台灣3至19歲兒童COVID-19 預防措施之附帶效益的間斷時間序列分析

Abstract

Introduction: The ancillary effects of school-based policies implemented during the COVID-19 pandemic in Taiwan in protecting children aged 3-19 from other respiratory infections, including influenzas and enterovirus, has been mostly obscured. Objective: In this study, the collateral benefits of Taiwan’s Ministry of Education COVID-19 school-based prevention regulations are evaluated in terms of protecting children from both severe influenza and enterovirus infections with severe complications. Data Source: Secondary data used in this investigation was obtained from the Taiwan Centers for Disease Control for the period from January 2018 to June 2020. Methodology: This was a natural experiment to make a causal inference about the efficacy of the Taiwan’s Ministry of Education COVID-19 school-based prevention regulations in protecting children from influenza and enterovirus using secondary data. Scatterplots and time series plots were used to inspect the data for seasonal patterns, outliers visually, and trends in the incidence of influenza and enterovirus, respectively. Unpaired t-tests were used to examine whether the difference in the mean number of influenza and enterovirus cases in the pre-intervention and post-intervention period was significantly different. An interrupted time-series regression based on the level change impact model and Poisson regression for counts was fitted to determine whether Taiwan’s Ministry of Education COVID-19 school-based prevention regulations had an impact on the number of reported cases for both diseases. Sensitivity analyses were performed to correct for overdispersion and autocorrelation. Results: The unadjusted interrupted time series (ITS) regression models assuming a level change impact model revealed a strong and statistically significant influence of Taiwan’s Ministry of Education school-based regulations implemented during the COVID-19 pandemic on the incidence of influenza among Taiwanese children, with a reduction of 235% (relative risk (RR)= 0.0950; 95% confidence interval (CI) [0.0244– 0.2738]; p<0.05). Similarly, the incidence of enterovirus with severe complications reduced by 257% (relative risk (RR)= 0.0762; 95% confidence interval (CI) [0.0065– 0.3433]; p<0.05). Conclusion: This study shows that after the Taiwan’s Ministry of Education COVID-19 school-based preventive measures were implemented, the severe cases of influenza and enterovirus among children aged 3 to 19 years decreased significantly, which demonstrates the effectiveness of the policies. Findings from this research are likely to revolutionize how the public perceives public health policies such as facemask use and school operation during a pandemic especially in places that lack capacity to how class online, following evidence of reductions in other respiratory illnesses among children.