新冠疫情后儿童呼吸道感染激增与“免疫债”概念

Surge of Pediatric Respiratory Tract Infections after the COVID-19 Pandemic and the Concept of "Immune Debt".

作者信息

Lenglart Lea, Titomanlio Luigi, Bognar Zsolt, Bressan Silvia, Buonsenso Danilo, De Tisham, Farrugia Ruth, Honeyford Kate, Maconochie Ian K, Moll Henriette A, Oostenbrink Rianne, Parri Niccolo, Roland Damian, Akyüz Özkan Esra, Almeida Laura, Alberti Ilaria, Angoulvant François, Assad Zein, Aupiais Camille, Barrett Michael, Basmaci Romain, Borensztajn Dorine, Castanhinha Susana, Chiaretti Antonio, Cohen Robert, Durnin Sheena, Fitzpatrick Patrick, Greber-Platzer Susanne, Guedj Romain, Hey Florian, Jankauskaite Lina, Keitel Kristina, Mascarenhas Ines, Milani Gregorio P, Musolino Anna Maria, Pučuka Zanda, Ryd Rinder Malin, Supino Maria Chiara, Tirelli Francesca, Nijman Ruud G, Ouldali Naim

机构信息

Pediatric Emergency Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France.

Pediatric Emergency Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France; Paris Cité University, INSERM U1141, DHU Protect, Paris, France.

出版信息

J Pediatr. 2025 Sep;284:114420. doi: 10.1016/j.jpeds.2024.114420. Epub 2024 Nov 22.

DOI:10.1016/j.jpeds.2024.114420

PMID:39579868

Abstract

OBJECTIVE

To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTIs) during the 2020 implementation of nonpharmaceutical interventions (NPIs) and the increase thereafter during NPI lifting.

STUDY DESIGN

We conducted an interrupted, time-series analysis based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included. We used generalized additive models to correlate the magnitude of decrease of each RTI during NPI (such as social distancing) implementation and its subsequent increase during NPI lifting. Urinary tract infections served as control outcome.

RESULTS

In total, 528 055 patients were included. We observed reductions in cases during the NPI period, from -76% (95% CI -113 to -53 in pneumonia) to -65% (95% CI -100 to -39 for tonsillitis/pharyngitis), followed by strong increases during NPI lifting, from +83% (95% CI 29-150 for tonsillitis/pharyngitis) to +329% (95% CI 149-517 for bronchiolitis). For each RTI, we found a significant association between the magnitude of decrease during NPI implementation and the increase during NPI lifting. Urinary tract infection cases remained stable.

CONCLUSIONS

The magnitude of increase in RTI observed after NPI lifting was directly correlated to the magnitude of case reduction during NPI implementation, suggesting a "dose-response" relationship from an "immune debt" phenomenon. The likely rebound in RTIs should be expected when implementing and lifting NPI in the future.

摘要

目的

研究2020年实施非药物干预措施（NPIs）期间小儿呼吸道感染（RTIs）减少幅度与随后解除NPIs期间感染增加幅度之间的剂量反应关系。

研究设计

我们基于一个跨国监测系统进行了一项中断时间序列分析。纳入了2018年1月至2022年6月期间来自13个欧洲国家25个儿科急诊科因各种RTI症状和体征前来就医的所有16岁以下患者。我们使用广义相加模型来关联NPIs（如社交距离）实施期间每种RTI的减少幅度及其在解除NPIs期间的随后增加幅度。尿路感染作为对照结果。

结果

共纳入528055例患者。我们观察到在NPIs期间病例减少，肺炎减少幅度为-76%（95%CI -113至-53），扁桃体炎/咽炎减少幅度为-65%（95%CI -100至-39），随后在解除NPIs期间大幅增加，扁桃体炎/咽炎增加幅度为+83%（95%CI 29 - 150），细支气管炎增加幅度为+329%（95%CI 149 - 517）。对于每种RTI，我们发现NPIs实施期间的减少幅度与解除NPIs期间的增加幅度之间存在显著关联。尿路感染病例保持稳定。