Abstract
Background: Children are largely unaffected following Sars-CoV-2 infection with low rates of significant disease and the inflammatory syndrome MIS-C. However, the lives of children have been substantially disrupted by the pandemic through physical distancing measures and the impact on health systems and economies. In this study, the impact of the COVID-19 pandemic on hospital admissions for childhood respiratory infections, severe invasive infections, and vaccine preventable disease in England was assessed along with associated mortality outcomes.Methods: In this population-based observational study, we examined hospital admission data from every National Health Service hospital from Mar 1 2017 to Feb 28 2021. We report monthly and annual numbers of individuals hospitalised with 19 common childhood respiratory, severe invasive, and vaccine preventable infections. We compare the frequency of admissions for these conditions before and after the onset of the pandemic in England and calculate percentage changes since Mar 1 2020 for each infection overall and by demographic characteristics including age, region, deprivation, and comorbidity, and quantify mortality outcomes.Findings: In the 12 months from Mar 1 2020, there were significant reductions compared with the preceding 36 months in the numbers of children admitted for every infection studied except pyelonephritis. These reductions were seen in all geographic regions, Index of Multiple Deprivation categories, ethnic groups and in those with underlying comorbidities. Among the respiratory infections, the greatest percentage reductions were for influenza where the number of individuals admitted decreased by 94% (95% CI 88, 97) from 5,061 (annual mean from Mar 1 2017 - Feb 29 2020) to 290 in the 12 months after Mar 1 2020, and for bronchiolitis where the number of individuals admitted decreased by over 80% (95% CI 78, 83) from 41,777 (annual mean 2017–2020) to 7,883 in 2020-21. Among the severe invasive infections, percentage decreases ranged from 20% (95% CI 13, 26) for osteomyelitis to 54% (95% CI 51, 56) for meningitis. Among the vaccine preventable infections, the greatest reduction was for measles, where the number of individuals admitted in the 12 months after Mar 1 2020 (n=12) was 92% lower (95% CI 84, 96) than the average number admitted in the previous three years (n=143). Admissions for Neisseria meningitidis decreased by 70% (95% CI 55, 80), and admissions for Streptococcus pneumoniae, Haemophilus influenzae and mumps more than halved. Alongside the decreases in admissions, there were also decreases in the absolute numbers of 60-day fatalities after admission for sepsis, meningitis, bronchiolitis, pneumonia, viral wheeze and upper respiratory tract infection (RTI). For pneumonia, although the absolute number of 60-day fatalities decreased (from a 3-year average of 159 to 115 after Mar 1 2020), the proportion of individuals admitted who died within 60 days increased (age-sex adjusted odds ratio 1.73, 95% CI 1.42, 2.11).Interpretation: During the COVID-19 pandemic, a range of behavioural changes (adoption of non-pharmacological interventions (NPIs)) and societal strategies (school closures, lockdowns and restricted travel) were used to reduce transmission of SARS CoV2 which have also significantly reduced transmission of common and severe childhood infections. NPIs could be used in the future to better protect healthcare systems and the most vulnerable children in society.Funding Information: Public Health England, Health Data Research UK, and the National Institute for Health Research Oxford Biomedical Research Centre.Declaration of Interests: None to declare. Ethics Approval Statement: Ethical approval to study the record-linked datasets was obtained from the Central and South Bristol Multi-Centre Research Ethics Committee (04/Q2006/176). All patient records were pseudonymized by the data providers through encryption of personal identifiers.
Highlights
Children younger than 16 years have accounted for less than 2% of all people with covid-19.1-3 One of the earliest and largest epidemiological studies in children with symptomatic covid-19 showed that only 13 of 2143 (0.6%) children had developed critical illness.4 In Europe and North America, less than 1% of children admitted to hospital with covid-19 have died.5 6The indirect effects of covid-19 on children’s health appear to be substantial
OBJECTIVE To assess the impact of the covid-19 pandemic on hospital admission rates and mortality outcomes for childhood respiratory infections, severe invasive infections, and vaccine preventable disease in England
For the vaccine preventable infections, reductions ranged from 53% (32% to 68%) for mumps to 90% (80% to 95%) for measles
Summary
Children younger than 16 years have accounted for less than 2% of all people with covid-19.1-3 One of the earliest and largest epidemiological studies in children with symptomatic covid-19 showed that only 13 of 2143 (0.6%) children had developed critical illness. In Europe and North America, less than 1% of children admitted to hospital with covid-19 have died.5 6The indirect effects of covid-19 on children’s health appear to be substantial. In May 2020, the World Health Organization reported that services had been suspended or postponed in 68 lower income countries, affecting more than 80 million children younger than 1 year. This disruption is partly because of a lack of transport of vaccines between countries and a shortage of healthcare staff.. The first UK national lockdown began in March 2020, after which in London there was a reported 20% reduction in measles, mumps, and rubella vaccination counts, national coverage of most routine childhood immunisations subsequently increased during 2020.13 Monitoring the rates of vaccine preventable disease, with disruptions to vaccinations and as herd immunity potentially wanes, is critical to understanding how to adapt immunisation programmes during the pandemic and achieve high rates of coverage. In addition to delayed presentations, attendances to paediatric emergency departments in countries worst affected by covid-19 have reduced considerably since the onset of the pandemic. During 2020, laboratory surveillance data and observational studies worldwide have shown major decreases in some childhood infections, which might have contributed to this reduction.
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