Has COVID-19 Affected the Course of Chickenpox in Children?
Justyna Franczak1,2, Zuzanna Wasielewska1,2, Anna Maria Fotyga2
1Department of Infectious Diseases and Hepatology, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland.
Insights
The COVID-19 pandemic altered chickenpox cases in children, with fewer hospitalizations during the pandemic but increased severe bacterial skin infections post-pandemic. Improved hygiene practices reduced gastrointestinal symptom cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted public health, potentially altering the course of common childhood infections like chickenpox.
- Understanding these changes is crucial for pediatric infectious disease management and public health strategies.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on chickenpox (varicella) epidemiology and clinical presentation in children.
- To analyze trends in chickenpox complications and associated pathogens before, during, and after the pandemic.
Main Methods:
- Retrospective analysis of medical records for 350 children under 18 hospitalized with chickenpox between January 2018 and December 2023.
- Data collection included patient demographics, clinical course, complications, and microbiological findings.
Main Results:
- Chickenpox hospitalizations were lowest during the pandemic, increasing significantly in 2023.
- Bacterial dermatitis and lower respiratory tract infections were the most common complications (84.86%).
- Post-pandemic, a rise in generalized inflammatory reactions and invasive *Streptococcus pyogenes* infections (41.46% of skin lesions) was noted, with 5.90% requiring surgery. Gastrointestinal symptom hospitalizations decreased significantly post-pandemic.
Conclusions:
- The post-pandemic period saw an increase in severe bacterial skin infections and generalized inflammatory reactions in pediatric chickenpox cases, potentially linked to increased invasive group A streptococcal infections.
- Enhanced hygiene practices adopted during the pandemic contributed to a significant reduction in chickenpox cases presenting with gastrointestinal symptoms.
Objectives Of The Study:
The aim of this study was to assess the impact of the COVID-19 pandemic on the epidemiology and clinical course of chickenpox in children based on 6 years of self-reported observations.
Material And Methods:
The medical records of 350 patients under 18 years of age hospitalised in the Department of Paediatrics, Infectious Diseases, and Hepatology between 1 January 2018 to 31 December 2023 were analysed retrospectively.
Results:
During the analysed period, 350 children were hospitalised due to chickenpox, the fewest in the pandemic period, the greatest number in 2023. Complications of chickenpox were diagnosed in 297 children (84.86%). The most commonly diagnosed complications were bacterial dermatitis (168, 48%) and lower respiratory tract infections (13.42%). After the pandemic period, a generalised inflammatory reaction was observed significantly more often (p ≤ 0.01069). Among children hospitalised in 2023, 5.90% of patients with bacterial dermatitis required surgical intervention due to skin abscess or fasciitis. In 2023, 41.46% of cultures from swabs taken from skin lesions grew Streptococcus pyogenes. After the pandemic, children with chickenpox and gastrointestinal symptoms were hospitalised significantly less frequently (p ≤ 0.00001).
Conclusions:
In the post-pandemic period, there were more hospitalisations of patients with chickenpox complicated by bacterial skin infection progressing to a generalised inflammatory reaction or septicaemia, related to the increase in invasive group A streptococcal infections observed in Europe. On the other hand, thanks to the widespread adaption of hygiene practices and infection prevention measures, the number of patients with gastrointestinal symptoms significantly decreased.
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