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Sustained Increase in Pediatric Mastoiditis in the Post-COVID-19 Era: A 9-Year Interrupted Time-Series Analysis Based
Apolline Furgier1, Romain Basmaci2, Zaba Valtuille3
1Paris Cité University, Infection, Antimicrobials, Modelling, Evolution (IAME) Research Unit, Paris, France; Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Cité Université, Paris, France.
Insights
COVID-19 non-pharmaceutical interventions (NPI) initially reduced pediatric mastoiditis cases but led to a significant rebound post-pandemic. This study highlights the lasting impact of NPI on childhood infections and pathogen shifts.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health interventions
Background:
- The COVID-19 pandemic necessitated widespread non-pharmaceutical interventions (NPI).
- The impact of these NPI on the incidence of pediatric mastoiditis and its causative pathogens remains under investigation.
- Understanding these effects is crucial for managing future public health crises.
Purpose of the Study:
- To evaluate the effect of COVID-19 pandemic-related NPI on pediatric mastoiditis incidence.
- To identify changes in causative pathogens and complications following NPI implementation and lifting.
- To inform strategies for managing pediatric infections during and after pandemics.
Main Methods:
- A population-based interrupted time-series analysis was performed using French national surveillance data (2016-2024).
- Hospitalized mastoiditis cases in children (<18 years) were analyzed for monthly incidence trends.
- Quasi-Poisson regression models accounted for seasonality to assess NPI impact.
Main Results:
- A total of 7390 pediatric mastoiditis cases were included.
- Mastoiditis incidence decreased by 58.9% during strict NPI periods, followed by a 71.7% increase post-NPI compared to expected trends.
- Significant increases in mastoiditis caused by Streptococcus pyogenes (+627.8%) and Streptococcus pneumoniae (+135.6%) were observed post-NPI. Complication and surgery rates remained stable.
Conclusions:
- A sustained increase in pediatric mastoiditis incidence and altered etiology occurred post-COVID-19 pandemic.
- These changes are linked to the implementation and subsequent lifting of NPI.
- Findings underscore the need to consider pandemic-related consequences in future public health management.
Objective:
To assess the impact of COVID-19 pandemic-related non-pharmaceutical interventions (NPI) on the incidence of mastoiditis cases, causative pathogens, and associated complications in children.
Study Design:
We conducted a population-based interrupted time-series analysis using national surveillance data from France between January 2016 and December 2024. All hospitalized mastoiditis cases among individuals younger than 18 years in France were included. The main outcome was the monthly incidence of mastoiditis cases, analyzed using quasi-Poisson regression models, accounting for seasonality.
Results:
We included 7390 hospitalized cases of mastoiditis in children. Following a decrease in the incidence of mastoiditis by 58.9% (95% CI: 68.2% to 46.9%, P < .001) during the strict NPI period, we observed an increase of 71.7% (95% CI: 26.4% to 133.3%, P < .001) in the post-NPI period compared with the expected trend without NPI. The proportions of complicated cases and those requiring surgery remained stable over time. By pathogen, the most important increase in the post-NPI period was observed among mastoiditis caused by Streptococcus pyogenes (+627.8%, 95% CI: +269.1% to +1335.0%, P < .001), followed by Streptococcus pneumoniae (+135.6%, 95% CI: +20.5% to +360.6%, P = .012) and Haemophilus influenzae (+124.3%, -17.0% to +506.0%, P = .111).
Conclusions:
In this 9-year population-based national study, we observed a sustained increase in the incidence and etiology of mastoiditis in children during the post-COVID-19 period. We hypothesize that these changes, associated with NPI during the pandemic and lifting postpandemic, reflect consequences that should be considered in the management of future pandemics.
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