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Analyzing the Effects of Respiratory Syncytial Virus Pre- and Post-Pandemic

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Currently, respiratory syncytial virus (RSV) infection is the leading cause of hospitalization of young children as a result of respiratory complications of apnea, bronchiolitis, and pneumonia.1 Prior to the COVID-19 pandemic, more than two million children 5 years of age or younger in the United States needed medical care for RSV infections yearly, which included 80,000 hospitalizations and up to 300 deaths.1

However, during the early days of the pandemic, there was a significant decrease in pediatric hospitalizations for RSV infections, being that the standard virus circulation patterns were disrupted, which allowed for children to avoid RSV exposure in the early years of their lives. In 2022-2023, after the social distancing mandates and masking were no longer required, RSV infections resurged, which caused a massive rise in the number of hospitalizations and admissions to the intensive care unit (ICU).

Being that national data surrounding hospitalization and ICU use—along with advanced respiratory support modalities—are yet to go reported, a retrospective cross-sectional study published in JAMA Network Open1 sought to explore how these post–COVID-19 pandemic season numbers in 2022-2023 compared to seasons in the pre-pandemic era.

The study gathered children’s data from 48 children’s hospitals in the United States that agreed to be a part of the Pediatric Health Information System (PHIS) database, which provides administrative and bill data, diagnostic and procedure codes, and discharge and encounter data.

PHIS was utilized to identify patients 5 years of age or younger who were diagnosed with an RSV infection from July 1, 2017, to June 30, 2023. RSV season were defined as running from July 1 to June 30; pre-pandemic RSV seasons included 2017 to 2018, 2018 to 2019, and 2019 to 2020. The post-pandemic season was considered 2022 to 2023.

In total, there were 288,816 children the age of 5 or younger (median [IQR] age, 8.9 [3.3-21.5] months; 159,348 [55.2%] male) presented to 48 US children’s hospitals with RSV during the aforementioned timeframe. RSV hospital presentations increased from 39,698 before the pandemic to 94,347 after the pandemic (P < .001), with 86.7% more hospitalizations than prior to the pandemic (50,619 vs 27,114; P < .001). In 2022 to 2023, the post-pandemic season, children were older (median [IQR] age, 11.3 [4.1-26.6] months vs 6.8 [2.6-16.8] months; P < .001) and had fewer comorbidities (17.6% vs 21.8% of hospitalized patients; P < .001) compared to during the pre-pandemic seasons.

The use of advanced respiratory support increased 70.1% in 2022 to 2023 (9,094 vs 5,340; P < .001), and children that needed high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV) were older than during pre-pandemic seasons (median [IQR] age for HFNC, 6.9 [2.7-16.0] months vs 4.6 [2.0-11.7] months; for NIV, 6.0 [2.1-16.5] months vs 4.3 [1.9-11.9] months). Comorbid conditions were less common after the pandemic across all respiratory support modalities (HFNC, 14.9% vs 19.1%, NIV, 22.0% vs 28.5%, invasive mechanical ventilation, 30.5% vs 38.0%; P < .001).

Due to this data, the investigators concluded that, “In this retrospective cross-sectional study, we report a post-pandemic pediatric RSV surge with significant increases in ED presentations, total hospital- and ICU-days, and number of children requiring advanced respiratory support. Notably, noninvasive respiratory support with HFNC and NIV was used more frequently during the 2022 to 2023 post-pandemic season than in previous seasons, whereas mechanical ventilation use was similar.

“Moreover, the post-pandemic pediatric RSV population requiring respiratory support was older with fewer comorbid conditions than in the pre-pandemic period. The post-pandemic surge of RSV in both vulnerable, younger populations and older, previously healthy children led to substantial increases in US hospital volumes and healthcare system burden. Although these trends need to be evaluated in subsequent years, this study highlights possible epidemiologic shifts and trends in respiratory support use that may help inform guidelines and expanded age considerations for new RSV vaccines as they become more widely available.”


1. Winthrop ZA, Perez JM, Staffa SJ, McManus ML, Duvall MG. Pediatric Respiratory Syncytial Virus Hospitalizations and Respiratory Support After the COVID-19 Pandemic. JAMA Netw Open. 2024;7(6):e2416852. doi:10.1001/jamanetworkopen.2024.16852


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