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

  1. Sasidharanpillai Sabeena
  2. Nagaraja Ravishankar
  3. Sudandiradas Robin
  4. Sabitha Sasidharan Pillai

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Abstract

Background

The COVID-19 pandemic has changed the epidemiology of RSV infection which accounts for most bronchiolitis cases and viral pneumonias in infants.

Aim

This 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.

Methods

The 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).

Results

We 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).

Conclusion

There 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.

Article activity feed

  1. Version published to 10.1101/2022.04.26.22274244v9 on medRxiv
  2. Version published to 10.1101/2022.04.26.22274244v8 on medRxiv
  3. Version published to 10.1101/2022.04.26.22274244v7 on medRxiv
  4. Version published to 10.1101/2022.04.26.22274244v6 on medRxiv
  5. Version published to 10.1101/2022.04.26.22274244v5 on medRxiv
  6. Version published to 10.1101/2022.04.26.22274244v4 on medRxiv
  7. ScreenIT

    SciScore for 10.1101/2022.04.26.22274244: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    2 Study Protocol: An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for all the articles in English published between January 2020 and March 2022 regarding the impact of the COVID-19 pandemic on bronchiolitis or lower respiratory tract infection due to the respiratory syncytial virus using search terms such as “impact” AND “COVID-19” OR “SARS-CoV-2” AND “RSV” NOT “vaccines”.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    The forest plots were constructed using metaprop package in STATA.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitation: Before the COVID-19 pandemic, there was no routine testing of bronchiolitis samples for RSV from developing countries in South East Asia, Africa and Latin America. All the studies included in the meta-analysis were from Europe and China. Even though there were studies from other parts of the world reporting low RSV activity among infants during the COVID-19 pandemic, very few studies reported RSV positivity before the pandemic. During the coming seasons, health care professionals and hospitals must be prepared to manage the increasing number of symptomatic RSV cases. This review emphasises the importance of promoting RSV maternal vaccines and passive childhood immunisation with monoclonal antibodies (mAbs). Conclusion: There was an increase in RSV activity after relaxing stringent public health measures during the COVID-19 pandemic in the northern and southern hemispheres. Efforts for the diagnosis and surveillance for RSV must be reinforced along with influenza and SARS-CoV-2 viruses to minimise the burden of hospitalisation and mortality among infants.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  8. Version published to 10.1101/2022.04.26.22274244v3 on medRxiv
  9. Version published to 10.1101/2022.04.26.22274244v2 on medRxiv
  10. Version published to 10.1101/2022.04.26.22274244v1 on medRxiv