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Epidemiological changes of acute respiratory infections in children: A single-center experience after COVID-19

Indrė Stacevičienė¹, Inga Ivaškevičienė¹, Sigita Burokienė¹

¹Faculty of Medicine, Vilnius University, Vilnius, Lithuania.

|April 5, 2024

Insights

Following COVID-19 lockdowns, pediatric acute respiratory infections (ARIs) shifted, with fewer COVID-19 cases and more influenza, RSV, and GAS. COVID-19 became milder, while other infections led to increased hospitalizations.

Area of Science:

Pediatric infectious diseases
Epidemiology
Public health

Background:

The COVID-19 pandemic significantly altered the landscape of pediatric acute respiratory infections (ARIs).
Predicting the epidemiology of ARIs in children has become challenging post-lockdown.
Understanding these shifts is crucial for pediatric healthcare management.

Purpose of the Study:

To evaluate epidemiological changes in pediatric ARIs after pandemic lockdowns.
To assess clinical outcomes of various respiratory infections in children during the post-lockdown era.
To compare the trends of COVID-19, influenza, RSV, and GAS infections in children across two cold seasons.

Main Methods:

A retrospective cross-sectional study was conducted at a large pediatric emergency department in Lithuania.
Data were collected over two consecutive cold seasons (2021-2022 and 2022-2023).
Children under 18 tested for COVID-19 were included, with additional data on influenza, RSV, and GAS infections.

Main Results:

COVID-19 positivity rates decreased from 14.5% to 5.9% between Season I and Season II.
Concurrently, influenza, RSV, and GAS infection rates significantly increased.
Season II saw milder COVID-19 cases, but higher hospitalization rates for influenza and RSV, with one influenza-related death.

Conclusions:

The post-lockdown period in children was characterized by a decline in COVID-19 and a resurgence of influenza, RSV, and GAS.
RSV significantly contributed to pediatric respiratory infection hospitalizations, especially in Season II.
Coinfections did not appear to worsen disease severity in this pediatric cohort.

Read full analysis

Abstract

Background:

Since the start of the COVID-19 pandemic, the epidemiology of acute respiratory infections (ARIs) has continually changed, making it difficult to predict. Our study aimed to evaluate epidemiological changes and clinical outcomes of ARIs in pediatric patients in the post-lockdown period.

Methods:

A single-center retrospective cross-sectional study was performed in one of the largest pediatric emergency departments in Lithuania during two cold seasons-from October 1, 2021, to April 30, 2022 (Season I) and in the same period in 2022-2023 (Season II). Patients under 18 years of age who had been tested for COVID-19 were enrolled in the study. Additional data about other respiratory pathogens in the study group (specifically influenza A/B, respiratory syncytial virus (RSV) and group A Streptococcus (GAS)), were included.

Results:

During both seasons of our study, 19,366 children were screened for COVID-19. Positive tests for COVID-19 decreased from 14.5% in Season I to 5.9% in Season II, while at the same time, the rates of other infections increased significantly: influenza from 17.5% to 27.1%, RSV from 8.8% to 27.6%, and GAS from 8.4% to 44%, respectively. In Season II, COVID-19 infection presented in fewer admissions to pediatric intensive care (0.8% vs. 3.7%, p<0.01) and there were no deaths, while influenza presented in a higher proportion of hospitalizations (10.5% vs. 6.1%, p<0.01) and there was one death. The proportion of RSV hospitalizations also increased in Season II (34.6% vs. 44.0%, p<0.01).

Conclusions:

The early post-lockdown period saw a decline of COVID-19 and re-emergence of influenza, RSV and GAS infections in children. In Season II, COVID-19 cases became milder contrary to influenza. RSV infection contributed significantly to hospitalizations for respiratory infections in children in both seasons, particularly in Season II. Coinfections were not associated with a more severe course of the disease.

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