Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic.
Malou Bourdeau, Nirma Khatri Vadlamudi, Nathalie Bastien, Joanne Embree, Scott A Halperin, Taj Jadavji, Kescha Kazmi, Joanne M Langley, Marc H Lebel, Nicole Le Saux, Dorothy Moore, Shaun K Morris, Jeffrey M Pernica, Joan Robinson, Manish Sadarangani, Julie A Bettinger, Jesse Papenburg, Canadian Immunization Monitoring Program Active (IMPACT) Investigators
Author Information
Malou Bourdeau: Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Nirma Khatri Vadlamudi: Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Nathalie Bastien: National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
Joanne Embree: Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
Scott A Halperin: Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Taj Jadavji: Section of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
Kescha Kazmi: Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Joanne M Langley: Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Marc H Lebel: Division of Pediatric Infectious Diseases, Department of Pediatrics, Sainte-Justine, Montreal, Quebec, Canada.
Nicole Le Saux: Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Dorothy Moore: Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Shaun K Morris: Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Jeffrey M Pernica: Division of Infectious Diseases, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Joan Robinson: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Manish Sadarangani: Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Julie A Bettinger: Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Jesse Papenburg: Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.
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.
