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Changes in Pediatric Acute Respiratory Infections Before, During, and After the COVID-19 Pandemic: A Retrospective
Ana Fradique1, Marta Rodrigues2, Laura Isabel Azevedo E Sousa3
1Pediatrics, Unidade Local de Saúde de Coimbra, Coimbra, PRT.
Insights
Non-pharmacological interventions (NPIs) during COVID-19 significantly reduced pediatric acute respiratory infections (ARIs). Post-pandemic, ARI incidence surged beyond pre-pandemic levels, though severity remained unchanged.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- Acute respiratory infections (ARIs) are a major cause of childhood illness and emergency department visits.
- Non-pharmacological interventions (NPIs) were implemented globally to curb SARS-CoV-2 transmission during the COVID-19 pandemic.
- These NPIs impacted the circulation patterns of various respiratory pathogens in children.
Purpose of the Study:
- To quantify the changes in incidence and severity of pediatric ARIs before, during, and after the COVID-19 pandemic.
- To assess the impact of NPIs on the epidemiological trends of pediatric ARIs.
Main Methods:
- Retrospective observational time-series study of children aged 0-10 years.
- Data collected from a pediatric emergency department in Covilhã, Portugal, from April 2019 to April 2023.
- Analysis of admissions from the first five days of each month, categorized into pre-COVID-19, COVID-19, and post-COVID-19 periods.
Main Results:
- The proportion of ARI visits decreased during the COVID-19 period compared to pre-pandemic levels.
- A significant increase in ARI incidence was observed in the post-COVID-19 period, exceeding pre-pandemic levels.
- No significant variations were found in hospitalization rates, length of stay, or oxygen requirements.
Conclusions:
- COVID-19 NPIs led to a notable reduction and altered seasonality of pediatric ARIs.
- Following the lifting of restrictions, ARI incidence rose sharply, surpassing previous levels.
- The findings underscore the influence of public health measures and exposure dynamics on pediatric respiratory infection epidemiology.
Introduction And Objectives:
Acute respiratory infections (ARIs) are a significant cause of morbidity in children and a common reason for emergency department (ED) visits. During the COVID-19 pandemic, governments adopted non-pharmacological interventions (NPIs) to limit SARS-CoV-2 transmission. These measures also reduced the circulation and seasonality of other respiratory pathogens, with little impact on infections in non-respiratory organ systems. This study aimed to quantify changes in the incidence and severity of pediatric ARIs before, during, and after the pandemic.
Materials And Methods:
We conducted a retrospective observational time-series study of children aged 0-10 years presenting with ARIs to a level 2 pediatric ED in Covilhã, Portugal, from April 2019 to April 2023. To ensure representativeness while controlling data volume, admissions from the first five days of each month were analyzed. Three periods were defined: pre-COVID-19 (Pre-C), COVID-19 (C), and post-COVID-19 (Post-C). All statistical analyses were performed using SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). A significance level of p = 0.05 was applied.
Results:
Among 7,448 sampled ED visits, 2,210 (29.7%) involved ARIs. Their proportion fell from Pre-C to C (p = 0.028) and rose sharply in Post-C (p < 0.001), exceeding Pre-C levels (p < 0.001). In C, atypical inter-seasonal peaks occurred. Hospitalization rates, length of stay, and oxygen requirements showed no significant variation.
Conclusions:
COVID-19 NPIs were associated with a marked reduction and altered timing of pediatric ARIs, whereas infections in other organ systems were largely unaffected. After restrictions were lifted, ARI incidence surpassed pre-pandemic levels, but disease severity remained stable. These findings highlight how public health measures and subsequent exposure shifts can reshape respiratory infection epidemiology in children.
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