Testing practices during and after the COVID-19 pandemic were found to have significant implications on the post-pandemic understanding of respiratory diseases, according to a study published in the Journal of Infection and Public Health.1 Because of increased COVID-19 testing for healthy individuals, researchers uncovered a potential for overdiagnosis of infectious diseases including respiratory syncytial virus (RSV), influenza, and invasive pneumococcal disease.
“RSV is a major cause of infant hospitalizations, while influenza tends to affect toddlers and school-aged children more commonly,” wrote authors of the study. “Bacterial infections, though less frequent, remain a concern. Especially, children with complex chronic diseases are more susceptible to invasive infections caused by Streptococcus Pneumonia, known as invasive pneumococcal disease, which is a severe and potentially life-threatening condition.”
Indeed, researchers’ understanding of how respiratory diseases interact with one another was crucial during times like the COVID-19 pandemic. Even more important for pediatric patients, major pandemic-level events have been found to significantly impact epidemiology patterns of respiratory diseases.2
The current study’s researchers wanted to place the focus on the pandemic and the non-pharmaceutical interventions (NPIs) that came from it. | image credit: Drobot Dean / stock.adobe.com
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Along with older adults over 65, children too are deemed at risk of contracting respiratory illnesses; a risk that was significantly increased during the COVID-19 pandemic. According to BMC Pulmonary Medicine, rhinovirus/enterovirus and RSV were the most prominent among children during the COVID-19 era.3
Many researchers and health care professionals are aware of the complex interplay between various respiratory viruses and how they are manifested in children. However, researchers of the current study wanted to place the focus on the pandemic and the non-pharmaceutical interventions (NPIs) that came from it.
“A potential consequence of these interventions has been the phenomenon known as ‘immunity debt,’ which refers to the reduction in population immunity due to lack of exposure to common pathogens during the pandemic,” continued the authors.1 “The concept of immunity debt has been hypothesized to explain the post-pandemic surge in respiratory infections, and the focus of this study is to present empirical data scrutinizing and quantifying these patterns.”
Focusing on the 3 aforementioned respiratory diseases, researchers’ goal was to explore the overall impact NPIs that emerged during the pandemic had on RSV, influenza, and invasive pneumococcal disease. They conducted a national, population-based analysis of children in Denmark over a 10-year period lasting from 2012 to 2022.
Throughout the time period, researchers scanned microbiology tests and hospital contacts for infection rates and testing patterns before, during, and after the pandemic. All participants included in the study were born in Denmark and between 0 and 17 years old during the study period.
“The outcomes of interest were the occurrences of tests for 3 different pathogens, specifically RSV, influenza virus, and pneumococcus,” they wrote.1 “Testing for COVID-19 was also included to provide context within the study period. Testing patterns were described based on both the absolute number of tests performed and the percentage of positive tests.”
Researchers included a total of 1,790,464 unique individuals in the final analysis.
Overall, COVID-19 restrictions and lockdowns led to decreased cases of respiratory diseases. Once those lockdowns were lifted, respiratory infections experienced a resurgence. With COVID-19 emerging at this time as a notable respiratory illness alongside RSV, the flu, and pneumococcus, testing for respiratory pathogens noticeably increased among children in Denmark.
“The NPIs for COVID-19 not only limited the spread of the targeted virus but also substantially decreased the incidence of RSV, influenza, and pneumococcus,” wrote the authors.1 “The subsequent lifting of restrictions led to a notable resurgence of these infections, likely attributable to immunity debt arising from reduced pathogen circulation.”
With further evidence regarding immunity debt uncovered, studies like this are constantly being conducted to further the knowledge of health care professionals and their understanding of COVID-19. Like many of the ongoing studies regarding COVID-19’s impact on health care and respiratory health, evidence from the current study can now be used to inform future policy regarding respiratory viruses, infectious diseases, and how they interact with each other among children.
“Our study comprehensively described the impact of behavioral changes and immunity debt on infectious disease epidemiology,” concluded the authors.1 “The rising number of tests among healthy children contributes to ongoing discussions regarding overdiagnosis and the implications for health care policy.”
READ MORE: Respiratory Resource Center
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