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Background: Covid-19 pandemic control has imposed several non-pharmaceutical interventions (NPIs). Strict application of these measures has had a dramatic reduction on the epidemiology of several infectious diseases. As the pandemic is ongoing for more than 2 years, some of these measures have been removed, mitigated, or less well applied. The aim of this study is to investigate the trends of pediatric ambulatory infectious diseases before and up to two years after the onset of the pandemic., Methods: We conducted a prospective surveillance study in France with 107 pediatricians specifically trained in pediatric infectious diseases. From January 2018 to April 2022, the electronic medical records of children with an infectious disease were automatically extracted. The annual number of infectious diseases in 2020 and 2021 was compared to 2018-2019 and their frequency was compared by logistic regression., Findings: From 2018 to 2021, 185,368 infectious diseases were recorded. Compared to 2018 ( n= 47,116) and 2019 ( n= 51,667), the annual number of cases decreased in 2020 ( n= 35,432) by about a third. Frequency of scarlet fever, tonsillopharyngitis, enteroviral infections, bronchiolitis, and gastroenteritis decreased with OR varying from 0·6 (CI95% [0·5;0·7]) to 0·9 (CI95% [0·8;0·9]), p< 0·001. In 2021, among the 52,153 infectious diagnoses, an off-season rebound was observed with increased frequency of enteroviral infections, bronchiolitis, gastroenteritis and otitis with OR varying from 1·1 (CI95% [1·0;1·1]) to 1·5 (CI95% [1·4;1·5]), p< 0·001., Interpretation: While during NPIs strict application, the overall frequency of community-acquired infections was reduced, after relaxation of these measures, a rebound of some of them (enteroviral infections, bronchiolitis, gastroenteritis, otitis) occurred beyond the pre-pandemic level. These findings highlight the need for continuous surveillance of infectious diseases, especially insofar as future epidemics are largely unpredictable., Funding: ACTIV, AFPA, GSK, MSD, Pfizer and Sanofi., Competing Interests: RC reports grants to the institution ACTIV, personal fees, and nonfinancial support from GSK, Sanofi, Pfizer, and Merck, outside the submitted work. AR reports travel grants from Pfizer and AstraZeneca. FA reports receiving personal fees from MSD, AstraZeneca, Sanofi and Pfizer.NO reports travel grants from Pfizer, Sanofi, and GSK, outside the submitted work. BF is employed by CompuGroup Medical. CL reports grants to the institution ACTIV from GSK, Sanofi, Pfizer, and Merck, and personal fees and nonfinancial support from Pfizer and Merck, outside the conduct of the study. All other authors report no potential conflicts., (© 2022 The Author(s).)

Background: Many ambulatory networks in several countries have established syndromic surveillance systems to detect outbreaks of different illnesses. Here, we describe a new Pediatric and Ambulatory Research in Infectious diseases network that combined automated data extraction from the computers of primary care pediatricians., Methods: Pediatricians who used the same software, AxiSanté 5-Infansoft for electronic medical records were specially trained in infectious diseases, encouraged to comply with French treatments' recommendations, use of point-of-care tests and vaccination guidelines. Infectious disease diagnoses in children <16 years old in the records triggered automatic data extraction of complete records. A quality control process and external validation were developed., Results: From September 2017 to February 2020, 107 pediatricians enrolled 57,806 children (mean age 2.9 ± 2.6 years at diagnosis) with at least one infectious disease diagnosis among those followed by the network. Among the 118,193 diagnoses, the most frequent were acute otitis media (n = 44,924, 38.0%), tonsillopharyngitis (n = 13,334, 11.3%), gastroenteritis (n = 12,367, 10.5%), influenza (n = 11,062, 9.4%), bronchiolitis (n = 10,531, 8.9%), enteroviral infections (n = 8474, 7.2%) and chickenpox (n = 6857, 5.8%). A rapid diagnostic test was performed in 84.7% of cases of tonsillopharyngitis and was positive in 44%. The antibiotic recommendations from French guidelines were strictly followed: amoxicillin was the most prescribed antibiotic and less than 10% of presumed viral infections were treated., Conclusions: This "tailor-made" network set up with quality controls and external validation represents a new approach to the surveillance of pediatric infectious diseases in the digital era and could highly optimize pediatric practices., Competing Interests: R.C. received personal fees and nonfinancial support from Pfizer; reported personal fees from Merck, GSK, Sanofi and AstraZeneca outside the submitted work. N.G. received nonfinancial support from Pfizer outside the submitted work. B.F. is employed by CompuGroup Medical France. F.V.L.S. reported personal fees from MSD Vaccins and GSK outside the submitted work. G.T. reported personal fees and nonfinancial support from MSD Vaccins, Sanofi Aventis, Pfizer outside the submitted work. F.C.-S. reported personnal fee and nonfinancial support from MSD Vaccins and Sanofi outside the submitted work. A.W. reported personal fees from MSD Vaccins, Sanofi Aventis, ALK-Abello, GSK, Pierre Fabre, Shire, Novartis and Pfizer outside the submitted work. N.O. received nonfinancial support from Pfizer, GSK and Sanofi outside the submitted work. C.L. received personal fees and nonfinancial support from Pfizer and Merck outside the submitted work. The other authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)