Clinical Impact of Serious Respiratory Disease in Children Under the Age of 2 Years During the 2021-2022 Bronchiolitis Season in England, Scotland, and Ireland

Abstract

Background: Interventions introduced to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a widespread reduction in childhood infections. However, from spring 2021 onwards the United Kingdom and Ireland experienced an unusual out-of-season epidemic of respiratory disease.

Methods: We conducted a prospective observational study (BronchStart), enrolling children 0-23 months of age presenting with bronchiolitis, lower respiratory tract infection, or first episode of wheeze to 59 emergency departments across England, Scotland, and Ireland from May 2021 to April 2022. We combined testing data with national admissions datasets to infer the impact of respiratory syncytial virus (RSV) disease.

Results: The BronchStart study collected data on 17 899 presentations for 17 164 children. Risk factors for admission and escalation of care included prematurity and congenital heart disease, but most admissions were for previously healthy term-born children. Of those aged 0-11 months who were admitted and tested for RSV, 1907 of 3912 (48.7%) tested positive. We estimate that every year in England and Scotland 28 561 (95% confidence interval, 27 637-29 486) infants are admitted with RSV infection.

Conclusions: RSV infection was the main cause of hospitalizations in this cohort, but 51.3% of admissions in infants were not associated with the virus. The majority of admissions were in previously healthy term-born infants.

Keywords: immunization; respiratory infections; respiratory syncytial virus.

Figure 1.

A, Virology testing showed RSV was the main pathogen during the study period (1 May 2021 to 30 April 2022). B, Graphical representation of other viruses identified in attendances in addition to RSV; area is proportional to number of positive tests. Abbreviations: HMPV, human metapneumovirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Figure 2.

A, Highest level of care for BronchStart attendances including proportion of children with comorbidities. B, Children with comorbidities in HDU and PICU admissions. Data from Table 3, area of plots scaled to number of cases. Patients were ranked hierarchically so that each patient could only be assigned 1 category of comorbidity; congenital heart disease subsumed preterm birth or other comorbidities, and preterm birth other comorbidities. Abbreviations: CHD, congenital heart disease; ED, emergency department; HDU, high-dependency unit; PICU, pediatric intensive care unit.