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Abstract

Background

Non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic affected respiratory syncytial virus (RSV) circulation worldwide.

Aim

To describe, for children aged < 5 years, the 2021 and 2022/23 RSV seasons in Germany.

Methods

Through data and 16,754 specimens from outpatient sentinel surveillance, we investigated RSV seasonality, circulating lineages, and affected children’s age distributions in 2021 and 2022/23. Available information about disease severity from hospital surveillance was analysed for patients with RSV-specific diagnosis codes (n = 13,104). Differences between RSV seasons were assessed by chi-squared test and age distributions trends by Mann–Kendall test.

Results

RSV seasonality was irregular in 2021 (weeks 35–50) and 2022/23 (weeks 41–3) compared to pre-COVID-19 2011/12–2019/20 seasons (median weeks 51–12). RSV positivity rates (RSV-PR) were higher in 2021 (40% (522/1,291); p < 0.001) and 2022/23 (30% (299/990); p = 0.005) than in prior seasons (26% (1,430/5,511)). Known globally circulating RSV-A (lineages GA2.3.5 and GA2.3.6b) and RSV-B (lineage GB5.0.5a) strains, respectively, dominated in 2021 and 2022/23. In 2021, RSV-PRs were similar in 1 – < 2, 2 – < 3, 3 – < 4, and 4 – < 5-year-olds. RSV hospitalisation incidence in 2021 (1,114/100,000, p < 0.001) and in 2022/23 (1,034/100,000, p < 0.001) was approximately double that of previous seasons’ average (2014/15–2019/20: 584/100,000). In 2022/23, proportions of RSV patients admitted to intensive care units rose (8.5% (206/2,413)) relative to pre-COVID-19 seasons (6.8% (551/8,114); p = 0.004), as did those needing ventilator support (6.1% (146/2,413) vs 3.8% (310/8,114); p < 0.001).

Conclusions

High RSV-infection risk in 2–4-year-olds in 2021 and increased disease severity in 2022/23 possibly result from lower baseline population immunity, after NPIs diminished exposure to RSV.

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2024-03-28
2024-04-28
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Atypical age distribution and high disease severity in children with RSV infections during two irregular epidemic seasons throughout the COVID-19 pandemic, Germany, 2021 to 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Wei+Cai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cai Wei</a>, <a href="/search?value1=Sophie+K%C3%B6ndgen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Köndgen Sophie</a>, <a href="/search?value1=Kristin+Tolksdorf&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tolksdorf Kristin</a>, <a href="/search?value1=Ralf+D%C3%BCrrwald&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dürrwald Ralf</a>, <a href="/search?value1=Ekkehard+Schuler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schuler Ekkehard</a>, <a href="/search?value1=Barbara+Biere&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Biere Barbara</a>, <a href="/search?value1=Brunhilde+Schweiger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schweiger Brunhilde</a>, <a href="/search?value1=Luise+Goerlitz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Goerlitz Luise</a>, <a href="/search?value1=Walter+Haas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haas Walter</a>, <a href="/search?value1=Thorsten+Wolff&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wolff Thorsten</a>, <a href="/search?value1=Silke+Buda&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Buda Silke</a>, <a href="/search?value1=Janine+Reiche&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Reiche Janine</a></span>. Atypical age distribution and high disease severity in children with RSV infections during two irregular epidemic seasons throughout the COVID-19 pandemic, Germany, 2021 to 2023. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(13):pii=2300465. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.13.2300465" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.13.2300465</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 28 Aug 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 01 Feb 2024 </span> </p>
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