Supervisors info:
Ξάνθος Θεόδωρος,Καθηγητής, Τμήμα Μαιευτικής, ΠΑΔΑ
Ιακωβίδου Νικολέττα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Εκμεκτζόγλου Κωνσταντίνος, Επίκουρος Καθηγητής, Τμήμα Ιατρικής, Ευρωπαϊκού Πανεπιστημίου Κύπρου
Summary:
Bronchiolitis is a common pediatric disease in children younger than 2 years. Its main causative agent is the respiratory syncytial virus. Every year it takes the form of an epidemic and affects health care systems around the world. Its maximum impact occurs in the winter months. Its treatment is based on supportive/conservative measures like other respiratory infections. The Covid 19 is a subcategory of already existing viruses (Coronaviruses). Starting from China at the end of 2019, it gradually began to spread to various regions of the world. From the beginning of 2020, it gradually started to be a global problem, taking the form of a pandemic. The symptomatology presented by pediatric patients is usually mostly mild like other viral respiratory syndromes. Similarly, with bronchiolitis, the treatment is mainly based on supportive preventive measures. It differs in that COVID has a plethora of vaccines aimed at patients with severe symptomatic diseases.
Therefore, through my personal observation of the reduction of the admissions of patients in a broader way and more specifically that of respiratory origin my interest was created to write a study about this specific topic. To summarize and observe bronchiolitis cases in a certain period of time of two different timetables, before the pandemic and after the pandemic, and compare these results with each other and summarize all the clinical characteristics and clinical picture of these two periods into one and write the results. There are any characteristics that are different between to these time frames? Are there any changes between clinical pictures of bronchiolitis between periods? Is the reduction of the admission rate of bronchiolitis statistically significant or does this represent a virtual item? At the same time, I have the opportunity to study other parameters in relation to the gender of the patients, the level of respiratory difficulty, the racial origin, the oxygen level etc.
The present study included all admissions with a diagnosis of Bronchiolitis who were hospitalized at the First Pediatric Clinic of the Panagiotis and Aglaia Kyriakou Children's Hospital, Athens. The time period for recording and observing the data was set from September 2019 to February 2020 and from September 2020 to February 2021. In this period, from all admissions, 62 cases of bronchiolitis were found in the period 2019-2020 and 6 cases in the period 2020 -2021. The processing of the statistical data was carried out by an expert with the statistical package SPSS v.28 as well as the R language environment (version for Windows 4.3.0). For descriptive statistics, the characteristics were presented as absolute frequency and the corresponding percentage (N,%) for quantitative variable, the median and range were used, for reasons of completeness the mean value and standard deviation presented in this diploma thesis. Differences between RSV-positive and negative infants were also determined by X2 independence tests and Fisher’s exact tests when required. The Z score method was used to compare percentages.
For differences between the two periods in both demographic and disease outcomes Fisher’s Exact test was used in the second period where there are only 6 cases available and the conditions for the X2 test were not met. For the comparison of the numerical variables between the two groups the Mann-Whitney U test was applied since normality was checked with the Shapiro-Wilk U test and was not ensured. For the present research, a significance level of a=0.05 was considered and all tests were two-sided.
In general, the coronavirus pandemic brought about significant changes in the incidence of bronchiolitis cases and directly affected the rate of admissions for both bronchiolitis and respiratory tract infections. A significant decrease in the percentage of imports of 50% was observed between the period September 2019 to February 2020 with the corresponding period of 2020/2021. The differences in the number of admissions overall but also in the number of bronchiolitis cases were statistically significant (p<0.001).
There was also a 90% reduction in bronchiolitis admissions as well as in all other respiratory system infections between the two time periods. In addition, we observe that the incidence of respiratory infections among all admissions decreased from 32.77% in 2019-2020 to 5.19% in 2020-2021, with a statistically significant difference (<0.001). However, the incidence of bronchiolitis as a percentage of respiratory infections remains at a stable rate (16.10% in 2019-2020, 17.14% in 2020-2021) (p=0.873). On the field of Rapid test results, during the period of 2019-2020 41.90% of cases were RSV-caused bronchiolitis, while during 2020-2021 only 16.7% of cases were RSV-caused. This means that the majority of cases in the period 2020-2021 (83.3%) were non-RSV in etiology. Another field was Pool virus results by period did not detect any patient with RSV in any of the cases in the period between 2020-2021.
In conclusion, the implementation of measures against the coronavirus pandemic seems to have played a role in the incidence of bronchiolitis in the pediatric population. The use of protective measures like masks, social isolation as well as remote education were the most decisive measures that seem to have affected the spread of bronchiolitis. The daily and continuous information from the local government authorities through promotional actions (advertisements, informative texts, etc.) in the media and also through local as also global health agencies (pg. WHO) brought about a change in the seasonality of the respiratory virus as well as other seasonal viruses that affects the pediatric population every year. Those measures were aimed more effectively at stopping the transmission of the COVID-19 infection seeming to have affected also the spread of bronchiolitis in that case. In this context, the role of COVID-19 in the context of other seasonal infections of the pediatric population should be investigated through other studies. The results of the study are revealed through the specter of daily clinical pediatric practice with all the negatives that accompany it. The knowledge and the role played by COVID-19 in our lives is a main through in this, for the establishment of epidemiological models as well as more effective recording systems of patients with the aim of more effective treatment and research into new future threats.
Keywords:
Bronchiolitis, Coronavirus, Respiratory infections, Pandemic, Comparative study, Epidemiology, Respiratory distress, Coronavirus clinical symptoms, Bronchiolitis clinical symptoms, Covid-19
