Background: The widespread transmission of SARS-CoV-2 in early 2020 profoundly affected daily life and placed substantial strain on the resources of national healthcare systems. Nations globally initiated a comprehensive range of infection prevention and control measures to mitigate the spread of the virus. However, empirical evidence from international studies suggests that the implementation of these rigorous measures not only played a pivotal role in decelerating the spread of SARS-CoV-2 but also exerted a noteworthy influence on the broader epidemiological landscape. This impact extended to the trajectories of other infectious diseases, particularly those transmitted by respiratory pathogens, encompassing both bacterial and viral agents. Objective: To assess the incidence trend of hospitalizations in the Pediatric Emergency Department due to infectious diseases of the upper and lower respiratory tract, with a specific emphasis on the epidemiological patterns of the primary viruses and bacteria isolated. This analysis will cover three distinct time periods: pre-pandemic (March 2017-February 2020), restriction period (March 2020-March 2021), and post-restriction period (April 2021-December 2022). Materials and Methods: This is a retrospective observational study conducted at the Pediatric Emergency Department of the Department of Women's and Children's Health in Padua. All patients hospitalized from March 1, 2017, to December 31, 2022, due to severe respiratory infection, as defined by specific ICD-9CM discharge codes, were included in the study, irrespective of microbiological isolation. Data were extracted from medical records and anonymously recorded on the REDCap data collection platform. Results: In total, 1689 patients were included, distributed across three periods: 930 (55.1%) in the pre-pandemic period, 433 (25.6%) during the restriction period, and 326 (19.3%) in the post-restriction period. Among these, 44 patients were included for bacterial infections, 1356 for viral infections, and 289 had no microbiological findings. The prevalence of bacterial or viral isolates, compared to total hospitalizations, significantly reduced (p < 0.001) during the COVID-19 emergency period. Furthermore, a significant reduction (p < 0.001) was observed in the prevalence of lower respiratory tract infections, which decreased from 70.8% to 55.4% during the pandemic period compared to the pre-pandemic period. The same decreasing trend was also observed for upper respiratory tract infections, with a decrease from 29.7% to 21.9% (p < 0.002) in the respective two periods. Containment measures had a different impact on different types of viruses, with a more persistent decrease for enveloped viruses (respiratory syncytial virus, influenza virus) compared to non-enveloped viruses (rhinovirus/enterovirus, adenovirus). In the case of enveloped viruses, during the pandemic phase, an almost disappearance of these viruses was observed, subsequently followed by a new increase after the easing of restriction measures, with higher peaks compared to the pre-pandemic period and with a seasonal pattern different from pre-pandemic years. However, no increase in the severity of respiratory infections was found in the pandemic and post-pandemic period compared to the pre-pandemic one, with the percentage of admission to the pediatric intensive care unit remaining stable across the three periods. Conclusions: Our study confirmed that measures implemented to curb the spread of SARS-CoV-2 influenced the epidemiology of other pathogens responsible for respiratory infections, as indicated by previous studies. These findings underscore the significance of implementing infection prevention and control measures, even for common respiratory infections. This emphasizes the need for a vigilant monitoring system to intervene promptly in response to evolving epidemiological shifts and post-pandemic developments.
La diffusione globale dell'infezione da SARS-CoV-2 all’inizio del 2020 ha avuto un impatto importante sulla vita quotidiana e sulle risorse dei sistemi sanitari nazionali. Di fronte a questa pandemia senza precedenti, tutti gli stati nel mondo hanno implementato una serie di misure di prevenzione e di controllo delle infezioni per contrastare la diffusione del virus. Studi internazionali hanno tuttavia dimostrato che l'attuazione di tali misure restrittive non solo ha contribuito a rallentare la diffusione del SARS-CoV-2, ma ha anche influenzato il panorama epidemiologico generale, incidendo sull'andamento di altre malattie infettive, in particolare quelle trasmesse da agenti patogeni respiratori, sia batterici che virali. Obiettivo: Valutare l’andamento dell’incidenza dei ricoveri nel reparto di Pediatria d’Urgenza per malattie infettive del tratto respiratorio superiore ed inferiore, con particolare interesse all’andamento epidemiologico dei principali virus e batteri isolati, in tre periodi temporali ben distinti: periodo pre-pandemico (marzo 2017-febbraio 2020), periodo delle restrizioni (marzo 2020-marzo 2021), periodo post-restrizioni (aprile 2021-dicembre 2022). Materiali e metodi: Si tratta di uno studio osservazionale retrospettivo condotto presso il Reparto di Pediatria d'Urgenza del Dipartimento di Salute della Donna e del Bambino di Padova. Sono stati inclusi nello studio tutti i pazienti ricoverati dal 1° marzo 2017 al 31 dicembre 2022 per infezione respiratoria severa, definita da specifici codici di dimissione ICD-9CM, sia con che senza isolamento microbiologico. I dati sono stati estratti dalle cartelle cliniche e registrati sulla piattaforma di raccolta dati REDCap in modo anonimo. Risultati: In totale sono stati inclusi 1689 pazienti, distribuiti nei tre periodi: 930 (55.1%) nel periodo pre-pandemico, 433 (25.6%) durante il periodo delle restrizioni e 326 (19.3%) nel periodo post-restrizioni. Tra questi, 44 pazienti sono stati inclusi per patologia batterica, 1356 per patologia virale e 289 non hanno avuto alcun riscontro microbiologico. La prevalenza di isolati batterici o virali rispetto al totale dei ricoveri si è significativamente ridotta (p < 0.001) durante il periodo dell'emergenza COVID-19. Inoltre, si è osservata una significativa riduzione (p < 0.001) nella prevalenza delle infezioni delle basse vie respiratorie, che si è ridotta dal 70.8% al 55.4% durante il periodo pandemico rispetto a quello pre-pandemico. La stessa tendenza in riduzione si è osservata anche per le infezioni delle alte vie respiratorie, con diminuzione dal 29.7% al 21.9% (p < 0.002) rispettivamente nei due periodi. Le misure di contenimento hanno avuto un impatto diverso sui diversi tipi di virus, con una diminuzione più persistente per i virus capsulati (virus respiratorio sinciziale, virus influenzale) rispetto ai virus non capsulati (rhinovirus/enterovirus, adenovirus). Nel caso dei virus capsulati, durante la fase pandemica si è osservata una quasi scomparsa, seguita successivamente da un nuovo aumento dopo l’allentamento delle misure di restrizione, con picchi più elevati e con un pattern stagionale differente rispetto agli anni pre-pandemia. Non è stata tuttavia riscontrata un’accentuazione della gravità delle infezioni respiratorie nel periodo pandemico e post-pandemico rispetto al periodo pre-pandemico, con una percentuale di ricovero in terapia intensiva pediatrica che è rimasta stabile nei tre periodi. Conclusioni: Il nostro studio ha confermato che le misure adottate per limitare la diffusione del SARS-CoV-2 hanno influenzato l'epidemiologia di altri patogeni responsabili di infezioni respiratorie, come indicato da studi precedenti. Questi risultati evidenziano l'importanza dell'implementazione delle misure di prevenzione e controllo delle infezioni anche per le infezioni respiratorie comuni, sottolineando la necessità di un sistema di monitoraggio attento per intervenire tempestivamente
Impatto della pandemia da SARS-CoV-2 sulle infezioni respiratorie in età pediatrica: l'esperienza del reparto di Pediatria d'Urgenza di Padova
LEVINTE, ELENA
2023/2024
Abstract
Background: The widespread transmission of SARS-CoV-2 in early 2020 profoundly affected daily life and placed substantial strain on the resources of national healthcare systems. Nations globally initiated a comprehensive range of infection prevention and control measures to mitigate the spread of the virus. However, empirical evidence from international studies suggests that the implementation of these rigorous measures not only played a pivotal role in decelerating the spread of SARS-CoV-2 but also exerted a noteworthy influence on the broader epidemiological landscape. This impact extended to the trajectories of other infectious diseases, particularly those transmitted by respiratory pathogens, encompassing both bacterial and viral agents. Objective: To assess the incidence trend of hospitalizations in the Pediatric Emergency Department due to infectious diseases of the upper and lower respiratory tract, with a specific emphasis on the epidemiological patterns of the primary viruses and bacteria isolated. This analysis will cover three distinct time periods: pre-pandemic (March 2017-February 2020), restriction period (March 2020-March 2021), and post-restriction period (April 2021-December 2022). Materials and Methods: This is a retrospective observational study conducted at the Pediatric Emergency Department of the Department of Women's and Children's Health in Padua. All patients hospitalized from March 1, 2017, to December 31, 2022, due to severe respiratory infection, as defined by specific ICD-9CM discharge codes, were included in the study, irrespective of microbiological isolation. Data were extracted from medical records and anonymously recorded on the REDCap data collection platform. Results: In total, 1689 patients were included, distributed across three periods: 930 (55.1%) in the pre-pandemic period, 433 (25.6%) during the restriction period, and 326 (19.3%) in the post-restriction period. Among these, 44 patients were included for bacterial infections, 1356 for viral infections, and 289 had no microbiological findings. The prevalence of bacterial or viral isolates, compared to total hospitalizations, significantly reduced (p < 0.001) during the COVID-19 emergency period. Furthermore, a significant reduction (p < 0.001) was observed in the prevalence of lower respiratory tract infections, which decreased from 70.8% to 55.4% during the pandemic period compared to the pre-pandemic period. The same decreasing trend was also observed for upper respiratory tract infections, with a decrease from 29.7% to 21.9% (p < 0.002) in the respective two periods. Containment measures had a different impact on different types of viruses, with a more persistent decrease for enveloped viruses (respiratory syncytial virus, influenza virus) compared to non-enveloped viruses (rhinovirus/enterovirus, adenovirus). In the case of enveloped viruses, during the pandemic phase, an almost disappearance of these viruses was observed, subsequently followed by a new increase after the easing of restriction measures, with higher peaks compared to the pre-pandemic period and with a seasonal pattern different from pre-pandemic years. However, no increase in the severity of respiratory infections was found in the pandemic and post-pandemic period compared to the pre-pandemic one, with the percentage of admission to the pediatric intensive care unit remaining stable across the three periods. Conclusions: Our study confirmed that measures implemented to curb the spread of SARS-CoV-2 influenced the epidemiology of other pathogens responsible for respiratory infections, as indicated by previous studies. These findings underscore the significance of implementing infection prevention and control measures, even for common respiratory infections. This emphasizes the need for a vigilant monitoring system to intervene promptly in response to evolving epidemiological shifts and post-pandemic developments.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/62702