Infection-related mortality in children in two European countries, 2015-2023: An interrupted time-series analysis

Manon Jaboyedoff; Pierre Alex Crisinel; Zaba Valtuille; Inès Fafi; Margherita Plebani; Yves Fougère; Karim Abawi; Romain Basmaci; Naïm Ouldali; François Angoulvant

doi:10.1016/j.jinf.2026.106688

Infection-related mortality in children in two European countries, 2015-2023: An interrupted time-series analysis

J Infect. 2026 Feb;92(2):106688. doi: 10.1016/j.jinf.2026.106688. Epub 2026 Jan 9.

Authors

Affiliations

¹ Unit of Pediatric Infectious Diseases and Vaccinology, Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 50, 1011 Lausanne, Switzerland; Paris Cité University, INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), 16 rue Henri Huchard, 75018 Paris, France. Electronic address: manon.jaboyedoff@chuv.ch.
² Unit of Pediatric Infectious Diseases and Vaccinology, Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 50, 1011 Lausanne, Switzerland.
³ Paris Cité University, INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), 16 rue Henri Huchard, 75018 Paris, France; Centre of Clinical Investigations, INSERM CIC 1426, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Cité Université, 48 Bd Sérurier, 75019 Paris, France.
⁴ Paris Cité University, INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), 16 rue Henri Huchard, 75018 Paris, France; Centre of Clinical Investigations, INSERM CIC 1426, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Cité Université, 48 Bd Sérurier, 75019 Paris, France; Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Cité Université, 48 Bd Sérurier, 75019 Paris, France.
⁵ Federal Statistical Office, Espace de l'Europe 10, 2000 Neuchâtel, Switzerland.
⁶ Paris Cité University, INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), 16 rue Henri Huchard, 75018 Paris, France; Pediatric Emergency Department and General Pediatrics Department, Louis Mourier University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Cité Université, 178 Rue des Renouillers, 92700 Colombes, France.
⁷ Paris Cité University, INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), 16 rue Henri Huchard, 75018 Paris, France; Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Cité Université, 48 Bd Sérurier, 75019 Paris, France.
⁸ Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 50, 1011 Lausanne, Switzerland.

PMID: 41520795
DOI: 10.1016/j.jinf.2026.106688

Abstract

Background: Infections remain a leading cause of childhood mortality. Non-pharmaceutical interventions (NPI) implemented during COVID-19 pandemic altered the circulation of communicable pathogens. We aimed to assess how these changes affected paediatric infection-related mortality.

Methods: We conducted a population-based interrupted time-series analysis using national data from France and Switzerland (2015 to 2023), including deaths among individuals <18 years. Monthly infection-related mortality was analysed using quasi-Poisson regression models seasonally adjusted. Mortality rate ratios (MRR) were calculated to compare infection-related mortality among birth cohorts exposed to NPI or post-NPI periods versus pre-NPI cohorts.

Results: Among 32,619 paediatric deaths during the study period, 8272 were related to an infection. During the NPI period, infection-related mortality declined by 16% (95% CI: -23% to -7%), corresponding to an estimated reduction of 221 (95% CI: 90 to 371) deaths. Compared to pre-NPI birth cohorts, 2019 and 2020 cohorts had significantly lower infection-related MRR (0·80, 95% CI 0·66 to 0·98 and 0·80, 95% CI 0·65 to 0·98).

Conclusion: The reduction in paediatric infection-related deaths during the NPI period underscores the ongoing burden of preventable paediatric mortality and suggests that targeted preventive strategies may sustainably reduce infection-related deaths beyond pandemic settings.

Keywords: Adolescent; COVID-19; Child; Child mortality; Communicable diseases; Infant; Interrupted time series analysis; Mortality.

MeSH terms

Adolescent
COVID-19* / epidemiology
COVID-19* / mortality
COVID-19* / prevention & control
Child
Child Mortality / trends
Child, Preschool
Female
France / epidemiology
Humans
Infant
Infant, Newborn
Interrupted Time Series Analysis
Male
Pandemics
SARS-CoV-2
Switzerland / epidemiology