Comparative analysis of pediatric Respiratory Syncytial Virus epidemiology and clinical severity before and during the COVID-19 pandemic in British Columbia, Canada

Abstract

Background: The COVID-19 pandemic affected Respiratory Syncytial Virus (RSV) circulation and surveillance, causing logistical complexity for health systems. Our objective was to describe changes in epidemiology and clinical severity of RSV cases in British Columbia (BC), Canada. Methods: Comparative analysis of RSV detections in children <36 months at BC Children's Hospital (BCCH) between September 1 and August 31 of 2017-18, 2018-19, 2019-20, 2020-21 and 2021-22. Results: About one-fifth of children tested RSV positive on average across all periods. The median age of RSV cases was 11.8 [IQR: 3.8 to 22.3] months in 2021-22 versus 6.3 [IQR: 1.9 to 16.7] months in 2017-20 (p<0.001). Increased testing in 2021-22 (n=3,120) compared to 2017-20 (average n=1,222) detected milder infections with lower proportion hospitalized in all age subgroups <6 (26.0%), 6-11 (12.3%), 12-23 (12.2%) and 24-35 (16.0%) months versus 2017-20 (49.3%, 53.5%, 62.6%, 57.5%, respectively) (all p<0.001). Children <6 months consistently comprised most hospitalizations and those born prematurely <29 weeks or with chronic respiratory co-morbidities remained at highest hospitalization risk in 2021-22. Among hospitalized cases, intensive care, respiratory support or supplemental oxygen use did not differ between the 2017-20 and 2021-22 periods. Conclusions: RSV circulation halted during the pandemic, but with the lifting of mitigation measures a subsequent resurgence in children <36 months of age was accompanied by shift toward older (24-35 month) cases in 2021-22, without increased severity. For the 2022-23 season, increased circulation and residual vulnerability in additional birth cohorts spared from RSV infection during the pandemic could have marked cumulative healthcare impact, even with the same proportion hospitalized.

Competing Interest Statement

PML received nominal payments from Sanofi, but no matter directly relevant to this study. Other authors have no conflicts of interest to declare.

Funding Statement

This study was funded by the Government of Canada via its COVID-19 Immunity Task Force. PML is an employee of Provincial Health Authority Services of British Columbia who also received a portion of salary support, from the British Columbia Children's Hospital Foundation, through the Investigator Grant Award Program. BAR received a post-doctoral award from Michael Smith Health Research British Columbia. FR was funded by the (German Research Foundation (Deutsche Forschungsgemeinschaft) - RE 4598/1-1.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the University of British Columbia Children's & Women's Research Ethics Board (approval number H11-03424).

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Data Availability

All data produced in the present work are contained in the manuscript.

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