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Investigators of an observational study published in Respiratory Investigation sought to examine factors associated with the testing and diagnostic capacity for the influenza pandemic in 2009 were linked to those during the COVID-19 pandemic.

Insights into testing and diagnoses capacity for children could be valuable in preparing health care systems for future pandemics, wrote the study authors, who created an observational study using data obtained from the Japan Medical Data Center.

In the early stages of the COVID-19 pandemic in Japan, few facilities conducted polymerase chain reaction-based (PCR) testing in children, even after the Omicron strain emerged.

The limited testing capacity contrasted from the 2009 influenza pandemic. In this period, approximately 20 million children were diagnosed, while 10,000 required hospitalization.

The study explored organizational factors associated with diagnosis and testing capacity for COVID-19 among children younger than 20 years of age from 2020 to 2021.

To explore the determinants of testing and diagnoses capacity and the association between the pandemics, the investigators used multivariable generalized linear models.

Using a nationally representative administrative database, 4906 medical facilities and 1.7 million infections disease-related visits were used in the study. The majority of medical facilities were clinics (85.6%) with pediatrics (32.3%), or internal medicine departments (54.9%).

The majority of patients (53%) were male and the mean age of the study population was 6.5 years (SD, 4.7).

Compared to clinics, public hospitals (adjusted incidence rate ratio [aIRR], 1.52. 95% CI, 1.26 - 1.82) and university hospitals (aIRR, 1.44. 95% CI, 1.14 - 1.80) were more likely to perform COVID-19 testing among children.

The highest testing rate was demonstrated in the department of internal medicine (aIRR, 1.64; 95%CI, 1.32 2.04). Pediatrics (aIRR, 1.40; 95%CI, 1.10 1.78) and otolaryngology (aIRR, 1.21; 95%CI, 0.89 1.64) followed.

"Compared to the medical facilities in the lowest quartile of testing rate for influenza in 2009, those in the highest quartile were more likely to perform testing for COVID-19 (aIRR, 1.62; 95%CI, 1.431.83)," wrote the study authors.

Insights between the pandemics, with a highlight on the dose-response relationship, "could be valuable in preparing health care systems for future pandemics," concluded the investigators.

Reference:

Okubo Y, Uda K. Structural and organizational determinants of the capacity for COVID-19 testing and diagnoses in children: Insights from the 2009 influenza and COVID-19 pandemics. Respiratory Investigation. Volume 62, Issue 3. 2024. Pages 426-430. ISSN 2212-5345. https://doi.org/10.1016/j.resinv.2024.03.001.

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Testing and diagnoses capacity of 2009 influenza and COVID-19 pandemics - Contemporary Pediatrics