Clinical features and etiological analysis of 4644 cases of vulvovaginitis among children and adolescents in china before and during COVID19 pandemic

STUDY OBJECTIVE: The COVID-19 pandemic has been shown to result in a change in the incidence of respiratory tract infection 1-3. It is unknown whether the pandemic has the same impact on vulvovaginitis among girls and adolescents. This study aims to explore the potential changes in the epidemiology, pathogenic pattern, and drug susceptibility of girls with vulvovaginitis before and during COVID-19 pandemic in China. DESIGN: A retrospective study of prepubertal and adolescent girls (below 18 years old) diagnosed with vulvovaginitis between 2018 and 2021. The study was approved by the Human Subjects Committees of the Children's Hospital, Zhejiang University School of Medicine (approval number 2019-IBR-103). SETTING: Out-patient clinic, Department of Pediatric and Adolescent Gynecology (PAG) in the Children's Hospital, Zhejiang University School of Medicine. INTERVENTIONS/METHODS: The inclusion criteria were as follows: 1) patients who were clinically diagnosed with genital inflammation at their first clinical visit; 2) patients with abnormal vaginal discharge which was collected for microbiological investigation and drug sensitivity test. Demographic data, clinical features and laboratory study findings were analyzed. RESULTS: A total of 4644 cases of vulvovaginitis were identified during the study period, including 2427 cases in 2018-2019 before COVID-19 pandemic, and 2217 cases in 2020-2021 during COVID-19 pandemic. The average age was 7.55± 3.20 years and 8.24±3.33 years, respectively. The proportion of vulvovaginitis in the age group of 0-6 years significantly decreased from 40.23% (971/2427) in 2018-2019 to 31.30% (694/2217) in 2020-2021 (χ2=38.52, p < .001). The proportion of vulvovaginitis in the age group of 10-18 years increased from 30.09% (727/2427) in 2018-2019 to 39.60% (878/2217) in 2020-2021 (χ2=47.69, p < .001). Compared with 2018-2019, the major causative pathogens were similar in 2020-2021. The detection rates of Haemophilus influenzae, Streptococcus pyogene and Streptococcus pneumoniae in 2020-2021 were decreased (118/709 vs 268/648, 144/709 vs 277/648, 5/709 vs 20/648). The detection rates of Escherichia coli, Klebsiella pneumoniae and Candida Albicans were increased (96/709 vs 37/648, 19/709 vs 7/648, 206/709 vs 112/648). Concerning the drug susceptibility test of Haemophilus influenzae, the sensitivity to ampicillin/sulbactam and amoxicillin/clavulanate increased after the pandemic by 5.55% (χ2=7.44, P < 0.05) and 13.39% (χ2=12.18, P < 0.05) respectively. CONCLUSIONS: The COVID-19 has been found to result in similar changes in the epidemiology of vulvovaginitis in terms of the age distribution, and proportion of causative pathogens. There was no significant difference between drug susceptibility tests for most strains except Haemophilus influenzae.