In a recent study published in JAMA Network Open, researchers investigate the association between population-level coronavirus disease 2019 (COVID-19) mitigation strategies, including vaccination rates and face mask mandates, and the prevalence of symptomatic asthma among children.

Study: COVID-19 Vaccination and Parent-Reported Symptomatic Child Asthma Prevalence. Image Credit: SeventyFour / Shutterstock.com

COVID-19 and its impact on children with asthma

Asthma was initially considered a significant risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and subsequent hospitalization caused by COVID-19. Health professionals were concerned that children with asthma would be particularly vulnerable during the pandemic.

Some of the different measures that promoted or enforced social distancing during the initial stages of the pandemic were found to reduce children’s emergency visits and hospitalizations related to asthma. Likewise, vaccination efforts in 2020 and 2021 significantly reduced the risk of being infected with SARS-CoV-2 for both children and adults.

Vaccination against COVID-19 can confer additional protective benefits, such as reductions in asthma symptoms. However, these potential benefits have not been studied. Furthermore, the relationship between exposure to illness caused by COVID-19, mitigation strategies, and symptomatic asthma among children remains unclear.

About the study

Using a cross-sectional design and publicly available data, researchers examined state-level trends and associations to better understand how public health measures during the COVID-19 pandemic may have influenced asthma symptomatology in children.

The analysis included data on the prevalence of asthma symptoms in children that parents reported through the National Survey of Children’s Health during 2018-2019 and 2020-2021. These data were collected at the state level.

Additional data included age-adjusted COVID-19 mortality rates from the United States Centers for Disease Control and Prevention (CDC) for 2020 and 2021, the proportion of the population aged five years or older who received the primary COVID-19 vaccination series, and state-level mask mandates in closed spaces until August 2021.

Changes in the state-level prevalence of childhood asthma symptoms, as reported by parents, were recorded between 2018-2019 and 2020-2021. Time trends in these symptoms were subsequently assessed using statistical tests, whereas trend associations with other state-level covariates were determined using pairwise linear regression and pairwise correlation analyses.

Study findings

The average rate of childhood asthma symptoms declined significantly from 7.8% in 2018-2019 to 6.9% in 2020-2021, an overall decrease of 0.85 percentage points. Notably, this reduction occurred amid significant public health efforts to control COVID-19, such as widespread vaccination and mandatory face masks.

During the same period, the average COVID-19 death rate at the state level rose from 80.3 to 99.3 for every 100,000 people in 2020 and 2021, respectively. By December 2021, the average COVID-19 vaccination rate at the state level was 72.3%.

A linear regression analysis showed that for every 10-percentage point increase in the coverage of COVID-19 vaccinations, the rate of parent-reported childhood asthma symptoms decreased by 0.4 percentage points. However, no significant association was observed between asthma symptoms and COVID-19 death rates or face mask mandates at the state level.

State-level COVID-19 vaccination rates were negatively associated with COVID-19 death rates in 2021 but not 2020. Comparatively, mandates for face masks were positively associated with higher vaccination rates.

These findings suggest that higher vaccination rates may provide broader health benefits beyond preventing COVID-19 by potentially reducing the rate of asthma symptoms in children.

Conclusions

Higher COVID-19 vaccination rates were associated with reduced parent-reported childhood asthma symptoms, whereas state-level COVID-19 mortality and face mask mandates were not significantly correlated.

The study findings emphasize the importance of vaccination in mitigating health risks during pandemics. The widespread COVID-19 vaccination also appears to have broader health benefits, as it reduces the prevalence of childhood asthma symptoms.

Notable strengths of the current study include the use of comprehensive state-level data and the focus on population-level trends. However, a significant limitation is the lack of specific data on vaccination rates for children with asthma, which prevents a direct comparison of vaccinated and unvaccinated children.

Future research should further explore this relationship and assess whether sustained vaccination efforts against COVID-19 can continue to mitigate asthma symptoms in children. Ongoing public health strategies are also needed to address chronic conditions during pandemics and emphasize the role of vaccination in protecting vulnerable populations.