'Dramatic' Fall in Hospital Admissions for Childhood Infections During Pandemic

Peter Russell

January 13, 2022

Rates of hospital admissions for common and severe childhood infections in England underwent a "substantial" reduction in the first 12 months of COVID-19, a study found.

Cases of influenza, bronchiolitis, and meningitis dipped as pandemic lockdown measures were introduced, bringing school closures, stay-at-home restrictions, and limited travel, as well as shielding measures for those in 'at risk' groups, researchers at the University of Oxford said.

Childhood immunisation programmes have been disrupted during the pandemic due to difficulties in accessing or administering vaccines, while reports have suggested fewer children have presented at hospital emergency departments, either because they were busy or because parents were worried about being exposed to SARS-CoV-2.

'Sustained' Reductions in Admission

To assess the impact of these factors on children's health, the researchers assessed hospital admission rates and mortality outcomes for 19 common childhood respiratory infections, severe invasive infections, and vaccine preventable diseases before and after the onset of the pandemic.

The study, published in The BMJ , included data for all children aged up to 14 who were admitted to an NHS hospital in England with an infection from 1 March 2017 to 30 June 2021.

The researchers found "substantial and sustained" reductions in admissions after 21 March in all but one of the infective conditions they analysed.

Among severe invasive infections, the reductions were:

  • Influenza (94%)

  • Bronchiolitis (82%)

  • Viral wheeze (56%)

  • Osteomyelitis (26%)

Among vaccine preventable infections, the reductions were:

  • Measles (90%)

  • Mumps (53%)

  • Meningitis (50%)

The only infection that did not register a reduction in hospital admissions was pyelonephritis, which saw a 4% rise in admissions, probably because non-pharmacological interventions and social restrictions would have no impact

on the condition.

More recent data indicated that croup and upper respiratory tract infections

increased to higher levels than usual after May 2021.

Reductions were similar across all geographical regions, deprivation, and ethnic groups, as well as among children with comorbidities who were at greatest risk of severe illness and death from infection.

Fall in Mortality

A decrease in the absolute number of 60-day fatalities was observed in patients with sepsis, meningitis, bronchiolitis, pneumonia, viral wheeze, and upper respiratory tract infections, compared with the 3-year average for 2017-20.

However, for pneumonia, the proportion admitted who died within 60 days increased after the onset of the pandemic, researchers said.

The authors stressed that the study was observational and did not cover patients outside a hospital setting.

Future Measures to Limit Infectious Diseases

They suggested that some of the measures introduced to reduce the spread of COVID could be continued to protect against other infections, particularly during winter months, "to minimise the burden on health systems and protect vulnerable children".

Updated results will be published on the Oxford Population Health website every month.

In an accompanying editorial, US paediatric specialists, Zachary Willis and Annabelle de St Maurice, argued that: "As populations derive increasing protection from COVID-19 through natural infections or vaccination, and measures such as lockdowns, mask mandates, and social distancing ease, there will probably be an increase in the incidence of primarily, but not exclusively, viral infections."

They suggested that as mitigation measures are relaxed, "controlled epidemiological studies to determine which interventions provide the greatest benefit for a wide range of infectious diseases should be a research priority".

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