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Impact of COVID-19 Pandemic on Bronchiolitis Epidemiology in Greece
Athina Koloi1, Dimitra Dimopoulou1, Dimitris Papakonstantinou2
1Second Department of Pediatrics, School of Medicine, "P. and A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Insights
The COVID-19 pandemic significantly altered bronchiolitis epidemiology in Greece, causing a sharp decline in hospitalizations during restrictive measures. Bronchiolitis severity remained unchanged, emphasizing the need for ongoing surveillance.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- Acute bronchiolitis is a major cause of infant hospitalization and illness globally.
- The COVID-19 pandemic has demonstrably impacted the global epidemiology of respiratory infections.
- Understanding these shifts is crucial for managing pediatric respiratory diseases.
Purpose of the Study:
- To evaluate the changes in bronchiolitis epidemiology in Greece during and after COVID-19 restrictive measures.
- To compare these changes against the pre-pandemic epidemiological patterns.
- To assess the impact on hospitalization rates, seasonality, and disease severity.
Main Methods:
- Retrospective analysis of 1505 infant hospitalizations (0-24 months) for bronchiolitis.
- Data collected from a tertiary pediatric hospital in Greece from November 2017 to September 2024.
- Analysis across seven distinct seasonal periods to identify trends.
Main Results:
- A 98% decrease in bronchiolitis hospitalizations occurred in 2020-2021, followed by a return to pre-pandemic levels and a subsequent 58.7% increase in 2022-2023.
- The seasonal onset of bronchiolitis shifted earlier in 2021-2022 but returned to pre-pandemic patterns later.
- Respiratory Syncytial Virus (RSV)-positive cases dropped significantly in 2020-2021, and disease severity remained consistent across all periods.
Conclusions:
- The COVID-19 pandemic profoundly affected bronchiolitis epidemiology in Greece, altering hospitalization rates and seasonal distribution.
- Disease severity did not change, indicating the pandemic's impact was primarily on transmission dynamics.
- Continuous monitoring of bronchiolitis and RSV is vital, especially with new preventive strategies like maternal RSV vaccination and monoclonal antibodies.
Abstract:
Background and Objectives: Acute bronchiolitis is a leading cause of hospitalization and morbidity in infants and young children. The COVID-19 pandemic has impacted its epidemiology globally. This study aims to assess changes in bronchiolitis epidemiology in Greece during the period of COVID-19 restrictive measures and after their removal, compared to the pre-pandemic period. Materials and Methods: A retrospective non-interventional study was conducted at a tertiary pediatric hospital, including all children aged 0-24 months hospitalized for bronchiolitis between 1 November 2017 and 30 September 2024. A total of 1505 cases were included. Data were analyzed across seven seasonal periods. Results: Bronchiolitis hospitalizations decreased by 98% in 2020-2021, returned to pre-pandemic levels in 2021-2022, and increased by 58.7% in January 2022-2023. The seasonal distribution shifted earlier in 2021-2022, with a return to pre-pandemic patterns in 2022-2023 and 2023-2024. No shift was observed in the peak age group (1-3 months), although neonatal hospitalizations decreased significantly in 2020-2021 (p = 0.009). RSV-positive cases dropped notably during 2020-2021 (41.2%). There was no change in disease severity across periods, assessed by indirect indicators and the Modified Tal Score. The proportion of bronchiolitis cases among total pediatric admissions increased to 5.6% in 2023-2024, compared to 4.9% in 2022-2023 and 3.9% pre-pandemic (2017-2020). Conclusions: Bronchiolitis epidemiology was significantly impacted by the COVID-19 pandemic in Greece, though disease severity remained unchanged. Ongoing monitoring of bronchiolitis and RSV circulation is crucial particularly with the introduction of maternal RSV vaccination and new monoclonal antibodies to inform prevention strategies and reduce disease burden.
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