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

Lea Lenglart^{1

2}, Naim Ouldali^{3

4

5

6

2}, Kate Honeyford⁷, Zsolt Bognar⁸, Silvia Bressan⁹, Danilo Buonsenso¹⁰, Liviana Da Dalt⁹, Tisham De¹¹, Ruth Farrugia¹², Ian K Maconochie^{13

14}, Henriette A Moll¹⁵, Rianne Oostenbrink¹⁵, Niccolo Parri¹⁶, Damian Roland^{17

18}, Katy Rose¹³, Esra Akyüz Özkan¹⁹, François Angoulvant³, Camille Aupiais^{5

20}, Clarissa Barber²¹, Michael Barrett^{22

23}, Romain Basmaci²⁴, Susana Castanhinha²⁵, Antonio Chiaretti¹⁰, Sheena Durnin²⁶, Patrick Fitzpatrick²⁷, Laszlo Fodor²⁸, Borja Gomez²⁹, Susanne Greber-Platzer³⁰, Romain Guedj³¹, Florian Hey³², Lina Jankauskaite³³, Daniela Kohlfuerst³⁴, Ines Mascarenhas³⁵, Anna Maria Musolino³⁶, Zanda Pučuka³⁷, Sofia Reis³⁸, Alexis Rybak^{1

5

6}, Petra Salamon⁸, Matthias Schaffert³⁹, Keren Shahar-Nissan⁴⁰, Maria Chiara Supino³⁶, Ozlem Teksam⁴¹, Caner Turan⁴², Roberto Velasco⁴³, Ruud G Nijman^{11

13

14

44}, Luigi Titomanlio^{1

45

44}; EPISODES Study Group

Affiliations

¹ Paediatric Emergency Department, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France.
² L. Lenglart and N. Ouldali contributed equally to this work.
³ Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France.
⁴ Infectious Diseases Division, CHU Sainte Justine, Montreal University, Montreal, QC, Canada.
⁵ Paris University, INSERM UMR 1123, ECEVE, Paris, France.
⁶ Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France.
⁷ Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, UK.
⁸ Paediatric Emergency Department, Heim Pal National Paediatric Institute, Budapest, Hungary.
⁹ Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.
¹⁰ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹¹ Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.
¹² Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta.
¹³ Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK.
¹⁴ Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK.
¹⁵ Department of General Paediatrics, ErasmusMC - Sophia, Rotterdam, The Netherlands.
¹⁶ Emergency Department and Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy.
¹⁷ SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK.
¹⁸ Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK.
¹⁹ Paediatric Emergency Department, Ondokuz Mayıs University, Samsun, Turkey.
²⁰ Paediatric Emergency Department, Jean Verdier Hospital, AP-HP, Sorbonne Paris Cité, Bondy, France.
²¹ Paediatric Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
²² Paediatric Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland.
²³ Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.
²⁴ Paediatric Emergency Department, Louis Mourier Hospital, AP-HP, Université de Paris, Colombes, France.
²⁵ Hospital Dona Estefania, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
²⁶ Department of Paediatric Emergency Medicine, Children's Health Ireland at Tallaght, Dublin, Ireland.
²⁷ Paediatric Emergency Department, Children's Health Ireland at Temple Street, Dublin, Ireland.
²⁸ Paediatric Emergency Department, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary.
²⁹ Paediatric Emergency Department, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
³⁰ Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria.
³¹ Paediatric Emergency Department, Armand Trousseau Hospital, AP-HP, Sorbonne Université, CRESS Inserm U-1153 Paris, Epopé Team, Paris, France.
³² Pediatric Intensive Care Unit and Emergency Department, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
³³ Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania.
³⁴ Department of General Paediatrics, Medical University of Graz, Graz, Austria.
³⁵ Departamento da Criança e do Jovem, Urgencia Pediatrica, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal.
³⁶ Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³⁷ Paediatric Emergency Department, Children's Clinical University Hospital, Riga Stradins University, Riga, Latvia.
³⁸ Paediatric Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
³⁹ Department of Pediatrics and Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria.
⁴⁰ Paediatric Emergency Department, Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Petach Tikva, Israel.
⁴¹ Division of Paediatric Emergency Medicine, Department of Paediatrics, Hacettepe University School of Medicine, Ankara, Turkey.
⁴² Department of Paediatrics, Division of Emergency Medicine, Mersin City Training and Research Hospital, Toroslar, Turkey.
⁴³ Paediatric Emergency Unit, Hospital Universitario Río Hortega, Valladolid, Spain.
⁴⁴ R.G. Nijman and L. Titomanlio contributed equally to this work.
⁴⁵ Paris University, INSERM U1141, DHU Protect, Paris, France.

PMID: 36356971
DOI: 10.1183/13993003.01172-2022

Free article

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

Lea Lenglart et al. Eur Respir J. 2023.

Free article

. 2023 Feb 16;61(2):2201172.

doi: 10.1183/13993003.01172-2022. Print 2023 Feb.

Authors

Affiliations

¹ Paediatric Emergency Department, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France.
² L. Lenglart and N. Ouldali contributed equally to this work.
³ Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France.
⁴ Infectious Diseases Division, CHU Sainte Justine, Montreal University, Montreal, QC, Canada.
⁵ Paris University, INSERM UMR 1123, ECEVE, Paris, France.
⁶ Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France.
⁷ Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, UK.
⁸ Paediatric Emergency Department, Heim Pal National Paediatric Institute, Budapest, Hungary.
⁹ Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.
¹⁰ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹¹ Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.
¹² Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta.
¹³ Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK.
¹⁴ Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK.
¹⁵ Department of General Paediatrics, ErasmusMC - Sophia, Rotterdam, The Netherlands.
¹⁶ Emergency Department and Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy.
¹⁷ SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK.
¹⁸ Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK.
¹⁹ Paediatric Emergency Department, Ondokuz Mayıs University, Samsun, Turkey.
²⁰ Paediatric Emergency Department, Jean Verdier Hospital, AP-HP, Sorbonne Paris Cité, Bondy, France.
²¹ Paediatric Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
²² Paediatric Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland.
²³ Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.
²⁴ Paediatric Emergency Department, Louis Mourier Hospital, AP-HP, Université de Paris, Colombes, France.
²⁵ Hospital Dona Estefania, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
²⁶ Department of Paediatric Emergency Medicine, Children's Health Ireland at Tallaght, Dublin, Ireland.
²⁷ Paediatric Emergency Department, Children's Health Ireland at Temple Street, Dublin, Ireland.
²⁸ Paediatric Emergency Department, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary.
²⁹ Paediatric Emergency Department, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
³⁰ Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria.
³¹ Paediatric Emergency Department, Armand Trousseau Hospital, AP-HP, Sorbonne Université, CRESS Inserm U-1153 Paris, Epopé Team, Paris, France.
³² Pediatric Intensive Care Unit and Emergency Department, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
³³ Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania.
³⁴ Department of General Paediatrics, Medical University of Graz, Graz, Austria.
³⁵ Departamento da Criança e do Jovem, Urgencia Pediatrica, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal.
³⁶ Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³⁷ Paediatric Emergency Department, Children's Clinical University Hospital, Riga Stradins University, Riga, Latvia.
³⁸ Paediatric Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
³⁹ Department of Pediatrics and Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria.
⁴⁰ Paediatric Emergency Department, Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Petach Tikva, Israel.
⁴¹ Division of Paediatric Emergency Medicine, Department of Paediatrics, Hacettepe University School of Medicine, Ankara, Turkey.
⁴² Department of Paediatrics, Division of Emergency Medicine, Mersin City Training and Research Hospital, Toroslar, Turkey.
⁴³ Paediatric Emergency Unit, Hospital Universitario Río Hortega, Valladolid, Spain.
⁴⁴ R.G. Nijman and L. Titomanlio contributed equally to this work.
⁴⁵ Paris University, INSERM U1141, DHU Protect, Paris, France.

PMID: 36356971
DOI: 10.1183/13993003.01172-2022

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: N. Ouldali reports travel grants from Pfizer, GSK and Sanofi. No other authors have conflicts of interest to disclose.

Comment in

Preventing bronchiolitis among infants with non-pharmaceutical interventions outside pandemics: is it realistic?
Pedersen ESL, Kuehni CE. Pedersen ESL, et al. Eur Respir J. 2023 Feb 16;61(2):2202214. doi: 10.1183/13993003.02214-2022. Print 2023 Feb. Eur Respir J. 2023. PMID: 36796850 No abstract available.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
- HighWire
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical