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.
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.
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DOI：
10.1016/s1473-3099(22)00525-4
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发表时间：
2023-01
影响因子：
56.3
通讯作者：
Elliot, Alex J.
中科院分区：
文献类型：
--
作者：
Bardsley, Megan;Morbey, Roger A.;Hughes, Helen E.;Beck, Charles R.;Watson, Conall H.;Zhao, Hongxin;Ellis, Joanna;Smith, Gillian E.;Elliot, Alex J.
呼吸道合胞病毒（RSV）的季节性流行在幼儿中造成临床显著的疾病负担。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动。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。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相关疾病住院以及RSV相关疾病的症状指标（急性支气管炎或细支气管炎的急诊就诊，咳嗽的非紧急健康咨询电话服务[NHS 111]，呼吸道感染的全科医生[GP]小时内咨询，和GP非工作时间接触急性支气管炎或细支气管炎）进行了分析，从2014年12月29日至2022年3月13日，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用于估计针对SARS-CoV-2的非药物干预对RSV指标的影响，通过比较观察值和预测值计算绝对和相对变化。2020-21年冬季，英格兰所有RSV指标的RSV相关活动均有所减少 ，（相对变化-99统计5%[95%预测区间-100统计0至-99统计1]）实验室确诊病例减少，二十二·二（-99统计学6%）个百分点，检测阳性率降低92 530（-80统计8%[-80统计9至-80统计8]）住院人数减少，96 672（-73统计7%[-73统计7至-73统计7]）减少NHS 111呼叫，2924（-88统计8%[-90统计4至-87统计2]）非工作时间GP接触减少，91 304（-89统计9%[-90统计0至-89统计9]）小时内全科医生咨询， （-85统计3%[-85统计4至-85统计2]）与基于COVID-19大流行前冬季的预测值相比，5岁以下儿童的急诊就诊人数减少。2021年夏季出现了前所未有的RSV活动激增，包括11255 例（1258.3%[1178.3至1345.8]）额外实验室确诊病例，检测阳性率高出11.6个百分点（527.3%），7604例（10.7%[10.7至10.8]）额外入院，84425例（1258.3%[1178.3至1345.8 ]（124.8%[124.7至124.9]）更多的呼叫NHS 111，409（39.0%[36.6至41.8]）更多的非工作时间GP接触，9789（84.9%[84.5至85.4]）急诊科就诊与预测值相比，尽管有 21805（-34统计1%[-34统计1至-34统计0]）小时内GP咨询比预期少。大多数指标也低于2021-22年冬季的预期，尽管程度低于2020-21年冬季。2020- 2021年冬季RSV的异常缺乏可能导致一组幼儿对RSV没有天然免疫力，从而增加了RSV发病率增加的可能性，当限制SARS-CoV-2传播的措施放松时，反季节活动和卫生服务压力。一个也没有。
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. 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. 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. 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. None.