Emerging Infectious Diseases in Children: Epidemiology, ClinicalManifestations, and Management Strategies - A Systematic Review(2020–2022)

Abstract

Background: The 2020–2022 period was defined by the COVID-19 pandemic, which fundamentally reshaped the
landscape of paediatric infectious diseases. Beyond SARS-CoV-2 itself, this period saw major shifts in the epidemiology of other
pathogens, including the off-season resurgence of respiratory syncytial virus (RSV), the emergence of multisystem inflammatory
syndrome in children (MIS-C), and the persistent burden of arboviruses and vaccine-preventable diseases.
Objective: To systematically review the epidemiology, clinical manifestations, and management strategies of emerging infectious
diseases affecting children during 2020–2022.
Methods: PubMed/MEDLINE, Scopus, Web of Science, and Embase were searched for English-language studies published
between January 2020 and December 2022, supplemented by targeted searches for pre-pandemic context. Observational studies,
systematic reviews, and meta-analyses reporting laboratory-confirmed emerging infections in children aged 0–18 years were
eligible. Study selection followed PRISMA 2020 guidance, and findings were synthesised narratively.
Results: Forty-six studies were included. SARS-CoV-2 infection in children was typically milder than in adults, with fever (63.3%)
and cough (33.7%) the most common symptoms. MIS-C emerged as a distinct post-infectious hyperinflammatory syndrome
characterised by fever (100%), gastrointestinal symptoms (82%), and cardiac involvement (66%), frequently requiring intensive
care. Non-pharmaceutical interventions profoundly disrupted RSV and influenza circulation, producing atypical seasonality and
post-lockdown surges. Arboviral diseases continued to impose a substantial burden, with chikungunya most severe in infants under
one year. Antimicrobial resistance among paediatric pathogens remained a critical concern, compounded by pandemic-related
disruption of stewardship programmes.
Conclusion: Although COVID-19 generally spared children from severe acute disease, its indirect consequences, including MISC, disrupted immunisation, and altered pathogen circulation, were substanti