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We read with interest the publication by Li et al. and Zhou et al. reporting a decreasing trend of the infection in children with Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) before and after the coronavirus disease 2019 (COVID-19) pandemic in Henan, China.
However, respiratory syncytial virus (RSV), which is one of the leading causes of lower respiratory tract infection in children as well as the bacteria mentioned in this journal, has not been reported on the epidemiology dynamics resulting from the COVID-19 pandemic. Therefore, we demonstrated the changes of RSV infection in children before and after the COVID-19 pandemic in Henan, China.
RSV is a non-segmented single negative strand RNA enveloped virus belonging to the Paramyxoviridae family, and is related to clinical pictures such as bronchiolitis, pneumonia, ashmatic bronchitis.
RSV is the most important virus responsible for hospitalization and even death in children under 5 years of age with acute lower respiratory tract infection (ALRI), especially in infants.
Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis.
Otherwise, multiple studies have shown that RSV not only causes reinfections throughout the life, but also increases the risk of asthma attacks and language learning disabilities in pre-school children.
Unfortunately, attempts to date have failed to develop safe and effective vaccines for clinical prevention in RSV infection in children, though developing vaccines for RSV has been a global priority. Nevertheless, RSV causes annual epidemic outbreaks between September and May in the Northern Hemisphere, posing a serious threat to the health of children in low-income and middle-income countries.
Therefore, monitoring the changes of RSV infection in children is necessary to explore control strategies and improve the survival of children.
Henan Children's Hospital is a 3A pediatric hospital with more than 2 million visits per year, accounting for approximately 10% of total number of children in Henan, which has been approved as the National Children's Regional Medical Center, Henan Children's Medical Center, and Henan Pediatric Disease Clinical Medical Research Center. In this study, laboratory-based surveillance of RSV infection in children under 11 years old were conducted from January 2017 to October 2022 at Henan Children's Hospital. We compared the number of RSV infections as well as the permillage of positive in six years before and after the COVID-19 pandemic to explore the impact of the outbreak on the prevalence trend of RSV infection in children. As shown in Fig. 1, RSV infections and positive rate demonstrated seasonal fluctuations annually between September and May from 2017 to 2019, whereas there were two sharp drops in RSV infections in January 2020 and July 2021, reflecting the two outbreaks of the COVID-19 pandemic in Henan. Although there was a modestly increase in RSV infection and positive rate in children during the recovery period of the COVID-19 pandemic from September 2020 to March 2021, it was still lower than the same period before the COVID-19 pandemic. Notably, the reduction of RSV infections and positive rates persisted for several months after the end of the second COVID-19 pandemic, which may have suppressed the seasonal rise trend in RSV infection. Therefore, epidemiological trend of the infection of RSV in children had indeed changed before and after the COVID-19 pandemic in Henan.
Fig. 1The number of positive and positive rates of RSV infection among children aged 0 - 11 years during January 2017 to October 2022.
Furthermore, RSV infections and positive rates were evaluated in different age groups (0 - 1 month, 1 month - 2 years, 2 - 5 years, and 5 - 11 years) before and after the COVID-19 pandemic. The number of positive decreased after the COVID-19 pandemic in the third and fourth age groups, while those in the first and second age groups (children at home) remained unchanged or even rose (Fig. 2A), which indicated that the COVID-19 pandemic may have hindered community transmission of RSV, rather than household transmission. In addition, there were obvious decrease in positive rates of RSV in all age groups, especially in children over 5 years old, suggesting that the COVID-19 pandemic had reduced the prevalence of RSV infection in school- age children. Remarkably, after the outbreak of the COVID-19 pandemic, 2y - 5y replaced over 5 years old as the main age of RSV infection and the infection risk of pre-school children was increasing relatively, proving that the susceptible age of RSV was decreasing (Fig. 2B). Hence, the epidemiological characteristics of RSV were changed before and after the COVID-19 pandemic in children of different ages, which may be caused by a combination of many factors, such as class suspension, increased awareness of wearing masks, reducing contact between children, maintaining ventilation, and paying attention to hand hygiene.
Fig. 2(A) The number of positive of RSV infection by month in every age group from January 2017 to October 2022. (B) The permillage of positive of RSV infection in children during January 2017 to October 2022. Note: the data of 2022 only covers the period from January to October.
The COVID-19 pandemic has ravaged the world, reminding us once again that our fate is closely linked to the natural world. Although countries around the world have taken a series of measures to temporarily slow the spread of the virus, scientific analysis is necessary to prevent similar incidents from happening again, as the outbreak of the COVID-19 pandemic will affect more than just the epidemic trend of the respiratory pathogens. Thus, it is urgent to establish a new balanced relationship between human and nature, as well as call for a global community with a shared future for mankind. The future should be a post-pandemic era where ecology, economy and safety are integrated into how we learn, travel and work.
In conclusion, the COVID-19 pandemic had a certain impact on the transmission of RSV in children, specifically referring to the reduction of RSV infection in school-age children and the relative increase in the risk of RSV infection in pre-school children. Close monitoring of epidemiology changes is of great significance for the prevent of RSV infection in children, especially in children aged from 1 month to 5 years.
Declaration of Competing Interest
None.
Acknowledgement
This work was funded by the National Natural Science Foundation of China (32201237), China Postdoctoral Science Foundation (2020M672301), Scientific and technological projects of Henan province (222102310270, 222102310109).
References
Zhou J.
Zhao P.
Nie M.
Gao K.
Yang J.
Sun J.
Changes of Haemophilus influenzae infection in children before and after the COVID-19 pandemic, Henan, China.
Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis.
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