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.
Abstract
Among the various non-pharmaceutical interventions implemented against SARS-CoV-2 in Europe, full lockdown, school closure, facial masking and teleworking were preventive measures associated with a reduction in the number of bronchiolitis cases https://bit.ly/3SyqqYS
Footnotes
EPISODES Study Group: Vanda Anacleto, Departamento da Criança e do Jovem, Urgencia Pediatrica, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal; Orkun Aydin, Division of Paediatric Emergency Medicine, Department of Paediatrics, Hacettepe University School of Medicine, Ankara, Turkey; Elena Bellelli, Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Ron Berant, Paediatric Emergency Department, Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Petach Tikva, Israel; Thibault De Groc, Paediatric Emergency Department, Louis Mourier Hospital, AP-HP, Université de Paris, Colombes, France; Sara Geitoeira, Paediatric Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal; Florian Hoffmann, Pediatric Intensive Care Unit and Emergency Department, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Franziska Leeb, Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria; Fiona Leonard, Paediatric Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland; Mark Lyttle, Paediatric Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK; Lia Mano, Department of Paediatric Emergency Medicine, Children's Health Ireland at Tallaght, Dublin, Ireland; Vytenis Masillonis, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania; Rosa Morello, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Francisa Saraiva, Departamento da Criança e do Jovem, Urgencia Pediatrica, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal; Gabor Simon, Paediatric Emergency Department, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary; Ines Silva Costa, Paediatric Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal; Joao Sous Marques, Paediatric Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal; Jonas Thüminger, Department of Pediatrics and Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria; Corinne Vasilico, Department of Pediatrics and Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria; Anna Chiara Vittucci, Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; and Christoph Zurl, Medical University of Graz, Department of General Paediatrics, Graz, Austria.
This article has an editorial commentary: https://doi.org/10.1183/13993003.02214-2022
Conflict of interest: N. Ouldali reports travel grants from Pfizer, GSK and Sanofi. No other authors have conflicts of interest to disclose.
Support statement: N. Ouldali is supported by the ESPID 2021-2023 fellowship award, R.G. Nijman by the NIHR ACL 2018-021-007 award and K. Honeyford by the NIHR (HS&DR) project NIHR129082. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received June 8, 2022.
- Accepted September 23, 2022.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org
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