Jorgensen Sarah C J, Hernandez Alejandro, Buchan Sarah A, Fitzpatrick Tiffany, Guttmann Astrid, Morris Shaun K, Kwong Jeffrey C
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Open Forum Infect Dis. 2024 Oct 8;11(10):ofae601. doi: 10.1093/ofid/ofae601. eCollection 2024 Oct.
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transitions to endemicity and respiratory syncytial virus (RSV) and influenza reestablish their seasonal circulation patterns, understanding their comparative burden on infants and children can guide health system responses and funding priorities.
This was a population-based cohort study of children aged <5 years in Ontario, Canada, from September 2018 to August 2023 using linked health administrative databases.
Seasonal cohorts comprised 731 838 to 763 660 children. RSV- and influenza-related hospital admission rates immediately decreased in March 2020. In 2021-2022, RSV-related admissions rebounded but remained 8%-11% lower than prepandemic seasons, whereas 2022-2023 RSV-related admissions increased 105%-113% versus prepandemic seasons and peak admissions occurred in November versus December. Influenza did not rebound until 2022-2023, when admissions were 28%-37% higher than prepandemic seasons. Coronavirus disease 2019 (COVID-19)-related admissions remained low until 2021-2022 and were lower than RSV-related admissions across all age groups during prepandemic and pandemic seasons. By contrast, 2021-2022 COVID-19-related admissions exceeded prepandemic influenza-related admissions by 30%-40% but decreased by 45% in 2022-2023 and were lower than prepandemic influenza-related admissions, except among infants aged <12 months who remained at highest risk. There was no distinct seasonal pattern for COVID-19-related admissions during the study.
RSV remains a major cause of childhood hospitalization. Although COVID-19 appears to be receding, its disease burden as it transitions to endemicity remains to be established. The unprecedented peaks in RSV-related hospital admissions during 2022-2023, together with the return of influenza and ongoing SARS-CoV-2 transmission, underscore the need to strengthen systems for real-time surveillance and to proactively prepare for critical healthcare scenarios.
随着严重急性呼吸综合征冠状病毒2（SARS-CoV-2）转变为地方性流行，呼吸道合胞病毒（RSV）和流感重新建立其季节性流行模式，了解它们对婴幼儿和儿童的相对负担可为卫生系统应对措施和资金优先事项提供指导。
这是一项基于人群的队列研究，利用加拿大安大略省的健康管理数据库，对2018年9月至2023年8月期间5岁以下儿童进行研究。
季节性队列包括731838至763660名儿童。2020年3月，RSV和流感相关的住院率立即下降。在2021 - 2022年，RSV相关的住院人数有所反弹，但仍比疫情前季节低8% - 11%，而2022 - 2023年RSV相关的住院人数比疫情前季节增加了105% - 113%，且住院人数峰值出现在11月而非12月。流感直到2022 - 2023年才反弹，当时住院人数比疫情前季节高28% - 37%。2019冠状病毒病（COVID - 19）相关的住院人数在2021 - 2022年之前一直较低，在疫情前和疫情期间，所有年龄组的COVID - 19相关住院人数均低于RSV相关住院人数。相比之下，2021 - 2022年COVID - 19相关住院人数比疫情前流感相关住院人数高出30% - 40%，但在2022 - 2023年下降了45%，且低于疫情前流感相关住院人数，但12个月以下婴儿的风险仍然最高。在研究期间，COVID - 19相关住院人数没有明显的季节性模式。
RSV仍然是儿童住院的主要原因。尽管COVID - 19似乎在消退，但其向地方性流行转变过程中的疾病负担仍有待确定。2022 - 2023年RSV相关住院人数出现前所未有的峰值，再加上流感的回归和SARS-CoV-2的持续传播，凸显了加强实时监测系统以及积极应对关键医疗场景的必要性。
