Changes in paediatric respiratory infections at a UK teaching hospital 2016-2021; impact of the SARS-CoV-2 pandemic

Abstract

Objective To describe the impact of the SARS-CoV-2 pandemic on the incidence of paediatric viral respiratory tract infection in Oxfordshire, UK. Methods Data on paediatric Emergency Department (ED) attendances (0-15 years inclusive), respiratory virus testing, vital signs and mortality at Oxford University Hospitals were summarised using descriptive statistics. Results Between 1-March-2016 and 30-July-2021, 155,056 ED attendances occurred and 7,195 respiratory virus PCRs were performed. Detection of all pathogens was suppressed during the first national lockdown. Rhinovirus and adenovirus rates increased when schools reopened September-December 2020, then fell, before rising in March-May 2021. The usual winter RSV peak did not occur in 2020/21, with an inter-seasonal rise (32/1,000 attendances in 0-3 yr olds) in July 2021. Influenza remained suppressed throughout. A higher paediatric early warning score (PEWS) was seen for attendees with adenovirus during the pandemic compared to pre-pandemic (p = 0.04, Mann-Witney U test), no other differences in PEWS were seen. Conclusions SARS-CoV-2 caused major changes in the incidence of paediatric respiratory viral infection in Oxfordshire, with implications for clinical service demand, testing strategies, timing of palivizumab RSV prophylaxis, and highlighting the need to understand which public health interventions are most effective for preventing respiratory virus infections.

Keywords: Influenza; Paediatric; Respiratory syncytial virus; Respiratory tract infection; Respiratory virus; Rhinovirus; SARS-CoV-2.

Fig. 1

Paediatric attendance, respiratory virus testing and positivity rates over time. (A) Rate of paediatric ED attendances, (B) Rate of tests per 1000 attendances per month, (C) Rate of positives per 1000 attendances per month. Left hand panels show 0–3 years, central panels 4–11 years and right hand panels 12–15 years. Red dashed line indicates the start of the pandemic period, defined here as March 2020. SARS-CoV-2 = SARS-CoV-2 specific PCR, Biofire PCR = BioFire multiplex respiratory PCR.

Fig. 2

Respiratory virus detection in children age 0–15 pre- and during the SARS-CoV-2 pandemic. Stacked bars represent proportions of pathogens during each period. Frequency of individual pathogens are shown in white text, with totals for each period in the x-axis legend. Respiratory viruses were detected using (i) Influenza A/B/RSV PCR, (ii) Biofire respiratory multiplex PCR, (iii) SARS-CoV-2 PCR or (iv) Cepheid Flu A/B/RSV/SARS-CoV-2 (see supplementary Table 1).

Fig. 3

Rates of respiratory diagnoses over time, by pathogen and age group (number of positive diagnoses per 1000 attendances per month). Vertical coloured bars represent the daily Oxford COVID-19 Government Response Tracker (OxCGRT) stringency index values on a scale from 0 to 100, with larger (darker pink) values indicating that higher stringency measures were in place in England. Red vertical dotted line indicates start of pandemic period, defined here as March 2020. RSV = respiratory syncytial virus, HMPV = human metapneumovirus, hCoV = human coronaviruses (non-SARS-CoV-2).

Fig. 4.

Rate of multiple respiratory virus identifications over time in paediatric ED attenders. Vertical coloured bars represent the daily Oxford COVID-19 Government Response Tracker (OxCGRT) stringency index values on a scale from 0 to 100, with larger (darker pink) values indicating that higher stringency measures were in place in England. Red vertical dotted line indicates start of pandemic period, defined here as March 2020.

Fig. 5.

Paediatric early warning scores (PEWS) comparison between pathogens and time periods. Maximum PEWS per ED attendance comparing pre-pandemic and pandemic periods for the five respiratory viruses detected during both time periods of the study, plus SARS-CoV-2 for reference. The central bar indicates the median PEWS, the lower and upper bounds of the box indicate the first and third quartiles (IQR), the lower whisker extends from the first quartile to the lowest value within 1.5*IQR of the first quartile, the upper whisker extends from the third quartile to the highest value within 1.5*IQR of the third quartile. P values (Mann-Witney U test) comparing pre-pandemic and pandemic PEWS for each pathogen are presented above the paired bars.