pandemia de COVID-19

AnalesdePediatría96(2022)537---547

www.analesdepediatria.org

SCIENTIFIC LETTER

Reduction in the incidence of acute bronchiolitis and related hospital admissions during the COVID-19 pandemic ^夽

Reducción de la tasa de incidencia de

bronquiolitis aguda y de las hospitalizaciones asociadas a la enfermedad, durante la

pandemia de COVID-19

DearEditor:

Acutebronchiolitis (AB) is themost frequent lower respi- ratorytractinfectioninchildrenagedlessthan2years.It is themain reasonfor hospitaladmission ininfants under 1 year,¹ constitutingasignificant health care burdenwith a substantial economic and social impact.² It has been hypothesized that public health measures against coron- avirus disease 2019 (COVID-19) such as social distancing, lockdowns,andhygieneinthegeneralpopulationcouldalso decrease the incidence of other infections, especially in children.InNewSouthWales,Australia,duringthefirstwave of the COVID-19 pandemic, therewas a 94% reduction in thenumberofdetectedcasesofrespiratorysyncytialvirus anda85%---89%reductioninhospitaladmissionsduetobron- chiolitiscomparedtopreviousyears(2015−19).³Similarly, there wasan observed 70% decrease in infantadmissions due toAB inBrazil.⁴ Inthe northern hemisphere, several studieshaveestimatedthereductioninABcasesduringthe 2020 winter bronchiolitis season (through the end of the year).InFrance,thereweredecreasesof82.1%and82.5%in bronchiolitis-relatedmedicalvisitsandhospitaladmissions, respectively, during theepidemic season of winter2020.⁵ In Belgium, bronchiolitis-related admissions decreased by 92.5%andcasesofrespiratorysyncytialvirusby99%during thewinterpeakcomparedtotheepidemicseasonsofthe3 previousyears.⁶Allthesestudieshighlightedthatthemea- suresadopted to reduce thetransmissionof severe acute respiratorysyndromecoronavirus2(SARS-CoV-2),thevirus responsibleforCOVID-19,werethemostimportantcontrib- utortothisreduction.

Further evidence on the impact of the COVID-19 pan- demic on AB is needed, especially data for the entire

夽 Please cite this article as: Montejo M, Sánchez A, Paniagua N, Saiz-Hernando C,Benito J. Reducción de la tasade inciden- ciadebronquiolitisagudaydelashospitalizacionesasociadasala enfermedad,durantelapandemiadeCOVID-19.AnPediatr(Barc).

2022;96:537---539.

bronchiolitisseasoninnorthernhemisphere.Seekingtofill thisgapin theliterature,weaimedtodescribeandmea- sure any changes in the incidence of AB at the primary care,emergencydepartmentandinpatientcarelevelsina regionalhealthsysteminthenorthofSpain(theOsakidetza- PublicHealthSystemoftheBasqueCountry)inthefirstfull bronchiolitis season after the start of the COVID-19 pan- demic(October2020---March2021)comparedtotheprevious 2years.

Tothisend,weconductedaretrospectiveobservational studyoftheincidenceofABin3cohortsofchildrenaged0---2 years,inthreesuccessiveABseasons(October2018---March 2019,October2019---March2020,andOctober2020---March 2021).Foreachseason,westartedbyestablishingthepop- ulationatrisk(childrenaged0---2yearsatsomepointduring the observation period) and identifying all the diagnosed casesofAB, whichallowed ustoestimatethe cumulative incidence. Then, we determined the specific time-at-risk for each individual during the observation period, which allowedustocalculatetherateratioasthetotalnumberof eventsperperson-timeobservedin1000person-months.We assessedfordifferencesinincidenceinthe2020---2021sea- soncomparedtopreviousseasons bymean ofrateratios.

The study had a retrospective observational design and involvedcollectionofinformationrecordedinreal-lifeclini- calpracticebyhealthprofessionals,andwasthusexempted fromtheneedtoobtaininformedconsentfrompatients.The datawerekeptconfidentialandanonymised,andweused themsolelyforthepurposeofthestudyinadherencewith OrganicLaw15/1999ofDecember13ontheprotectionof personaldata.

In the 2020−21 season, the observed incidence and cumulative incidence of AB were substantially lower and associatedwithasizeabledecreaseinthenumberofemer- gencyvisitsand hospitaladmissionscomparedtoprevious years(Table1andFig.1).Notably,therewere89%and88%

fewerABcases inthe current seasoncomparedto 1year and2yearsprior,withincidenceratesdroppingfrom24.7 and23.8cases,respectively,to2.7casesper1000person- months.Wealsofoundareductionofapproximately92%in thenumberofhospitaladmissionsinthe lastseasoncom- paredtoadmissionsinthepreviousyears.

Basedonwhathasbeenobservedtodateinbothhemi- spheres, public health measures for reducing COVID-19 transmissionseemtohavedecreasedtheburdenofcommu- nicablediseasessuchasAB.Specifically,weobservedstrong reductionsinthenumberofABcasesandassociatedhospital admissionsinourregionalhealthsystemthroughtheentire 2020---2021season.Theseoutcomesareprobablyduetothe implementation

SCIENTIFICLETTER Table1 Incidenceandrateratiosofacutebronchiolitis(AB)casesandhospitaladmissionsinthelast3bronchiolitisseasonsinthehealthcaresystemoftheBasqueCountry.

C1:Oct2018---Mar2019 C2:Oct2019---Mar2020 C3:Oct2020---Mar2021 C1vs

C3

C2vs C3

Event Events,

n

Patients, n

Incidence^a Events, n

Patients, n

Incidence^a Events, n

Patients, n

Incidence^a % Reduc- tion in Inci- dence Rates

% Reduc- tion in Inci- dence Rates

ABCases 5114 24.57 4622 23.83 505 2.71 88.9 88.6

45 286

42 483

39017

Hospital admis- sions

489 2.25 467 2.3 34 0.18 92.0 92.0

C,cohort.

a Expressedascases/1000inhabitants/month.

538

AnalesdePediatría96(2022)537---547

Figure1 Weeklycumulativeincidenceofacutebronchiolitisinthelast3bronchiolitisseasonsinthePublicHealthSystemofthe BasqueCountry.

of preventive strategies such as social distancing, use ofmasks,ventilation,handwashingandotherhygienemea- sures.Thesefindingsshouldbetakenintoaccounttoguide thedevelopmentandevaluationofnewinitiativesforhealth promotion,especiallywhenitcomestoeducationandtrain- ingonpreventivemeasuresaimedatfutureABepidemics.

Funding

ThisstudywassupportedbytheInstitutodeSaludCarlosIII throughresearchgrantPI19/00234,co-fundedbytheEuro- pean Regional Development Fund, A wayto make Europe programme. The funding bodies were notinvolved in the design ofthestudy,the collection,analysis orinterpreta- tionofthedataorthewritingofthemanuscript.None of theauthorsreceivedanypaymentfortheircontributionsto the manuscript.The authorshave norelevant conflictsof interesttodisclose.

References

1.Sanchez-LunaM,ElolaFJ,Fernandez-PerezC,BernalJL,Lopez- Pineda A. Trends in respiratory syncytial virus bronchiolitis hospitalizationsinchildrenlessthan1year:2004-2012.CurrMed ResOpin.2016;32:693---8.

2.HasegawaK,Tsugawa Y,BrownDF,MansbachJM,CamargoCA Jr.Temporaltrendsinemergencydepartmentvisitsforbronchi- olitisintheUnitedStates,2006to2010. PediatrInfect DisJ.

2014;33:11---8.

3.FriedrichF,OngarattoR,ScottaMC,VerasTN,SteinR,Lumertz MS,etal.EarlyimpactofsocialdistancinginresponsetoCOVID- 19onhospitalizationsforacutebronchiolitisininfantsinBrazil.

ClinInfectDis.2020,http://dx.doi.org/10.1093/cid/ciaa1458.

4.BrittonPN,HuN,SaravanosG,ShrapnelJ,DavisJ,SnellingT, etal.COVID-19publichealthmeasuresandrespiratorysyncytial virus.LancetChildAdolescHealth.2020;4:e42---3.

5.GuedjR,LorrotM,LecarpentierT,LegerPL,CorvolH,Carbajal R. Infantbronchiolitisdramaticallyreduced duringthesecond FrenchCOVID-19outbreak.ActaPaediatr.2021;110:1297---9.

6.VanBrusselenD,DeTroeyerK, TerHaarE,VanderAuweraA, PoschetK,VanNuijsS,etal.BronchiolitisinCOVID-19times:a nearlyabsentdisease?EurJPediatr.2021;30:1---5.

MartaMontejo^a,AlvaroSánchez^b,NataliaPaniagua^c, CarlosSaiz-Hernando^d,JavierBenito^c,∗

aCentrodeSaluddeRontegi,Barakaldo,Bizkaia,Spain

bUnidaddeInvestigacióndeAtenciónPrimariadeBizkaia, InstitutodeInvestigacionSanitariaBioCruces-Bizkaia, Osakidetza,Barakaldo,Bizkaia,Spain

cServiciodeUrgenciasPediátricas,OSI

Ezkerraldea-Enkarterri-Cruces,Barakaldo,Bizkaia,Spain

dServiciodeDocumentaciónClínica,HospitalUniversitario Cruces,Barakaldo,Bizkaia,Spain

∗Correspondingauthor.

E-mailaddress:

[email protected] (J.Benito).

https://doi.org/10.1016/j.anpede.2022.03.003

2341-2879/©2022PublishedbyElsevierEspa˜na,S.L.U.onbehalf ofAsociaci´onEspa˜noladePediatr´ıa.Thisisanopenaccessarticle undertheCCBY-NC-NDlicense(http://creativecommons.org/

licenses/by-nc-nd/4.0/).

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