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[Lancet Infect Dis发表论文]:南非新冠疫情期间与疫情前5岁以下儿童因下呼吸道感染住院情况
2023年10月13日 时讯速递, 进展交流 [Lancet Infect Dis发表论文]:南非新冠疫情期间与疫情前5岁以下儿童因下呼吸道感染住院情况已关闭评论

ARTICLES| VOLUME 23, ISSUE 9, P1031-1041, SEPTEMBER 2023Download Full Issue

All-cause and pathogen-specific lower respiratory tract infection hospital admissions in children younger than 5 years during the COVID-19 pandemic (2020–22) compared with the pre-pandemic period (2015–19) in South Africa: an observational study

Alane Izu, Marta C Nunes, Fatima Solomon, et al.

Lancet Infect Dis 2023; 23: 1031-1041 Published: May 01, 2023

DOI:https://doi.org/10.1016/S1473-3099(23)00200-1

Summary

Background

Non-pharmaceutical interventions affected the circulation of and illness due to endemic respiratory pathogens during the COVID-19 pandemic. We investigated the incidence of admissions to hospital for overall and specific pathogen-associated lower respiratory tract infection (LRTI) during the COVID-19 pandemic compared with incidence in the pre-pandemic period.

Methods

In this observational study, we analysed surveillance data for children younger than 5 years from two public hospitals in Soweto, South Africa, for all-cause LRTI, respiratory syncytial virus (RSV), influenza, human metapneumovirus, and Bordetella pertussis from Jan 1, 2015 to Dec 31, 2022. Data were obtained from an electronic database that includes information for all admissions to the general paediatric wards at the two hospitals, automatically identified by a computer program. We excluded children admitted to hospital with incidental SARS-CoV-2 infection or COVID-19 without LRTI diagnosis. Incidence during COVID-19 pandemic years (2020, 2021, and 2022) were compared with pre-pandemic rates (2015–19).

Findings

Overall, there were 42 068 all-cause hospital admissions, including 18 303 all-cause LRTI hospital admissions, from Jan 1, 2015, to Dec 31, 2022, 17 822 (42·4%) of whom were female, 23 893 (57·0%) were male, and 353 (0·8%) had missing data. All-cause LRTI incidence risk ratio (IRR) was 30% lower in 2020 (IRR 0·70, 95% CI 0·67–0·74) and 13% lower in 2021 (0·87, 0·83–0·91), but 16% higher in 2022 (1·16, 1·11–1·21) compared with the pre-pandemic period. Furthermore, compared with the pre-pandemic period, incidence of RSV-associated LRTI (0·52, 0·45–0·58), influenza-associated LRTI (0·05, 0·02–0·11), and pulmonary tuberculosis (0·52, 0·41–0·65) were lower in 2020, with similar trends observed for human-metapneumovirus-associated LRTI, pertussis, and invasive pneumococcal disease (IPD). Compared with the pre-pandemic period, by 2022, RSV-associated LRTI incidence was similar (1·04, 0·95–1·14) and influenza-associated LRTI showed a non-significant increase (1·14, 0·92–1·39), whereas incidence remained lower for tuberculosis (0·79, 0·65–0·94) and IPD (0·51, 0·24–0·99). In 2022, the incidence of COVID-19-associated LRTI hospital admission (65 per 100 000 children younger than 5 years) was lower than pre-pandemic RSV-associated LRTI (0·23, 0·19–0·27) but higher than pre-pandemic influenza-associated LRTI (1·19, 0·97–1·45), although the difference was not significant. All-cause LRTI death in 2022 (57 per 100 000 children younger than 5 years) was 28% higher than in the pre-pandemic period (1·28, 1·03–1·58).

Interpretation

The higher incidence of all-cause LRTI admissions to hospital in 2022 compared with the pre-pandemic period is partly due to ongoing COVID-19 admission to hospital, and could worsen if other endemic respiratory pathogens revert to pre-pandemic incidence. Interventions, including the introduction of vaccines for people who are pregnant that aim to prevent RSV and possibly COVID-19 in young children, are warranted.

Funding

The Bill & Melinda Gates Foundation.

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