Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study

Alexis Rybak^{1

2

3}, Naïm Ouldali^{1

3

4}, François Angoulvant^{4

5

6}, Philippe Minodier^{6

7}, Sandra Biscardi^{6

8}, Fouad Madhi^{6

9}, Isabelle Hau^{6

9}, Audrey Santos², Emilie Bouvy^{6

10}, François Dubos^{6

10}, Alain Martinot^{6

10}, Marie-Aliette Dommergues^{6

11}, Christèle Gras-Le Guen^{6

12}, Elise Launay^{6

12}, Karine Levieux^{6

12}, Ferielle Zenkhri^{6

13}, Irina Craiu^{6

13}, Mathie Lorrot^{6

14}, Yves Gillet^{6

15}, Ellia Mezgueldi^{6

15}, Albert Faye^{3

4

6}, Stéphane Béchet^{1

6}, Emmanuelle Varon^{6

16}, Robert Cohen^{1

6

17

18

19}, Corinne Levy^{1

6

17

18}

Affiliations

¹ ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.
² Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France.
³ INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France.
⁴ Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.
⁵ INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.
⁶ Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.
⁷ Department of Pediatric Emergency, Centre Hospitalier Universitaire Nord, Marseille, France.
⁸ Department of Pediatric Emergency, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
⁹ Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
¹⁰ Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France.
¹¹ Department of General Pediatrics, Centre Hospitalier de Versailles, Le Chesnay, France.
¹² Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France.
¹³ Department of Pediatric Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France.
¹⁴ Department of General Pediatrics, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Université Sorbonne Paris Cité, Paris, France.
¹⁵ Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France.
¹⁶ National Reference Center for Pneumococci, Laboratoire de Microbiologie, Hôpital Intercommunal, Créteil, France.
¹⁷ Paris Est University, IMRB-GRC GEMINI, Créteil, France.
¹⁸ Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
¹⁹ Neonates Department, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.

PMID: 35391746
PMCID: PMC8980475
DOI: 10.3389/fped.2022.782894

Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study

Alexis Rybak et al. Front Pediatr. 2022.

. 2022 Mar 22:10:782894.

doi: 10.3389/fped.2022.782894. eCollection 2022.

Authors

Affiliations

¹ ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.
² Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France.
³ INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France.
⁴ Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.
⁵ INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.
⁶ Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.
⁷ Department of Pediatric Emergency, Centre Hospitalier Universitaire Nord, Marseille, France.
⁸ Department of Pediatric Emergency, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
⁹ Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
¹⁰ Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France.
¹¹ Department of General Pediatrics, Centre Hospitalier de Versailles, Le Chesnay, France.
¹² Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France.
¹³ Department of Pediatric Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France.
¹⁴ Department of General Pediatrics, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Université Sorbonne Paris Cité, Paris, France.
¹⁵ Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France.
¹⁶ National Reference Center for Pneumococci, Laboratoire de Microbiologie, Hôpital Intercommunal, Créteil, France.
¹⁷ Paris Est University, IMRB-GRC GEMINI, Créteil, France.
¹⁸ Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
¹⁹ Neonates Department, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.

PMID: 35391746
PMCID: PMC8980475
DOI: 10.3389/fped.2022.782894

Abstract

Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 were implemented in March 2020. These measures were followed by a major impact on viral and non-viral diseases. We aimed to assess the impact of NPI implementation in France on hospitalized community-acquired pneumonia (hCAP) frequency and the clinical and biological characteristics of the remaining cases in children. We performed a quasi-experimental interrupted time-series analysis. Between June 2014 and December 2020, eight pediatric emergency departments throughout France reported prospectively all cases of hCAP in children from age 1 month to 15 years. We estimated the impact on the monthly number of hCAP using segmented linear regression with autoregressive error model. We included 2,972 hCAP cases; 115 occurred during the NPI implementation period. We observed a sharp decrease in the monthly number of hCAP after NPI implementation [-63.0% (95 confidence interval, -86.8 to -39.2%); p < 0.001]. Children with hCAP were significantly older during than before the NPI period (median age, 3.9 vs. 2.3 years; p < 0.0001), and we observed a higher proportion of low inflammatory marker status (43.5 vs. 33.1%; p = 0.02). Furthermore, we observed a trend with a decrease in the proportion of cases with pleural effusion (5.3% during the NPI period vs. 10.9% before the NPI; p = 0.06). NPI implementation during the COVID-19 (coronavirus disease 2019) pandemic led not only to a strong decrease in the number of hCAP cases but also a modification in the clinical profile of children affected, which may reflect a change in pathogens involved.

Keywords: COVID-19; children; community-acquired pneumonia; non-pharmaceutical intervention; time series analysis.

Copyright © 2022 Rybak, Ouldali, Angoulvant, Minodier, Biscardi, Madhi, Hau, Santos, Bouvy, Dubos, Martinot, Dommergues, Gras-Le Guen, Launay, Levieux, Zenkhri, Craiu, Lorrot, Gillet, Mezgueldi, Faye, Béchet, Varon, Cohen and Levy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
**(A)** Impact of non-pharmaceutical interventions (NPIs) on monthly number of hospitalized community-acquired pneumonia (hCAP) in children from June 2014 to December 2020 (N = 2,968). The black line shows the observed data. The bold blue slope shows the model estimates based on observed data (linear regression modeling) with confidence intervals represented as dashed lines. March 16, 2020 (start of the first lockdown), is indicated by the vertical black arrows. **(B)** Auto-correlation function of residuals of the main outcome model. **(C)** Partial auto-correlation function of residuals of the main outcome model.

**Figure 2**
**(A)** Impact of non-pharmaceutical interventions (NPIs) on monthly number of hospitalized community-acquired pneumonia (hCAP) in children after exclusion of respiratory syncytial virus and influenza virus cases from June 2014 to December 2020 (N = 2,968). The black line shows the observed data. The bold blue slope shows the model estimates based on observed data (linear regression modeling) with confidence intervals represented as dashed lines. March 16, 2020 (start of the first lockdown) is indicated by the vertical black arrows. **(B)** Auto-correlation function of residuals of the sensitivity analysis. **(C)** Partial auto-correlation function of residuals of the sensitivity analysis.

See this image and copyright information in PMC

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Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study

Affiliations

Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources