Unique Changes in the Incidence of Acute Chest Syndrome in Children with Sickle-Cell Disease Unravel the Role of Respiratory Pathogens: A Time-Series Analysis

International audienceBackground: Acute chest syndrome (ACS) is a life-threatening complication of sickle-cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that ACS incidence followed the unprecedented population-level changes in respiratory pathogens dynamics following the COVID-19-related non-pharmaceutical interventions (NPIs).Research question: What is the respective role of respiratory pathogens in ACS epidemiology?Study design: AND METHODS. We performed an interrupted time-series analysis of patient records from a national hospital-based surveillance system. All children < 18 years of age with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1000 children with SCD over time was analyzed using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen.Results: Among the 55,941 hospitalizations of children with SCD, 2306 episodes of ACS were included (median [IQR] age, 9 [5-13] years). We observed a significant decrease in ACS incidence after NPI implementation in March 2020 (-29.5%; 95% CI, -46.8% to -12.2%; P = .001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2% to 41.6%; P = .007). Using population-level incidence of several respiratory pathogens, we found that Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9% to 56.9%; P = .02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3% to 11.3%; P = .004), whereas other respiratory pathogens had only a minor role.Interpretation: NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiological situation allowed to unravel the contribution of these respiratory pathogens, in particular S. pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population

Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system

Background Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries. Methods We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling. Results In total, 42 916 children were included. We observed an overall cumulative 78% (95% CI −100–−54%; p<0.0001) reduction in bronchiolitis cases following NPI implementation. The decrease varied between countries from −97% (95% CI −100– −47%; p=0.0005) to −36% (95% CI −79–7%; p=0.105). Full lockdown (incidence rate ratio (IRR) 0.21 (95% CI 0.14–0.30); p<0.001), secondary school closure (IRR 0.33 (95% CI 0.20–0.52); p<0.0001), wearing a mask indoors (IRR 0.49 (95% CI 0.25–0.94); p=0.034) and teleworking (IRR 0.55 (95% CI 0.31–0.97); p=0.038) were independently associated with reducing bronchiolitis. Conclusions Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis

Respective role of non-pharmaceutical interventions on bronchiolitis outbreaks, an interrupted time series analysis based on a multinational surveillance system

International audienceBackground Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of SARS-CoV-2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries. Methods We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of the 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling. Results In total, 42 916 children were included. We observed an overall cumulative 78% reduction (95%CI [−100;−54], p<0.0001) in bronchiolitis cases following NPI implementation. The decrease varied between countries from −97% (95%CI [−100;−47], p=0.0005) to −36% (95%CI [−79;+07], p=0.105). Full lockdown (IRR 0.21, 95%CI [0.14;0.30], p<0.001), secondary-school closure (IRR 0.33, 95%CI [0.20;0.52], p<0.0001), wearing a mask indoors (IRR 0.49, 95%CI [0.25;0.94], p=0.034), and teleworking (IRR 0.55, 95%CI [0.31;0.97], p=0.038) were independently associated with reducing bronchiolitis. Conclusion Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis

Respective role of non-pharmaceutical interventions on bronchiolitis outbreaks, an interrupted time series analysis based on a multinational surveillance system.

Background Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of SARS-CoV-2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries. Methods We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of the 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling. Results In total, 42 916 children were included. We observed an overall cumulative 78% reduction (95%CI [−100;−54], p Conclusion Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.</p