Impact of Postpandemic Pediatric Infection Rebound on Febrile Seizures: A Nationwide Cohort Study, 2013-2023
Yusuke Okubo1, Itaru Hayakawa2, Ryo Sugitate3
1Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Febrile seizures (FS) incidence dropped during COVID-19 but rebounded post-pandemic due to increased infections, not altered child susceptibility. Real-time infection surveillance can optimize pediatric care resources.
Area of Science:
- Pediatric neurology
- Epidemiology
- Public health
Background:
- Febrile seizures (FS) are common in young children, often linked to infections.
- The COVID-19 pandemic altered pediatric infectious disease patterns, but its impact on FS rates and healthcare use is unclear.
Purpose of the Study:
- To investigate the incidence rates of FS and associated healthcare resource utilization post-COVID-19 pandemic.
- To analyze the relationship between pediatric infectious disease trends and FS incidence.
Main Methods:
- A cohort study analyzed a nationwide claims database (2013-2023) covering 5.5 million person-years.
- Multivariable generalized linear models and geospatial microsimulation estimated FS incidence, hospitalization risks, costs, and national burden.
Main Results:
- FS incidence declined in 2020 but rose by 2023, exceeding prepandemic levels, mirroring pediatric infectious disease rates.
- Seizure-per-infection risks remained consistent with pre-pandemic levels.
- Estimated annual FS episodes, hospitalizations, and costs halved in 2020 and recovered by 2023.
Conclusions:
- The post-pandemic increase in FS is attributed to restored infection pressure, not increased host susceptibility.
- Real-time infection surveillance is recommended to guide pediatric care capacity and resource allocation.
Background:
Febrile seizures (FSs) affect younger children and typically accompany common infectious diseases. The COVID-19 pandemic disrupted pediatric infectious disease patterns, yet how these changes have influenced incidence rates of FS and associated health care resource use after the pandemic remains unknown.
Methods:
We conducted a cohort study using a nationwide administrative claims database among children from fiscal year 2013-2023, totaling 5.5 million person-years. We estimated incidence rates of FS, with relevant hospitalization risks, health care costs, and health care resource utilizations using multivariable generalized linear models with direct standardization. Geospatial microsimulation models were used to estimate the national burden of FS over the period.
Results:
The incidence rate of FS among children aged 6 months to <5 years was stable at 58.6-69.2 cases per 1000 person-years during 2013-2018, fell by 59.9% in 2020, and rose to 71.7 per 1000 person-years in 2023, surpassing prepandemic levels. The incidence rates of FS changed in direct proportion to the community pediatric infectious disease rates, and the seizure-per-infection risks were identical in 2023 to those observed before the COVID-19 pandemic. Microsimulation models estimated 260,000-340,000 FS episodes, 13,000-16,000 hospitalizations, and 10-12 billion Japanese yen in annual costs before the COVID-19 pandemic, halving in 2020 and recovering to 270,000 episodes, 13,000 admissions, and 10.5 billion Japanese yen by 2023.
Conclusions:
The postpandemic surge in FS reflects restored infection pressure, not heightened host susceptibility. Responsive pediatric care could be guided by real-time infection surveillance to align clinical capacity and resources with shifting community infection burden.
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