Epidemiological Trend of RSV Infection Before and During COVID-19 Pandemic: A Three-Year Consecutive Study in China

Abstract

Objective

This study aimed to explore the epidemiological trend and clinical characteristics of respiratory syncytial virus (RSV) infection among inpatient children with lower respiratory tract infection (LRTI) before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

A retrospective study of inpatients with LRTI was conducted at the Department of Pulmonology, The Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from January 2019 to December 2021. All respiratory specimens were tested for common respiratory pathogens. The clinical data in children with RSV-induced LRTI in the past three years were collected and analyzed.

Results

A total of 11,290 patients were enrolled, and RSV positive cases were 402 (7.6%), 288 (9.6%), 415 (13.8%) in 2019, 2020, 2021, respectively, with a significant statistical difference of the RSV positive rate among the three groups (p < 0.001). Most patients were under 2-year old, especially under 1-year old, and the median age of patients was 4 months, 5 months, 6 months in 2019, 2020, 2021, respectively, with a tendency to increase in age. In terms of the seasonal distribution, most patients of LRTI with RSV infection were admitted in winter, while in 2021 compared with in 2019, the cases significantly reduced in winter and increased in autumn. From 2019 to 2021, there was an increase in autumn trend year by year.

Conclusion

RSV infection was still an important cause of hospitalization in children with LRTI after the outbreak of COVID-19, and its proportion increased gradually. LRTI caused by RSV is still more common in infants under 1-year old, but there is a trend of increasing in older children. What deserves the attention of pediatricians and Center for Disease Control is that the incidence of RSV infection continues to rise in autumn, and the difference in seasonal distribution is narrowed.

Keywords:

• respiratory syncytial virus
• RSV
• COVID-19
• lower respiratory tract infection
• non-pharmaceutical interventions

Abbreviations

RSV, respiratory syncytial virus; LRTI, lower respiratory tract infection; COVID-19, coronavirus disease 2019; MP, Mycoplasma pneumonia; CT, Chlamydia trachomatis; NPIs, non-pharmaceutical interventions; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; DIF, direct immunofluorescence; Flu A, influenza virus A; Flu B, influenza virus B; ADV, adenovirus; PIV-1, Para-influenza virus 1; PIV-2, Para-influenza virus 2; PIV-3, Para-influenza virus 3; PCR, Polymerase chain reaction; LOS, length of stay; IQR, interquartile ranges.

Data Sharing Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Statements

This study was approved by Medical Ethics Committee of affiliated hospital of The Children’s Hospital, Zhejiang University School of Medicine in accordance with the Declaration of Helsinki (2021-IRB-325). The application for excepting informed consent was approved as the clinical data was retrospectively studied. The informed consent was waived due to the retrospective and anonymous nature of this study. We declare that the privacy of the participants was covered and the data was maintained with confidentiality throughout the study.

Acknowledgments

The authors thank the National Natural Science Foundation of China, Zhejiang Provincial Natural Science Foundation of China, Grant from the Key Program of the Independent Design Project of National Clinical Research Center for Child Health and Zhejiang Provincial Key R & D Projects for sponsoring the study and the participating children and their parents. The funding body had no role in the design of the study, the collection, analysis, and interpretation of data, or in writing the manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by Zhejiang Provincial Natural Science Foundation of China (LY22H100007), the Grant from the Key Program of the Independent Design Project of National Clinical Research Center for Child Health (G20B0003), Zhejiang Provincial Key R & D Projects (No. 2020C03062).