Changes in the epidemiology of respiratory syncytial virus infection in children before and after the COVID-19 pandemic at Klang Hospital, Bangkok
Keywords:
Respiratory syncytial virus, Pediatric lower respiratory tract infections, COVID-19 pandemic, Disease severity, Antimicrobial stewardshipAbstract
Background: Respiratory Syncytial Virus (RSV) remains a leading cause of pediatric lower respiratory tract infections (LRTIs) worldwide. The COVID-19 pandemic has substantially altered the epidemiology of RSV in many regions.
Objective: To evaluate temporal trends, clinical characteristics, and disease severity of pediatric RSV infections before and after the COVID-19 pandemic in Bangkok, Thailand.
Methods: We conducted a retrospective study using electronic health records of children younger than 15 years old diagnosed with RSV infection at Klang Hospital from January 2018 to December 2023. Demographic and clinical characteristics, oxygen therapy, hospital length of stay (LOS), treatment costs, and antibiotic prescribing patterns were compared between the pre-pandemic (2018-2020) and post-pandemic (2021-2023) periods. Statistical analyses were performed using the Mann-Whitney U test and chi-square test.
Results: A total of 137 pediatric RSV cases were identified. Number of RSV cases declined to zero in 2021 and subsequently rebounded during 2022-2023. The median age of affected children increased significantly from 12 months in the pre-pandemic period to 18 months in the post-pandemic period (p value 0.042). No significant differences were found in oxygen therapy requirements, LOS, or treatment costs between the two periods. The proportion of severe cases requiring advanced respiratory support showed a numerical increase in the post-pandemic period (19.1% vs. 5.8%). Antibiotic prescribing decreased significantly after the pandemic (26.5% vs. 50.7%, p value < 0.05).
Conclusion: The epidemiology of pediatric RSV pneumonia in Bangkok changed substantially following the COVID-19 pandemic, with an atypical resurgence and an older age at presentation in the post-pandemic period. However, major clinical outcomes remained largely unchanged, highlighting the need for continued RSV surveillance and effective preventive strategies to reduce the burden of RSV pneumonia in children.
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