Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study

Abstract

Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 were implemented in March 2020. These measures were followed by a major impact on viral and non-viral diseases. We aimed to assess the impact of NPI implementation in France on hospitalized community-acquired pneumonia (hCAP) frequency and the clinical and biological characteristics of the remaining cases in children. We performed a quasi-experimental interrupted time-series analysis. Between June 2014 and December 2020, eight pediatric emergency departments throughout France reported prospectively all cases of hCAP in children from age 1 month to 15 years. We estimated the impact on the monthly number of hCAP using segmented linear regression with autoregressive error model. We included 2,972 hCAP cases; 115 occurred during the NPI implementation period. We observed a sharp decrease in the monthly number of hCAP after NPI implementation [−63.0% (95 confidence interval, −86.8 to −39.2%); p < 0.001]. Children with hCAP were significantly older during than before the NPI period (median age, 3.9 vs. 2.3 years; p < 0.0001), and we observed a higher proportion of low inflammatory marker status (43.5 vs. 33.1%; p = 0.02). Furthermore, we observed a trend with a decrease in the proportion of cases with pleural effusion (5.3% during the NPI period vs. 10.9% before the NPI; p = 0.06). NPI implementation during the COVID-19 (coronavirus disease 2019) pandemic led not only to a strong decrease in the number of hCAP cases but also a modification in the clinical profile of children affected, which may reflect a change in pathogens involved.

Effects of COVID-19-targeted nonpharmaceutical interventions on children's respiratory admissions in China: a national multicenter time series study

“…The present study found that NPIs had the most significant impact of -62.7% on pneumonia admissions, which is in line with the results of another related study in France that reported the monthly number of hospitalized community-acquired pneumonia decreased by -63.0% after NPI implementation( Rybak et al, 2022 ). The reduction may be related to the drastic change in the distribution of causative pathogens of respiratory tract infections( Dähne et al, 2021 , Mutnal et al, 2020 , Tang et al, 2022 ).…”

Shift in Clinical Epidemiology of Human Parainfluenza Virus Type 3 and Respiratory Syncytial Virus B Infections in Korean Children Before and During the COVID-19 Pandemic: A Multicenter Retrospective Study

“…A recent study also showed that the age of children with community-acquired pneumonia was higher during the NPI period than before. 20 Considering that the clinical severity of PIV infection did not vary with age, 19 it is understandable that the proportion of LRTIs and the need for respiratory support did not significantly change in 2021. However, the hospitalization rate decreased in the 2021 PIV3 epidemic.…”

Community-acquired bacterial pneumonia in children: an update on antibiotic duration and immunization strategies

“…The importance of this viral-bacterial interaction was further validated during the first year of the SARS-CoV-2 pandemic when the rates of many childhood infections including pneumonia and invasive pneumococcal disease (IPD) decreased after the implementation of nonpharmacologic measures (masking, school closures, etc.) [11][12][13][14]. The significant reduction in IPD cases was thought to be secondary to a decrease in pneumococcal colonization; however, studies from France, Belgium and Israel showed that pneumococcal colonization was not impacted by nonpharmacologic measures [15][16][17].…”