Epidemiology of respiratory syncytial virus in children younger than 5 years in England during the COVID-19 pandemic, measured by laboratory, clinical, and syndromic surveillance: a retrospective observational study
- PMID: 36063828
- PMCID: PMC9762748
- DOI: 10.1016/S1473-3099(22)00525-4
Epidemiology of respiratory syncytial virus in children younger than 5 years in England during the COVID-19 pandemic, measured by laboratory, clinical, and syndromic surveillance: a retrospective observational study
Abstract
Background: Seasonal epidemics of respiratory syncytial virus (RSV) cause a clinically significant burden of disease among young children. Non-pharmaceutical interventions targeted at SARS-CoV-2 have affected the activity of other respiratory pathogens. We describe changes in the epidemiology of RSV among children younger than 5 years in England since 2020.
Methods: Surveillance data on RSV infections, comprising laboratory-confirmed cases, proportion of positive tests, hospital admissions for RSV-attributable illness, and syndromic indicators for RSV-associated disease (emergency department attendances for acute bronchitis or bronchiolitis, non-emergency health advice telephone service [NHS 111] calls for cough, general practitioner [GP] in-hours consultations for respiratory tract infections, and GP out-of-hours contacts for acute bronchitis or bronchiolitis) were analysed from Dec 29, 2014 to March 13, 2022, for children younger than 5 years. Data were extracted from national laboratory, clinical, and syndromic surveillance systems. Time-series analyses using generalised linear models were used to estimate the effect of non-pharmaceutical interventions targeting SARS-CoV-2 on RSV indicators, with absolute and relative changes calculated by comparing observed and predicted values.
Findings: RSV-associated activity was reduced for all RSV indicators during winter 2020-21 in England, with 10 280 (relative change -99·5% [95% prediction interval -100·0 to -99·1]) fewer laboratory-confirmed cases, 22·2 (-99·6%) percentage points lower test positivity, 92 530 (-80·8% [-80·9 to -80·8]) fewer hospital admissions, 96 672 (-73·7% [-73·7 to -73·7]) fewer NHS 111 calls, 2924 (-88·8% [-90·4 to -87·2]) fewer out-of-hours GP contacts, 91 304 (-89·9% [-90·0 to -89·9]) in-hours GP consultations, and 27 486 (-85·3% [-85·4 to -85·2]) fewer emergency department attendances for children younger than 5 years compared with predicted values based on winter seasons before the COVID-19 pandemic. An unprecedented summer surge of RSV activity occurred in 2021, including 11 255 (1258·3% [1178·3 to 1345·8]) extra laboratory-confirmed cases, 11·6 percentage points (527·3%) higher test positivity, 7604 (10·7% [10·7 to 10·8]) additional hospital admissions, 84 425 (124·8% [124·7 to 124·9]) more calls to NHS 111, 409 (39·0% [36·6 to 41·8]) more out-of-hours GP contacts, and 9789 (84·9% [84·5 to 85·4]) more emergency department attendances compared with the predicted values, although there were 21 805 (-34·1% [-34·1 to -34·0]) fewer in-hours GP consultations than expected. Most indicators were also lower than expected in winter 2021-22, although to a lesser extent than in winter 2020-21.
Interpretation: The extraordinary absence of RSV during winter 2020-21 probably resulted in a cohort of young children without natural immunity to RSV, thereby raising the potential for increased RSV incidence, out-of-season activity, and health-service pressures when measures to restrict SARS-CoV-2 transmission were relaxed.
Funding: None.
Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests We declare no competing interests.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9762748/bin/gr1_lrg.gif)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9762748/bin/gr2_lrg.gif)
Comment in
-
Quantifying the RSV immunity debt following COVID-19: a public health matter.Lancet Infect Dis. 2023 Jan;23(1):3-5. doi: 10.1016/S1473-3099(22)00544-8. Epub 2022 Sep 2. Lancet Infect Dis. 2023. PMID: 36063827 Free PMC article. No abstract available.
-
Estimating hospital admissions due to respiratory syncytial virus in children.Lancet Infect Dis. 2023 Jan;23(1):33. doi: 10.1016/S1473-3099(22)00809-X. Epub 2022 Dec 7. Lancet Infect Dis. 2023. PMID: 36495914 No abstract available.
-
Estimating hospital admissions due to respiratory syncytial virus in children - Authors' reply.Lancet Infect Dis. 2023 Jan;23(1):33-34. doi: 10.1016/S1473-3099(22)00815-5. Epub 2022 Dec 7. Lancet Infect Dis. 2023. PMID: 36495915 No abstract available.
Similar articles
-
The impact of coronavirus disease 2019 pandemic on bronchiolitis (lower respiratory tract infection) due to respiratory syncytial virus: A systematic review and meta-analysis.Indian J Public Health. 2023 Apr-Jun;67(2):284-291. doi: 10.4103/ijph.ijph_1334_22. Indian J Public Health. 2023. PMID: 37459026 Review.
-
Hospital admissions and need for mechanical ventilation in children with respiratory syncytial virus before and during the COVID-19 pandemic: a Danish nationwide cohort study.Lancet Child Adolesc Health. 2023 Mar;7(3):171-179. doi: 10.1016/S2352-4642(22)00371-6. Epub 2023 Jan 9. Lancet Child Adolesc Health. 2023. PMID: 36634692 Free PMC article.
-
Clinical Phenotype of Respiratory Syncytial Virus Bronchiolitis before and during the Coronavirus Disease 2019 Pandemic.Am J Perinatol. 2024 Mar;41(4):515-521. doi: 10.1055/s-0042-1759602. Epub 2022 Dec 21. Am J Perinatol. 2024. PMID: 36543242
-
Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis.Lancet. 2022 May 28;399(10340):2047-2064. doi: 10.1016/S0140-6736(22)00478-0. Epub 2022 May 19. Lancet. 2022. PMID: 35598608 Free PMC article. Review.
-
Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia.Arch Dis Child. 2022 Mar;107(3):e7. doi: 10.1136/archdischild-2021-322507. Epub 2021 Aug 25. Arch Dis Child. 2022. PMID: 34433552
Cited by
-
Epidemiology of Respiratory Syncytial Virus Hospitalizations in Poland: An Analysis from 2015 to 2023 Covering the Entire Polish Population of Children Aged under Five Years.Viruses. 2024 Apr 29;16(5):704. doi: 10.3390/v16050704. Viruses. 2024. PMID: 38793586 Free PMC article.
-
Modelling respiratory syncytial virus age-specific risk of hospitalisation in term and preterm infants.BMC Infect Dis. 2024 May 21;24(1):510. doi: 10.1186/s12879-024-09400-2. BMC Infect Dis. 2024. PMID: 38773455 Free PMC article.
-
Global Seasonal Activities of Respiratory Syncytial Virus Before the Coronavirus Disease 2019 Pandemic: A Systematic Review.Open Forum Infect Dis. 2024 Apr 25;11(5):ofae238. doi: 10.1093/ofid/ofae238. eCollection 2024 May. Open Forum Infect Dis. 2024. PMID: 38770210 Free PMC article. Review.
-
Epidemiology of Respiratory Viruses in Korean Children Before and After the COVID-19 Pandemic: A Prospective Study From National Surveillance System.J Korean Med Sci. 2024 May 20;39(19):e171. doi: 10.3346/jkms.2024.39.e171. J Korean Med Sci. 2024. PMID: 38769924 Free PMC article.
-
Impacts of human mobility on the citywide transmission dynamics of 18 respiratory viruses in pre- and post-COVID-19 pandemic years.Nat Commun. 2024 May 16;15(1):4164. doi: 10.1038/s41467-024-48528-2. Nat Commun. 2024. PMID: 38755171 Free PMC article.
References
-
- Obando-Pacheco P, Justicia-Grande AJ, Rivero-Calle I, et al. Respiratory syncytial virus seasonality: a global overview. J Infect Dis. 2018;217:1356–1364. - PubMed
-
- Zhang S, Akmar LZ, Bailey F, et al. Cost of respiratory syncytial virus-associated acute lower respiratory infection management in young children at the regional and global level: a systematic review and meta-analysis. J Infect Dis. 2020;222(suppl 7):S680–S687. - PubMed
-
- University of Oxford Vaccine Knowledge Project What is respiratory syncytial virus (RSV)? Nov 22, 2019. https://vk.ovg.ox.ac.uk/vk/rsv
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous