Why has the epidemiology of RSV changed during the COVID-19 pandemic?

Abu-Raya, Bahaa; Paramo, Marina Viñeta; Reicherz, Frederic; Lavoie, Pascal M.

doi:10.1016/j.eclinm.2023.102089

Cited by 60 publications

(49 citation statements)

References 71 publications

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“…In 2022, an earlier than usual start of the RSV season was reported in the Northern Hemisphere [ 17 , 21 ], with a peak of RSV-related hospitalizations between October and December [ 19 , 21 ]. The surge in RSV hospitalizations and the shift in the average age of children hospitalized with RSV (older in 2021-22) observed in our study are consistent with the results of other studies [ 48 , 49 ], and the findings might be attributable to the “immunity debt” that occurred because of the lack of exposure during the first pandemic year. However, it is not clear why important variability in the increase of the RSV hospitalization rate occurred globally, for example, it was relatively comparable to the prepandemic period in Germany but higher in the United States [ 19 , 21 ].…”

Section: Discussionsupporting

confidence: 92%

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study

Gilca,

Amini,

Carazo

et al. 2024

JMIR Public Health Surveill

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Background A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. Objective This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. Methods We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. Results During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. Conclusions Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations.

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Section: Discussionsupporting

confidence: 92%

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study

Gilca,

Amini,

Carazo

et al. 2024

JMIR Public Health Surveill

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“…A return to pre-pandemic infection rates was observed in the second and subsequent years of the pandemic. This aligns with the surge in infections observed during the 2021/2022 and 2022/2023 autumn and winter periods [19,20] and the perturbed epidemiology of certain infections in children after the introduction of COVID-19 [21].…”

Section: Discussionsupporting

confidence: 78%

Infection episodes and islet autoantibodies in children at increased risk for type 1 diabetes before and during the COVID-19 pandemic

Zeller,

Weiss,

Arnolds

et al. 2024

Preprint

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Purpose. To determine the impact of the COVID-19 pandemic on the incidence rates of infection and islet autoimmunity in children at risk for type 1 diabetes. Methods. 1050 children aged 4 to 7 months with an elevated genetic risk for type 1 diabetes were recruited from Germany, Poland, Sweden, Belgium and the UK. Reported infection episodes and islet autoantibody development were monitored until age 40 months from February 2018 to February 2023. Results. The overall infection rate was 311 (95% Confidence Interval [CI], 304–318) per 100 person years. Infection rates differed by age, country, family history of type 1 diabetes, and period relative to the pandemic. Total infection rates were 321 per 100 person-years (95% CI, 304–338) in the pre-pandemic period (until February 2020), 160 (95% CI, 148–173) per 100 person-years in the first pandemic year (March 2020 - February 2021; P < 0.001) and 337 (95% CI, 315–363) per 100 person-years in subsequent years. Similar trends were observed for respiratory and gastrointestinal infections. Islet autoantibody incidence rates were 1.6 (95% CI, 1.0-2.4) per 100 person-years in the pre-pandemic period, 1.2 (95% CI, 0.8–1.9) per 100 person-years in the first pandemic year (P = 0.46), and 3.4 (95% CI, 2.3–4.8) per 100 person-years in subsequent years (P = 0.005 vs. pre-pandemic year; P < 0.001 vs. first pandemic year). Conclusions. The COVID-19 pandemic significantly altered infection patterns. Islet autoantibody incidence rates increased two-fold when infection rates returned to pre-pandemic levels.

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“…In all likelihood, the number of immunologically vulnerable children may have increased due to the lack of immune stimulation by RSV or other respiratory viruses during the prolonged period of social distancing (ie, “immunity debt” concept). 9,10 It was also suggested that SARS-CoV-2 infections have induced immune dysregulation that has made children more susceptible to other respiratory viruses. Finally, but although not supported by solid evidence, an increased RSV virulence has also been suggested.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, but although not supported by solid evidence, an increased RSV virulence has also been suggested. 10…”

Section: Discussionmentioning

confidence: 99%

Children Hospitalized With Respiratory Syncytial Virus Infection: A Pre Versus Late COVID-19 Pandemic Comparison

Solus,

Huet,

Perez-Martin

et al. 2023

Pediatric Infectious Disease Journal

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Our study aimed to compare children under 5 years hospitalized with respiratory syncytial virus in prepandemic and late-pandemic periods. We included 209 children at the Dijon University Hospital (France). We observed a nearly 3-fold increase in the number of cases in the late period, with older children, but less frequently requiring intensive care. These observations could help prepare a new pandemic.

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Why has the epidemiology of RSV changed during the COVID-19 pandemic?

Cited by 60 publications

References 71 publications

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study

Infection episodes and islet autoantibodies in children at increased risk for type 1 diabetes before and during the COVID-19 pandemic

Children Hospitalized With Respiratory Syncytial Virus Infection: A Pre Versus Late COVID-19 Pandemic Comparison

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