Abstract
Social restrictions intended to limit the transmission of SARS-CoV-2 may have also been associated with decreased rates of other communicable diseases. Evidence suggests that infection incidence rates (IRs) are rebounding after easing of social restrictions (eg, mask mandates). The reemergence of infectious disease complicates efforts to manage the ongoing COVID-19 pandemic. To examine IRs of frequently occurring infectious diseases after a successful SARS-CoV-2 vaccination campaign in Israel and cessation of social restrictions. This cross-sectional study was conducted using records for respiratory and gastrointestinal infectious diseases at 209 community clinics in southern Israel from 2017 to 2021. Included patients attended community clinics from January 1, 2017, to June 30, 2021. Incidence of infectious diseases was estimated in the first 3 months after the easing of social restrictions (ie, April-June 2021) across age groups. Age-specific and disease-specific weekly IRs per 100 000 population for April to June were compared between 2017 and 2021 and expected current IR was estimated using segmented linear regression. Growth rates of respiratory infections across years and weekly diagnoses detected by real-time polymerase chain reaction testing were also compared. Among 386 711 patients with a total of 1 221 568 visits to community clinics, the mean (SD) age was 27.29 (23.93) years, and there were 202 494 (52.3%) male patients and 184 217 (47.7%) female patients. Children aged 0 to 3 years had significantly increased rates of respiratory and gastrointestinal infection diagnoses (IR ratio, 2.64; 95% CI, 2:30-2.91; P < .001). In addition, incidence of non-SARS-CoV-2 respiratory infections were significantly increased across age groups (IR ratio, 1.74; 95% CI, 1.56-1.94; P < .001). These morbidity trends observed in Israel suggest that similar trends could occur in coming months in other countries after easing of COVID-19-related restrictions, particularly with the ongoing challenges of SARS-CoV-2 variants.
Highlights
After a national campaign that vaccinated most adults in Israel against COVID-19 by March 25, 2021,1 the government began easing social restrictions, with a complete rescindment on April 18, the indoor mask requirement was later reinstated (Figure 1)
These morbidity trends observed in Israel suggest that similar trends could occur in coming months in other countries after easing of COVID-19–related restrictions, with the ongoing challenges of SARS-CoV-2 variants
Compared with the April to June COVID-19 lockdown, an increase in mean daily incidence rates (IRs) for non–SARS-CoV-2 respiratory and gastrointestinal infections was observed in 2021 for all ages
Summary
After a national campaign that vaccinated most adults in Israel against COVID-19 by March 25, 2021,1 the government began easing social restrictions, with a complete rescindment on April 18, the indoor mask requirement was later reinstated (Figure 1). Social restrictions included nonpharmaceutical interventions (NPIs), such as shelter-in-place orders, universal masking, social distancing, and 3 national lockdowns, each intended to decrease the burden of COVID-19 morbidity and mortality. These social restrictions were associated with decreases in non–SARSCoV-2 infections, such as influenza and the common cold.[2] There is growing global evidence suggesting that NPIs are associated with decreased rates of COVID-19 and non–COVID-19 infectious diseases, and a decreased burden associated with seasonal influenza, other upper and lower respiratory infections,[3] and food-borne[4] diseases. Age-specific incidence rates (IRs) of non–COVID-19 common infectious diseases compared with rates in prepandemic years have not been reported, to our knowledge
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