1
|
Plascevic J, Ward J, Viner RM, Hargreaves D, Turner S. Rising Unscheduled Healthcare Utilisation of Children and Young People: How Does the Rise Vary Across Deprivation Quintiles in UK Nations? Health Serv Insights 2024; 17:11786329241245235. [PMID: 38817927 PMCID: PMC11138194 DOI: 10.1177/11786329241245235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/09/2024] [Indexed: 06/01/2024] Open
Abstract
This retrospective population-based analysis assessed variations in urgent healthcare use by children and young people (CYP) across UK nations (England, Scotland and Wales) between 2007 and 2017. The study focused on urgent hospital admissions, short stay urgent admissions (SSUA) and Emergency Department (ED) attendances among CYP aged <25 years, stratified by age groups and Index of Multiple Deprivation (IMD) quintile groups. A linear mixed model was used to assess trends in healthcare activity over time and across deprivation quintiles. Urgent admissions, SSUA and ED attendances increased across all deprivation quintiles in all studied nations. Increasing deprivation was consistently associated with higher urgent healthcare utilisation. In England, the rise in urgent admissions and SSUA for CYP was slower for CYP from the quintile of greatest deprivation compared those from the least deprived quintile (respective mean differences 0.69/1000/y [95% CI 0.53, 0.85] and 0.25/1000/y [0.07, 0.42]), leading to a narrowing in health inequality. Conversely, in Scotland, urgent admissions and SSUA increased more rapidly for CYP from all deprivation quintiles, widening health inequality. Understanding the differences we describe here could inform changes to NHS pathways of care across the UK which slow the rise in urgent healthcare use for CYP.
Collapse
Affiliation(s)
| | - Joseph Ward
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell M. Viner
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dougal Hargreaves
- Mohn Centre for Children’s Health & Wellbeing, Imperial College London, London, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
- Women and Children Division, NHS Grampian, Aberdeen, UK
| |
Collapse
|
2
|
Chen L, Wang L, Xing Y, Xie J, Su B, Geng M, Ren X, Zhang Y, Liu J, Ma T, Chen M, Miller JE, Dong Y, Song Y, Ma J, Sawyer S. Persistence and Variation of the Indirect Effects of COVID-19 Restrictions on the Spectrum of Notifiable Infectious Diseases in China: Analysis of National Surveillance Among Children and Adolescents From 2018 to 2021. JMIR Public Health Surveill 2024; 10:e47626. [PMID: 38748469 PMCID: PMC11137434 DOI: 10.2196/47626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Beyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown. OBJECTIVE This study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels. METHODS The Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference. RESULTS A total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6% during 2020 but rebounded by 56.9% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95% CI 0.53-0.87), but rebounded in 2021. CONCLUSIONS The COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections.
Collapse
Affiliation(s)
- Li Chen
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Liping Wang
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Junqing Xie
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Binbin Su
- Institute of Population Research, Peking University Asia-Pacific Economic Cooperation Health Sciences Academy, Beijing, China
| | - Mengjie Geng
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang Ren
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Jessica E Miller
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Susan Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Warner BK, Durrant FG, Nguyen SA, Meyer TA. Global Otitis Media Incidence Changes During the COVID Pandemic: Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:2028-2037. [PMID: 37921380 DOI: 10.1002/lary.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim was to analyze the global impact of the COVID-19 pandemic and national lockdowns on the incidence of otitis media (OM), a common otolaryngologic disease. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS A systematic review and meta-analysis were performed using PRISMA reporting guidelines. OM incidence (measured as newly diagnosed OM cases over total patients seen over a time period), OM antibiotic prescriptions (OM cases for which antibiotics were prescribed over total OM cases), and tympanostomy tube surgeries (all tympanostomy tube surgeries over total surgical cases) were extracted. Meta-analysis of proportions and comparison of proportions were performed. RESULTS Of 1004 studies screened, 26 studies in 11 countries met inclusion criteria. The percentages of OM cases pre- and during-lockdown were 6.67%, 95% CI [4.68%, 8.99%], and 2.63% [2.02%, 3.31%], respectively, with an OR of 0.31 favoring during-lockdown [0.25, 0.39] (p < 0.00001). Antibiotic prescriptions per all OM episodes pre- and during-lockdown were 1.61% [0.17%, 8.46%] and 0.62% [0.07%, 3.32%], with an OR of 0.37 favoring during-lockdown ([0.35, 0.40], p < 0.00001). Tympanostomy tube surgery proportions pre- and during-lockdown were 31.64% [6.85%, 64.26%] and 29.99% [4.14%, 66.55%], with an OR of 0.94 favoring neither during- nor pre-lockdown [0.45, 2.00] (p = 0.88). CONCLUSION The incidence of OM decreased significantly following international lockdowns due to the COVID-19 pandemic, with antibiotic prescriptions for OM episodes showing a corresponding decrease. Despite these reductions, numbers of tympanostomy tube procedures did not change significantly. These reductions are likely due to social distancing, decreased exposure through high transmission facilities such as day cares, decreased health care utilization, and even possibly decreased air pollution. Laryngoscope, 134:2028-2037, 2024.
Collapse
Affiliation(s)
- Brendon K Warner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Frederick G Durrant
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| |
Collapse
|
4
|
Yang Y, He Y, Huang J, Yan H, Zhang X, Xiao Z, Lu X. Characteristics and spectrum changes of PICU cases during the COVID-19 pandemic: a retrospective analysis. Front Pediatr 2024; 12:1325471. [PMID: 38725989 PMCID: PMC11079195 DOI: 10.3389/fped.2024.1325471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Objective This study aims to compare the changes in the disease spectrum of children admitted to the Pediatric Intensive Care Units (PICU) during the COVID-19 pandemic with the three years prior to the pandemic, exploring the impact of the COVID-19 pandemic on the disease spectrum of PICU patients. Methods A retrospective analysis was conducted on critically ill children admitted to the PICU of Hunan Children's Hospital from January 2020 to December 2022, and the results were compared with cases from the same period between January 2017 and December 2019. The cases were divided into pre-pandemic period (January 2017-December 2019) with 8,218 cases, and pandemic period (January 2020-December 2022) with 5,619 cases. General characteristics, age, and gender were compared between the two groups. Results Compared to the pre-pandemic period, there was a 31.62% decrease in the number of admitted children during the pandemic period, and a 52.78% reduction in the proportion of respiratory system diseases. The overall mortality rate decreased by 87.81%. There were differences in age and gender distribution between the two periods. The length of hospital stay during the pandemic showed no statistical significance, whereas hospitalization costs exhibited statistical significance. Conclusion The COVID-19 pandemic has exerted a certain influence on the disease spectrum of PICU admissions. Implementing relevant measures during the pandemic can help reduce the occurrence of respiratory system diseases in children. Considering the changes in the disease spectrum of critically ill PICU children, future clinical prevention and treatment in PICUs should continue to prioritize the respiratory, neurological, and hematological oncology systems.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Xiulan Lu
- Department of Intensive Care Unit, Affiliated School of Medicine of Central South University (Hunan Children's Hospital), Changsha, Hunan, China
| |
Collapse
|
5
|
Lyon E, Olarte L. Community-acquired bacterial pneumonia in children: an update on antibiotic duration and immunization strategies. Curr Opin Pediatr 2024; 36:144-149. [PMID: 38169463 DOI: 10.1097/mop.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review is structured to update clinicians on the epidemiology, antibiotic treatment, and prevention of pediatric bacterial pneumonia. The review provides information regarding the current research on antibiotic management for bacterial pneumonia and the newest immunization recommendations to prevent pneumococcal pneumonia and other respiratory infections. RECENT FINDINGS The recommended length of antibiotic therapy for bacterial pneumonia has been discrepant between low-income and high-income countries. Recently, randomized controlled trials conducted in high-income countries provided evidence to support a short antibiotic course (3-5 days) for uncomplicated bacterial pneumonia in otherwise healthy children. The negative impact of inaccurate penicillin allergy labels in children with pneumonia has emphasized the importance of prompt allergy de-labeling. Newer pneumococcal vaccines are recommended for children and are expected to have a significant impact on bacterial pneumonia rates. SUMMARY Pediatric bacterial pneumonia is an important contributor to childhood morbidity and mortality. A short antibiotic course seems to be sufficient for the outpatient management of uncomplicated bacterial pneumonia; however, more studies are required in the inpatient setting. Future studies will inform the impact of recently introduced pneumococcal and respiratory syncytial virus vaccines on the epidemiology of bacterial pneumonia.
Collapse
Affiliation(s)
- Edward Lyon
- Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Kansas City
| | - Liset Olarte
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
6
|
Parums DV. A Review of the Resurgence of Measles, a Vaccine-Preventable Disease, as Current Concerns Contrast with Past Hopes for Measles Elimination. Med Sci Monit 2024; 30:e944436. [PMID: 38525549 PMCID: PMC10946219 DOI: 10.12659/msm.944436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
On 22 February 2024, the World Health Organization (WHO) stated that, following the recent resurgence of measles cases in Europe, more than half the world's countries could expect significant measles outbreaks this year. Measles is a highly infectious virus with a primary case reproduction number (R0) of 12-18. Measles infection can be severe, resulting in pneumonia, and also more rarely in subacute sclerosing panencephalitis (SSPE), which occurs in 1 child out of every 1,000 and can be fatal. Until the 1990s, the hope of eliminating measles seemed possible following the successful development of effective vaccines, given individually or in the combined measles, mumps, and rubella (MMR) vaccine. Vaccine hesitancy due to misinformation about possible vaccine side effects, reduced vaccine uptake during and after the COVID-19 pandemic, and lack of awareness of the severe consequences of measles infection have contributed to low vaccine uptake, resulting in vulnerable communities. This article aims to review the recent resurgence of measles cases in the US, Europe, and the UK, to provide a reminder of the potential severity of measles, and to consider the causes of the failure to eliminate this vaccine-preventable viral infection.
Collapse
|
7
|
Kovacevic A, Smith DRM, Rahbé E, Novelli S, Henriot P, Varon E, Cohen R, Levy C, Temime L, Opatowski L. Exploring factors shaping antibiotic resistance patterns in Streptococcus pneumoniae during the 2020 COVID-19 pandemic. eLife 2024; 13:e85701. [PMID: 38451256 PMCID: PMC10923560 DOI: 10.7554/elife.85701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Non-pharmaceutical interventions implemented to block SARS-CoV-2 transmission in early 2020 led to global reductions in the incidence of invasive pneumococcal disease (IPD). By contrast, most European countries reported an increase in antibiotic resistance among invasive Streptococcus pneumoniae isolates from 2019 to 2020, while an increasing number of studies reported stable pneumococcal carriage prevalence over the same period. To disentangle the impacts of the COVID-19 pandemic on pneumococcal epidemiology in the community setting, we propose a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and antibiotic-sensitive and -resistant strains of S. pneumoniae. To test hypotheses underlying these trends five mechanisms were built into the model and examined: (1) a population-wide reduction of antibiotic prescriptions in the community, (2) lockdown effect on pneumococcal transmission, (3) a reduced risk of developing an IPD due to the absence of common respiratory viruses, (4) community azithromycin use in COVID-19 infected individuals, (5) and a longer carriage duration of antibiotic-resistant pneumococcal strains. Among 31 possible pandemic scenarios involving mechanisms individually or in combination, model simulations surprisingly identified only two scenarios that reproduced the reported trends in the general population. They included factors (1), (3), and (4). These scenarios replicated a nearly 50% reduction in annual IPD, and an increase in antibiotic resistance from 20% to 22%, all while maintaining a relatively stable pneumococcal carriage. Exploring further, higher SARS-CoV-2 R0 values and synergistic within-host virus-bacteria interaction mechanisms could have additionally contributed to the observed antibiotic resistance increase. Our work demonstrates the utility of the mathematical modeling approach in unraveling the complex effects of the COVID-19 pandemic responses on AMR dynamics.
Collapse
Affiliation(s)
- Aleksandra Kovacevic
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - David RM Smith
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- Health Economics Research Centre, Nuffield Department of Health, University of OxfordOxfordUnited Kingdom
| | - Eve Rahbé
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Sophie Novelli
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Paul Henriot
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de CréteilCréteilFrance
| | - Robert Cohen
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier, Intercommunal de CréteilCréteilFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Corinne Levy
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Lulla Opatowski
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| |
Collapse
|
8
|
von Mollendorf C, Ulziibayar M, Nguyen CD, Batsaikhan P, Suuri B, Luvsantseren D, Narangerel D, de Campo J, de Campo M, Tsolmon B, Demberelsuren S, Dunne EM, Satzke C, Mungun T, Mulholland EK. Effect of Pneumococcal Conjugate Vaccine on Pneumonia Incidence Rates among Children 2-59 Months of Age, Mongolia, 2015-2021. Emerg Infect Dis 2024; 30:490-498. [PMID: 38407131 PMCID: PMC10902538 DOI: 10.3201/eid3003.230864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Starting in June 2016, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced into the routine immunization program of Mongolia by using a 2+1 dosing schedule, phased by district. We used prospective hospital surveillance to evaluate the vaccine's effect on pneumonia incidence rates among children 2-59 months of age over a 6-year period. Of 17,607 children with pneumonia, overall adjusted incidence rate ratios showed decreased primary endpoint pneumonia, very severe pneumonia, and probable pneumococcal pneumonia until June 2021. Results excluding and including the COVID-19 pandemic period were similar. Pneumonia declined in 3 districts that introduced PCV13 with catch-up campaigns but not in the 1 district that did not. After PCV13 introduction, vaccine-type pneumococcal carriage prevalence decreased by 44% and nonvaccine-type carriage increased by 49%. After PCV13 introduction in Mongolia, the incidence of more specific pneumonia endpoints declined in children 2-59 months of age; additional benefits were conferred by catch-up campaigns.
Collapse
|
9
|
Urichuk M, Azzi JL, Leitao DJ. The Impact of COVID-19 Restrictions on Hospital Admissions of Common Head and Neck Infections. Laryngoscope 2024. [PMID: 38415842 DOI: 10.1002/lary.31366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Following the emergence of COVID-19, multiple preventative measures were implemented to limit the spread of the disease. This study aims to elucidate the impact of COVID-19 restrictions on hospital admissions of otolaryngology-related infections. MATERIALS AND METHODS A retrospective chart review was conducted to capture all admissions for otolaryngology-related infections in the 2 years pre- and post-COVID-19 at the Health Sciences Centre in Winnipeg, Manitoba. These infections included croup, tracheitis, neck abscess, peritonsillar abscess, otitis media, mastoiditis, sinus infection, orbital infection, pharyngotonsillitis, retro/parapharyngeal abscess, and acute epiglottitis. Demographic information and admission details were collected and analyzed to compare pre- and post-COVID-19 admissions. Further analysis was conducted to compare hospital admissions of patients from rural/remote regions. RESULTS Between March 2018 and March 2022, 253 pediatric patients and 197 adults were admitted for otolaryngology-related infections. Total pediatric admissions decreased post-COVID-19 (154 pre-COVID-19, 99 post-COVID-19; p < 0.001) whereas adult admissions remained stable (107 pre-COVID-19, 90 post-COVID-19; p = 0.25). No significant difference in mean patient age, admission duration, surgical rates or in the proportion of admissions from patients from rural/remote regions was observed in the pediatric or adult cohort when comparing pre-COVID-19 data to post-COVID-19 data. Diagnosis-specific changes in admissions were observed in pediatric croup (40 pre-COVID-19, 15 post-COVID-19; p < 0.001) and in adult orbital infections (30 pre-COVID-19, six post-COVID-19; p < 0.001). CONCLUSION Following the implementation of COVID-19 restrictions, there was a decrease in admissions due to pediatric croup and adult orbital infections with an overall decrease in pediatric Otolaryngology-infection related admissions. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
Collapse
Affiliation(s)
- Matthew Urichuk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Lee Azzi
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Darren J Leitao
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
10
|
Treggiari D, Pomari C, Zavarise G, Piubelli C, Formenti F, Perandin F. Characteristics of Respiratory Syncytial Virus Infections in Children in the Post-COVID Seasons: A Northern Italy Hospital Experience. Viruses 2024; 16:126. [PMID: 38257826 PMCID: PMC10820224 DOI: 10.3390/v16010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Public health measures for COVID-19 mitigation influenced the circulation of Respiratory Syncytial Virus (RSV) during the 2020-2021 winter season. In the following autumn, an unprecedented resurgence of RSV occurred. Our study monitored RSV pediatric infections one and two years after the relaxation of containment measures for the COVID-19 pandemic. METHODS We analyzed diagnostic molecular data for SARS-CoV-2, flu, and RSV infections and clinical data from children with respiratory symptoms referring to our hospital during the 2021-2022 and 2022-2023 seasons. RESULTS In the 2021-2022 season, the number of RSV-affected children was very high, especially for babies <1 year. The outbreak appeared in a shorter interval of time, with a high clinical severity. In the 2022-23 season, a reduced number of infected pediatric patients were detected, with a similar hospitalization rate (46% vs. 40%), and RSV accounted for 12% of the infections. Coinfections were observed in age <2 years. In RSV patients, symptoms were similar across the two seasons. CONCLUSIONS The clinical presentation of RSV in the two post-COVID seasons suggests that the pathophysiology of the virus did not change across these two years. Further studies are needed to continuously monitor RSV to support an effective prevention strategy.
Collapse
Affiliation(s)
- Davide Treggiari
- Department of Tropical, Infectious Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy; (F.F.); (F.P.)
| | - Chiara Pomari
- Andrus Center, University of Southern California, Los Angeles, CA 90089, USA;
| | - Giorgio Zavarise
- Department of Pediatrics, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy;
| | - Chiara Piubelli
- Department of Tropical, Infectious Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy; (F.F.); (F.P.)
| | - Fabio Formenti
- Department of Tropical, Infectious Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy; (F.F.); (F.P.)
| | - Francesca Perandin
- Department of Tropical, Infectious Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy; (F.F.); (F.P.)
| |
Collapse
|
11
|
Iskander C, Stukel TA, Diong C, Guan J, Saunders N, Cohen E, Brownell M, Mahar A, Shulman R, Gandhi S, Guttmann A. Acute health care use among children during the first 2.5 years of the COVID-19 pandemic in Ontario, Canada: a population-based repeated cross-sectional study. CMAJ 2024; 196:E1-E13. [PMID: 38228342 PMCID: PMC10802996 DOI: 10.1503/cmaj.221726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The effects of the decline in health care use at the start of the COVID-19 pandemic on the health of children are unclear. We sought to estimate changes in rates of severe and potentially preventable health outcomes among children during the pandemic. METHODS We conducted a repeated cross-sectional study of children aged 0-17 years using linked population health administrative and disease registry data from January 2017 through August 2022 in Ontario, Canada. We compared observed rates of emergency department visits and hospital admissions during the pandemic to predicted rates based on the 3 years preceding the pandemic. We evaluated outcomes among children and neonates overall, among children with chronic health conditions and among children with specific diseases sensitive to delays in care. RESULTS All acute care use for children decreased immediately at the onset of the pandemic, reaching its lowest rate in April 2020 for emergency department visits (adjusted relative rate [RR] 0.28, 95% confidence interval [CI] 0.28-0.29) and hospital admissions (adjusted RR 0.43, 95% CI 0.42-0.44). These decreases were sustained until September 2021 and May 2022, respectively. During the pandemic overall, rates of all-cause mortality, admissions for ambulatory care-sensitive conditions, newborn readmissions or emergency department visits or hospital admissions among children with chronic health conditions did not exceed predicted rates. However, after declining significantly between March and May 2020, new presentations of diabetes mellitus increased significantly during most of 2021 (peak adjusted RR 1.49, 95% CI 1.28-1.74 in July 2021) and much of 2022. Among these children, presentations for diabetic ketoacidosis were significantly higher than expected during the pandemic overall (adjusted RR 1.14, 95% CI 1.00-1.30). We observed similar time trends for new presentations of cancer, but we observed no excess presentations of severe cancer overall (adjusted RR 0.91, 95% CI 0.62-1.34). INTERPRETATION In the first 30 months of the pandemic, disruptions to care were associated with important delays in new diagnoses of diabetes but not with other acute presentations of select preventable conditions or with mortality. Mitigation strategies in future pandemics or other health system disruptions should include education campaigns around important symptoms in children that require medical attention.
Collapse
Affiliation(s)
- Carina Iskander
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Therese A Stukel
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Christina Diong
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Jun Guan
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Natasha Saunders
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Eyal Cohen
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Marni Brownell
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Alyson Mahar
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Rayzel Shulman
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Sima Gandhi
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Astrid Guttmann
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man.
| |
Collapse
|
12
|
Gao ZX, Wang Y, Yan LY, Liu T, Peng LW. Epidemiological characteristics of respiratory viruses in children during the COVID-19 epidemic in Chengdu, China. Microbiol Spectr 2024; 12:e0261423. [PMID: 38051057 PMCID: PMC10783071 DOI: 10.1128/spectrum.02614-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE During the coronavirus disease 2019 epidemic, the Chinese government launched and used a series of nonpharmaceutical interventions (NPIs), including banning social gatherings, wearing face masks, home isolation, and maintaining hand hygiene, to control the disease spread. Whether and how NPIs influence other respiratory viruses in children remain unclear. In this article, we analyzed relative data and found that the number of samples and positive proportion of respiratory viruses decreased significantly compared with that before the epidemic. Clinicians and public health policymakers should pay attention to changes in the epidemic trends and types of respiratory viruses and maintain monitoring of respiratory-related viruses to avoid possible abnormal rebounds and epidemic outbreaks of these viruses.
Collapse
Affiliation(s)
- Zheng-Xiang Gao
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ya Wang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ling-Yi Yan
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ting Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Lei-Wen Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| |
Collapse
|
13
|
Deja E, Donohue C, Semple MG, Woolfall K. Stakeholders' perspectives on clinical trial acceptability and approach to consent within a limited timeframe: a mixed methods study. BMJ Open 2024; 14:e077023. [PMID: 38167280 PMCID: PMC10773389 DOI: 10.1136/bmjopen-2023-077023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES The Bronchiolitis Endotracheal Surfactant Study (BESS) is a randomised controlled trial to determine the efficacy of endo-tracheal surfactant therapy for critically ill infants with bronchiolitis. To explore acceptability of BESS, including approach to consent within a limited time frame, we explored parent and staff experiences of trial involvement in the first two bronchiolitis seasons to inform subsequent trial conduct. DESIGN A mixed-method embedded study involving a site staff survey, questionnaires and interviews with parents approached about BESS. SETTING Fourteen UK paediatric intensive care units. PARTICIPANTS Of the 179 parents of children approached to take part in BESS, 75 parents (of 69 children) took part in the embedded study. Of these, 55/69 (78%) completed a questionnaire, and 15/69 (21%) were interviewed. Thirty-eight staff completed a questionnaire. RESULTS Parents and staff found the trial acceptable. All constructs of the Adapted Theoretical Framework of Acceptability were met. Parents viewed surfactant as being low risk and hoped their child's participation would help others in the future. Although parents supported research without prior consent in studies of time critical interventions, they believed there was sufficient time to consider this trial. Parents recommended that prospective informed consent should continue to be sought for BESS. Many felt that the time between the consent process and intervention being administered took too long and should be 'streamlined' to avoid delays in administration of trial interventions. Staff described how the training and trial processes worked well, yet patients were missed due to lack of staff to deliver the intervention, particularly at weekends. CONCLUSION Parents and staff supported BESS trial and highlighted aspects of the protocol, which should be refined, including a streamlined informed consent process. Findings will be useful to inform proportionate approaches to consent in future paediatric trials where there is a short timeframe for consent discussions. TRIAL REGISTRATION NUMBER ISRCTN11746266.
Collapse
Affiliation(s)
- Elizabeth Deja
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| |
Collapse
|
14
|
Kyne S, Ní Shíocháin D, McDonnell C, Byrne A, Sutton-Fitzpatrick U, Crowley N, Nertney L, Myers C, Waldron J, Ahmed A, Wrynne C, Fennell J, Fitzpatrick P, Fitzsimons JJ, Scanlan B, Vaughan D, Gorman KM, Cunney R, Smyth AE, Hourihane JO. Increased rates of invasive bacterial disease in late 2022. Eur J Pediatr 2024; 183:323-334. [PMID: 37882822 DOI: 10.1007/s00431-023-05282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
Invasive bacterial disease is associated with significant morbidity and mortality. In winter 2022, there was an apparent increased rate of invasive bacterial disease compared to preceding years. Cross-site retrospective analysis of the three Children's Health Ireland (CHI) hospitals looking at children admitted between 1st October 2022-31st December 2022 (Q4) with community-acquired invasive bacterial disease, defined as an abscess in a normally sterile site in the head, neck and chest or isolation or PCR detection of Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus pyogenes (Group A streptococcus) or Haemophilus influenzae from a normally sterile site. Case numbers were compared to Q4 in each of 2018-2021. Eighty-two children met the case definition in Q4 2022 vs 97 (Q4 2018-2021). In 2022, 42/82 (51%) were female, median age 3.75 years (1.5-8.25 years). Only 2 (2%) were immunosuppressed and 2 others (2%) had underlying neurodisability. Fifty (61%) were admitted on second or subsequent presentation to a healthcare setting. Fifty-six (68%) had an abscess in a sterile site. Bloodstream infection (positive blood culture or PCR: 24 (29%)) was the most common site of infection, followed by neck 22 (27%) and intracranial 12 (15%). Group A streptococcus (GAS) 27 (33%) was the most common organism isolated. Seven cases (9%) died in 2022 compared to 2 patients (2%) from 2018 to 2021 (p < 0.05). More children had Paediatric Overall Performance Category (POPC) scores > 1 in 2022 than 2018-2021 (p = 0.003). Conclusion: Invasive bacterial diseases increased in Q4 2022 with higher morbidity and mortality than in the preceding 4 years. Group A streptococcal infection was the most significant organism in 2022. What is known: • Invasive bacterial disease is the leading cause of childhood mortality globally. • There was an increase in cases of invasive Group A streptococcus infections reported in many countries (including Ireland) during the winter of 2022/23. What is new: • Head, neck and chest abscesses increased in Q4 of 2022 compared to the previous 4 years combined. • Invasive bacterial infections in Q4 of 2022 were associated with higher rates of mortality (9%), paediatric intensive care unit (PICU) admission (24%) and requirement for surgical drainage or intervention (67%) than in the preceding years.
Collapse
Affiliation(s)
- Sarah Kyne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland.
| | | | | | - Aisling Byrne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | | | - Niamh Crowley
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Leona Nertney
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Conor Myers
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - John Waldron
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Aneeq Ahmed
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Caragh Wrynne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Jerome Fennell
- Clinical Microbiology, Children's Health Ireland, Dublin, Ireland
| | - Patrick Fitzpatrick
- Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - John J Fitzsimons
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Barry Scanlan
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - David Vaughan
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Kathleen M Gorman
- Neurology, Children's Health Ireland, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Robert Cunney
- Clinical Microbiology, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Anna E Smyth
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Jonathan O'B Hourihane
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| |
Collapse
|
15
|
Sarlin S, Koskela U, Honkila M, Tähtinen PA, Pokka T, Renko M, Tapiainen T. Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2340608. [PMID: 37917062 PMCID: PMC10623191 DOI: 10.1001/jamanetworkopen.2023.40608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023] Open
Abstract
Importance New approaches for the prevention of acute otitis media (AOM), the most common reason for antibiotic use in children, are needed. Objective To assess the efficacy of the Streptococcus salivarius K12 oral probiotics in the primary prevention of AOM. Design, Setting, and Participants This double-blind, randomized placebo-controlled clinical trial was conducted from August 1, 2020, to May 31, 2021, at 50 day care centers in the Oulu region of Finland. A total of 827 children aged 1 to 6 years attending day care were included. The exclusion criteria consisted of ongoing antimicrobial prophylaxis or immunodeficiency. The follow-up time was 6 months and was completed on May 31, 2021. Data were analyzed from October 24, 2022, to September 16, 2023, based on intention to treat. Intervention Eligible participants were randomly allocated to receive 1 daily dose of a S salivarius K12 product or placebo every evening for 6 months. A daily dose was defined as 1 sachet of soluble oral powder for children younger than 3 years or 1 chewable tablet for children 3 years or older containing 1 × 109 colony-forming units of S salivarius K12. Main Outcomes and Measures The primary outcome was the proportion of children with at least 1 episode of AOM requiring antimicrobial therapy within 6 months of randomization. All physician visits and purchases of antimicrobial drugs were retrieved from the electronic national medical record and prescription register. The primary outcome was met if the legal guardian had purchased an antimicrobial prescription for AOM. Results A total of 827 children with a mean (SD) age of 4.1 (1.6) years (433 boys [52.4%]) were randomized to S salivarius K12 oral products (n = 413) or placebo (n = 414). Thirty-four children (8.2%) in the S salivarius group and 24 children (5.8%) in the placebo group experienced at least 1 episode of AOM requiring antimicrobial therapy during the 6-month follow-up period (relative risk, 1.42 [95% CI, 0.86-2.34]; proportion difference, -2.44% [95% CI, -5.94% to 1.09%]; P = .17). Time to first AOM episode did not differ between the groups (174 [95% CI, 171-177] days in the S salivarius group vs 176 [95% CI, 173-179] days in the placebo group; P = .18). Conclusions and Relevance In this randomized placebo-controlled clinical trial, the daily use of the S salivarius K12 products for 6 months did not reduce the occurrence of AOM. New approaches for primary prevention of AOM among children are needed. Trial Registration ClinicalTrialsRegister.eu Identifier: 2020-001076-14.
Collapse
Affiliation(s)
- Suvi Sarlin
- Department of Pediatrics and Adolescent Medicine and Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Ulla Koskela
- Department of Pediatrics and Adolescent Medicine and Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Minna Honkila
- Department of Pediatrics and Adolescent Medicine and Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Paula A. Tähtinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tytti Pokka
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Marjo Renko
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine and Medical Research Center, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| |
Collapse
|
16
|
Lewer D, Brothers TD, Croxford S, Desai M, Emanuel E, Harris M, Hope VD. Opioid Injection-Associated Bacterial Infections in England, 2002-2021: A Time Series Analysis of Seasonal Variation and the Impact of Coronavirus Disease 2019. Clin Infect Dis 2023; 77:338-345. [PMID: 36916065 PMCID: PMC10425189 DOI: 10.1093/cid/ciad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Bacterial infections cause substantial pain and disability among people who inject drugs. We described time trends in hospital admissions for injecting-related infections in England. METHODS We analyzed hospital admissions in England between January 2002 and December 2021. We included patients with infections commonly caused by drug injection, including cutaneous abscesses, cellulitis, endocarditis, or osteomyelitis, and a diagnosis of opioid use disorder. We used Poisson regression to estimate seasonal variation and changes associated with coronavirus disease 2019 (COVID-19) response. RESULTS There were 92 303 hospital admissions for injection-associated infections between 2002 and 2021. Eighty-seven percent were skin, soft-tissue, or vascular infections; 72% of patients were male; and the median age increased from 31 years in 2002 to 42 years in 2021. The rate of admissions reduced from 13.97 per day (95% confidence interval [CI], 13.59-14.36) in 2003 to 8.94 (95% CI, 8.64-9.25) in 2011, then increased to 18.91 (95% CI, 18.46-19.36) in 2019. At the introduction of COVID-19 response in March 2020, the rate of injection-associated infections reduced by 35.3% (95% CI, 32.1-38.4). Injection-associated infections were also seasonal; the rate was 1.21 (95% CI, 1.18-1.24) times higher in July than in February. CONCLUSIONS This incidence of opioid injection-associated infections varies within years and reduced following COVID-19 response measures. This suggests that social and structural factors such as housing and the degree of social mixing may contribute to the risk of infection, supporting investment in improved social conditions for this population as a means to reduce the burden of injecting-related infections.
Collapse
Affiliation(s)
- Dan Lewer
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, United Kingdom
- Department of Epidemiology and Public Health, UCL, London, United Kingdom
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Thomas D Brothers
- Department of Epidemiology and Public Health, UCL, London, United Kingdom
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Croxford
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, United Kingdom
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, United Kingdom
| | - Eva Emanuel
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, United Kingdom
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vivian D Hope
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, United Kingdom
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| |
Collapse
|
17
|
Smith DRM, Shirreff G, Temime L, Opatowski L. Collateral impacts of pandemic COVID-19 drive the nosocomial spread of antibiotic resistance: A modelling study. PLoS Med 2023; 20:e1004240. [PMID: 37276186 DOI: 10.1371/journal.pmed.1004240] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Circulation of multidrug-resistant bacteria (MRB) in healthcare facilities is a major public health problem. These settings have been greatly impacted by the Coronavirus Disease 2019 (COVID-19) pandemic, notably due to surges in COVID-19 caseloads and the implementation of infection control measures. We sought to evaluate how such collateral impacts of COVID-19 impacted the nosocomial spread of MRB in an early pandemic context. METHODS AND FINDINGS We developed a mathematical model in which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and MRB cocirculate among patients and staff in a theoretical hospital population. Responses to COVID-19 were captured mechanistically via a range of parameters that reflect impacts of SARS-CoV-2 outbreaks on factors relevant for pathogen transmission. COVID-19 responses include both "policy responses" willingly enacted to limit SARS-CoV-2 transmission (e.g., universal masking, patient lockdown, and reinforced hand hygiene) and "caseload responses" unwillingly resulting from surges in COVID-19 caseloads (e.g., abandonment of antibiotic stewardship, disorganization of infection control programmes, and extended length of stay for COVID-19 patients). We conducted 2 main sets of model simulations, in which we quantified impacts of SARS-CoV-2 outbreaks on MRB colonization incidence and antibiotic resistance rates (the share of colonization due to antibiotic-resistant versus antibiotic-sensitive strains). The first set of simulations represents diverse MRB and nosocomial environments, accounting for high levels of heterogeneity across bacterial parameters (e.g., rates of transmission, antibiotic sensitivity, and colonization prevalence among newly admitted patients) and hospital parameters (e.g., rates of interindividual contact, antibiotic exposure, and patient admission/discharge). On average, COVID-19 control policies coincided with MRB prevention, including 28.2% [95% uncertainty interval: 2.5%, 60.2%] fewer incident cases of patient MRB colonization. Conversely, surges in COVID-19 caseloads favoured MRB transmission, resulting in a 13.8% [-3.5%, 77.0%] increase in colonization incidence and a 10.4% [0.2%, 46.9%] increase in antibiotic resistance rates in the absence of concomitant COVID-19 control policies. When COVID-19 policy responses and caseload responses were combined, MRB colonization incidence decreased by 24.2% [-7.8%, 59.3%], while resistance rates increased by 2.9% [-5.4%, 23.2%]. Impacts of COVID-19 responses varied across patients and staff and their respective routes of pathogen acquisition. The second set of simulations was tailored to specific hospital wards and nosocomial bacteria (methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase producing Escherichia coli). Consequences of nosocomial SARS-CoV-2 outbreaks were found to be highly context specific, with impacts depending on the specific ward and bacteria evaluated. In particular, SARS-CoV-2 outbreaks significantly impacted patient MRB colonization only in settings with high underlying risk of bacterial transmission. Yet across settings and species, antibiotic resistance burden was reduced in facilities with timelier implementation of effective COVID-19 control policies. CONCLUSIONS Our model suggests that surges in nosocomial SARS-CoV-2 transmission generate selection for the spread of antibiotic-resistant bacteria. Timely implementation of efficient COVID-19 control measures thus has 2-fold benefits, preventing the transmission of both SARS-CoV-2 and MRB, and highlighting antibiotic resistance control as a collateral benefit of pandemic preparedness.
Collapse
Affiliation(s)
- David R M Smith
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - George Shirreff
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
| | - Lulla Opatowski
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
| |
Collapse
|
18
|
Chand K, Butt MI, Tahir HM. Parental Attitude, Knowledge, and Practices Regarding the Usage of Antibiotics for Upper Respiratory Tract Infections in Children During the COVID-19 Pandemic. Cureus 2023; 15:e39932. [PMID: 37415993 PMCID: PMC10319945 DOI: 10.7759/cureus.39932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has raised knowledge of the proper antibiotic dosage for treating childhood upper respiratory tract infections (URTIs). In order to ensure proper antibiotic usage and prevent the establishment of illnesses that is antibiotic-resistant during the COVID-19 pandemic, parental attitudes, knowledge, and behaviour surrounding antibiotic use for URTIs in children are essential. The goal of this study was to find out the parental attitude, knowledge, and practices regarding the usage of antibiotics for URTIs in children during the COVID-19 epidemic. METHODOLOGY This cross-sectional was conducted in the Department of Paediatric Medicine, Central Hospital, Ganesh Nagar, New Delhi, India from September 2022 to February 2023. The study analysed a total of 500. All the children had URTIs. A structured questionnaire was randomly distributed among parents. Socio-demographic information like gender, age, occupation, monthly family income, and age of the children were noted at the time of enrollment. Outcomes were recorded in terms of responses to questions regarding attitude, knowledge, and practices regarding the use of antibiotics for URTIs in children during the COVID-19 epidemic. Results: Of a total of 500 parents, 380 (76.0%) were male. The mean age was 39.9±8.3 years while 280 (56.0%) participants were aged between 31 to 45 years. Relatively older age (p<0.0001) and occupational status as unemployed (p<0.0001) were found to have a significant association with response to "virus being the cause of COVID-19". Females (p=0.0004) and increasing age (p<0.0001) were found to have significant associations with incorrect responses to "antibiotics are essential for managing the symptoms in children with COVID-19". Incorrect responses to "without the use of antibiotics, children usually suffer from greater periods of sickness" were associated with females and increasing age (p<0.0001). Incorrect responses to "not using antibiotics will prove beneficial for the children suffering from COVID-19" were significantly associated with female gender (p=0.0016) and increasing age (p<0.0001). The incorrect responses to "how often are antibiotics being prescribed to the COVID-19 children" was significantly linked with females and relatively older age (p<0.0001). CONCLUSIONS Parental attitude, knowledge, and practices regarding the usage of antibiotics for URTIs in children during the COVID-19 epidemic showed variations. Parental attitude, knowledge, and practices were associated with gender, age, and socio-economic status.
Collapse
Affiliation(s)
- Kanwal Chand
- Department of Paediatric Medicine, Central Hospital, Delhi, IND
| | | | | |
Collapse
|
19
|
Moscovich DP, Averbuch D, Kerem E, Cohen-Cymberknoh M, Berkun Y, Brooks R, Reiff S, Meir MB, Wolf D, Breuer O. Pediatric respiratory admissions and related viral infections during the COVID-19 pandemic. Pediatr Pulmonol 2023. [PMID: 37097057 DOI: 10.1002/ppul.26434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has affected the incidence of respiratory viral infections. Our aim was to assess changes in pediatric admissions due to respiratory diseases and associated respiratory viral infections. METHODS An observational study including all respiratory admissions to the pediatric departments from January 2015 to August 2021. We compared respiratory admission percentage, respiratory viral panel results and clinical characteristics of these admissions between two study periods, January 2015 to February 2020 (pre-COVID-19 era) and March 2020 to August 2021 (COVID-19 era). RESULTS A total of 8774 respiratory admissions were included, 7157 pre-COVID-19 era and 1617 COVID-19 era. Relative to all pediatric admissions, there was a 17% decrease in respiratory admission percentage during the COVID-19 era (p < 0.001) and a 31% and 22% decreased in the admission percentages due to bronchiolitis (p < 0.001) and pneumonia (p < 0.001), respectively. However, admission percentages for asthma, wheezing illness, complicated pneumonia, and stridor remained the same. There was a significant decrease in the detection of a respiratory viral pathogen associated with these respiratory admissions (p < 0.001). This was related to a significant decrease in the detection of respiratory syncytial virus (RSV) (37% vs. 27%, p < 0.001) and influenza (5% vs. 0.3%, p < 0.001), but not other respiratory viruses. An alteration in the circulation pattern of most respiratory viruses, was observed. CONCLUSIONS During the COVID-19 pandemic, a decrease in the prevalence of RSV and influenza was associated with a significant decrease in admissions for bronchiolitis and pediatric pneumonia. This may allow us to estimate the significance of preventive measures for RSV and influenza on pediatric respiratory admissions.
Collapse
Affiliation(s)
- Dana Peer Moscovich
- Pediatric Pulmonology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Diana Averbuch
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Pediatric Infectious Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eitan Kerem
- Pediatric Pulmonology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yackov Berkun
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Rebecca Brooks
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Shimon Reiff
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Maskit Bar Meir
- Paediatrics and Infectious Diseases Division, Shaare Zedek Medical and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Dana Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Departments of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| |
Collapse
|
20
|
Matsuda A, Asayama K, Obara T, Yagi N, Ohkubo T. Behavioral changes of preventive activities of influenza among children in satellite cities of a metropolitan area of Tokyo, Japan, by the COVID-19 pandemic. BMC Public Health 2023; 23:727. [PMID: 37085782 PMCID: PMC10119014 DOI: 10.1186/s12889-023-15606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE In children in a metropolitan area of Tokyo, Japan, behavioral change and influenza infection associated with the frequency of nonpharmaceutical interventions (NPI) was assessed from the 2018-2019 season (Preseason) and the 2020-2021 season (coronavirus disease 2019 [COVID-19] season). METHODS We conducted an exclusive survey among children attending preschool, elementary school, and junior high school in the Toda and Warabi regions, Japan, during the 2018-2019 (Preseason, distributed via mail) and 2020-2021 seasons (COVID-19 season, conducted online). The proportion of preventive activities (hand washing, face mask-wearing, and vaccination) was compared in the Preseason with that of the COVID-19 season. The multivariate logistic regression model was further applied to calculate the adjusted odds ratio (AOR) with 95% confidence intervals (CIs) for influenza infection associated with NPI frequency (hand washing and face mask wearing) in each Preseason and COVID-19 season. RESULTS The proportion of vaccinated children who carried out hand washing and face mask wearing was remarkably higher during the COVID-19 season (48.8%) than in the Preseason (18.2%). A significant influenza infection reduction was observed among children who washed hands and wore face masks simultaneously (AOR, 0.87; 95% CI, 0.76-0.99; P = 0.033). CONCLUSIONS A strong interest and performance in the intensive measures for the prevention of influenza under the COVID-19 pandemic was demonstrated. Positive association was observed from a combination of NPI, hand washing, and face mask-wearing and influenza infection. This study's findings could help in activities or preventive measures against influenza and other communicable diseases in children.
Collapse
Affiliation(s)
- Ayako Matsuda
- Center for Health Informatics policy, National Institute of Public Health, 2-3-6 Minami, Wako-Shi, 351-0197, Saitama, Japan.
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Naoto Yagi
- Warabi-Toda Medical Association, Toda, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| |
Collapse
|
21
|
Geppe NA, Zaplatnikov AL, Kondyurina EG, Chepurnaya MM, Kolosova NG. The Common Cold and Influenza in Children: To Treat or Not to Treat? Microorganisms 2023; 11:microorganisms11040858. [PMID: 37110281 PMCID: PMC10146091 DOI: 10.3390/microorganisms11040858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
The common cold, which is mostly caused by respiratory viruses and clinically represented by the symptoms of acute respiratory viral infections (ARVI) with mainly upper respiratory tract involvement, is an important problem in pediatric practice. Due to the high prevalence, socio-economic burden, and lack of effective prevention measures (except for influenza and, partially, RSV infection), ARVI require strong medical attention. The purpose of this descriptive literature review was to analyze the current practical approaches to the treatment of ARVI to facilitate the choice of therapy in routine practice. This descriptive overview includes information on the causative agents of ARVI. Special attention is paid to the role of interferon gamma as a cytokine with antiviral and immunomodulatory effects on the pathogenesis of ARVI. Modern approaches to the treatment of ARVI, including antiviral, pathogenesis-directed and symptomatic therapy are presented. The emphasis is on the use of antibody-based drugs in the immunoprophylaxis and immunotherapy of ARVI. The data presented in this review allow us to conclude that a modern, balanced and evidence-based approach to the choice of ARVI treatment in children should be used in clinical practice. The published results of clinical trials and systematic reviews with meta-analyses of ARVI in children allow us to conclude that it is possible and expedient to use broad-spectrum antiviral drugs in complex therapy. This approach can provide an adequate response of the child’s immune system to the virus without limiting the clinical possibilities of using only symptomatic therapy.
Collapse
|
22
|
Bakare AA, Olojede OE, King C, Graham H, Uchendu O, Colbourn T, Falade AG, Alvesson HM. Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study. BMJ Open 2023; 13:e069294. [PMID: 36882237 PMCID: PMC10008198 DOI: 10.1136/bmjopen-2022-069294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE To explore healthcare seeking practices for children and the context-specific direct and indirect effects of public health interventions during the first two waves of COVID-19 in Lagos State, Nigeria. We also explored decision-making around vaccine acceptance at the start of COVID-19 vaccine roll-out in Nigeria. DESIGN, SETTING AND PARTICIPANTS A qualitative explorative study involving 19 semistructured interviews with healthcare providers from public and private primary health facilities and 32 interviews with caregivers of under-five children in Lagos from December 2020 to March 2021. Participants were purposively selected from healthcare facilities to include community health workers, nurses and doctors, and interviews were conducted in quiet locations at facilities. A data-driven reflexive thematic analysis according to Braun and Clark was conducted. FINDINGS Two themes were developed: appropriating COVID-19 in belief systems, and ambiguity about COVID-19 preventive measures. The interpretation of COVID-19 ranged from fearful to considering it as a 'scam' or 'falsification from the government'. Underlying distrust in government fuelled COVID-19 misperceptions. Care seeking for children under five was affected, as facilities were seen as contagious places for COVID-19. Caregivers resorted to alternative care and self-management of childhood illnesses. COVID-19 vaccine hesitancy was a major concern among healthcare providers compared with community members at the time of vaccine roll-out in Lagos, Nigeria. Indirect impacts of COVID-19 lockdown included diminished household income, worsening food insecurity, mental health challenges for caregivers and reduced clinic visits for immunisation. CONCLUSION The first wave of the COVID-19 pandemic in Lagos was associated with reductions in care seeking for children, clinic attendance for childhood immunisations and household income. Strengthening health and social support systems with context-specific interventions and correcting misinformation is crucial to building adaptive capacity for response to future pandemics. TRIAL REGISTRATION NUMBER ACTRN12621001071819.
Collapse
Affiliation(s)
- Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Omotayo E Olojede
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hamish Graham
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Centre for International Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Obioma Uchendu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Department of Paediatrics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | | |
Collapse
|
23
|
Faraguna MC, Lepri I, Clavenna A, Bonati M, Vimercati C, Sala D, Cattoni A, Melzi ML, Biondi A. The bronchiolitis epidemic in 2021-2022 during the SARS-CoV-2 pandemic: experience of a third level centre in Northern Italy. Ital J Pediatr 2023; 49:26. [PMID: 36803828 PMCID: PMC9942300 DOI: 10.1186/s13052-023-01425-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the 2021-2022 bronchiolitis season to the four previous years (2017-2018, 2018-2019, 2019-2020, 2020-2021) to see if there was an anticipation of the peak, an overall increase of cases, and an increased need of intensive care. METHODS A retrospective single-centre study in the San Gerardo Hospital Fondazione MBBM, Monza, Italy was performed. Emergency Departments (ED) visits of patients aged < 18 years and ≤ 12 months were analyzed: the incidence of bronchiolitis on total assessments, the urgency level at triage and the hospitalization rate were compared. Data of children admitted to the Pediatric Department due to bronchiolitis were analyzed in terms of need of intensive care, respiratory support (type and duration), length of hospital stay, main etiological agent, patient characteristics. RESULTS During 2020-2021 (first pandemic period) an important reduction in the ED attendance for bronchiolitis was observed, while in 2021-2022 there was an increase in incidence of bronchiolitis (13% of visits in infants < 1 year) and in the rate of urgent accesses (p = 0.0002), but hospitalization rates did not differ compared to previous years. Furthermore, an anticipated peak in November 2021 was observed. In the 2021-2022 cohort of admitted children to the Pediatric Department, a statistically significative increased need of intensive care unit was detected (Odds Ratio 3.1, 95% CI 1.4-6.8 after adjustment for severity and clinical characteristics). Instead, respiratory support (type and duration) and length of hospital stay did not differ. RSV was the main etiological agent and RSV-bronchiolitis determined a more severe infection (type and duration of breathing support, intensive care need and length of hospital stay). CONCLUSIONS During Sars-CoV-2 lockdowns (2020-2021), there was a dramatic decrease of bronchiolitis and others respiratory infections. In the following season, 2021-2022, an overall increase of cases with an anticipated peak was observed and data analysis confirmed that patients in 2021-2022 required more intensive care than children in the four previous seasons.
Collapse
Affiliation(s)
| | - Irene Lepri
- Residency in Pediatrics, University of Milano Bicocca, Monza, Italy.
| | - Antonio Clavenna
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Vimercati
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Debora Sala
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Alessandro Cattoni
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Maria Luisa Melzi
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Andrea Biondi
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| |
Collapse
|
24
|
Facchin G, Bella A, Del Manso M, Rota MC, Filia A. Decline in reported measles cases in Italy in the COVID-19 era, January 2020 - July 2022: The need to prevent a resurgence upon lifting non-pharmaceutical pandemic measures. Vaccine 2023; 41:1286-1289. [PMID: 36669968 PMCID: PMC9837224 DOI: 10.1016/j.vaccine.2023.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
From January 2020 to July 2022, 120 measles cases were reported to the Italian national surveillance system, of which 105 had symptom onset in 2020, nine in 2021 and six in the first seven months of 2022. This represents a sharp decline compared to the time period immediately preceding the COVID-19 pandemic, most likely due to the non-pharmaceutical interventions implemented to prevent SARS-CoV2 transmission. Of 105 cases reported in 2020, 103 acquired the infection before a national lockdown was instituted on 9 March 2020. Overall, one quarter of cases reported at least one complication. As non-pharmaceutical pandemic measures are being eased worldwide, and considering measles seasonality, infectiousness, and its potential severity, it is important that countries ensure high vaccination coverage and close immunity gaps, to avoid risk of future outbreaks.
Collapse
Affiliation(s)
- Giacomo Facchin
- Italian National Institute of Health, Rome, Italy,University of Padua, Italy
| | | | | | | | | |
Collapse
|
25
|
Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England. Vaccines (Basel) 2023; 11:vaccines11020288. [PMID: 36851166 PMCID: PMC9962700 DOI: 10.3390/vaccines11020288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.
Collapse
|
26
|
Kanda N, Hashimoto H, Imai T, Yoshimoto H, Goda K, Mitsutake N, Hatakeyama S. Indirect impact of the COVID-19 pandemic on the incidence of non-COVID-19 infectious diseases: a region-wide, patient-based database study in Japan. Public Health 2023; 214:20-24. [PMID: 36436277 PMCID: PMC9595362 DOI: 10.1016/j.puhe.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has forced people to change many behaviours, including physical distancing, hygiene measures and lifestyles. This study aimed to evaluate the indirect impact of the COVID-19 pandemic on the incidence of non-COVID-19 infections and medical care costs/visits using health insurance claims. STUDY DESIGN This was an observational study using patient-based administrative claims covering approximately 800,000 insured persons and their dependents in the Mie Prefecture in Japan. METHODS This study identified non-COVID-19 infectious disease incidences, number of outpatient visits and healthcare costs between 2017 and 2021. Each year was divided into quarters. The adjusted incidence rate ratios (IRRs) during the pandemic (January 2020 to September 2021) and during the prepandemic period (January 2017 to December 2019) were determined using Poisson regression. RESULTS The adjusted influenza IRRs from April 2020 were close to zero. The incidence of upper respiratory tract infections and bacterial pneumonia was significantly reduced (IRRs range: 0.39-0.73 and 0.43-0.84, respectively). Gastrointestinal and urinary tract infection incidences decreased by approximately 30% and 10%, respectively. In contrast, sexually transmitted infections (STIs), including syphilis, gonococcal infection and Chlamydia trachomatis infection, did not decrease during the pandemic but increased significantly between April and June 2021 (adjusted IRR, 1.37; 95% confidence interval, 1.18-1.60). The adjusted IRRs for outpatient visits and healthcare costs were 0.86-0.93 and 0.91-0.97, respectively. CONCLUSIONS In contrast to other infections, STIs did not decrease during the COVID-19 pandemic. The IRR of STIs during the pandemic period is an area of public health concern. Appropriate screening and medical consultations are strongly recommended.
Collapse
Affiliation(s)
- N. Kanda
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - H. Hashimoto
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan,Department of Infectious Diseases, University of Tokyo Hospital, Tokyo, Japan
| | - T. Imai
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - H. Yoshimoto
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - K. Goda
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - N. Mitsutake
- Institute for Health Economics and Policy, Tokyo, Japan
| | - S. Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan,Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan,Corresponding author. Division of General Internal Medicine, Jichi Medical University Hospital, Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan. Tel.: +81 285 58-7498; fax: +81 285 40-5160
| |
Collapse
|
27
|
Zarur‐Torralvo S, Stand‐Niño I, Flórez‐García V, Mendoza H, Viana‐Cárdenas E. Viruses responsible for acute respiratory infections before (2016-2019) and during (2021) circulation of the SARS-CoV-2 virus in pediatric patients in a reference center at Barranquilla Colombia: A pattern analysis. J Med Virol 2023; 95:e28439. [PMID: 36573419 PMCID: PMC9880681 DOI: 10.1002/jmv.28439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the behavior of the viruses responsible for acute respiratory infections before (2016-2019) and after (2020-2021) the start of the circulation of the SARS-CoV-2 virus in pediatric patients treated at a reference center from Barranquilla, Colombia. MATERIALS AND METHODS A descriptive observational study was carried out, and data were obtained by reviewing the influenza-like illness and severe acute respiratory infection database in the pediatric population of the sentinel surveillance reference center in the district of Barranquilla during the years 2016-2021, applying inclusion and exclusion criteria. RESULTS During 2016-2019, the average age of individuals was 1.3 (±1.7) years, during 2021, it was 2.3 (±3.5) years. The distribution by sex was similar, predominantly male. August and February were the months with the highest record of symptoms for 2016-2019 and 2021, respectively, the most frequent being cough, fever, shortness of breath, and diarrhea. By 2021 there was a higher use of antibiotics and antivirals reported than in 2016-2019. Most patients tested negative for viral detection. When comparing the percentage of viruses detected by age group and years of detection, positivity was lower in 2021 by every age group, and respiratory syncytial virus (RSV) was the most frequently detected. CONCLUSIONS There was less virus positivity in viral detection tests in the pediatric population in 2021. RSV persists as the main etiology affecting this population, especially infants. The use of antibiotic therapy in viral infections continues to be a problematic practice in their management. Sentinel surveillance can be strengthened throughout the country.
Collapse
Affiliation(s)
- Shiara Zarur‐Torralvo
- Department of PediatricsSchool of Medicine, Universidad del NorteBarranquillaColombia
| | - Iván Stand‐Niño
- Department of Pediatric PulmonologySchool of Medicine, Universidad del NorteBarranquillaColombia
| | - Victor Flórez‐García
- Department of Public HealthUniversidad del NorteBarranquillaColombia,Department of Public HealthJoseph J. Zilber School of Public Health, University of Wisconsin‐MilwaukeeWisconsinMilwaukeeUSA
| | - Humberto Mendoza
- Department of Public HealthUniversidad del NorteBarranquillaColombia,Division of Public HealthSecretary of Health of Barranquilla City HallBarranquillaColombia
| | - Erika Viana‐Cárdenas
- Department of Public HealthUniversidad del NorteBarranquillaColombia,Division of Public HealthSecretary of Health of Barranquilla City HallBarranquillaColombia
| |
Collapse
|
28
|
Firman N, Marszalek M, Gutierrez A, Homer K, Williams C, Harper G, Dostal I, Ahmed Z, Robson J, Dezateux C. Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in North East London: a longitudinal study using electronic health records. BMJ Open 2022; 12:e066288. [PMID: 36456017 PMCID: PMC9723415 DOI: 10.1136/bmjopen-2022-066288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination. DESIGN Longitudinal study using primary care electronic health records. SETTING 285 general practices in North East London. PARTICIPANTS Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort). MAIN OUTCOME MEASURE Receipt of timely MMR vaccination between 12 and 18 months of age. METHODS We used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations. RESULTS Timely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic. CONCLUSIONS The COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.
Collapse
Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Milena Marszalek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ana Gutierrez
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Crystal Williams
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Isabel Dostal
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Zaheer Ahmed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - John Robson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
29
|
McBride M, Williman J, Best E, Walls T, Sadarangani M, Grant CC, Martin NG. The epidemiology of aseptic meningitis in New Zealand children from 1991 to 2020. J Paediatr Child Health 2022; 58:1980-1989. [PMID: 35861029 PMCID: PMC9796418 DOI: 10.1111/jpc.16131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
Abstract
AIM Aseptic meningitis, including culture negative and viral meningitis, contributes a significant health-care burden, including unnecessary antibiotic use and hospitalisation to treat possible bacterial meningitis. This study analysed aseptic meningitis hospitalisations in New Zealand (NZ) children over 29 years. METHODS In this population-based study, aseptic meningitis hospitalisations in NZ children <15 years old were analysed from 1991 to 2020. Incident rate ratios were calculated using Poisson regression models. Variations in hospitalisations by age, year, sex, ethnicity, geographical region and socio-economic deprivation were analysed. RESULTS There were 5142 paediatric aseptic meningitis hospitalisations from 1991 to 2020. Most were unspecified viral meningitis (64%), followed by enterovirus (29%). Hospitalisation rates varied annually with a median of 18.4/100 000 children including a peak in 2001 of 56.4/100 000 (51.7-61.6). From 2002 to 2019, rates increased by 8.4%/year (7.2-9.5%) in infants <90 days old but decreased in all other age groups. In 2020, a reduction in hospitalisations to 9.6/100 000 (7.9-11.8) occurred, and in infants <90 days old were 0.37 times expected. Hospitalisations were 1.50 times (1.49-1.68) higher in males than females; higher in children of Māori (P < 0.001) and Pacific (P < 0.001) versus European ethnicity; and higher for children living in the most (2.44 times, (2.16-2.75)) versus least deprived households; and in northern versus southern NZ. CONCLUSIONS Aseptic meningitis hospitalisations increased in young infants during 29 years of surveillance, apart from 2020 when admissions reduced during the COVID-19 pandemic. In contrast, hospitalisations decreased in children aged >1 year. Further investigation into reasons for higher admissions by ethnic group, geographical location and increased deprivation are required.
Collapse
Affiliation(s)
- Michelia McBride
- Department of PaediatricsUniversity of Otago ChristchurchChristchurchNew Zealand
| | - Jonathan Williman
- Department of Population HealthUniversity of Otago ChristchurchChristchurchNew Zealand
| | - Emma Best
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand,Department of Paediatric Infectious DiseasesStarship Children's HospitalAucklandNew Zealand
| | - Tony Walls
- Department of PaediatricsUniversity of Otago ChristchurchChristchurchNew Zealand
| | - Manish Sadarangani
- Vaccine Evaluation CenterBC Children's Hospital Research InstituteVancouverBritish ColumbiaCanada,Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Natalie G Martin
- Department of PaediatricsUniversity of Otago ChristchurchChristchurchNew Zealand
| |
Collapse
|
30
|
Schroeder AR, Dahlen A, Purington N, Alvarez F, Brooks R, Destino L, Madduri G, Wang M, Coon ER. Healthcare utilization in children across the care continuum during the COVID-19 pandemic. PLoS One 2022; 17:e0276461. [PMID: 36301947 PMCID: PMC9612476 DOI: 10.1371/journal.pone.0276461] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Healthcare utilization decreased during the COVID-19 pandemic, likely due to reduced transmission of infections and healthcare avoidance. Though various investigations have described these changing patterns in children, most have analyzed specific care settings. We compared healthcare utilization, prescriptions, and diagnosis patterns in children across the care continuum during the first year of the pandemic with preceding years. Study design Using national claims data, we compared enrollees under 18 years during the pre-pandemic (January 2016 –mid-March 2020) and pandemic (mid-March 2020 through March 2021) periods. The pandemic was further divided into early (mid-March through mid-June 2020) and middle (mid-June 2020 through March 2021) periods. Utilization was compared using interrupted time series. Results The mean number of pediatric enrollees/month was 2,519,755 in the pre-pandemic and 2,428,912 in the pandemic period. Utilization decreased across all settings in the early pandemic, with the greatest decrease (76.9%, 95% confidence interval [CI] 72.6–80.5%) seen for urgent care visits. Only well visits returned to pre-pandemic rates during the mid-pandemic. Hospitalizations decreased by 43% (95% CI 37.4–48.1) during the early pandemic and were still 26.6% (17.7–34.6) lower mid-pandemic. However, hospitalizations in non-psychiatric facilities for various mental health disorders increased substantially mid-pandemic. Conclusion Healthcare utilization in children dropped substantially during the first year of the pandemic, with a shift away from infectious diseases and a spike in mental health hospitalizations. These findings are important to characterize as we monitor the health of children, can be used to inform healthcare strategies during subsequent COVID-19 surges and/or future pandemics, and may help identify training gaps for pediatric trainees. Subsequent investigations should examine how changes in healthcare utilization impacted the incidence and outcomes of specific diseases.
Collapse
Affiliation(s)
- Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
- * E-mail:
| | - Alex Dahlen
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Natasha Purington
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Francisco Alvarez
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Rona Brooks
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Lauren Destino
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Gayatri Madduri
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Marie Wang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Eric R. Coon
- Department of Pediatrics, Primary Children’s Hospital and University of Utah School of Medicine, Salt Lake City, UT, United States of America
| |
Collapse
|
31
|
Ozeki S, Kawada JI, Yamashita D, Yasufuku C, Akano T, Kato M, Suzuki K, Tano C, Matsumoto K, Mizutani SH, Mori A, Nishio N, Kidokoro H, Yasui Y, Takahashi Y, Sato Y. Impact of the COVID-19 pandemic on the clinical features of pediatric RSV infection in Japan. Open Forum Infect Dis 2022; 9:ofac562. [PMCID: PMC9620303 DOI: 10.1093/ofid/ofac562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Mitigation measures implemented during the coronavirus disease 2019 (COVID-19) pandemic remarkably reduced the incidence of infectious diseases among children. However, a reemergence of respiratory syncytial virus (RSV) infection was observed in 2021 in Japan. We compared the clinical characteristics of hospitalized patients with RSV infection before and during COVID-19. Methods We retrospectively enrolled children aged <6 years who were hospitalized with RSV infection in 18 hospitals and compared their clinical characteristics before (January 2019 to April 2020, 1,675 patients) and during COVID-19 (September 2020 to December 2021, 1,297 patients). Results The mean age of patients with RSV infection was significantly higher during COVID-19 than before (17.4 vs. 13.7 months, P < .001). Compared with before COVID-19, a 2.6-fold increase in RSV cases in the 2–5 years age group was observed from sentinel surveillance during COVID-19, while a 1.2-fold increase was noted in the same age group among hospitalized patients. On average for all patients, consolidation shadows obtained on radiography were less frequently observed (26.1 vs. 29.6%, P = .04) and reduced respiratory assistance (42.2% vs. 48.7%, P < .001) and hospitalization stay (5.7 vs. 6.0 days, P < .001) was required in patients with RSV infection during COVID-19. Conclusions COVID-19 and social activity restriction caused epidemiological changes in pediatric RSV infections, and a majority of patients with RSV infection aged ≥2 years did not develop severe symptoms requiring hospitalization. The RSV symptoms during the COVID-19 outbreak were equivalent to or milder than in the previous seasons.
Collapse
Affiliation(s)
- Shoko Ozeki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun-ichi Kawada
- Corresponding author: Jun-ichi Kawada, MD, PhD Department of Pediatrics Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Daiki Yamashita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chika Yasufuku
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Akano
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Kato
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Konomi Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chihiro Tano
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Matsumoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shu-hei Mizutani
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayumi Mori
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiro Nishio
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Advanced Medicine, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Yasui
- Department of Surveillance and Information, Aichi Prefectural Institute of Public Health, Nagoya, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Sato
- Alternate corresponding author: Yoshiaki Sato, MD, PhD Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| |
Collapse
|
32
|
辛 美, 吴 敬, 王 小, 韩 蕾. [Changes in the disease spectrum in the pediatric intensive care units within 2 years before and after the outbreak of coronavirus disease 2019]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1098-1103. [PMID: 36305109 PMCID: PMC9627991 DOI: 10.7499/j.issn.1008-8830.2205074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the changes in the disease spectrum among hospitalized children in the pediatric intensive care units (PICU) within 2 years before and after the outbreak of coronavirus disease 2019 (COVID-19). METHODS The related data on disease diagnosis were collected from all children who were hospitalized in the PICU of Affiliated Hospital of Jining Medical College from January 2018 to December 2019 (pre-COVID-19 group) and from January 2020 to December 2021 (post-COVID-19 group). A statistical analysis was performed for the disease spectrum of the two groups. RESULTS There were 2 368 children in the pre-COVID-19 group and 1 653 children in the post-COVID-19 group. The number of children in the post-COVID-19 group was reduced by 30.19% compared with that in the pre-COVID-19 group. There was a significant difference in age composition between the two groups (P<0.05). The top 10 diseases in the pre-COVID-19 group by number of cases were respiratory diseases, neurological diseases, sepsis, critical illness, circulatory system diseases, severe neurosurgical diseases, digestive system diseases, unintentional injuries, endocrine system diseases, and tumors. The top 10 diseases in the post-COVID-19 group by number of cases were respiratory diseases, neurological diseases, sepsis, circulatory system diseases, unintentional injuries, endocrine system diseases, severe neurosurgical diseases, acute abdomen, trauma surgical diseases, and digestive system diseases. The proportions of respiratory diseases, critical illness and severe neurosurgical diseases in the post-COVID-19 group were lower than those in the pre-COVID-19 group (P<0.05), while the proportions of unintentional injuries, acute abdomen, endocrine system diseases, trauma surgical diseases and sepsis were higher than those in the pre-COVID-19 group (P<0.05). CONCLUSIONS COVID-19 epidemic has led to a significant reduction in the number of children admitted to the PICU, and there are significant changes in the disease spectrum within 2 years before and after the outbreak of COVID-19. Relevant prevention and control measures taken during the COVID-19 epidemic can reduce the incidence of respiratory diseases, neurological diseases, and other critical illness in children, but it is necessary to strengthen the prevention of unintentional injuries and chronic disease management during the epidemic.
Collapse
|
33
|
Bertran M, Amin-Chowdhury Z, Sheppard CL, Eletu S, Zamarreño DV, Ramsay ME, Litt D, Fry NK, Ladhani SN. Increased Incidence of Invasive Pneumococcal Disease among Children after COVID-19 Pandemic, England. Emerg Infect Dis 2022; 28:1669-1672. [PMID: 35876698 PMCID: PMC9328924 DOI: 10.3201/eid2808.220304] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During July–December 2021, after COVID-19 restrictions were removed in England, invasive pneumococcal disease incidence in children <15 years of age was higher (1.96/100,000 children) than during the same period in 2020 (0.7/100,000 children) and in prepandemic years 2017–2019 (1.43/100,000 children). Childhood vaccine coverage should be maintained to protect the population.
Collapse
|
34
|
Belza C, Cohen E. A Silver Lining in a Dark Cloud? Pandemic Hospitalizations in Children With Medical Complexity. Hosp Pediatr 2022; 12:e134-e136. [PMID: 35257160 DOI: 10.1542/hpeds.2022-006542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Christina Belza
- aEdwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- bTransplant and Regenerative Medicine Centre
| | - Eyal Cohen
- aEdwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- cChild Health Evaluative Services, The Hospital for Sick Children, Toronto, Canada
- dDepartment of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Camporesi A, Morello R, Ferro V, Pierantoni L, Rocca A, Lanari M, Trobia GL, Sciacca T, Bellinvia AG, De Ferrari A, Valentini P, Roland D, Buonsenso D. Epidemiology, Microbiology and Severity of Bronchiolitis in the First Post-Lockdown Cold Season in Three Different Geographical Areas in Italy: A Prospective, Observational Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040491. [PMID: 35455535 PMCID: PMC9024462 DOI: 10.3390/children9040491] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.
Collapse
Affiliation(s)
- Anna Camporesi
- Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (A.D.F.)
| | - Rosa Morello
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (P.V.)
| | - Valentina Ferro
- Department of Pediatric Emergency, Bambin Gesù Children’s Hospital IRCCS, 00168 Rome, Italy;
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.R.); (M.L.)
| | - Alessandro Rocca
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.R.); (M.L.)
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.R.); (M.L.)
| | - Gian Luca Trobia
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital-Catania, 95126 Catania, Italy; (G.L.T.); (T.S.); (A.G.B.)
| | - Tiziana Sciacca
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital-Catania, 95126 Catania, Italy; (G.L.T.); (T.S.); (A.G.B.)
| | - Agata Giuseppina Bellinvia
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital-Catania, 95126 Catania, Italy; (G.L.T.); (T.S.); (A.G.B.)
| | - Alessandra De Ferrari
- Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (A.D.F.)
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (P.V.)
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospital, Leicester LE1 5WW, UK;
- Social science APPlied to Healthcare Improvement REsearch, SAPPHIRE Group, Health Sciences, Leicester University, Leicester LE1 7RH, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (P.V.)
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30154390
| |
Collapse
|
36
|
Hurley S, Franklin R, McCallion N, Byrne AM, Fitzsimons J, Byrne S, White M, O'Mahony L, Hourihane JO. Allergy-related outcomes at 12 months in the CORAL birth cohort of Irish children born during the first COVID 19 lockdown. Pediatr Allergy Immunol 2022; 33:e13766. [PMID: 35338733 PMCID: PMC9115474 DOI: 10.1111/pai.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Sadhbh Hurley
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| | - Ruth Franklin
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Naomi McCallion
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Rotunda Maternity Hospital, Dublin, Ireland
| | - Aideen M Byrne
- Children's Health Ireland, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | | | - Susan Byrne
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| | - Martin White
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Coombe Hospital, Dublin, Ireland
| | - Liam O'Mahony
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| |
Collapse
|
37
|
Tang HJ, Lai CC, Chao CM. Changing Epidemiology of Respiratory Tract Infection during COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11030315. [PMID: 35326778 PMCID: PMC8944752 DOI: 10.3390/antibiotics11030315] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
The outbreak of COVID-19 has significantly changed the epidemiology of respiratory tract infection in several ways. The implementation of non-pharmaceutical interventions (NPIs) including universal masking, hand hygiene, and social distancing not only resulted in a decline in reported SARS-CoV-2 cases but also contributed to the decline in the non-COVID-19 respiratory tract infection-related hospital utilization. Moreover, it also led to the decreased incidence of previous commonly encountered respiratory pathogens, such as influenza and Streptococcus pneumoniae. Although antimicrobial agents are essential for treating patients with COVID-19 co-infection, the prescribing of antibiotics was significantly higher than the estimated prevalence of bacterial co-infection, which indicated the overuse of antibiotics or unnecessary antibiotic use during the COVID-19 pandemic. Furthermore, inappropriate antimicrobial exposure may drive the selection of drug-resistant microorganisms, and the disruption of infection control in COVID-19 setting measures may result in the spread of multidrug-resistant organisms (MDROs). In conclusion, NPIs could be effective in preventing respiratory tract infection and changing the microbiologic distribution of respiratory pathogens; however, we should continue with epidemiological surveillance to establish updated information, antimicrobial stewardship programs for appropriate use of antibiotic, and infection control prevention interventions to prevent the spread of MDROs during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 710, Taiwan;
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan
- Correspondence:
| |
Collapse
|
38
|
Affiliation(s)
- Zachary Willis
- Division of Pediatric Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Annabelle de St Maurice
- University of California Los Angeles, Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|