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In this journal, Li et al. and Zhou et al. demonstrated Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) infections among children are on a decreasing trend during the COVID-19 pandemic,
However, no data is available regarding Moraxella catarrhalis (M. catarrhalis) infections during the COVID-19 pandemic.
M. catarrhalis is a gram-negative, non-encapsulated diplococci human pathogen, and transmitted through respiratory secretion droplets and direct close contact.
M. catarrhalis can colonize in the nasopharynx of healthy people, with a carriage rate between 25.8% to 76.6% in global healthy children, which is an important prerequisite for infection in children.
Asymptomatic carriers might also become symptomatic patients through bacterial superinfection or after a viral infection or autoimmunity is reduced. From the nasopharyngeal site, pathobionts can spread directly to cause otitis media or pneumonia or invade the bloodstream to cause sepsis or meningitis.
M. catarrhalis can cause other serious infections, such as meningoencephalitis and community-acquired pneumonia, as well as multiple life-threatening system complications such as respiratory and circulatory failure.
Clinically, S. pneumoniae, H. influenzae and M. catarrhalis are considered to be the three most common bacterial causes of respiratory infections in children. While, with the use of pneumococcal conjugate vaccine (PCV) and H. influenzae serotypes b vaccine (Hib) in children in part of the country, the number of deaths among children from S. pneumoniae related and H. influenzae related diseases has declined, apparently.
Unfortunately, as a pure human pathogen, there is a lack of a good animal model of M. catarrhalis infection, and studies on M. catarrhalis pathogenesis and host response are limited, making it difficult to develop a vaccine to control M. catarrhalis infection, resulting the persistent increasing colonization in children by the infection of M. catarrhalis.
Therefore, the prevention and control of childhood M. catarrhalis infection is a major public health problem worldwide.
Therefore, we evaluated the positive rate, age characteristics and epidemic trend of M. catarrhalis infection in children before and after the COVID-19 pandemic to provide fundamental basis for clinical implementation of prevention strategies. The number positive of M. catarrhalis infection among children aged 0–18 years, as well as a comparison of neonatal (0–28d), infant (29d–1y), pre-school (1–3y) and school-age (3–18y) children were studied from January 1, 2017, to October 31, 2022, at Henan Children's Hospital based on laboratory surveillance. The number of children with M. catarrhalis infection keep increasing from 2017 to 2019. However, the number of children with M. catarrhalis infection has shown a steep decline due to the outbreak of COVID-19 in Zhengzhou. In addition, M. catarrhalis infections from 2017 to 2019 before the COVID-19 pandemic had obvious seasonality, in which the number of positive infection was higher in winter from November to January, while the seasonality in 2020 and 2021 was not obvious (Fig. 1). Moreover, the positive detection rate (positive detected specimens/total specimens) with M. catarrhalis infections from 2017 to 2019 before the pandemic had obvious seasonality, in which the positive detection rate was higher in winter from November to January, while the seasonality in 2020 and 2021 was not fully highlighted (Fig. 2). The total number of infections and the positive detection rate of M. catarrhalis infection in 2021 is slightly higher than in 2020, which may be related to the relative stability of the epidemic, the beginning of children's enrollment in nurseries and schools, the relative gathering of people and people's awareness of protection may decrease slightly after vaccinated against COVID-19. Nevertheless, both the number of M. catarrhalis infections and the positive detection rate of M. catarrhalis infections rapid descent due to the second wave of COVID-19 outbreak out in Zhengzhou in July 2021 (Fig. 1A and B). Therefore, the COVID-19 epidemic can indeed influence the infection status of M. catarrhalis.
Fig. 1(A) The number of positive infection of M. catarrhalis from January, 2017, to October, 2022. (B) The positive detection rate of M. catarrhalis from January, 2017, to October, 2022.
Fig. 2(A) The number of positive infection of M. catarrhalis form 2017 to 2021. (B) The positive detection number of M. catarrhalis at different ages from January, 2017, to October, 2022.
Further, the number of children infected with M. catarrhalis during the neonatal period, infancy and pre-school age accounted for 78% of the total number of infected children from 2017 to 2021 (Fig. 2A). It indicates that M. catarrhalis infections are mainly among people under 3 years old, especially children under 1 year old. In particular, we found that infant, pre-school, and school-age children experienced a decrease in the number of infections during the two COVID-19 epidemics, suggesting that lockdowns have curbed community transmission of M. catarrhalis (Fig. 2B).
The COVID-19 pandemic changed the epidemiological trend of M. catarrhalis infection in children in Zhengzhou. Several factors have contributed to this change: reduced child-to-child contact during the COVID-19 pandemic (kindergartens and schools were closed), hand hygiene, the wear of mask, and restrictions on children's movement outside the home. Although COVID-19 epidemic is still occurring in some Chinese cities and has generally been brought under control, the global epidemic continues and the situation of epidemic prevention and control remains grim. Therefore, the long-term prevalence of M. catarrhalis in children deserves our continued attention. In addition, children under 3 years of age, especially those under 1 year of age, should be aware of the risk of M. catarrhalis infection.
In summary, we found that M. catarrhalis infections in children have been on the decline during the COVID-19 pandemic. Maintaining effective and continuous surveillance is important for preventing M. catarrhalis infection in children under 1 years of age.
Declaration of Competing Interest
None.
Acknowledgments
This work was funded by the National Natural Science Foundation of China (32201237), China Postdoctoral Science Foundation (2020M672301), Scientific and technological projects of Henan province (222102310270, 222102310109)
References
Li Y.
Guo Y.
Duan Y.
Changes in Streptococcus pneumoniae infection in children before and after the COVID-19 pandemic in Zhengzhou, China.
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