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. 2023 Sep:260:113491.
doi: 10.1016/j.jpeds.2023.113491. Epub 2023 May 16.

Respiratory Syncytial Virus, Influenza, and Coronavirus Disease 2019 Hospitalizations in Children in Colorado During the 2021-2022 Respiratory Virus Season

Suchitra Rao  1 , Isaac Armistead  2 , Amy Tyler  3 , Madelyn Lensing  2 , Samuel R Dominguez  3 , Nisha B Alden  2
Affiliations

Respiratory Syncytial Virus, Influenza, and Coronavirus Disease 2019 Hospitalizations in Children in Colorado During the 2021-2022 Respiratory Virus Season

Suchitra Rao et al. J Pediatr. 2023 Sep.

Abstract

Objective: To compare demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season.

Methods: We conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. Multivariable log-binomial regression modeling evaluated associations between pathogen type and diagnosis, intensive care unit admission, hospital length of stay, and highest level of respiratory support received.

Results: Among 847 hospitalized cases, 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were <4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases (P < .0001), although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases (P < .0001). Using multivariable log-binomial regression analyses, compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza (relative risk, 1.97; 95% CI, 1.22-3.19), whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV.

Conclusions: In a season with respiratory pathogen cocirculation, children were hospitalized most commonly for RSV, were younger, and required higher oxygen support and non-invasive ventilation compared with children with influenza and COVID-19.

Keywords: COVID-19; RSV; bronchiolitis; croup; influenza; respiratory infection.

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Conflict of interest statement

Declaration of Competing Interest S. R. reports prior grant support from GSK and Biofire and is a former consultant for Sequiris. S. R. D. reports grant support from Biofire and Pfizer and is a consultant for Biofire and Karius. The other authors declare no conflicts of interest. The findings and conclusions in this report are those of the authors do not necessarily represent the official position of the state of Colorado, the Centers for Disease Control and Prevention, or the authors' institutions. This work was supported by the Centers for Disease Control and Prevention through an Emerging Infections Program cooperative agreement (grant CK17-1701). A.T. is supported by grant number K08HS026512 from the Agency for Healthcare Research and Quality. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Figures

Figure
Figure
Epidemic curve of RSV, influenza, and SARS-CoV-2 infections from hospitalized children in Colorado from October 1, 2021, to April 30, 2022. Line graphs represent number of cases by week. Black line represents RSV, medium grey line represents influenza, light grey line represents COVID-19.
See this image and copyright information in PMC

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