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Published on: November 7, 2020
Impact of COVID-19 pandemic on childhood asthma and wheezing disorders
Yu-Han Xing1,2, Jayson Ka-Long Wong3, Yuan-Yuan Zhu4
1School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China. xingyh8@mail.sysu.edu.cn.
Insights
Following COVID-19, pediatric wheezing admissions surged, with increased respiratory syncytial virus (RSV) and coinfections. Continued pathogen surveillance is vital for managing post-pandemic respiratory infections in children.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Epidemiology
Background:
- The lifting of COVID-19 control measures has led to a resurgence of common respiratory pathogens.
- The impact of these infections on children with wheezing illnesses remains a significant public health concern.
Purpose of the Study:
- To investigate the trends and pathogen profiles of pediatric wheezing disorders before, during, and after the COVID-19 pandemic in Hong Kong.
- To assess the impact of pandemic restrictions and their removal on wheezing-related hospital admissions in children.
Main Methods:
- A prospective study of children (under 18 years) hospitalized for wheezing disorders from 2016 to 2025 in Hong Kong.
- Nasopharyngeal aspirates were analyzed using rapid antigen detection, viral culture, and multiplex polymerase chain reaction (PCR).
- Bacterial pathogens, including Chlamydia pneumoniae and Mycoplasma pneumoniae, were identified via cultures and PCR.
Main Results:
- A total of 2499 children and 3272 admissions were analyzed, showing a reduction during the pandemic followed by a significant increase post-pandemic.
- Post-pandemic, wheezing admissions, particularly for bronchiolitis, increased fivefold compared to the pandemic period (P < 0.001).
- Respiratory syncytial virus (RSV) proportion increased significantly post-pandemic, especially in children under 5 (P < 0.01), with more frequent coinfections.
Conclusions:
- The removal of COVID-19 restrictions has resulted in a resurgence of pediatric wheezing admissions and respiratory infections.
- Ongoing monitoring of respiratory pathogens is essential in the post-pandemic era.
- Preventive strategies are necessary to mitigate the impact of future health crises on pediatric respiratory health.
Background:
Since the lifting of COVID-19 control measures, infections by common respiratory pathogens have emerged as a public health issue, and the impacts on vulnerable children with wheezing illnesses remain uncertain.
Methods:
This prospective study enrolled children (< 18 years) hospitalized for wheezing disorders in Hong Kong (2016‒2025). Nasopharyngeal aspirates collected within 12 h of admission were tested via rapid antigen detection, viral culture, and multiplex polymerase chain reaction (PCR) for respiratory viruses. Bacterial pathogens were identified through cultures of blood/airway specimens or PCR, including Chlamydia pneumonia and mycoplasma pneumoniae detection via PCR.
Results:
A total of 2499 children [66.8% male, median age 2.9 (3.6) years)] with 3272 admissions due to wheezing disorders were identified. There was a substantial reduction in pediatric wheezing admissions during the COVID-19 pandemic (February 2020 to January 2023) compared to the pre-pandemic period (September 2016 to January 2020). After removing pandemic restrictions, wheezing admissions drastically increased from February 2023 to February 2025, exceeding the pre-pandemic level. A fivefold increase was observed in admissions due to "bronchiolitis" compared with that during the pandemic period (P < 0.001). The post-pandemic proportion of respiratory syncytial virus (RSV) significantly increased, especially among those under 5 years of age (P < 0.01). Coinfections with multiple pathogens were more common during and after the pandemic than pre-pandemic (P < 0.05).
Conclusions:
Lifting restrictions led to a resurgence of wheezing admissions and respiratory infections. Continued pathogen monitoring in the post-pandemic era is crucial, and preventive measures for future health crises are needed.
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