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; Naïm Ouldali; François Angoulvant; Philippe Minodier; Sandra Biscardi; Fouad Madhi; Isabelle Hau; Audrey Santos; Emilie Bouvy; François Dubos; Alain Martinot; Marie-Aliette Dommergues; Christèle Gras-Le Guen; Elise Launay; Karine Levieux; Ferielle Zenkhri; Irina Craiu; Mathie Lorrot; Yves Gillet; Ellia Mezgueldi; Albert Faye; Stéphane Béchet; Emmanuelle Varon; Robert Cohen; Corinne Levy

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

Front Pediatr. 2022 Mar 22:10:782894. doi: 10.3389/fped.2022.782894. eCollection 2022.

Authors

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.

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.