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Multicenter Study
. 2024 Jul 1;154(1):e2023065623.
doi: 10.1542/peds.2023-065623.

Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022

Meredith L McMorrow  1   2 , Heidi L Moline  1   2 , Ariana P Toepfer  1 , Natasha B Halasa  3 , Jennifer E Schuster  4 , Mary A Staat  5 , John V Williams  6 , Eileen J Klein  7 , Geoffrey A Weinberg  8 , Benjamin R Clopper  1 , Julie A Boom  9 , Laura S Stewart  3 , Rangaraj Selvarangan  4 , Elizabeth P Schlaudecker  5 , Marian G Michaels  6 , Janet A Englund  7 , Christina S Albertin  8 , Barbara E Mahon  1 , Aron J Hall  1 , Leila C Sahni #  9 , Aaron T Curns #  1
Affiliations
Multicenter Study

Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022

Meredith L McMorrow et al. Pediatrics. .

Abstract

Background: The coronavirus disease 2019 pandemic disrupted respiratory syncytial virus (RSV) seasonality resulting in early, atypical RSV seasons in 2021 and 2022, with an intense 2022 peak overwhelming many pediatric healthcare facilities.

Methods: We conducted prospective surveillance for acute respiratory illness during 2016-2022 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested respiratory specimens for RSV and other respiratory viruses. We estimated annual RSV-associated hospitalization rates in children aged <5 years and compared hospitalization rates and characteristics of RSV-positive hospitalized children over 4 prepandemic seasons (2016-2020) to those hospitalized in 2021 or 2022.

Results: There was no difference in median age or age distribution between prepandemic and 2021 seasons. Median age of children hospitalized with RSV was higher in 2022 (9.6 months vs 6.0 months, P < .001). RSV-associated hospitalization rates were higher in 2021 and 2022 than the prepandemic average across age groups. Comparing 2021 to 2022, RSV-associated hospitalization rates were similar among children <2 years of age; however, children aged 24 to 59 months had significantly higher rates of RSV-associated hospitalization in 2022 (rate ratio 1.68 [95% confidence interval 1.37-2.00]). More RSV-positive hospitalized children received supplemental oxygen and there were more respiratory virus codetections in 2022 than in prepandemic seasons (P < .001 and P = .003, respectively), but there was no difference in the proportion hypoxemic, mechanically ventilated, or admitted to intensive care.

Conclusions: The atypical 2021 and 2022 RSV seasons resulted in higher hospitalization rates with similar disease severity to prepandemic seasons.

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Conflict of interest statement

Dr Halasa receives research support from Sanofi and Quidel; Dr Schuster’s institution receives research funding from Merck for a study on which she is an investigator; Dr Staat is an investigator and Dr Schlaudecker is a principal investigator for the Pfizer MATISSE maternal vaccine trial; Dr Weinberg received Honoria from Merck and Co. for the writing and revision of chapters in the Merck Manual; Dr Selvarangan received research funds from Merck and serves on an advisory board for GlaxoSmithKline; Dr Englund receives research support from AstraZeneca, GlaxoSmithKline, and Pfizer and has consulted for Abbvie, AstraZeneca, Meissa Vaccines, Moderna, Pfizer and Sanofi; and the other authors have indicated that they have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
RSV-associated hospitalizations in children aged <5 years by month, New Vaccine Surveillance Network, 2016 to 2022.
FIGURE 2
FIGURE 2
RSV-associated hospitalization rates in children aged <5 years by site, New Vaccine Surveillance Network, 2016 to 2022.
See this image and copyright information in PMC

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