Resurgence of Respiratory Syncytial Virus Infection During COVID-19 Pandemic Among Children in Shanghai, China

Abstract

Respiratory syncytial virus (RSV) is the most common pathogen causing acute lower respiratory tract infection (LRTI) in children. RSV usually peaks in winter and declines by early spring in China. The outbreak of coronavirus disease 2019 (COVID-19) was reported to bring changes to the transmission pattern of respiratory pathogens including RSV. Here in this paper, we analyzed RSV-positive nasopharyngeal aspirates from inpatients in the Children’s Hospital of Fudan University from October 2019 to October 2021 and compared the clinical features of the RSV-positive patients before and during COVID-19. We found an atypical upsurge of RSV infection in the late summer of 2021 after a major suppression in 2020. RSV B was the main subtype spreading among children throughout the study. Phylogenetic analysis revealed that all RSV A strains belonged to ON1 genotype and all RSV B strains were BA9 genotype. Deduced amino acid analysis displayed different substitutions in the RSV strains observed before and during COVID-19. Demographic analysis suggested that males and infants aged under 5 months were the main populations infected with RSV by gender and age, respectively. Less severe clinical outcomes were observed in patients during COVID-19 than before the pandemic, especially in RSV B-positive patients. Our findings described the epidemiological changes in RSV infection brought by COVID-19, which further underscored the importance of continuous surveillance of RSV in the shadow of COVID-19 at both local and global scales.

Changes in endemic patterns of respiratory syncytial virus infection in pediatric patients under the pressure of nonpharmaceutical interventions for COVID‐19 in Beijing, China

“…This may be due to the decrease in RSV exposure caused by various NPIs during the period of COVID-19 in Beijing and the accumulation of RSV-susceptible people resulting in the delay or even outbreak of the epidemic. According to the data on hospitalization duration, ICU admission, and clinical outcome, we found that the severity of ARTI caused by RSV decreased significantly, which was similar to the results in Shanghai, China 31. However, some studies have shown that the clinical symptoms of respiratory tract infections caused by RSV are more serious during the COVID-19 pandemic 28,36.…”

Respiratory syncytial virus, recurrent wheeze and asthma: A narrative review of pathophysiology, prevention and future directions

“…Interseasonal resurgences of RSV however have since been observed nation‐wide, 44 in some cases exceeding the peak incidence of previous years and displaying a higher average age of infection 45 with an approximately three‐fold increase in hospitalisations in children observed in Victoria, Australia in early 2021 compared to pre‐pandemic levels 46 . A similar effect has been observed world‐wide, 44 in a large number of countries including the USA 47 and China 48 . Although public health restrictions have now largely eased across Australia and internationally the epidemiology of RSV remains difficult to predict in light of future COVID‐19 outbreaks 44 .…”

“…46 A similar effect has been observed world-wide, 44 in a large number of countries including the USA 47 and China. 48 Although public health restrictions have now largely eased across Australia and internationally the epidemiology of RSV remains difficult to predict in light of future COVID-19 outbreaks. 44 Williams et al discussed the challenges inherent to this shift in epidemiology and preparation of health-care services to meet demands of unseasonal peaks in RSV infections, in addition to disruption to RSV-related research and vaccine trials.…”

Impact of COVID-19 on viral respiratory infection epidemiology in young children: A single-center analysis

“…Countries all over the globe have reported a delayed start of the RSV epidemic, including France (3-4 months after usual onset), South Africa (5 months), the United States and Australia (6 months), the Netherlands and Japan (7 months), and New Zealand (12 months) (32,33). This unusual RSV occurrence from early to mid 2021, separate from its usual seasonality, has been described in literature as a global phenomenon (49)(50)(51)(52).…”