186 Outbreak of Bacterial Subdural Empyema in Pediatric Patients After Relaxation of COVID-19 Non-pharmaceutical Interventions (NPIs)

Abstract

INTRODUCTION: Non-pharmaceutical interventions (NPIs), in response to the COVID-19 viral pandemic altered viral transmission. In addition, endemic viral strains (influenza, RSV, etc) also experienced unprecedentedly low infection rates. Endemic viral infections typically followed seasonal outbreak spikes, but these spikes were noticeably absent in the COVID-19 control period. After many COVID-19 restrictions were ceased, there was an unusually high spike in endemic viral infections. Many COVID-19 measures were relaxed in the early/middle part of 2021, and we noted a sharp increase in post-viral, complicated sinusitis/subdural empyema cases. METHODS: Data collection was via retrospective chart review of subdural empyema cases at our institution. “Post-viral” was defined as positive viral test or VURI symptoms within 30 days. RESULTS: Our group previously published our case series on the management of subdural empyema. That served as an historical cohort of 16 patients and 23 procedures over an 8 year period (July 2013-June 2021). During the previous academic year, July 2021 to June 2022, there were a total of 14 patients and 19 surgeries, which nearly doubles the previous 8 years combined. The current academic year (to date) has had 9 empyema patients and 12 surgical cases. 100% of patients in the previous 2 years has had historical symptoms of viral URI symptoms or positive viral URI testing within 30 days. None were documented positive for COVID-19. In less than 2 years since many NPIs were lifted, post-viral, bacterial empyema cases have increased dramatically by a fold of 2.56. CONCLUSIONS: NPIs may have created an endemic viral “immunity gap” and an immunologically susceptible population, and thereby could have contributed to a sharp increase in bacterial subdural empyema.