How has the SARS‐CoV‐2 pandemic changed the epidemiology and management of acute bronchiolitis?

Abstract

Objective SARS‐COV‐2 pandemic profoundly impacted acute bronchiolitis epidemiology worldwide, especially respiratory syncytial virus (RSV) diffusion and the burden of disease, with remarkable implications on the management of health resources. We aimed to study the epidemiology and clinical course of bronchiolitis in the past 5 years in our region and to assess the trends that occurred during and after the SARS‐COV‐2 pandemic. Methods We conducted an observational study including all children aged 0–2 years with bronchiolitis admitted to a tertiary children's hospital during the last 5 years. Demographic, clinical, and microbiological data were collected. Comparisons between patient subgroups were carried out. Results A total of 647 patients admitted for bronchiolitis were included (median age 78 days). Molecular diagnostic tests were performed in 617 patients (95.4%) with RSV detected in 51.5% of patients in prepandemic years and 74.5% in pandemic years. Through the study period, we observed a progressive increase in the number of children requiring respiratory support, RSV infections, and children with a history of prematurity. Conversely, this was not true for mechanical ventilation, duration of respiratory support, intensive care unit admission, and length of stay. Conclusions Clinical course and epidemiology of bronchiolitis showed a significant change through the study years with a heavy impact during the 2021–2022 season. The increase in the number of patients requiring respiratory support, although not associated with an increase in mechanical ventilation, may be explained by the higher prevalence of RSV. The change in epidemiology highlights the importance of surveillance systems to monitor RSV circulation, to plan prophylactic strategies, and prepare healthcare systems.

The increase of bronchiolitis severity in the 2022–2023 season in an Italian tertiary children's hospital: An isolated phenomenon or a warning sign?

“…Recent literature has shown a higher incidence of bronchiolitis in the post‐pandemic period, but the reports regarding disease severity are conflicting 7–9 . A previous study by our group showed that in our setting the number of hospitalized bronchiolitis and the need for respiratory support increased over the last 5 years (2017–2022), probably due to a higher prevalence of RSV infections, although no significant changes were seen regarding the need for mechanical ventilation (MV) and intensive care admissions 10 …”

“…The non‐pharmaceutical interventions imposed by the pandemic initially determined a dramatic reduction in incidence rates of all infections, including bronchiolitis, 15–17 followed by a significant resurgence associated with epidemiological changes, including out‐of‐season outbreaks 6,10,18 …”

“…14 The non-pharmaceutical interventions imposed by the pandemic initially determined a dramatic reduction in incidence rates of all infections, including bronchiolitis, [15][16][17] followed by a significant resurgence associated with epidemiological changes, including outof-season outbreaks. 6,10,18 In our setting, as we have previously described, we had an outof-season resurgence in summer 2021, mainly driven by RSV, followed by an intense and early 2021-2022 bronchiolitis season.…”

“…[7][8][9] A previous study by our group showed that in our setting the number of hospitalized bronchiolitis and the need for respiratory support increased over the last 5 years (2017-2022), probably due to a higher prevalence of RSV infections, although no significant changes were seen regarding the need for mechanical ventilation (MV) and intensive care admissions. 10 After the 2022-2023 season, concerns have been raised for the upcoming years, as a highly unpredictable pattern in intensive care admission rates for bronchiolitis may develop, potentially threatening critical healthcare capacity. 11 This single-center retrospective observational study was designed to describe the epidemiology, disease severity, and microbiology of bronchiolitis during the 2022-2023 season compared to the previous 5 years, and to characterize patients who required intensive care support.…”

Predictors of prolonged length of stay in PICU of infants with severe bronchiolitis: are initial blood gases helpful?

“…The epidemiology of acute bronchiolitis has been highly modi ed after the covid with one of the most severe epidemics in 2022-2023 [10,11,28]. The widespread of Nirsevimab in the coming years (RSVspeci c antibody) might also change the characteristics of infants with severe bronchiolitis [29].…”