December 22, 2023
3 min read
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Key takeaways:
- The rate of young children hospitalized with RSV increased after the start of the COVID-19 pandemic.
- PICU admissions and use of supplemental oxygen also increased.
Young children with respiratory syncytial virus were hospitalized at a higher rate in the years after the start of the COVID-19 pandemic than in the six seasons before it, according to a study in JAMA Pediatrics.
“Last year there was a lot of buzz in the press with the so called tripledemic and how bad the respiratory season was,” Asuncion Mejias, MD, PhD, MsCS, a physician in the department of infectious diseases at St. Jude Children’s Research Hospital, told Healio. “I wanted to assess whether all the information that we were reading in the news and TV was accurate, and what better way than by analyzing the actual data?”
Mejias and colleagues collected and analyzed data on 6,986 children aged younger than 5 years who were admitted to Nationwide Children’s Hospital in Columbus, Ohio, with a confirmed RSV infection. They separated cases into those who were hospitalized in the six seasons before the COVID-19 pandemic — from 2012 to 2018 — or 2021 and 2022-2023. They left out the year 2020 because there was no RSV season — a result of mitigation measures against COVID-19.
“We compared the demographic characteristics and clinical outcomes of these children … to assess whether the median age of hospitalized children with RSV infection had changed during the pandemic, and assess whether RSV disease severity was worst during the two RSV pandemic seasons compared to the prior six RSV seasons pre-pandemic,” Mejias said.
They also analyzed standard parameters, including the patients’ need for supplemental oxygen, pediatric ICU (PICU) admission, mechanical ventilation or intubation and duration of hospitalization.
There were 5,143 patients hospitalized with RSV infection in the 2012 to 2018 period, 908 in 2021, and 935 in the 2022-2023 season. They found that the median age at admission increased from 5.3 months pre-pandemic to 6.3 months in 2021 and 8.2 months in 2022 to 2023.
The researchers noted that the age increase was primarily observed among children aged 1 year to younger than 5 years, who accounted for 30% of all RSV hospitalizations from 2012 to 2018, increasing to 37% in 2021 and 42% in 2022-2023.
Across seasons, there were minor differences in race and ethnicity but no significant differences in sex or underlying conditions. Additionally, there were higher rates of PICU admission and supplemental oxygen use in the pandemic and post-pandemic RSV seasons.
“While I expected the age of hospitalized children to increase during the two RSV pandemic seasons, likely due to the lack of exposure to RSV the first year and half of the pandemic, we found that RSV disease severity was significantly worse during these two pandemic seasons only in infants up to 6 months of age and those 6 to 12 months old but not in older children,” Mejias said.
The lack of maternal antibodies during the pandemic, she added, could be a reason for the increase in disease severity in infants up to 6 months of age but not in those aged 6 to 12 months old because maternally transferred antibodies last approximately 3 to 4 months in nonimmunized moms.
“These results emphasize the importance of RSV prevention, for which we now have two extremely important and needed interventions: extended half-life monoclonal antibodies and ,” Mejias said. “These results also emphasize the need to continue developing preventive strategies for older infants and young children, as they can also develop severe RSV disease.”
Mejias added that she is interested in future research that reinforces “the importance of RSV prevention through our approved interventions, as well as the different hygienic measures that we’ve been recommending for many years,” such as washing hands, avoiding crowded spaces and avoiding contact with ill patients.
“It is also very important to continue monitoring RSV activity, since this virus, as we saw last year, is worse than other viruses and could circulate off season,” Mejias said.
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Sources/Disclosures
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Disclosures:
Mejias reports receiving a grant from the NIH during the conduct of the study, grants to institution from Janssen and Merck outside the submitted work and receiving personal fees from AstraZeneca, Pfizer and Sanofi-Pasteur outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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