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. 2022 Mar 15;225(6):957-964.
doi: 10.1093/infdis/jiab606.

Understanding the Potential Drivers for Respiratory Syncytial Virus Rebound During the Coronavirus Disease 2019 Pandemic

You Li  1   2 , Xin Wang  1   2 , Bingbing Cong  1 , Shuyu Deng  1 , Daniel R Feikin  3 , Harish Nair  2
Affiliations

Understanding the Potential Drivers for Respiratory Syncytial Virus Rebound During the Coronavirus Disease 2019 Pandemic

You Li et al. J Infect Dis. .

Abstract

Nonpharmaceutical interventions (NPIs) were widely introduced to combat the coronavirus disease 2019 (COVID-19) pandemic. These interventions also likely led to substantially reduced activity of respiratory syncytial virus (RSV). From late 2020, some countries observed out-of-season RSV epidemics. Here, we analyzed the role of NPIs, population mobility, climate, and severe acute respiratory syndrome coronavirus 2 circulation in RSV rebound through a time-to-event analysis across 18 countries. Full (re)opening of schools was associated with an increased risk for RSV rebound (hazard ratio [HR], 23.29 [95% confidence interval {CI}, 1.09-495.84]); every 5°C increase in temperature was associated with a decreased risk (HR, 0.63 [95% CI, .40-.99]). There was an increasing trend in the risk for RSV rebound over time, highlighting the role of increased population susceptibility. No other factors were found to be statistically significant. Further analysis suggests that increasing population susceptibility and full (re)opening of schools could both override the countereffect of high temperatures, which explains the out-of-season RSV epidemics during the COVID-19 pandemic.

Keywords: COVID-19; humidity; nonpharmaceutical intervention; pandemic; respiratory syncytial virus; school; seasonality; susceptibility; temperature; wind speed.

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Figures

Figure 1.
Figure 1.
Schematic figure of the study design. A, Definition of respiratory syncytial virus (RSV) onset. The numbers next to the dots denote the difference in weeks between the number of weeks with increased RSV activity and the number of weeks with nonincreased RSV activity (ie, “net increasing weeks”). B, Definition of period at risk for RSV rebound.
Figure 2.
Figure 2.
Effect of time-dependent exposures (A) and time at risk (B) on respiratory syncytial virus rebound. A, Dots denote the point estimates and error bars denote the corresponding 95% confidence intervals (CIs). B, Reference is the starting week of observation (ie, week 0); lines in the middle denote the point estimates and upper and lower lines denote the corresponding 95% CIs. Abbreviation: COVID-19, coronavirus disease.
Figure 3.
Figure 3.
Predicted risk for respiratory syncytial virus (RSV) rebound under different scenarios on school opening status. A 2-week time lag in the effect of school opening/closing was assumed. For all comparisons, reference temperature was set as 10°C (the median temperature when a typical RSV season occurs in the 18 countries) and reference week was week 0 (ie, the week when school opening status changes for panels A and B, and the week of typical RSV onset for panel C.) Abbreviations: HR, hazard ratio; RSV, respiratory syncytial virus.
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Comment in

  • SARS-CoV-2 pandemics and RSV off-season outbreaks.
    Baptista Pestana R, Aguiar AR, Morais-Almeida M. Baptista Pestana R, et al. Eur Ann Allergy Clin Immunol. 2023 Jan;55(1):47-48. doi: 10.23822/EurAnnACI.1764-1489.263. Epub 2022 Jul 9. Eur Ann Allergy Clin Immunol. 2023. PMID: 35852514 No abstract available.

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