Epidemiology of respiratory syncytial virus in children younger than 5 years in England during the COVID-19 pandemic, measured by laboratory, clinical, and syndromic surveillance: a retrospective observational study,The Lancet Infectious Diseases

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Epidemiology of respiratory syncytial virus in children younger than 5 years in England during the COVID-19 pandemic, measured by laboratory, clinical, and syndromic surveillance: a retrospective observational study
The Lancet Infectious Diseases ( IF 36.4 ) Pub Date : 2022-09-02 , DOI: 10.1016/s1473-3099(22)00525-4
Megan Bardsley ₁ , Roger A Morbey ₂ , Helen E Hughes ₃ , Charles R Beck ₄ , Conall H Watson ₅ , Hongxin Zhao ₅ , Joanna Ellis ₅ , Gillian E Smith ₆ , Alex J Elliot ₆

Affiliation

UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK; Field Service South West, Field Services Directorate, UK Health Security Agency, Bristol, UK.
Real-time Syndromic Surveillance Team, Field Services Directorate, UK Health Security Agency, Birmingham, UK; National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK.
Real-time Syndromic Surveillance Team, Field Services Directorate, UK Health Security Agency, Birmingham, UK; National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
Field Service South West, Field Services Directorate, UK Health Security Agency, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK.
Real-time Syndromic Surveillance Team, Field Services Directorate, UK Health Security Agency, Birmingham, UK; National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK; National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.

Background

Seasonal epidemics of respiratory syncytial virus (RSV) cause a clinically significant burden of disease among young children. Non-pharmaceutical interventions targeted at SARS-CoV-2 have affected the activity of other respiratory pathogens. We describe changes in the epidemiology of RSV among children younger than 5 years in England since 2020.

Methods

Surveillance data on RSV infections, comprising laboratory-confirmed cases, proportion of positive tests, hospital admissions for RSV-attributable illness, and syndromic indicators for RSV-associated disease (emergency department attendances for acute bronchitis or bronchiolitis, non-emergency health advice telephone service [NHS 111] calls for cough, general practitioner [GP] in-hours consultations for respiratory tract infections, and GP out-of-hours contacts for acute bronchitis or bronchiolitis) were analysed from Dec 29, 2014 to March 13, 2022, for children younger than 5 years. Data were extracted from national laboratory, clinical, and syndromic surveillance systems. Time-series analyses using generalised linear models were used to estimate the effect of non-pharmaceutical interventions targeting SARS-CoV-2 on RSV indicators, with absolute and relative changes calculated by comparing observed and predicted values.

Findings

RSV-associated activity was reduced for all RSV indicators during winter 2020–21 in England, with 10 280 (relative change –99·5% [95% prediction interval –100·0 to –99·1]) fewer laboratory-confirmed cases, 22·2 (–99·6%) percentage points lower test positivity, 92 530 (–80·8% [–80·9 to –80·8]) fewer hospital admissions, 96 672 (–73·7% [–73·7 to –73·7]) fewer NHS 111 calls, 2924 (–88·8% [–90·4 to –87·2]) fewer out-of-hours GP contacts, 91 304 (–89·9% [–90·0 to –89·9]) in-hours GP consultations, and 27 486 (–85·3% [–85·4 to –85·2]) fewer emergency department attendances for children younger than 5 years compared with predicted values based on winter seasons before the COVID-19 pandemic. An unprecedented summer surge of RSV activity occurred in 2021, including 11 255 (1258·3% [1178·3 to 1345·8]) extra laboratory-confirmed cases, 11·6 percentage points (527·3%) higher test positivity, 7604 (10·7% [10·7 to 10·8]) additional hospital admissions, 84 425 (124·8% [124·7 to 124·9]) more calls to NHS 111, 409 (39·0% [36·6 to 41·8]) more out-of-hours GP contacts, and 9789 (84·9% [84·5 to 85·4]) more emergency department attendances compared with the predicted values, although there were 21 805 (–34·1% [–34·1 to –34·0]) fewer in-hours GP consultations than expected. Most indicators were also lower than expected in winter 2021–22, although to a lesser extent than in winter 2020–21.

Interpretation

The extraordinary absence of RSV during winter 2020–21 probably resulted in a cohort of young children without natural immunity to RSV, thereby raising the potential for increased RSV incidence, out-of-season activity, and health-service pressures when measures to restrict SARS-CoV-2 transmission were relaxed.

Funding

None.

中文翻译：

COVID-19 大流行期间英国 5 岁以下儿童呼吸道合胞病毒的流行病学，通过实验室、临床和症状监测进行测量：一项回顾性观察研究

背景

呼吸道合胞病毒 (RSV) 的季节性流行在幼儿中造成临床上显着的疾病负担。针对 SARS-CoV-2 的非药物干预措施影响了其他呼吸道病原体的活性。我们描述了自 2020 年以来英格兰 5 岁以下儿童中 RSV 流行病学的变化。

方法

RSV 感染的监测数据，包括实验室确诊病例、阳性检测比例、因 RSV 引起的疾病住院情况以及 RSV 相关疾病的症状指标（急性支气管炎或毛细支气管炎急诊就诊、非紧急健康咨询电话服务）从 2014 年 12 月 29 日到 2022 年 3 月 13 日，分析了 [NHS 111] 咳嗽呼吁、全科医生 [GP] 呼吸道感染的工作时间咨询以及 GP 非工作时间接触急性支气管炎或细支气管炎的情况， 5 岁以下的儿童。数据来自国家实验室、临床和症状监测系统。使用广义线性模型的时间序列分析被用来估计针对 SARS-CoV-2 的非药物干预对 RSV 指标的影响，

发现

2020-21 年冬季，英格兰所有 RSV 指标的 RSV 相关活动均降低，实验室确诊病例减少 10 280（相对变化 –99·5% [95% 预测区间 –100·0 至 –99·1]） , 检测阳性率降低 22·2 (–99·6%) 个百分点，住院人数减少 92 530 (–80·8% [–80·9 至 –80·8])，96 672 (–73·7% [ –73·7 至 –73·7]) 更少的 NHS 111 呼叫，2924 (–88·8% [–90·4 至 –87·2]) 更少的非工作时间 GP 联系，91 304 (–89· 9% [–90·0 至 –89·9]) 小时内 GP 咨询，5 岁以下儿童急诊就诊次数减少 27 486（–85·3% [–85·4 至 –85·2]）年与基于 COVID-19 大流行之前冬季的预测值进行比较。2021 年夏季出现了前所未有的 RSV 活动激增，包括 11255（1258·3% [1178·3 至 1345·8]）个额外的实验室确诊病例，检测阳性率提高 11·6 个百分点 (527·3%)，7604 (10·7% [10·7 至 10·8]) 人入院，84425 (124·8% [124·7 至 124·9]) ]) 更多拨打 NHS 111、409（39·0% [36·6 至 41·8]）更多非工作时间全科医生联系人，以及 9789（84·9% [84·5 至 85·4]）与预测值相比，更多的急诊科就诊人数，尽管 21 805 (–34·1% [–34·1 至 –34·0]) 小时全科医生咨询比预期少。大多数指标在 2021-22 年冬季也低于预期，尽管程度低于 2020-21 年冬季。和 9789（84·9% [84·5 至 85·4]）急诊就诊人数比预测值多，尽管有 21805（–34·1% [–34·1 至 –34·0]）全科医生的上班时间咨询比预期的要少。大多数指标在 2021-22 年冬季也低于预期，尽管程度低于 2020-21 年冬季。和 9789（84·9% [84·5 至 85·4]）急诊就诊人数比预测值多，尽管有 21805（–34·1% [–34·1 至 –34·0]）全科医生的上班时间咨询比预期的要少。大多数指标在 2021-22 年冬季也低于预期，尽管程度低于 2020-21 年冬季。