Acute respiratory infections (ARI), especially lower respiratory infections (LRI), are a leading cause of childhood morbidity and mortality globally. Non-pharmaceutical interventions (NPI) employed during the COVID-19 pandemic have impacted on the epidemiology and burden of paediatric ARI, although accurately describing the full nature of the impact is challenging. For most ARI pathogens, a reduction was observed in the early phase of the pandemic, correlating with the most stringent NPI. In later phases of the pandemic resurgence of disease was observed as NPI eased. This pattern was most striking for seasonal viruses, such as influenza and respiratory syncytial virus. The impact on ARI-associated bacterial disease varied; marked reductions in invasive Streptococcus pneumoniae and Streptococcus pyogenes were observed, followed by a resurgence that correlated with increases in respiratory viral infections. For Corynebacterium diphtheriae, Bordetella pertussis, and Mycoplasma pneumoniae, a sustained reduction of disease was observed well into 2022 in most regions. Proposed mechanisms for the varied epidemiological disruption amongst ARI pathogens include differential effects of NPI on specific pathogens, population-level immunological effects, and ecological and genetic pathogen adaptations. Additionally, important indirect effects of pandemic restrictions on paediatric respiratory infections have been identified. These occurred as a result of disruptions to routine health services, reductions in vaccination coverage, and disruptions to respiratory infection research and surveillance activities. Impacts have been disproportionately borne by those in low resource settings. We discuss opportunities to leverage pandemic learnings to support improved understanding of the epidemiology of paediatric respiratory infections to inform future prevention and health system strengthening.

Educational Aims

The reader will gain an improved understanding of:

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  The global burden of acute respiratory infections in children.

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  The direct impacts of non-pharmaceutical interventions (NPI) used in the COVID-19 pandemic on the epidemiology of paediatric respiratory infections.

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  The probable underlying mechanisms for the altered epidemiology of paediatric respiratory infections.

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  The indirect impacts of the pandemic on the burden of paediatric respiratory infections now and into the future.

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  Post-pandemic health system priorities for addressing paediatric respiratory infections.

急性呼吸道感染（ARI），特别是下呼吸道感染（LRI），是全球儿童发病和死亡的主要原因。尽管准确描述影响的全部性质具有挑战性，但在 COVID-19 大流行期间采用的非药物干预措施 (NPI) 对儿科 ARI 的流行病学和负担产生了影响。对于大多数 ARI 病原体，在大流行早期阶段观察到减少，这与最严格的 NPI 相关。在大流行的后期阶段，随着 NPI 的缓解，我们观察到疾病死灰复燃。这种模式对于季节性病毒最为显着，例如流感和呼吸道合胞病毒。对 ARI 相关细菌性疾病的影响各不相同；观察到侵袭性肺炎链球菌和化脓性链球菌显着减少，随后又出现复苏，这与呼吸道病毒感染的增加有关。对于白喉棒杆菌、百日咳博德特氏菌和肺炎支原体，大多数地区在 2022 年之前都观察到疾病持续减少。提出的ARI 病原体不同流行病学破坏机制包括NPI 对特定病原体的不同影响、群体水平的免疫效应以及生态和遗传病原体适应。此外，已经确定了大流行限制对儿童呼吸道感染的重要间接影响。这些事件的发生是由于常规卫生服务中断、疫苗接种覆盖率下降以及呼吸道感染研究和监测活动中断。资源匮乏地区的人们承受了不成比例的影响。我们讨论了利用大流行病知识来支持加深对儿科呼吸道感染流行病学的了解的机会，为未来的预防和加强卫生系统提供信息。    

教育目标

读者将更好地理解：

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  儿童急性呼吸道感染的全球负担。

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  COVID-19 大流行中使用的非药物干预措施 (NPI) 对儿科呼吸道感染流行病学的直接影响。

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  儿科呼吸道感染流行病学改变的可能潜在机制。

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  大流行对现在和未来儿童呼吸道感染负担的间接影响。

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  大流行后卫生系统解决儿童呼吸道感染的优先事项。