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Published on: January 21, 2018
Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis
Lea Lenglart1,2, Naim Ouldali3,4,5,6,2, Kate Honeyford7
1Paediatric Emergency Department, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France.
Insights
Non-pharmaceutical interventions (NPIs) significantly reduced bronchiolitis outbreaks in children. Full lockdowns, school closures, mask-wearing, and teleworking were key NPIs that lowered the incidence of this common childhood respiratory illness.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Bronchiolitis is a significant cause of illness and death in young children globally.
- Non-pharmaceutical interventions (NPIs) for COVID-19 may have impacted bronchiolitis outbreaks.
- Understanding the specific impact of each NPI is crucial for future public health strategies.
Purpose of the Study:
- To assess the impact of individual NPIs on bronchiolitis outbreaks across 14 European countries.
- To differentiate the effects of various NPIs on the incidence of pediatric bronchiolitis.
- To inform public health policies for managing bronchiolitis seasonality.
Main Methods:
- A quasi-experimental, interrupted time-series analysis was employed.
- Data from 27 pediatric emergency departments across Europe (January 2018-March 2021) were analyzed.
- Seasonally adjusted multivariable quasi-Poisson regression modeled the association between NPIs and bronchiolitis trends.
Main Results:
- A 78% overall reduction in bronchiolitis cases was observed following NPI implementation.
- Significant reductions were seen in countries with strict measures, ranging from 36% to 97%.
- Full lockdown, secondary school closure, indoor mask-wearing, and teleworking were independently associated with decreased bronchiolitis incidence.
Conclusions:
- Multiple NPIs, including lockdowns, school closures, and mask mandates, effectively reduced bronchiolitis outbreaks.
- These findings suggest that specific NPIs can be considered to mitigate the global burden of bronchiolitis.
- Public health interventions targeting respiratory virus transmission show promise in controlling pediatric diseases.
Background:
Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries.
Methods:
We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling.
Results:
In total, 42 916 children were included. We observed an overall cumulative 78% (95% CI -100- -54%; p<0.0001) reduction in bronchiolitis cases following NPI implementation. The decrease varied between countries from -97% (95% CI -100- -47%; p=0.0005) to -36% (95% CI -79-7%; p=0.105). Full lockdown (incidence rate ratio (IRR) 0.21 (95% CI 0.14-0.30); p<0.001), secondary school closure (IRR 0.33 (95% CI 0.20-0.52); p<0.0001), wearing a mask indoors (IRR 0.49 (95% CI 0.25-0.94); p=0.034) and teleworking (IRR 0.55 (95% CI 0.31-0.97); p=0.038) were independently associated with reducing bronchiolitis.
Conclusions:
Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.
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