. In stable patients with oxygen treatment (stage I) HCQ (18.3%), azithromycin (16.9%) and Ig (9.9%) were most frequently used. In cases of early signs (stage II) or a manifest cytokine storm (stage III) anakinra (40.8% for stage II and 46.5% for stage III), tocilizumab (26.8% and 40.8%, respectively), steroids (25.4% and 33.8%, respectively) and remdesivir (29.6% and 38.0%, respectively) were most frequently used. The need for a personalized approach based on the current clinical situation was emphasized by many respondents.
CONCLUSION
The currently low prevalence of COVID-19 in Germany limits the general clinical experience. Therefore, the presented results have to be interpreted with caution and mostly as hypothetical treatment considerations. It is to be expected that there will always be a limited amount of evidence on pediatric COVID-19; therefore, a continuous and critical exchange of expert opinions on the treatment strategies is important.
DOI: 10.1007/s00393-020-00854-8
PubMed: 32809050
PubMed Central: PMC7432543
Links to Exploration step
pubmed:32809050Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">[COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey].</title><author><name sortKey="Janda, A" sort="Janda, A" uniqKey="Janda A" first="A" last="Janda">A. Janda</name><affiliation><nlm:affiliation>Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland. ales.janda@uniklinik-ulm.de.</nlm:affiliation></affiliation></author><author><name sortKey="Schuetz, C" sort="Schuetz, C" uniqKey="Schuetz C" first="C" last="Schuetz">C. Schuetz</name><affiliation><nlm:affiliation>Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Heeg, M" sort="Heeg, M" uniqKey="Heeg M" first="M" last="Heeg">M. Heeg</name><affiliation><nlm:affiliation>Institut für Immundefizienz und Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Minden, K" sort="Minden, K" uniqKey="Minden K" first="K" last="Minden">K. Minden</name><affiliation><nlm:affiliation>Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Hedrich, C M" sort="Hedrich, C M" uniqKey="Hedrich C" first="C M" last="Hedrich">C M Hedrich</name><affiliation><nlm:affiliation>Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, Großbritannien.</nlm:affiliation></affiliation></author><author><name sortKey="Kallinich, T" sort="Kallinich, T" uniqKey="Kallinich T" first="T" last="Kallinich">T. Kallinich</name><affiliation><nlm:affiliation>Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Hinze, C" sort="Hinze, C" uniqKey="Hinze C" first="C" last="Hinze">C. Hinze</name><affiliation><nlm:affiliation>Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Münster, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Schulz, A" sort="Schulz, A" uniqKey="Schulz A" first="A" last="Schulz">A. Schulz</name><affiliation><nlm:affiliation>Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Speth, F" sort="Speth, F" uniqKey="Speth F" first="F" last="Speth">F. Speth</name><affiliation><nlm:affiliation>Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Sektion Pädiatrische Stammzelltransplantation und Immunologie, Abteilung Kinderrheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32809050</idno><idno type="pmid">32809050</idno><idno type="doi">10.1007/s00393-020-00854-8</idno><idno type="pmc">PMC7432543</idno><idno type="wicri:Area/Main/Corpus">000E68</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000E68</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">[COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey].</title><author><name sortKey="Janda, A" sort="Janda, A" uniqKey="Janda A" first="A" last="Janda">A. Janda</name><affiliation><nlm:affiliation>Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland. ales.janda@uniklinik-ulm.de.</nlm:affiliation></affiliation></author><author><name sortKey="Schuetz, C" sort="Schuetz, C" uniqKey="Schuetz C" first="C" last="Schuetz">C. Schuetz</name><affiliation><nlm:affiliation>Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Heeg, M" sort="Heeg, M" uniqKey="Heeg M" first="M" last="Heeg">M. Heeg</name><affiliation><nlm:affiliation>Institut für Immundefizienz und Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Minden, K" sort="Minden, K" uniqKey="Minden K" first="K" last="Minden">K. Minden</name><affiliation><nlm:affiliation>Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Hedrich, C M" sort="Hedrich, C M" uniqKey="Hedrich C" first="C M" last="Hedrich">C M Hedrich</name><affiliation><nlm:affiliation>Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, Großbritannien.</nlm:affiliation></affiliation></author><author><name sortKey="Kallinich, T" sort="Kallinich, T" uniqKey="Kallinich T" first="T" last="Kallinich">T. Kallinich</name><affiliation><nlm:affiliation>Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Hinze, C" sort="Hinze, C" uniqKey="Hinze C" first="C" last="Hinze">C. Hinze</name><affiliation><nlm:affiliation>Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Münster, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Schulz, A" sort="Schulz, A" uniqKey="Schulz A" first="A" last="Schulz">A. Schulz</name><affiliation><nlm:affiliation>Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland.</nlm:affiliation></affiliation></author><author><name sortKey="Speth, F" sort="Speth, F" uniqKey="Speth F" first="F" last="Speth">F. Speth</name><affiliation><nlm:affiliation>Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Sektion Pädiatrische Stammzelltransplantation und Immunologie, Abteilung Kinderrheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Zeitschrift fur Rheumatologie</title><idno type="eISSN">1435-1250</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antirheumatic Agents (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Child (MeSH)</term><term>Coronavirus Infections (drug therapy)</term><term>Coronavirus Infections (therapy)</term><term>Germany (MeSH)</term><term>Humans (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (therapy)</term><term>Rheumatologists (MeSH)</term><term>SARS-CoV-2 (MeSH)</term><term>Surveys and Questionnaires (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antirheumatic Agents</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Germany</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term><term>COVID-19</term><term>Child</term><term>Humans</term><term>Pandemics</term><term>Rheumatologists</term><term>SARS-CoV-2</term><term>Surveys and Questionnaires</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Reliable data on the course and treatment of pediatric COVID-19 ("corona virus disease 2019") in immunosuppressed patients with rheumatic diseases are missing.</p></div><div type="abstract" xml:lang="en"><p><b>AIM</b></p><p>Delineation of individual strategies of the members of the Society for Pediatric Rheumatology (GKJR) in cases of COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>In May 2020 all GKJR members were invited to take part in an online survey. Opinion data regarding an approach using disease-modifying anti-rheumatic drugs (DMARD) in cases of COVID-19 as well as the readiness to use new therapeutic agents in patients in different stages of the disease were collected.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>A total of 71 respondents (27.3% of all contacted pediatric rheumatologists) took part in the survey. Of these 28.2% had treated patients with COVID-19. Over 95% of the respondents did not support a preventive adaptation of the anti-rheumatic treatment during the SARS-CoV‑2 pandemic. In the case of outpatients under immunosuppression with proven COVID-19 more than 50% of the respondents would refrain from administering intravenous high-dose steroids, cyclophosphamide, anti-CD20 antibodies as well as BAFF, CTLA‑4 and TNF-alpha blockades. Conversely, >70% of the respondents would continue the treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine (HCQ), oral steroids, mycophenolate, IL‑1 blockade and immunoglobulins (Ig). In the case of inpatients 74.6% of respondents would consider targeted COVID-19 treatment. In stable patients with oxygen treatment (stage I) HCQ (18.3%), azithromycin (16.9%) and Ig (9.9%) were most frequently used. In cases of early signs (stage II) or a manifest cytokine storm (stage III) anakinra (40.8% for stage II and 46.5% for stage III), tocilizumab (26.8% and 40.8%, respectively), steroids (25.4% and 33.8%, respectively) and remdesivir (29.6% and 38.0%, respectively) were most frequently used. The need for a personalized approach based on the current clinical situation was emphasized by many respondents.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>The currently low prevalence of COVID-19 in Germany limits the general clinical experience. Therefore, the presented results have to be interpreted with caution and mostly as hypothetical treatment considerations. It is to be expected that there will always be a limited amount of evidence on pediatric COVID-19; therefore, a continuous and critical exchange of expert opinions on the treatment strategies is important.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">32809050</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>10</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1435-1250</ISSN><JournalIssue CitedMedium="Internet"><Volume>79</Volume><Issue>7</Issue><PubDate><Year>2020</Year><Month>Sep</Month></PubDate></JournalIssue><Title>Zeitschrift fur Rheumatologie</Title><ISOAbbreviation>Z Rheumatol</ISOAbbreviation></Journal><ArticleTitle>[COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey].</ArticleTitle><Pagination><MedlinePgn>710-717</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s00393-020-00854-8</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Reliable data on the course and treatment of pediatric COVID-19 ("corona virus disease 2019") in immunosuppressed patients with rheumatic diseases are missing.</AbstractText><AbstractText Label="AIM" NlmCategory="OBJECTIVE">Delineation of individual strategies of the members of the Society for Pediatric Rheumatology (GKJR) in cases of COVID-19.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">In May 2020 all GKJR members were invited to take part in an online survey. Opinion data regarding an approach using disease-modifying anti-rheumatic drugs (DMARD) in cases of COVID-19 as well as the readiness to use new therapeutic agents in patients in different stages of the disease were collected.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">A total of 71 respondents (27.3% of all contacted pediatric rheumatologists) took part in the survey. Of these 28.2% had treated patients with COVID-19. Over 95% of the respondents did not support a preventive adaptation of the anti-rheumatic treatment during the SARS-CoV‑2 pandemic. In the case of outpatients under immunosuppression with proven COVID-19 more than 50% of the respondents would refrain from administering intravenous high-dose steroids, cyclophosphamide, anti-CD20 antibodies as well as BAFF, CTLA‑4 and TNF-alpha blockades. Conversely, >70% of the respondents would continue the treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine (HCQ), oral steroids, mycophenolate, IL‑1 blockade and immunoglobulins (Ig). In the case of inpatients 74.6% of respondents would consider targeted COVID-19 treatment. In stable patients with oxygen treatment (stage I) HCQ (18.3%), azithromycin (16.9%) and Ig (9.9%) were most frequently used. In cases of early signs (stage II) or a manifest cytokine storm (stage III) anakinra (40.8% for stage II and 46.5% for stage III), tocilizumab (26.8% and 40.8%, respectively), steroids (25.4% and 33.8%, respectively) and remdesivir (29.6% and 38.0%, respectively) were most frequently used. The need for a personalized approach based on the current clinical situation was emphasized by many respondents.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">The currently low prevalence of COVID-19 in Germany limits the general clinical experience. Therefore, the presented results have to be interpreted with caution and mostly as hypothetical treatment considerations. It is to be expected that there will always be a limited amount of evidence on pediatric COVID-19; therefore, a continuous and critical exchange of expert opinions on the treatment strategies is important.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Janda</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland. ales.janda@uniklinik-ulm.de.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schuetz</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Heeg</LastName><ForeName>M</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Institut für Immundefizienz und Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Minden</LastName><ForeName>K</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hedrich</LastName><ForeName>C M</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, Großbritannien.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kallinich</LastName><ForeName>T</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hinze</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Münster, Deutschland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schulz</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Speth</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Sektion Pädiatrische Stammzelltransplantation und Immunologie, Abteilung Kinderrheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.</Affiliation></AffiliationInfo></Author></AuthorList><Language>ger</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>COVID-19: Behandlungsstrategien der deutschsprachigen Kinderrheumatologen : Ergebnisse einer Online-Umfrage.</VernacularTitle></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Z Rheumatol</MedlineTA><NlmUniqueID>0414162</NlmUniqueID><ISSNLinking>0340-1855</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D018501">Antirheumatic Agents</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D018501" MajorTopicYN="N">Antirheumatic Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005858" MajorTopicYN="N" Type="Geographic">Germany</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, 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