2021 年至 2023 年 COVID-19 大流行期间，德国两次不规则疫情季节中儿童呼吸道合胞病毒感染的非典型年龄分布和高疾病严重程度。

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.

机构信息

Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.

Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany.

出版信息

Euro Surveill. 2024 Mar;29(13). doi: 10.2807/1560-7917.ES.2024.29.13.2300465.

BackgroundNon-pharmaceutical interventions (NPIs) during the COVID-19 pandemic affected respiratory syncytial virus (RSV) circulation worldwide.AimTo describe, for children aged < 5 years, the 2021 and 2022/23 RSV seasons in Germany.MethodsThrough 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.ResultsRSV 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).ConclusionsHigh 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.

背景

在 COVID-19 大流行期间，非药物干预（NPIs）影响了全球范围内的呼吸道合胞病毒（RSV）传播。

目的

描述 2021 年和 2022/23 年德国<5 岁儿童的 RSV 季节。

方法

通过数据和来自门诊哨点监测的 16754 份标本，我们研究了 2021 年和 2022/23 年 RSV 的季节性、循环谱系以及受影响儿童的年龄分布。对具有 RSV 特异性诊断代码的患者（n=13104）的医院监测中有关疾病严重程度的可用信息进行了分析。通过卡方检验评估 RSV 季节之间的差异，通过曼肯德尔检验评估年龄分布趋势。

结果

与 2011/12-2019/20 年之前的 COVID-19 季节（中位周数 51-12）相比，2021 年（第 35-50 周）和 2022/23 年（第 41-3 周）的 RSV 季节性不规则。2021 年（40%（522/1291）；p<0.001）和 2022/23 年（30%（299/990）；p=0.005）的 RSV 阳性率（RSV-PR）高于之前的季节（26%（1430/5511））。已知全球循环的 RSV-A（谱系 GA2.3.5 和 GA2.3.6b）和 RSV-B（谱系 GB5.0.5a）株分别在 2021 年和 2022/23 年占主导地位。2021 年，1-<2、2-<3、3-<4 和 4-<5 岁儿童的 RSV-PR 相似。2021 年（1114/100,000，p<0.001）和 2022/23 年（1034/100,000，p<0.001）的 RSV 住院发病率大约是之前季节平均水平（2014/15-2019/20：584/100,000）的两倍。2022/23 年，与 COVID-19 之前的季节相比（6.8%（551/8114）；p=0.004），需要入住重症监护病房的 RSV 患者的比例（8.5%（206/2413））有所增加，需要呼吸机支持的患者比例也有所增加（6.1%（146/2413）vs 3.8%（310/8114）；p<0.001）。

结论

2021 年 2-4 岁儿童 RSV 感染风险高，2022/23 年疾病严重程度增加，可能是由于 NPIs 降低了 RSV 暴露，基础人群免疫力下降所致。