The impact of COVID-19 pandemic on bronchiolitis (lower respiratory tract infection) due to respiratory syncytial virus: A systematic review and meta-analysis

Abstract

AbstractBackgroundThe COVID-19 pandemic has changed the epidemiology of RSV infection which accounts for most bronchiolitis cases and viral pneumonias in infants.AimThis systematic review and meta-analysis aimed to quantitatively assess the effect of COVID-19 pandemic on respiratory syncytial virus (RSV) associated bronchiolitis among hospitalised infants globally.MethodsThe study protocol was registered in the PROSPERO database (CRD42022314000) and was designed based on PRISMA guidelines updated in May 2020. An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles regarding the impact of the COVID-19 pandemic on bronchiolitis or lower respiratory tract infection due to the respiratory syncytial virus in English published between January 2019 and March 2022. The meta-analysis component was modified appropriately to synthesise the pooled proportion of infants having RSV-associated bronchiolitis before the COVID-19 pandemic in 2019 and during the pandemic with 95% confidence interval (CI).ResultsWe screened 189 articles and systematically reviewed fifty studies reporting RSV-associated bronchiolitis cases in infants before the pandemic in 2019 and during the pandemic in 2020/2021. Eight qualified studies from Europe and China, which reported RSV-bronchiolitis both in 2019 and in 2020/21 were pooled by random-effects meta-analysis. These studies comprised 109,186 symptomatic cases of bronchiolitis before the pandemic in 2019 and 61,982 cases in 2020-2021. The quantitative analysis included laboratory-confirmed RSV infection in 7691 infants with bronchiolitis reported before the pandemic in 2019. Meanwhile, during the pandemic, 4964 bronchiolitis cases were associated with RSV infection. The pooled proportion of RSV-associated bronchiolitis cases before the pandemic in 2019 was 16.74% (95% CI 11.73, 22.43%, 95% prediction interval 0.032, 34.16). The pooled proportion of confirmed RSV cases during the pandemic in 2020/2021 was 19.20 % (95% CI 12.01, 27.59%, 95% prediction interval 0.046, 42.35).ConclusionThere was an increase in RSV activity after the relaxation of stringent public health measures during the COVID-19 pandemic.Key Messages (Provide appropriate messages of about 35-50 words to be printed in centre box)This systematic review and meta-analysis reports the pooled proportion of RSV associated bronchiolitis cases in 2019 (before the COVID-19 pandemic) and during the pandemic.Eight observational studies from China and Europe were qualified for the meta-analysis.A decline in reported cases of bronchiolitis was observed during the COVID-19 pandemic which might be attributed to non-pharmaceutical measures and a fall in the hospitalisation rates of respiratory non-SARS-CoV-2 infections.The pooled proportion of RSV positivity rate among bronchiolitis cases was more during the COVID-19 pandemic.