{
  "abstract": "Introduction Non-pharmaceutical interventions (NPIs) such as mask-wearing and social distancing, implemented as public health measures to slow COVID-19 transmission, had a major impact on the epidemiology of viral infections. However, little is known about their influence on bacterial infections in children.Methods We performed a multicentre observational study including eight hospitals in three countries (Spain, UK and USA). All hospitalisations in children under the age of 18 from January 2019 to February 2023 were included. Electronic health record data were used to assess changes in hospitalisations for bacterial infections in three different periods based on NPI stringency, classified as pre-NPI (January 2019 to February 2020), full NPI (March 2020 to February 2021) and partial NPI (March 2021 to February 2023). The primary outcomes were the counts of hospitalisations for invasive, respiratory and skin-associated bacterial infections. To identify changes in the monthly counts of bacterial infections in a data-driven manner, we used a multivariable quasi-Poisson regression model adjusting for important covariates with adaptive lasso penalty. We then assessed the statistical significance of the identified changes and examined the temporal trend before and after each change point.Results We found that of the 508 585 paediatric hospitalisations, 41 076 (8.1%) were associated with any bacterial infection. 14 656 (35.7%) were invasive bacterial infections, 6763 (16.5%) were respiratory tract-associated and 7757 (18.9%) were skin-associated. Counts of bacterial infections decreased during the full-NPI period (average count 93.7 infections/month) compared with the pre-NPI period (average count 104.8 infections/month) and increased during the partial NPI period (average count 112.4 infections/month). A quasi-Poisson regression model showed a significant decrease in respiratory tract-associated bacterial infections after the start of the COVID-19 pandemic and a subsequent significant increase after the gradual lifting of NPIs, peaking during the winter of 2022–2023. No significant changes were observed over time for skin-associated and invasive bacterial infections.Conclusions The implementation of COVID-19 NPIs was significantly associated with changes in hospitalisations for respiratory associated-bacterial infections, but not invasive and skin-associated bacterial infections. These findings suggest that the impact of NPIs has been greatest for respiratory infections and indicate the potential of targeted NPIs to reduce these infections among children in the future.",
  "authors": [
    {
      "affiliations": [
        "Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA",
        "Department of Paediatric Infectious Diseases and Immunology, University Medical Center Rotterdam, Rotterdam, The Netherlands"
      ],
      "name": "Joany M Zachariasse"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Alba Gutiérrez-Sacristán"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Simran Makwana"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Xiudi Li"
    },
    {
      "affiliations": [
        "Division of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, USA"
      ],
      "name": "Surbhi Bhatnagar"
    },
    {
      "affiliations": [
        "Department of Learning Health Sciences, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA"
      ],
      "name": "David A Hanauer"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Cohen Children’s Medical Center, New York, New York, USA"
      ],
      "name": "Mundeep K Kainth"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Michele Morris"
    },
    {
      "affiliations": [
        "Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Spain"
      ],
      "name": "Paula Rubio-Mayo"
    },
    {
      "affiliations": [
        "Biomedical Data Science Lab, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, Valencia, Spain"
      ],
      "name": "Carlos Sáez"
    },
    {
      "affiliations": [
        "Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, England, UK"
      ],
      "name": "Mohsin Ali Shah"
    },
    {
      "affiliations": [
        "Departments of Biomedical Informatics, Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA",
        "Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA"
      ],
      "name": "Bruce J Aronow"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, SurgicalTrauma Intensive Care and Pain Clinic, Hospital Clinico Universitario de Valencia, Valencia, Spain"
      ],
      "name": "Rafael Badenes"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Tianxi Cai"
    },
    {
      "affiliations": [
        "Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Spain"
      ],
      "name": "Noelia Garcia Barrio"
    },
    {
      "affiliations": [
        "Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, England, UK"
      ],
      "name": "Richard W Issitt"
    },
    {
      "affiliations": [
        "Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Kenneth D Mandl"
    },
    {
      "affiliations": [
        "Department of Clinical Science and Community Health, University of Milan, Milan, Italy"
      ],
      "name": "Gregorio P Milani"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK"
      ],
      "name": "Karyn Moshal"
    },
    {
      "affiliations": [
        "Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Jane W Newburger"
    },
    {
      "affiliations": [
        "Departments of Computational Medicine and Bioinformatics, Internal Medicine, Human Genetics, Environmental Health, University of Michigan, Ann Arbor, Michigan, USA"
      ],
      "name": "Gilbert S Omenn"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, SurgicalTrauma Intensive Care and Pain Clinic, Hospital Clinico Universitario de Valencia, Valencia, Spain"
      ],
      "name": "Nekane Romero-Garcia"
    },
    {
      "affiliations": [
        "Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Francesca Sperotto"
    },
    {
      "affiliations": [
        "Genomic Medicine, Great Ormond Street Hospital for Children, London, UK"
      ],
      "name": "Anastasia Spiridou"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Shyam Visweswaran"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Zongqi Xia"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Florence T Bourgeois"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA",
        "Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Paul Avillach"
    },
    {
      "affiliations": [],
      "name": "The Consortium for Clinical Characterization of COVID-19 by EHR (4CE)"
    }
  ],
  "title": "Impact of COVID-19 non-pharmaceutical interventions on bacterial infections in children: an international electronic health record-based study",
  "uid": "1c0a47cd-e672-5750-b303-dfcce6b4a505"
}