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Time is now, prepare GI uncertainties brought by COVID-19

Time is now, prepare GI uncertainties brought by COVID-19

The prevalence of gastrointestinal infections has changed after COVID-19

The prevalence of gastrointestinal (GI) infections has been significantly affected worldwide during and after the COVID-19 pandemic. The most notable example is the increasing incidence of norovirus in various regions (Figure. 1)¹‧²‧³‧⁴.

In the case of the UK, it has observed a 34% increase in norovirus cases in early January 2023 compared to the average of the same period before the emergence of COVID-19⁵. Furthermore, there has been a significant rise in enteric adenovirus, astrovirus, and sapovirus, which were notably suppressed during the pandemic.

The changes in the prevalence of bacterial enteritis have also been observed. Salmonella has become more common in children under five in Korea (Figure. 2)⁶. In contrast, Shigella spp., Listeria spp., and Salmonella spp. have decreased in England⁷, the US⁸, and Canada⁹ in 2020.

Immunity gap could cause unpredictable GI outbreaks

The COVID-19 pandemic has increased preventive measures such as wearing masks and social distancing and further exacerbated health inequalities by disrupting essential health services and interventions such as vaccinations¹⁰. The reduced exposure to such pathogens may have led to an immunity gap, reducing the opportunity for immunity development, which may increase the risk of unpredictable outbreaks of GI infections¹¹‧¹².

The immunity gap for vaccine-preventable diseases is compounded by decreases in childhood vaccinations resulting from pandemic-related disruptions to healthcare delivery¹¹. For instance, the percentage of children aged five months up-to-date on all recommended vaccines has decreased in the US from two-thirds during 2016-2019 to less than half in May 2020¹³.

Moreover, the vaccination coverage of human rotavirus (HRV) dropped to 29.6% in Brazil in 2021 (Figure. 3)¹⁴, further widening the immunity gap. This immunity gap could lead to future outbreaks of GI infections, particularly among vulnerable populations¹².
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¹KDCA Infectious Disease; ²KDCA, PHWR (week 13, 2023); ³CDC, NoroSTAT Data; ⁴CDC, Norovirus National Trends; ⁵UKHSA, National norovirus and rotavirus report (8 January 2023); ⁶Hyunseok Cho et al., 2023; ⁷Nicola K Love et al., 2021; ⁸Logan C. Ray et al., 2021; ⁹Brendan Dougherty et al., 2023; ¹⁰Anita K Kambhampati et al., 2022; ¹¹Robert Cohen et al., 2021; ¹²Kevin Messacar et al., 2022; ¹³Cristi A Bramer et al., 2020; ¹⁴Larissa Lima Barros et al., 2023;