TY - JOUR
T1 - Surge of Pediatric Respiratory Tract Infections After the COVID-19 Pandemic and the Concept of "Immune Debt"
AU - Lenglart, Lea
AU - Titomanlio, Luigi
AU - Bognar, Zsolt
AU - Bressan, Silvia
AU - Buonsenso, Danilo
AU - De, Tisham
AU - Farrugia, Ruth
AU - Honeyford, Kate
AU - Maconochie, Ian K
AU - Moll, Henriette A
AU - Oostenbrink, Rianne
AU - Parri, Niccolo
AU - Roland, Damian
AU - Akyüz Özkan, Esra
AU - Almeida, Laura
AU - Alberti, Ilaria
AU - Angoulvant, François
AU - Assad, Zein
AU - Aupiais, Camille
AU - Barrett, Michael
AU - Basmaci, Romain
AU - Borensztajn, Dorine
AU - Castanhinha, Susana
AU - Chiaretti, Antonio
AU - Cohen, Robert
AU - Durnin, Sheena
AU - Fitzpatrick, Patrick
AU - Greber-Platzer, Susanne
AU - Guedj, Romain
AU - Hey, Florian
AU - Jankauskaite, Lina
AU - Keitel, Kristina
AU - Mascarenhas, Ines
AU - Milani, Gregorio P
AU - Musolino, Anna Maria
AU - Pučuka, Zanda
AU - Ryd Rinder, Malin
AU - Supino, Maria Chiara
AU - Tirelli, Francesca
AU - Nijman, Ruud G
AU - Ouldali, Naim
AU - EPISODES Study Group
N1 - Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.
PY - 2024/11/21
Y1 - 2024/11/21
N2 - OBJECTIVE: To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTI) during the 2020 implementation of non-pharmaceutical interventions (NPI) and the rise thereafter during NPI lifting.STUDY DESIGN: We conducted an interrupted, time-series analysis, based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included. We used generalized additive models to correlate the magnitude of decrease of each RTI during NPI (such as social distancing) implementation and its subsequent increase during NPI lifting. Urinary tract infections (UTI) served as control outcome.RESULTS: 528,055 patients were included. We observed reductions in cases during the NPI period, from -76% (95%CI -113;-53) in pneumonia) to -65% (95%CI[-100;-39) for tonsillitis/pharyngitis), followed by strong increases during NPI lifting, from +83% (95%CI 29;150) for tonsillitis/pharyngitis) to +329% (95%CI (149;517) bronchiolitis). For each RTI, we found a significant association between the magnitude of decrease during NPI implementation and the increase during NPI lifting. UTI cases remained stable.CONCLUSIONS: The magnitude of increase in RTI observed following NPI lifting was directly correlated to the magnitude of cases' reduction during NPI implementation, suggesting a "dose-response" relationship from an "immune debt" phenomenon. The likely rebound in RTIs should be expected when implementing and lifting NPI in the future.
AB - OBJECTIVE: To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTI) during the 2020 implementation of non-pharmaceutical interventions (NPI) and the rise thereafter during NPI lifting.STUDY DESIGN: We conducted an interrupted, time-series analysis, based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included. We used generalized additive models to correlate the magnitude of decrease of each RTI during NPI (such as social distancing) implementation and its subsequent increase during NPI lifting. Urinary tract infections (UTI) served as control outcome.RESULTS: 528,055 patients were included. We observed reductions in cases during the NPI period, from -76% (95%CI -113;-53) in pneumonia) to -65% (95%CI[-100;-39) for tonsillitis/pharyngitis), followed by strong increases during NPI lifting, from +83% (95%CI 29;150) for tonsillitis/pharyngitis) to +329% (95%CI (149;517) bronchiolitis). For each RTI, we found a significant association between the magnitude of decrease during NPI implementation and the increase during NPI lifting. UTI cases remained stable.CONCLUSIONS: The magnitude of increase in RTI observed following NPI lifting was directly correlated to the magnitude of cases' reduction during NPI implementation, suggesting a "dose-response" relationship from an "immune debt" phenomenon. The likely rebound in RTIs should be expected when implementing and lifting NPI in the future.
U2 - 10.1016/j.jpeds.2024.114420
DO - 10.1016/j.jpeds.2024.114420
M3 - Article
C2 - 39579868
SN - 0022-3476
SP - 114420
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -