Clinical characteristics of infants with respiratory syncytial virus infection under 3 months of age before, during, and after the SARS-CoV-2 pandemic

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Objectives: To assess the changes in epidemiologic and clinical characteristics of respiratory syncytial virus (RSV) infection among inpatient under 3 months of age with lower respiratory tract infection (LRTI) in different stages of the SARS-CoV-2 pandemic. Methods: A retrospective cohort study was conducted. Clinical data on general condition and laboratory tests were collected from 3 144 RSV-positive LRTI infants less than 3 months of age hospitalized at Children's Hospital, Zhejiang University School of Medicine from January 2017 to January 2024. Based on the admission date, all patients were categorized into three groups: pre-SARS-CoV-2 infection, during SARS-CoV-2 infection and after SARS-CoV-2 infection. Clinical data from three groups of patients were compared using ANOVA or chi-square test or Kruskal Wallis text to assess the impact of the SARS-CoV-2 infection on the epidemiological and clinical characteristics of RSV. Results: Among the 3 144 RSV-positive children, there were 1 872 males and 1 272 females, with an age of 42 (24, 61) d. The pre-SARS-CoV-2 infection, during SARS-CoV-2 infection and after SARS-CoV-2 infection in 1 224, 1 173 and 747 cases respectively. There were statistically significant differences in RSV infection in winter, summer and autumn (all P<0.001). Compared with the pre-SARS-CoV-2 pandemic and during the SARS-CoV-2 pandemic, children with RSV infection in the post-SARS-CoV-2 pandemic had higher hospitalization costs (8 831.3 (5 925.0, 12 887.6) vs.7 153.8 (4 918.0, 9 834.2) vs. 7 842.0 (4 920.0, 11 414.2) yuan, H=57.57, P<0.001), lower admission oxygen saturation (0.95 (0.94,0.97) vs. 0.97 (0.95,0.98) vs. 0.97 (0.95,0.98), H=143.96, P<0.001), an increased rate of intravenous glucocorticosteroid application (56.8% (424/747) vs. 35.9% (439/1 224) vs. 29.9% (351/1 173), χ2=144.58, P<0.001), immunoglobulin application (27.7% (207/747) vs. 16.2% (198/1 224) vs. 14.6% (171/1 173), χ2=58.41, P<0.001), respiratory support (45.5% (340/747) vs. 38.9% (476/1 224) vs. 36.7% (431/1 173), χ2=15.03, P=0.001), and intensive care unit admission (3.9% (29/747) vs. 1.3% (16/1 224) vs. 3.0% (35/1 173), χ2=13.86, P=0.001). Conclusions: During the post-SARS-CoV-2 pandemic, there were off-season outbreaks of RSV, with peaks occurring in the summer and fall. RSV-positive infants in the post-SARS-CoV-2 infection period had lower oxygen saturation on admission and higher rates of intravenous glucocorticosteroids, immunoglobulin application, respiratory support, and admission to the intensive care unit.