Journal Article

Impact of COVID-19 non-pharmaceutical interventions on bacterial infections in children: an international electronic health record-based study

Toh, Emma MS, Zahner, Janet J, Paris, Nicolas, Norman, James B, Honerlaw, Jacqueline P, He, Bing, Visweswaran, Shyam, Huling, Kenneth M, Dagliati, Arianna, Samayamuthu, Malarkodi Jebathilagam, Wolkewitz, Martin, Newburger, Jane W., Olson, Karen L, Esteve, Loic, Vallejos, Andrew K, Daniel, Christel, Marwaha, Jayson S, Bucalo, Mauro, Chiovato, Luca, Adam, Atif, Mahmood, Sadiqa, Pfaff, Emily R, Maidlow, Sarah E, Wang, Xuan, Quirós-González, Víctor, Hilka, Martin, Kainth, Mundeep K, Moshal, Karyn L, Anthony, Li L.L.J, Ganslandt, Thomas, Martel, Patricia, Sáez, Carlos, Neto, Carlos Tadeu Breda, Vidorreta, Fernando J Sanz, Xia, Zongqi, Wassermann, Demian, Lynch, Kristine E, Boeker, Martin, Cruz-Bermúdez, Juan Luis, Ngiam, Kee Yuan, Terriza-Torres, Ana I, Bell, Douglas S, Zhang, Harrison G, Sacchi, Paolo, Luo, Yuan, Bryant, William A, Blanco-Martínez, Alvar, Albi, Giuseppe, Ashraf, Fatima, Albayrak, Adem, Cannataro, Mario, Key, Daniel A, Wagholikar, Kavishwar B, Vie, Jill-Jênn, Santhanam, Nandhini, Verdy, Guillaume, Follett, Robert W, Bourgeois, Florence T, Salamanca, Elisa, Savino, Maria, Bellasi, Antonio, Kate

2025

Overview

IntroductionNon-pharmaceutical interventions (NPIs) such as mask-wearing and social distancing, implemented as public health measures to slow COVID-19 transmission, had a major impact on the epidemiology of viral infections. However, little is known about their influence on bacterial infections in children.MethodsWe performed a multicentre observational study including eight hospitals in three countries (Spain, UK and USA). All hospitalisations in children under the age of 18 from January 2019 to February 2023 were included. Electronic health record data were used to assess changes in hospitalisations for bacterial infections in three different periods based on NPI stringency, classified as pre-NPI (January 2019 to February 2020), full NPI (March 2020 to February 2021) and partial NPI (March 2021 to February 2023). The primary outcomes were the counts of hospitalisations for invasive, respiratory and skin-associated bacterial infections. To identify changes in the monthly counts of bacterial infections in a data-driven manner, we used a multivariable quasi-Poisson regression model adjusting for important covariates with adaptive lasso penalty. We then assessed the statistical significance of the identified changes and examined the temporal trend before and after each change point.ResultsWe found that of the 508 585 paediatric hospitalisations, 41 076 (8.1%) were associated with any bacterial infection. 14 656 (35.7%) were invasive bacterial infections, 6763 (16.5%) were respiratory tract-associated and 7757 (18.9%) were skin-associated. Counts of bacterial infections decreased during the full-NPI period (average count 93.7 infections/month) compared with the pre-NPI period (average count 104.8 infections/month) and increased during the partial NPI period (average count 112.4 infections/month). A quasi-Poisson regression model showed a significant decrease in respiratory tract-associated bacterial infections after the start of the COVID-19 pandemic and a subsequent significant increase after the gradual lifting of NPIs, peaking during the winter of 2022–2023. No significant changes were observed over time for skin-associated and invasive bacterial infections.ConclusionsThe implementation of COVID-19 NPIs was significantly associated with changes in hospitalisations for respiratory associated-bacterial infections, but not invasive and skin-associated bacterial infections. These findings suggest that the impact of NPIs has been greatest for respiratory infections and indicate the potential of targeted NPIs to reduce these infections among children in the future.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Bacteria / Bacterial diseases / Bacterial infections / Codes / Consortia / COVID-19 / Disease Outbreaks / Disease transmission / Disease Transmission, Infectious / Electronic health records / Epidemiology / Hospitalization / Hospitals / Infectious diseases / Medical coding / Observational studies / Original Research / Pandemics / Pediatrics / Pharmaceuticals / Pneumonia / Public Health / Quality control / Respiratory tract / Severe acute respiratory syndrome coronavirus 2 / Skin / Social distancing / Trends / Viral infections