Estimation of the Timing and Intensity of Reemergence of Respiratory Syncytial Virus Following the COVID-19 Pandemic in the US

Abstract

IMPORTANCERespiratory syncytial virus (RSV) is a leading cause of hospitalizations in young children. RSV largely disappeared in 2020 owing to precautions taken because of the COVID-19 pandemic. Estimating the timing and intensity of the reemergence of RSV and the age groups affected is crucial for planning for the administration of prophylactic antibodies and anticipating hospital capacity. OBJECTIVE To examine the association of different factors, including mitigation strategies, duration of maternal-derived immunity, and importation of external infections, with the dynamics of reemergent RSV epidemics. DESIGN, SETTING, AND PARTICIPANTS This simulation modeling study used mathematical models to reproduce the annual epidemics of RSV before the COVID-19 pandemic in New York and California.These models were modified to project the trajectory of RSV epidemics from 2020 to 2025 under different scenarios with varying stringency of mitigation measures for SARS-CoV-2. Simulations also evaluated factors likely to affect the reemergence of RSV epidemics, including introduction of the virus from out-of-state sources and decreased transplacentally acquired immunity in infants. Models using parameters fitted to similar inpatient data sets from Colorado and Florida were used to illustrate these associations in populations with biennial RSV epidemics and year-round RSV circulation, respectively. Statistical analysis was performed from February to October 2021. MAIN OUTCOMES AND MEASURESThe primary outcome of this study was defined as the estimated number of RSV hospitalizations each month in the entire population. Secondary outcomes included the age distribution of hospitalizations among children less than 5 years of age, incidence of any RSV infection, and incidence of RSV lower respiratory tract infection. RESULTS Among a simulated population of 19.45 million people, virus introduction from external sources was associated with the emergence of the spring and summer epidemic in 2021. There was a tradeoff between the intensity of the spring and summer epidemic in 2021 and the intensity of the epidemic in the subsequent winter. Among children 1 year of age, the estimated incidence of RSV hospitalizations was 707 per 100 000 children per year in the 2021 and 2022 RSV season, compared with 355 per 100 000 children per year in a typical RSV season. CONCLUSIONS AND RELEVANCEThis simulation modeling study found that virus introduction from external sources was associated with the spring and summer epidemics in 2021. These findings suggest that pediatric departments should be alert to large RSV outbreaks in the coming seasons, the intensity of which could depend on the size of the spring and summer epidemic in that location.Enhanced surveillance is recommended for both prophylaxis administration and hospital capacity management.

Out-of-Season Epidemic of Respiratory Syncytial Virus during the COVID-19 Pandemic: The High Burden of Child Hospitalization in an Academic Hospital in Southern Italy in 2021

“…Mathematical models have forecast large RSV outbreaks in the next few years due to a buildup of susceptible children [ 34 , 39 ]. In 2021, Australia experienced an interseasonal resurgence of RSV infections with a peak during the austral summer, and the USA also experienced an unusual increase in RSV cases during the spring and summer of 2021 [ 40 , 41 , 42 ].…”

Out-of-Season Influenza during a COVID-19 Void in the State of Rio de Janeiro, Brazil: Temperature Matters

“…Early in the COVID-19 pandemic, reports described dramatic reductions in circulating influenza and RSV strains globally [ 23 , 24 , 25 ], with one report even considering the extinction of specific influenza viral lineages [ 26 ]. As the pandemic progressed, other respiratory viruses were shown to circulate off-season, frequently during a period of SARS-CoV-2 decline, a phenomenon likely driven by changing weather patterns, other prevailing competing viruses in the ecosystem and possibly limited use of mitigating measures such as masks and social distancing [ 27 ]. One such example is respiratory syncytial virus, which occurred off-season in the summer of 2021 in the United States, Japan and Australia, also coinciding with a low COVID-19 case load [ 28 , 29 , 30 ].…”

Estimated effectiveness of vaccines and extended half-life monoclonal antibodies against respiratory syncytial virus (RSV) hospitalizations in young children

“…We extended a previously published age-stratified RSV transmission model [20, 25]. This model assumes newborn infants are protected against RSV infections because they acquire neutralizing antibodies transplacentally from their mothers and/or have few contacts outside the household.…”

“…Following each infection, individuals gain partial immunity that lowers both their susceptibility to subsequent infections and the duration and infectiousness of subsequent infections (see Figure 1). The risk of lower respiratory disease depends on both the number of previous infections and age at infection in the model [20, 25]. We assume frequency-dependent age-specific contact patterns, which were obtained from previous studies that projected contact patterns for the United States [26].…”