UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK; Field Service South West, Field Services Directorate, UK Health Security Agency, Bristol, UK.
Real-time Syndromic Surveillance Team, Field Services Directorate, UK Health Security Agency, Birmingham, UK; National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK.
Lancet Infect Dis. 2023 Jan;23(1):56-66. doi: 10.1016/S1473-3099(22)00525-4. Epub 2022 Sep 2.
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.
呼吸道合胞病毒（RSV）季节性流行给幼儿带来了显著的临床疾病负担。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 年以来英国 5 岁以下儿童中 RSV 的流行病学变化。
对 2014 年 12 月 29 日至 2022 年 3 月 13 日期间 5 岁以下儿童的 RSV 感染的监测数据进行了分析，包括实验室确诊病例、阳性检测比例、因 RSV 相关疾病住院、以及与 RSV 相关疾病的综合征指标（因急性支气管炎或细支气管炎到急诊就诊、因咳嗽拨打 NHS 111 非紧急健康咨询服务电话、因呼吸道感染看全科医生门诊、因急性支气管炎或细支气管炎看全科医生夜间服务电话）。数据从国家实验室、临床和综合征监测系统中提取。使用广义线性模型进行时间序列分析，以估计针对 SARS-CoV-2 的非药物干预措施对 RSV 指标的影响，通过比较观察值和预测值计算绝对值和相对变化。
2020-21 年冬季，英格兰所有 RSV 指标的活动均减少，实验室确诊病例减少 10280 例（相对变化 -99.5%[95%预测区间 -100.0 至 -99.1]），检测阳性率下降 22.2 个百分点（-99.6%[-99.6 至 -99.5]），住院人数减少 92530 例（-80.8%[-80.8 至 -80.7]），NHS 111 咨询电话减少 96672 例（-73.7%[-73.7 至 -73.7]），夜间全科医生就诊减少 2924 例（-88.8%[-90.4 至 -87.2]），白天全科医生门诊就诊减少 91304 例（-89.9%[-90.0 至 -89.8]），5 岁以下儿童因急性支气管炎或细支气管炎到急诊就诊的人数减少 27486 例（-85.3%[-85.3 至 -85.2]），与基于 COVID-19 大流行前冬季的预测值相比。2021 年夏季出现了史无前例的 RSV 活动高峰，包括实验室确诊病例增加 11255 例（1258.3%[1178.3 至 1345.8]），检测阳性率上升 11.6 个百分点（527.3%），住院人数增加 7604 例（10.7%[10.7 至 10.8]），NHS 111 咨询电话增加 84425 例（124.8%[124.7 至 124.9]），夜间全科医生就诊增加 409 例（39.0%[36.6 至 41.8]），因急性支气管炎或细支气管炎到急诊就诊的人数增加 9789 例（84.9%[84.5 至 85.4]），与预测值相比，虽然白天全科医生门诊就诊减少 21805 例（-34.1%[-34.1 至 -34.0]）。2021-22 年冬季的大多数指标也低于预期，但程度低于 2020-21 年冬季。
2020-21 年冬季 RSV 的异常缺失可能导致了一群没有 RSV 天然免疫力的幼儿，从而增加了 RSV 发病率、非季节性活动以及 SARS-CoV-2 传播限制措施放松时卫生服务压力的可能性。
无。
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