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Infeções não respiratórias em idade pediátrica: o que mudou com a pandemia COVID-19?
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Abstract(s)
Introdução: Em março de 2020, um surto da Síndrome Respiratória Aguda Grave 2,
causado pelo coronavírus, foi declarado como pandemia pela Organização Mundial de
Saúde. Durante a pandemia COVID-19, foram implementadas medidas não farmacológicas
a fim de reduzir a disseminação deste vírus. Neste período, assistiu-se a um decréscimo do
número de admissões por causa infeciosa no serviço de urgência pediátrico, sendo as
infeções respiratórias uma das patologias com maior taxa de variação. Apesar destas serem
as infeções mais comuns em idade pediátrica, também infeções não respiratórias, (infeções
gastrointestinais, infeções urinárias e afeções cutâneas), apresentam uma elevada
frequência nesta faixa etária, sendo motivo frequente de recurso ao serviço de urgência. Nos
últimos anos, diversos estudos têm sido realizados para avaliar o impacto da pandemia e
das medidas não farmacológicas sobre as doenças do foro respiratório. No entanto, em
relação às patologias infeciosas não respiratórias, os estudos são escassos e os resultados
mostram-se muitas vezes divergentes e controversos.
Objetivos: Este estudo teve como objetivo principal avaliar as alterações a nível da
frequência, sazonalidade e grau de gravidade das infeções não respiratórias, tendo em conta
que as infeções em idade pediátrica estão frequentemente associadas a contágio
interpessoal. Foi ainda analisada a correlação destas variáveis com as medidas não
farmacológicas implementadas para prevenção de contágio durante o período da pandemia.
Métodos: Estudo observacional transversal, em crianças dos 0 aos 11 anos, que
recorreram ao serviço de urgência pediátrico de um Hospital de nível 2, por motivos de
infeção não respiratória. O período de estudo foi de 54 meses (fevereiro de 2019 a julho de
2023) e a amostra incidiu sobre os primeiros 5 dias de cada mês. Foram definidos 3 períodos
temporais, tendo em consideração a evolução da pandemia: pré-COVID-19, COVID-19 e
pós-COVID-19. Foram realizados estudos comparativos para avaliar a frequência, gravidade
e sazonalidade das infeções nos diferentes períodos temporais. A análise estatística foi
realizada com recurso ao Excel e ao software SPSS, versão 29. Definiu-se um nível de
significância de 5%.
Resultados: A amostra incluiu 989 episódios de urgência, 367 (37,1%) foram
registados no subgrupo Pré-COVID-19, 263 (26,6%) em COVID-19 e 359 (36,3%) no PósCOVID-19. Quando comparado o número de admissões em cada período, verificou-se
diminuição estatisticamente significativa da proporção de infeções não respiratórias entre Pré-COVID-19 e COVID-19, seguido de aumento entre COVID-19 e Pós-COVID-19. Das 989
crianças admitidas no serviço de urgência pediátrico neste período, 51,2% eram do sexo
masculino e 48,8% do sexo feminino, com mediana de idade de 3 anos (amplitude
interquartil [1,5] anos). Relativamente aos diagnósticos foram identificadas no estudo 30
patologias, distribuídas em 5 categorias: afeções cutâneas, infeções gastrointestinais,
infeções do trato urinário, “outros diagnósticos” e co-infeção. Verificou-se que a
gastroenterite aguda (GEA) foi a principal patologia diagnosticada (49,4%), seguida das
afeções cutâneas (34,8%), das co-infeções (8,9%), infeções do trato urinário (3,7%) e
“outros diagnósticos” (2,0%). Relativamente aos subtipos de infeção, observou-se uma
redução estatisticamente significativa da proporção das admissões por afeções cutâneas e
gastrointestinais na pandemia face ao período pré-pandémico. Ao analisar isoladamente
cada patologia, observou-se diminuição da proporção de casos de GEA, varicela e
escarlatina entre Pré-COVID-19 e COVID-19. Entre o período pandémico e pós-pandémico,
observou-se um aumento da proporção das admissões por varicela, escarlatina e exantema
por enterovírus. Porém, nos casos de varicela e na categoria “outras afeções cutâneas”,
assistiu-se a uma diminuição da proporção do período pré-pandémico para o póspandémico. A varicela foi a única patologia que apresentou alterações estatisticamente
significativas entre os 3 períodos. No período pandémico, 62,3% dos casos apresentavam
contexto epidemiológico familiar positivo. Quanto à gravidade das infeções, não se
verificaram variações significativas relativamente à necessidade de internamento, tempo de
permanência hospitalar e complicações. No período pandémico e pós-pandémico, houve
mudança no padrão de sazonalidade, com picos intersazonais distintos do padrão prépandémico.
Conclusão: Com este estudo, conclui-se que as medidas não farmacológicas
implementadas durante a pandemia COVID-19 para redução da propagação do vírus SARSCOV-2, parecem ter contribuído para a redução da transmissão de outros agentes
etiológicos, o que resultou em alterações no que se refere à frequência, sazonalidade e
contexto epidemiológico das infeções.
Introduction: In March 2020, an outbreak of Severe Acute Respiratory Syndrome 2, caused by the coronavirus, was declared a pandemic by the World Health Organization. During the COVID-19 pandemic, non-pharmacological measures were implemented to reduce the spread of this virus. During this period, a decrease in the number of admissions due to infectious causes in pediatric emergency services was observed, with respiratory infections being one of the pathologies with the highest variation rate. Despite being the most common infections in pediatric age, non-respiratory infections, such as gastrointestinal infections, urinary tract infections, and skin conditions, also occur frequently in this age group, often leading to visits to the emergency department. In recent years, various studies have been conducted to assess the impact of the pandemic and nonpharmacological measures on respiratory diseases. However, regarding non-respiratory infectious pathologies, studies are less, and the results are often divergent and controversial. Objectives: This study aimed to evaluate changes in the frequency, seasonality, and severity of non-respiratory infections, considering that infections in pediatric age are often associated with interpersonal contagion. Additionally, we analized the correlation of these variables with the non-pharmacological measures implemented to prevent contagion during the pandemic period. Methods: This was a cross-sectional observational study conducted on children aged 0 to 11 years who visited the pediatric emergency department of a level 2 Hospital due to nonrespiratory infections. The study period covered 54 months (from February 2019 to July 2023), focusing on the first 5 days of each month. Three time periods were defined, considering the pandemic's progression: pre-COVID-19, COVID-19, and post-COVID-19. Comparative analyses were conducted to evaluate the frequency, severity, and seasonality of infections across the different time periods. Statistical analysis was performed using Excel and SPSS software, version 29. A significance level of 5% was established. Results: The sample included 989 emergency episodes, 367 (37.1%) occurred in the PreCOVID-19 subgroup, 263 (26.6%) during COVID-19, and 359 (36.3%) in the Post-COVID19 period. When comparing the number of admissions in each period, a statistically significant decrease in the proportion of non-respiratory infections was observed between Pre-COVID-19 and COVID-19, followed by an increase between COVID-19 and PostCOVID-19. Of the 989 children admitted to the pediatric emergency department during this period, 51.2% were male and 48.8% female, with a median age of 3 years (interquartile range [1.5] years). In relation to the diagnoses, 30 pathologies were identified in the study, distributed into 5 categories: skin conditions, gastrointestinal infections, urinary tract infections, “other diagnoses”, and co-infections. Acute gastroenteritis (GEA) was the main diagnosed condition (49.4%), followed by skin conditions (34.8%), co-infections (8.9%), urinary tract infections (3.7%), and “other diagnoses” (2.0%). Regarding infection subtypes, a statistically significant reduction in the proportion of admissions for skin and gastrointestinal infections was observed during the pandemic compared to the prepandemic period. When analyzing each condition individually, a decrease was observed in the proportion of cases of acute gastroenteritis, chickenpox, and scarlet fever between PreCOVID-19 and COVID-19. Between the pandemic and post-pandemic periods, an increase in the proportion of admissions for chickenpox, scarlet fever, and enterovirus-related exanthema was observed. However, for chickenpox and the category of “other skin conditions,” there was a decrease in the proportion from the pre-pandemic to the postpandemic period. Chickenpox was the only condition that showed statistically significant changes across the three periods. During the pandemic period, 62.3% of cases presented a positive family epidemiological context. Regarding the severity of infections, no significant variations were observed in terms of hospitalization needs, hospital stay duration, or complications. During the pandemic and post-pandemic periods, there was a change in the seasonality pattern, with inter-seasonal peaks distinct from the pre-pandemic pattern. Conclusion: With this study, we concluded that the non-pharmacological measures implemented during the COVID-19 pandemic to reduce the spread of the SARS-CoV-2 virus appear to have contributed to a reduction in the transmission of other etiological agents, resulting in changes in the frequency, seasonality, and epidemiological context of infections.
Introduction: In March 2020, an outbreak of Severe Acute Respiratory Syndrome 2, caused by the coronavirus, was declared a pandemic by the World Health Organization. During the COVID-19 pandemic, non-pharmacological measures were implemented to reduce the spread of this virus. During this period, a decrease in the number of admissions due to infectious causes in pediatric emergency services was observed, with respiratory infections being one of the pathologies with the highest variation rate. Despite being the most common infections in pediatric age, non-respiratory infections, such as gastrointestinal infections, urinary tract infections, and skin conditions, also occur frequently in this age group, often leading to visits to the emergency department. In recent years, various studies have been conducted to assess the impact of the pandemic and nonpharmacological measures on respiratory diseases. However, regarding non-respiratory infectious pathologies, studies are less, and the results are often divergent and controversial. Objectives: This study aimed to evaluate changes in the frequency, seasonality, and severity of non-respiratory infections, considering that infections in pediatric age are often associated with interpersonal contagion. Additionally, we analized the correlation of these variables with the non-pharmacological measures implemented to prevent contagion during the pandemic period. Methods: This was a cross-sectional observational study conducted on children aged 0 to 11 years who visited the pediatric emergency department of a level 2 Hospital due to nonrespiratory infections. The study period covered 54 months (from February 2019 to July 2023), focusing on the first 5 days of each month. Three time periods were defined, considering the pandemic's progression: pre-COVID-19, COVID-19, and post-COVID-19. Comparative analyses were conducted to evaluate the frequency, severity, and seasonality of infections across the different time periods. Statistical analysis was performed using Excel and SPSS software, version 29. A significance level of 5% was established. Results: The sample included 989 emergency episodes, 367 (37.1%) occurred in the PreCOVID-19 subgroup, 263 (26.6%) during COVID-19, and 359 (36.3%) in the Post-COVID19 period. When comparing the number of admissions in each period, a statistically significant decrease in the proportion of non-respiratory infections was observed between Pre-COVID-19 and COVID-19, followed by an increase between COVID-19 and PostCOVID-19. Of the 989 children admitted to the pediatric emergency department during this period, 51.2% were male and 48.8% female, with a median age of 3 years (interquartile range [1.5] years). In relation to the diagnoses, 30 pathologies were identified in the study, distributed into 5 categories: skin conditions, gastrointestinal infections, urinary tract infections, “other diagnoses”, and co-infections. Acute gastroenteritis (GEA) was the main diagnosed condition (49.4%), followed by skin conditions (34.8%), co-infections (8.9%), urinary tract infections (3.7%), and “other diagnoses” (2.0%). Regarding infection subtypes, a statistically significant reduction in the proportion of admissions for skin and gastrointestinal infections was observed during the pandemic compared to the prepandemic period. When analyzing each condition individually, a decrease was observed in the proportion of cases of acute gastroenteritis, chickenpox, and scarlet fever between PreCOVID-19 and COVID-19. Between the pandemic and post-pandemic periods, an increase in the proportion of admissions for chickenpox, scarlet fever, and enterovirus-related exanthema was observed. However, for chickenpox and the category of “other skin conditions,” there was a decrease in the proportion from the pre-pandemic to the postpandemic period. Chickenpox was the only condition that showed statistically significant changes across the three periods. During the pandemic period, 62.3% of cases presented a positive family epidemiological context. Regarding the severity of infections, no significant variations were observed in terms of hospitalization needs, hospital stay duration, or complications. During the pandemic and post-pandemic periods, there was a change in the seasonality pattern, with inter-seasonal peaks distinct from the pre-pandemic pattern. Conclusion: With this study, we concluded that the non-pharmacological measures implemented during the COVID-19 pandemic to reduce the spread of the SARS-CoV-2 virus appear to have contributed to a reduction in the transmission of other etiological agents, resulting in changes in the frequency, seasonality, and epidemiological context of infections.
Description
Keywords
Afeções Cutâneas Covid-19 Gastroenterite Aguda Infeções do Trato Urinário Pediatria