Study Pre-protocol for “BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations; a Multi-Centre Prospective Observational Cohort Study”

Abstract

Background: Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome. Information be released on a weekly basis and used to support clinical decision making.

2021/22 and 2022/23 Post-Pandemic Bronchiolitis Seasons in Two Major Italian Cities: A Prospective Study

“…This is a multi-center observational cohort study performed in two Italian university hospitals in two different geographic areas (Northern Italy (Milano) and Central Italy (Rome)) from 1 July 2021 to 31 March 2022 (Season 1) and from 1 July 2022 to 31 March 2023 (Season 2). The study was adapted from an open access BronchSTART protocol developed by the PERUKI network, aiming to monitor real-time new bronchiolitis cases in the United Kingdom and Ireland since July 2021 [ 14 ]. The study was approved by the Institutional Review Boards of both centers.…”

Impact of COVID-19 Pandemic and Lockdown on the Epidemiology of RSV-Mediated Bronchiolitis: Experience from Our Centre

“…The experience of measures adopted during the SARS-CoV-2 outbreak may pave the way to a new approach in preventing respiratory infections, highlighting the role of preventive measures, such as hygiene measures and early detection and isolation of infected people, due to widespread PCR testing. National data centres are needed to monitor RSV epidemics to plan and reinforce these measures [ 36 ]. Non-pharmaceutical interventions combined with the introduction of vaccination and/or monoclonal antibodies other than palivizumab, which are in the pipeline, should aim at decreasing the burden of RSV infection, health-care-associated costs, and improve children’s outcomes [ 37 , 38 , 39 ].…”

Clinical Impact of Serious Respiratory Disease in Children Under the Age of 2 Years During the 2021–2022 Bronchiolitis Season in England, Scotland, and Ireland

“…BronchStart was a multinational, multicentre prospective observational study conducted at Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI) network sites [ 18 ] supported by the RESCEU Consortium ( www.resc-eu.org ). The BronchStart protocol was structured in keeping with the principles of the STROBE statement [ 19 ] and has been previously peer reviewed and published [ 20 ]. Further details can be found in the Supplementary Methods .…”