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Background <p>Non-pharmaceutical interventions (NPIs) against COVID-19 globally altered RSV seasonality, yet longitudinal evidence on age-specific severity changes remains scarce in China.</p> Methods <p>In this hospital-based surveillance study, 20,305 children hospitalized with acute lower respiratory infection (ALRI) were enrolled. RSV was detected via RT-PCR across three phases: pre-pandemic (2017–2019), NPIs implementation (2020–2022), and post-NPIs (2023–2024).</p> Results <p>RSV positivity varied significantly between phases (<i>p</i> &lt; 0.001), peaking at 38.85% (742/1,910) in 2021. Seasonal peaks shifted from winter (pre-pandemic) to spring (post-NPIs). The disease burden shifted toward infants aged 7–12 months (38.92%, 845/2,171 vs. 20.55%, 200/973 pre-pandemic; <i>p</i> &lt; 0.001). Notably, mechanical ventilation was required in 8.00% (4/50) and 5.71% (2/35) of severe pneumonia cases aged 13–36 months during Phases II and III, respectively, whereas no cases were recorded pre-pandemic (0/14; <i>p</i> &gt; 0.05).</p> Conclusion <p>NPIs fundamentally reshaped RSV epidemiology, inducing seasonal shifts and redirecting disease burden toward older infants experiencing delayed primary infection due to “immune debt.”</p>

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Longitudinal Analysis of Respiratory Syncytial Virus in Children during and after COVID-19 Pandemic in China: Shifts in Seasonality and Disease Burden

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月10日

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  • Qiying Gu,
  • Guihua Lai,
  • Zhiyong Lai,
  • Guanzhen Lai

摘要

Background

Non-pharmaceutical interventions (NPIs) against COVID-19 globally altered RSV seasonality, yet longitudinal evidence on age-specific severity changes remains scarce in China.

Methods

In this hospital-based surveillance study, 20,305 children hospitalized with acute lower respiratory infection (ALRI) were enrolled. RSV was detected via RT-PCR across three phases: pre-pandemic (2017–2019), NPIs implementation (2020–2022), and post-NPIs (2023–2024).

Results

RSV positivity varied significantly between phases (p < 0.001), peaking at 38.85% (742/1,910) in 2021. Seasonal peaks shifted from winter (pre-pandemic) to spring (post-NPIs). The disease burden shifted toward infants aged 7–12 months (38.92%, 845/2,171 vs. 20.55%, 200/973 pre-pandemic; p < 0.001). Notably, mechanical ventilation was required in 8.00% (4/50) and 5.71% (2/35) of severe pneumonia cases aged 13–36 months during Phases II and III, respectively, whereas no cases were recorded pre-pandemic (0/14; p > 0.05).

Conclusion

NPIs fundamentally reshaped RSV epidemiology, inducing seasonal shifts and redirecting disease burden toward older infants experiencing delayed primary infection due to “immune debt.”