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Since the onset of the COVID-19 pandemic, there have been dramatic reductions in hospital admissions for common and severe childhood infections in England, according to a new study published by The BMJ today. Researchers from Oxford Population Health undertook the analyses.  

Worldwide, the indirect effects of COVID-19 on children’s health have been substantial. For instance, childhood immunisation programmes have been disrupted and emergency department visits have been delayed. Data from laboratory surveillance studies indicate worldwide reductions in some childhood infections since the onset of the pandemic, but the associated impact on paediatric hospitalisations and mortality outcomes has remained less clear. 

To address this, researchers from the University of Oxford assessed hospital admission rates and mortality outcomes for 19 common childhood respiratory infections, severe invasive infections, and vaccine preventable diseases before and after the onset of the pandemic in England. Their analysis included data for all children aged 0-14 years admitted to an NHS hospital in England with an infection from 1 March 2017 to 30 June 2021. 

Common respiratory infections included tonsilitis, influenza and bronchiolitis, while severe invasive infections included sepsis, meningitis and osteomyelitis (bone infection). Vaccine preventable diseases included measles, mumps and several bacterial causes of serious illnesses. 

Potentially influential factors including age, ethnic group, geographical region, deprivation, and existing conditions (comorbidities) were taken into account. 

After 1 March 2020, substantial and sustained reductions in hospital admissions were found for all but one of the 19 infective conditions studied.  

Among the common respiratory infections, the greatest percentage reduction was for influenza where the number of hospital admissions decreased by 94% from 5,379 (annual mean from 1 March 2017 to 29 February 2020) to 304 in the 12 months after 1 March 2020. For bronchiolitis, admissions decreased by more than 80% from 51,655 (annual mean 2017-20) to 9,423 in 2020-21.  

Among the severe invasive infections, percentage reductions ranged from 26% for osteomyelitis to 50% for meningitis. And for the vaccine preventable infections, reductions ranged from 53% for mumps to 90% for measles, where admissions fell from 149 (annual mean 2017-20) to 15 in 2020-21. 

Reductions were similar across all geographical regions, deprivation and ethnic groups, as well as among children with existing conditions who are at greatest risk of severe illness and death from infection. 

Absolute numbers of deaths within 60 days of hospital admission for sepsis, meningitis, bronchiolitis, pneumonia, viral wheeze, and upper respiratory tract infections also decreased, although the researchers note that the proportion of children admitted for pneumonia who died within 60 days increased.  

More recent data also indicate that some respiratory infections increased to higher levels than usual after May 2021. 

Raph Goldacre, epidemiologist in Oxford Population Health and co-lead author of the paper said ‘Our research suggests that measures used to reduce transmission of SARS-CoV-2, such as lockdowns, mask-wearing and restricted travel, have also reduced admissions for common and severe childhood infections in England. The pandemic has provided an unprecedented opportunity to assess which infective conditions are most strongly affected by such measures. 

‘Many of these measures are unsustainable outside the pandemic, but further evaluation of interventions and behavioural changes that could be sustained beyond the pandemic, especially during winter months, could potentially minimise the burden of infectious disease on health systems and protect vulnerable children in the longer term. As social restrictions evolve, continued monitoring of these conditions is also needed to identify any epidemiological shifts, such as delayed seasonal peaks or an increased burden of disease in older children, which might occur because of changes to natural immunity during the pandemic. The unusually high rates of some respiratory infections after May 2021 further underline this need.”

Updated results based on the latest data will be published online every month.