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Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis

Mohammad Al Sallakh Orcid Logo, Davies Adeloye Orcid Logo, Eleftheria Vasileiou Orcid Logo, Shanya Sivakumaran Orcid Logo, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Chris Robertson Orcid Logo, Igor Rudan Orcid Logo, Gwyneth Davies Orcid Logo, Aziz Sheikh Orcid Logo

JMIR Public Health and Surveillance, Volume: 10, Pages: e43173 - e43173

Swansea University Authors: Mohammad Al Sallakh Orcid Logo, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Gwyneth Davies Orcid Logo

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DOI (Published version): 10.2196/43173

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Background:The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses.Objective:We aimed to investigate the impact of...

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Published in: JMIR Public Health and Surveillance
ISSN: 2369-2960
Published: JMIR Publications Inc. 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa67489
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These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses.Objective:We aimed to investigate the impact of COVID-19&#x2013;related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic.Methods:A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic.Results:We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9&#x2013;61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8% (1890/2526) in 2019 to 85.2% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic.Conclusions:Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza.</abstract><type>Journal Article</type><journal>JMIR Public Health and Surveillance</journal><volume>10</volume><journalNumber/><paginationStart>e43173</paginationStart><paginationEnd>e43173</paginationEnd><publisher>JMIR Publications Inc.</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2369-2960</issnElectronic><keywords>influenza; hospitalization; mortality; COVID-19 pandemic; nonpharmaceutical interventions; Wales; COVID-19; community health; hospital admission; endemic virus; public health surveillance</keywords><publishedDay>21</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-08-21</publishedDate><doi>10.2196/43173</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This study makes use of anonymized data provided by patients and collected by the National Health Service (NHS) as part of their care and support. These data are held in the Secure Anonymised Information Linkage (SAIL) Databank. The authors would like to acknowledge all the data providers who make anonymized data available for research. SAIL is not responsible for the interpretation of these data. This work was supported by the Con-COV team funded by the Medical Research Council (grant MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006), funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and the Wellcome Trust. This work was supported by the Administrative Data Research (ADR) Wales program of work. The ADR Wales program of work is aligned to the priority themes as identified in the Welsh Government&#x2019;s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods at Cardiff University, and specialist teams within the Welsh Government to develop new evidence, which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyze anonymized data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation), funded by ADR UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. The authors wish to acknowledge the collaborative partnership that enabled acquisition and access to the deidentified data, which led to this output. The collaboration was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell and includes the following groups and organizations: the SAIL Databank, ADR Wales, Digital Health and Care Wales (formerly NHS Wales Informatics Service), Public Health Wales, NHS Shared Services, and the Welsh Ambulance Service Trust. All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (project 0911). This study was funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE&#x2014;The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. The funders played no role in the study design, data collection, analysis, interpretation, manuscript writing, or decision to publish.</funders><projectreference/><lastEdited>2024-09-19T13:54:21.3541962</lastEdited><Created>2024-08-28T20:11:23.4536456</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Mohammad</firstname><surname>Al Sallakh</surname><orcid>0000-0002-8333-7279</orcid><order>1</order></author><author><firstname>Davies</firstname><surname>Adeloye</surname><orcid>0000-0003-1316-8139</orcid><order>2</order></author><author><firstname>Eleftheria</firstname><surname>Vasileiou</surname><orcid>0000-0001-6850-7578</orcid><order>3</order></author><author><firstname>Shanya</firstname><surname>Sivakumaran</surname><orcid>0000-0003-1914-6643</orcid><order>4</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>5</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>6</order></author><author><firstname>Chris</firstname><surname>Robertson</surname><orcid>0000-0001-6848-5241</orcid><order>7</order></author><author><firstname>Igor</firstname><surname>Rudan</surname><orcid>0000-0001-6993-6884</orcid><order>8</order></author><author><firstname>Gwyneth</firstname><surname>Davies</surname><orcid>0000-0003-1218-1008</orcid><order>9</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><orcid>0000-0001-7022-3056</orcid><order>10</order></author></authors><documents><document><filename>67489__31389__6d92c549a03a48dc8c2d3987eb3c867a.pdf</filename><originalFilename>67489.VoR.pdf</originalFilename><uploaded>2024-09-19T13:52:48.2055162</uploaded><type>Output</type><contentLength>500087</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; Mohammad Alsallakh, Davies Adeloye, Eleftheria Vasileiou, Shanya Sivakumaran, Ashley Akbari, Ronan A Lyons, Chris Robertson, Igor Rudan, Gwyneth A Davies, Aziz Sheikh. This is an open-access article distributed under the terms of the Creative Commons Attribution License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2024-09-19T13:54:21.3541962 v2 67489 2024-08-28 Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis 6efc53139ba1416418a6c6e584a25f2d 0000-0002-8333-7279 Mohammad Al Sallakh Mohammad Al Sallakh true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false 2024-08-28 MEDS Background:The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses.Objective:We aimed to investigate the impact of COVID-19–related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic.Methods:A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic.Results:We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9–61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8% (1890/2526) in 2019 to 85.2% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic.Conclusions:Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza. Journal Article JMIR Public Health and Surveillance 10 e43173 e43173 JMIR Publications Inc. 2369-2960 influenza; hospitalization; mortality; COVID-19 pandemic; nonpharmaceutical interventions; Wales; COVID-19; community health; hospital admission; endemic virus; public health surveillance 21 8 2024 2024-08-21 10.2196/43173 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University This study makes use of anonymized data provided by patients and collected by the National Health Service (NHS) as part of their care and support. These data are held in the Secure Anonymised Information Linkage (SAIL) Databank. The authors would like to acknowledge all the data providers who make anonymized data available for research. SAIL is not responsible for the interpretation of these data. This work was supported by the Con-COV team funded by the Medical Research Council (grant MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006), funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and the Wellcome Trust. This work was supported by the Administrative Data Research (ADR) Wales program of work. The ADR Wales program of work is aligned to the priority themes as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods at Cardiff University, and specialist teams within the Welsh Government to develop new evidence, which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyze anonymized data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation), funded by ADR UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. The authors wish to acknowledge the collaborative partnership that enabled acquisition and access to the deidentified data, which led to this output. The collaboration was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell and includes the following groups and organizations: the SAIL Databank, ADR Wales, Digital Health and Care Wales (formerly NHS Wales Informatics Service), Public Health Wales, NHS Shared Services, and the Welsh Ambulance Service Trust. All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (project 0911). This study was funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. The funders played no role in the study design, data collection, analysis, interpretation, manuscript writing, or decision to publish. 2024-09-19T13:54:21.3541962 2024-08-28T20:11:23.4536456 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Mohammad Al Sallakh 0000-0002-8333-7279 1 Davies Adeloye 0000-0003-1316-8139 2 Eleftheria Vasileiou 0000-0001-6850-7578 3 Shanya Sivakumaran 0000-0003-1914-6643 4 Ashley Akbari 0000-0003-0814-0801 5 Ronan Lyons 0000-0001-5225-000X 6 Chris Robertson 0000-0001-6848-5241 7 Igor Rudan 0000-0001-6993-6884 8 Gwyneth Davies 0000-0003-1218-1008 9 Aziz Sheikh 0000-0001-7022-3056 10 67489__31389__6d92c549a03a48dc8c2d3987eb3c867a.pdf 67489.VoR.pdf 2024-09-19T13:52:48.2055162 Output 500087 application/pdf Version of Record true © Mohammad Alsallakh, Davies Adeloye, Eleftheria Vasileiou, Shanya Sivakumaran, Ashley Akbari, Ronan A Lyons, Chris Robertson, Igor Rudan, Gwyneth A Davies, Aziz Sheikh. This is an open-access article distributed under the terms of the Creative Commons Attribution License. true eng https://creativecommons.org/licenses/by/4.0/
title Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
spellingShingle Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
Mohammad Al Sallakh
Ashley Akbari
Ronan Lyons
Gwyneth Davies
title_short Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
title_full Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
title_fullStr Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
title_full_unstemmed Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
title_sort Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis
author_id_str_mv 6efc53139ba1416418a6c6e584a25f2d
aa1b025ec0243f708bb5eb0a93d6fb52
83efcf2a9dfcf8b55586999d3d152ac6
92d69cf8519a334ced3f55142c811d95
author_id_fullname_str_mv 6efc53139ba1416418a6c6e584a25f2d_***_Mohammad Al Sallakh
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
92d69cf8519a334ced3f55142c811d95_***_Gwyneth Davies
author Mohammad Al Sallakh
Ashley Akbari
Ronan Lyons
Gwyneth Davies
author2 Mohammad Al Sallakh
Davies Adeloye
Eleftheria Vasileiou
Shanya Sivakumaran
Ashley Akbari
Ronan Lyons
Chris Robertson
Igor Rudan
Gwyneth Davies
Aziz Sheikh
format Journal article
container_title JMIR Public Health and Surveillance
container_volume 10
container_start_page e43173
publishDate 2024
institution Swansea University
issn 2369-2960
doi_str_mv 10.2196/43173
publisher JMIR Publications Inc.
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background:The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses.Objective:We aimed to investigate the impact of COVID-19–related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic.Methods:A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic.Results:We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9–61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8% (1890/2526) in 2019 to 85.2% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic.Conclusions:Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza.
published_date 2024-08-21T20:46:55Z
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