Global Impact of COVID-19 Pandemic on Gastrointestinal Infections: A Scoping Review

Abstract

During the COVID-19 pandemic, nonpharmaceutical public health interventions (NPIs) were implemented worldwide to control the spread of severe acute respiratory syndrome coronavirus 2. However, the incidence of other pathogens, including gastrointestinal (GI) pathogens, was also affected. Here, we reviewed studies assessing the impact of NPIs during the COVID-19 pandemic on the incidence of GI infections, particularly foodborne infections. A systems literature search was conducted in May 2023, using Living Evidence on COVID-19 (COAP) and Scopus. Articles were identified and selected through a screening process with inclusion and exclusion criteria based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Data were extracted from each full-text article included in the review. Parameters included were GI viruses, GI bacteria, NPIs against the COVID-19 pandemic, and the associated impact of NPIs on GI pathogens. A total of 42 articles were included in the review, representing 18 countries. Overall, a larger reduction was observed for viral GI infections compared with bacterial GI infections during the COVID-19 pandemic, particularly for norovirus. For bacterial GI infections, Campylobacter and nontyphoidal Salmonella were the most frequently detected pathogens in the majority of the studies, with the largest reduction observed for Shigella and Shiga toxin-producing Escherichia coli infections. The sharp decrease in GI viral infections in most of the included countries is suggested to be related to the disruption of person-to-person transmission due to several implemented interventions (e.g., social distancing and hand hygiene). GI bacterial pathogens, more commonly transmitted via the foodborne route, were least impacted, and their reduction is associated with closure of food-providing settings and travel restrictions. However, the observed changes appear to be multifactorial; alterations in health-care-seeking behaviors and in routinary diagnostic testing have undeniably played a significant role, affecting national surveillance systems. Therefore, although NPIs likely had a substantial impact on the burden of GI infectious diseases, the extent of the true change cannot be fully assessed.

Keywords: COVID-19; gastrointestinal pathogens; impact; incidence; nonpharmaceutical interventions; surveillance.

FIG. 1.

PRISMA flow diagram for study selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.