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Effect of the COVID-19 pandemic on the pediatric infectious disease landscape

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Abstract

This narrative review aims to present an overview of the COVID-19 pandemic’s effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children (“long COVID”), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription.

     Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of “long COVID” in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage.

What is Known:

• COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible.

• The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse.

What is New:

• Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols.

• The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).

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Abbreviations

COVID-19:

Coronavirus disease 2019

SARS‑CoV‑2:

Severe acute respiratory syndrome coronavirus 2

MIS-C:

Multisystem inflammatory syndrome in children

HPV:

Human papillomavirus

LMIC:

Low-middle-income countries

AMR:

Antimicrobial resistance

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Authors and Affiliations

  1. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Moshe Shmueli, Idan Lendner & Shalom Ben-Shimol

  2. Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel

    Shalom Ben-Shimol

  3. Pediatric Department B, Soroka University Medical Center, Beer-Sheva, Israel

    Idan Lendner

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  1. Moshe Shmueli
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Moshe Shmueli, Idan Lender, and Shalom Ben-Shimol have all contributed equally to the conception and design of the review, drafted and revised the manuscript and approve its publication.

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Correspondence to Shalom Ben-Shimol.

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Shalom Ben-Shimol has received within the last 35 months grants by Pfizer. He serves as scientific consultant and on the review board of Pfizer and MSD, and belongs to the speaker bureau of Pfizer, MSD, and GSK. The other authors do not report any conflict of interest.

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Shmueli, M., Lendner, I. & Ben-Shimol, S. Effect of the COVID-19 pandemic on the pediatric infectious disease landscape. Eur J Pediatr 183, 1001–1009 (2024). https://doi.org/10.1007/s00431-023-05210-x

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