Epidemiological Characteristics of Respiratory Syncytial Virus Infection Among Hospitalized Children With Acute Respiratory Tract Infections From 2014 to 2022 in a Hospital in Hubei Province, China: Longitudinal Surveillance Study

Abstract

Background Longitudinal studies characterizing the epidemic trend of respiratory syncytial virus (RSV) in Hubei Province are scarce. Objective We aimed to depict the dynamics of the RSV epidemic among hospitalized children with acute respiratory tract infections (ARTIs) during 2014 to 2022 in the Maternal and Child Health Hospital of Hubei Province and investigate the influence of the 2-child policy and the COVID-19 pandemic on RSV prevalence. Methods The medical records and testing results of hospitalized children with ARTI from January 2014 to June 2022 were extracted. Nasopharyngeal samples were tested with direct immunofluorescence assay. Detection rates of RSV were categorized according to the diagnosis of patients: (1) overall, (2) upper respiratory tract infection (URTI), and (3) lower respiratory tract infection (LRTI). Poisson regression models were used to investigate the association between RSV detection rate and age, gender, or diagnosis. The detection rates of RSV before and after the implementation of the universal 2-child policy were compared using a Poisson regression model. Multiple comparisons of RSV detection rates were conducted among 3 stages of the COVID-19 pandemic using chi-square tests. Seasonal autoregressive integrated moving average was performed to predict RSV behaviors from February 2020 to June 2020 under the assumption of a non-COVID-19 scenario. Results Among 75,128 hospitalized children with ARTI, 11.1% (8336/75,128) were RSV-positive. Children aged <1 year had higher detection rates than older children (4204/26,498, 15.9% vs 74/5504, 1.3%; P<.001), and children with LRTI had higher detection rates than children with URTI (7733/53,145, 14.6% vs 603/21,983, 2.7%; P<.001). Among all the children, a clear seasonal pattern of the RSV epidemic was observed before 2021. Most of the highest detection rates were concentrated between December and February. The yearly detection rate of RSV remained at a relatively low level (about 8%) from 2014 to 2017, then increased to 12% and above from 2018. The highest monthly detection rate was in December 2018 (539/1493, 36.1%), and the highest yearly rate was in 2021 (1372/9328, 14.7%). There was a moderate increase in the RSV detection rate after the 2-child policy was implemented (before: 860/10,446, 8.2% vs after: 4920/43,916, 11.2%; P<.001). The largest increase, by 5.83%, occurred in children aged <1 year. The RSV epidemic level decreased sharply in the short term after the COVID-19 outbreak (detection rate before: 1600/17,010, 9.4% vs after: 32/1135, 2.8%; P<.001). The largest decrease, by 12.0%, occurred in children aged <1 year, but a rebounding epidemic occurred after 2020 (680/5744, 11.8%; P<.001). Conclusions Children have been experiencing increased prevalence of RSV since 2018 based on surveillance from a hospital in Hubei Province with a large sample size. The 2-child policy might have increased the RSV prevalence, and the COVID-19 epidemic had a temporary inhibitory effect on RSV transmission. Vaccines against RSV are urgently needed.

Timing patterns of initial respiratory syncytial virus infection and factors influencing disease severity in hospitalized infants with different health status

“…These findings may serve as a theoretical basis for formulating vaccination strategies. Furthermore, we observed a decrease in RSV following the COVID‐19 outbreak (Figure 2A), consistent with previous studies, 25,26 likely due to disruption of the transmission route of RSV under the implementation of non‐pharmaceutical interventions for COVID‐19.…”

“…First, cold weather may reduce the likelihood of seeking medical attention, potentially delaying treatment. Second, lower temperatures may induce vasoconstriction of the nasal mucosa, weakening respiratory tract immunity to viruses 25 . Furthermore, our results revealed a sex‐based disparity in the occurrence of severe RSV infections in healthy infants, with boys being found more susceptible to developing severe pneumonia (Table 1).…”

Current status and reflections on the diagnosis and treatment of respiratory tract infections in children in the COVID‐19 pandemic and post‐COVID‐19 era

“…15 In Wuhan, China, HRSV decreased sharply in the short term after the COVID-19 outbreak, with the detection rate declining from 9.4% to 2.8% (P < 0.001). 16 Comparably low HRSV prevalence in children during COVID-19 has also been found in other Chinese cities, such as Suzhou (4.91%), 17 Shanghai (4.55%), 18 and Beijing (3.15%). 19 However, as NPIs were gradually relaxed, an unprecedented rebound of HRSV occurred in some regions, and the peak season has changed from winter and spring to summer.…”

“…21 A similar HRSV resurgence has been observed in many other locations in northern and southern hemispheres (South Africa, New Zealand, the United States, China, and Japan). 16,22 Moreover, it appeared that the median age of HRSVinfected children was older than the pre-COVID-19 period, but there were no significant differences in the length of hospitalization or severity of the disease. 23,24…”

Molecular epidemiology and clinical characteristics of respiratory syncytial virus in hospitalized children during winter 2021–2022 in Bengbu, China

“…According to reports, the positive detection rate of RSV in Canada was significantly higher in the autumn and winter of 2022 than in previous years ( 19 ), and the positive detection rate of RSV in the United States increased significantly in the autumn of 2022, and the epidemic peak is earlier than in previous years ( 20 ). During the epidemic season before 2021, the RSV detection rate remained at an extremely low level in Hubei, China, while a moderate epidemic (approximately 10%) occurred in the same period in 2021 ( 21 ).…”