Abstract
ObjectiveTo 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.DesignPopulation based observational study of 19 common childhood respiratory, severe invasive, and vaccine preventable infections, comparing hospital admission rates and mortality outcomes before and after the onset of the pandemic in England.SettingHospital admission data from every NHS hospital in England from 1 March 2017 to 30 June 2021 with record linkage to national mortality data.PopulationChildren aged 0-14 years admitted to an NHS hospital with a selected childhood infection from 1 March 2017 to 30 June 2021.Main outcome measuresFor each infection, numbers of hospital admissions every month from 1 March 2017 to 30 June 2021, percentage changes in the number of hospital admissions before and after 1 March 2020, and adjusted odds ratios to compare 60 day case fatality outcomes before and after 1 March 2020.ResultsAfter 1 March 2020, substantial and sustained reductions in hospital admissions were found for all but one of the 19 infective conditions studied. Among the respiratory infections, the greatest percentage reductions were for influenza (mean annual number admitted between 1 March 2017 and 29 February 2020 was 5379 and number of children admitted from 1 March 2020 to 28 February 2021 was 304, 94% reduction, 95% confidence interval 89% to 97%), and bronchiolitis (from 51 655 to 9423, 82% reduction, 95% confidence interval 79% to 84%). Among the severe invasive infections, the greatest reduction was for meningitis (50% reduction, 47% to 52%). For the vaccine preventable infections, reductions ranged from 53% (32% to 68%) for mumps to 90% (80% to 95%) for measles. Reductions were seen across all demographic subgroups and in children with underlying comorbidities. Corresponding decreases were also found for the absolute numbers of 60 day case fatalities, although the proportion of children admitted for pneumonia who died within 60 days increased (age-sex adjusted odds ratio 1.71, 95% confidence interval 1.43 to 2.05). More recent data indicate that some respiratory infections increased to higher levels than usual after May 2021.ConclusionsDuring the covid-19 pandemic, a range of behavioural changes (adoption of non-pharmacological interventions) and societal strategies (school closures, lockdowns, and restricted travel) were used to reduce transmission of SARS-CoV-2, which also reduced admissions for common and severe childhood infections. Continued monitoring of these infections is required as social restrictions evolve.
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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