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. 2023 Oct 2;6(10):e2336863.
doi: 10.1001/jamanetworkopen.2023.36863.

Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic

Malou Bourdeau  1 , Nirma Khatri Vadlamudi  2   3 , Nathalie Bastien  4 , Joanne Embree  5 , Scott A Halperin  6 , Taj Jadavji  7 , Kescha Kazmi  8 , Joanne M Langley  6 , Marc H Lebel  9 , Nicole Le Saux  10 , Dorothy Moore  1 , Shaun K Morris  8 , Jeffrey M Pernica  11 , Joan Robinson  12 , Manish Sadarangani  2   3 , Julie A Bettinger  2   3 , Jesse Papenburg  13   14   15 ; Canadian Immunization Monitoring Program Active (IMPACT) Investigators
Collaborators, Affiliations

Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic

Malou Bourdeau et al. JAMA Netw Open. .

Abstract

Importance: Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations.

Objective: To describe the epidemiology and burden of RSV-associated hospitalizations among children and adolescents in Canadian tertiary pediatric hospitals from 2017 to 2022, including changes during the COVID-19 pandemic.

Design, setting, and participants: This cross-sectional study was conducted during 5 RSV seasons (2017-2018 to 2021-2022) at 13 pediatric tertiary care centers from the Canadian Immunization Monitoring Program Active (IMPACT) program. Hospitalized children and adolescents aged 0 to 16 years with laboratory-confirmed RSV infection were included.

Main outcomes and measures: The proportion of all-cause admissions associated with RSV and counts and proportions of RSV hospitalizations with intensive care unit (ICU) admission, prolonged stay (≥7 days), and in-hospital mortality were calculated overall and by season, age group, and region. Seasonality was described using epidemic curves. RSV hospitalizations for 2021-2022 were compared with those in the prepandemic period of 2017-2018 through 2019-2020. Bonferroni corrections were applied to P values to adjust for multiple statistical comparisons.

Results: Among 11 014 RSV-associated hospitalizations in children and adolescents (6035 hospitalizations among male patients [54.8%]; 5488 hospitalizations among patients aged <6 months [49.8%]), 2594 hospitalizations (23.6%) had admission to the ICU, of which 1576 hospitalizations (60.8%) were among children aged less than 6 months. The median (IQR) hospital stay was 4 (2-6) days. The mean (SD) number of RSV-associated hospitalizations during prepandemic seasons was 2522 (88.8) hospitalizations. There were 58 hospitalizations reported in 2020-2021, followed by 3170 hospitalizations in 2021-2022. The proportion of all-cause hospitalizations associated with RSV increased from a mean of 3.2% (95% CI, 3.1%-3.3%) before the pandemic to 4.5% (95% CI, 4.3%-4.6%) in 2021-2022 (difference, 1.3 percentage points; 95% CI, 1.1-1.5 percentage points; corrected P < .001). A significant increase in RSV-associated hospitalizations was found in 2021-2022 for 3 provinces (difference range, 2.5 percentage points; 95% CI, 1.4-3.6 percentage points for Quebec to 2.9 percentage points; 95% CI, 1.4-3.5 percentage points for Alberta; all corrected P < .001). Age, sex, ICU admission, prolonged length of stay, and case fatality rate did not change in 2021-2022 compared with the prepandemic period. Interregional differences in RSV seasonality were accentuated in 2021-2022, with peaks for 1 province in October, 4 provinces in December, and 3 provinces in April, or May.

Conclusions and relevance: This study found that the burden of RSV-associated hospitalizations in Canadian pediatric hospitals was substantial, particularly among infants aged less than 6 months, and RSV hospitalizations increased in 2021-2022 compared with the prepandemic period, while severity of illness remained similar. These findings suggest that RSV preventive strategies for infants aged less than 6 months would be associated with decreased RSV disease burden in children.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bettinger reports receiving grants from the Canadian Institutes for Health Research, BC Ministry of Health, Public Health Agency of Canada, and COVID Immunity Task Force outside the submitted work and serving on the National Advisory Committee on Immunization and BC Immunization Committee. Dr Halperin reports receiving personal fees for serving on Sanofi Pasteur, AstraZeneca, and GSK ad hoc advisory committees and grants from GSK outside the submitted work. Dr Langley reports receiving grants from Merck, Pfizer, GSK, and Janssen outside the submitted work. Dr Morris reports receiving grants from Pfizer and personal fees from GSK, Merck, Pfizer, Sanofi Pasteur, BioMerieux, and Apotex outside the submitted work. Dr Papenburg reports receiving grants from MedImmune and Merck, honorarium for an ad hoc advisory board meeting on molnupiravir from Merck, and personal fees from AstraZeneca outside the submitted work. Dr Pernica reports receiving grants from MedImmune and Merck paid to Hamilton Health Sciences Hospital and from the Hamilton Innovation Fund, Find, and Canadian Immunization Research Network outside the submitted work and participating in the International Network For Optimal Resistance Monitoring (INFORM) RSV study group. Dr Robinson reports receiving personal fees from Elsevier outside the submitted work. Dr Sadarangani reports receiving grants from GSK, Merck, Moderna, Pfizer, Sanofi Pasteur, Seqirus, Symvivo, and VBI Vaccines paid to the University of British Columbia outside the submitted work and support via salary awards from the BC Children’s Hospital Foundation and Michael Smith Health Research BC. Dr Vadlamudi reports receiving a postdoctoral fellowship from the Canadian Immunization Research Network and personal fees from Broadstreet Health Economics and Outcomes Research outside the submitted work.

Figures

Figure 1.
Figure 1.. Frequency and Proportion of Respiratory Syncytial Virus (RSV) Hospitalizations
Frequency and proportion of RSV hospitalizations over all-cause hospitalizations are presented by season at Immunization Monitoring Program Active (IMPACT) hospitals from 2017-2018 through 2021-2022. Bars indicate frequency of RSV-associated hospitalizations; open circles, proportion of RSV-associated hospitalizations over all-cause hospitalizations at IMPACT centers.
Figure 2.
Figure 2.. Monthly Respiratory Syncytial Virus (RSV)–Associated Hospitalizations
Monthly hospitalizations at Immunization Monitoring Program Active (IMPACT) hospitals, 2017-2018 through 2021-2022, are presented by province and year.
See this image and copyright information in PMC

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