A recently released preprint study shows an increasing number of RSV infections in children during the COVID-19 pandemic.
The authors are from Case Western Reserve University, The Center for Clinical Informatics Research and Education, and the National Institute on Drug Abuse, National Institutes of Health.
Respiratory syncytial virus (RSV) infections are a common seasonal infection among children. However, there has been a notable increase recently in cases.
The investigation compared the RSV cases before and during the COVID-19 pandemic. A total of 56 million patients ≤ 5 years of age, including very young children ≤ 1 year of age, across 50 US states were covered in the research.
They found that from 2010 to 2019, the monthly incidence rate of first-time RSV infection in young children (0-5 years of age) and very young children (0-1 year of age) followed a seasonal pattern with increases during the autumn, peaking in winter, subsiding in spring and summer.
RSV pattern changed with the pandemic
During the COVID-19 pandemic, the pattern changed. In 2020, the incidence rate of RSV infections was meager throughout the year.
In 2021, the RSV season expanded to 9 months, starting early in summer and peaking in October.
In 2022, RSV infections started to rise in May and were significantly higher than in previous years, reaching a historically highest incidence rate in November 2022.
COVID-19 and RSV
Among RSV-infected children in 2022, 19.2% had prior documented COVID-19 infection, significantly higher than the 9.7% among uninfected children.
This suggests that prior COVID-19 could be a risk factor for RSV infection or that there are common risk factors for both viral infections.
The figures below show the time trend of the monthly incidence rate of RSV infection among children ≤ 5 years old and < 1 year old in the US during 2010-2022, with an ending date of November 2022.
Monthly incidence rates were calculated as the number of cases per 1,000,000 person-days. The insert figures highlight the magnified pandemic years.
Other findings are a disproportionate increase in RSV infections in black and Hispanic children.
There were significant racial and ethnic disparities in the peak RSV infection rate during 2010-2021 and the disparities further exacerbated in 2022 with peak incidence rate in black and Hispanic children 2-3 times that in white children.
Explanation of trends
In their discussion, the authors said there is the possibility of a new RSV strain in 2019, which explains the higher infection rate and an earlier start.
In 2020 the low number of RSV cases could be due to the lockdowns, school and daycare closures, masking, and social distancing that contributed to reducing RSV exposure.
In 2021, when the RSV season started earlier during summer and lasted for nine months, the RSV increase may correspond to returning to school and relaxation of COVID-19 mitigation strategies.
For this year, 2022, the RSV season also started early. RSV cases were significantly higher than in 2021 and the pre-pandemic years. In November 2022, the RSV rate is historically high; at the time of the paper’s release, the peak is not yet established.
The racial disparity with higher rates in Black ad Hispanic children could be due to socioeconomic factors like crowded living conditions.
There is twice the number of RSV cases among those who had COVID-19. This suggests that COVID-19 or common associated risk factors might contribute to the increased RSV infections among young children in 2022. However, the study authors did not elaborate further.
The findings of this study echo the results of other researchers from Michigan, New York, and Australia.
RSV infections also high in Adults
The Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET) is a network that conducts active, population-based surveillance for laboratory-confirmed RSV-associated hospitalizations in children younger than 18 years of age and adults.
The figure below is an RSV-NET Dashboard. For the 2022-2023 season (green line), there is a higher overall rate of RSV-associated hospitalization per 100,000 people.
The RSV cases for 2022-2023 started earlier and have more cases than the previous four seasons.
The RSV-NET Dashboard is interactive, and you can go there and specify the age group, race and ethnicity, and sex.
Currently, there is no definite explanation for the increase in RSV cases. Is there something in the environment that lowered the immune system?
A study from Turkey concluded that the risk of coinfection of COVID-19 with influenza A, RSV, parainfluenza, and rhino/enterovirus was higher than with other viral agents.[2]
SARS-CoV-2 Spike Protein and Immunity
Is there something in the SARS-CoV-2 that lowers immunity? Could it be the spike protein?
Bortolotti et al. published a study in the journal Cells that showed that the SARS-CoV-2 spike protein causes the “exhaustion” of natural killer cells, making them less effective. [3]
Natural killer cells are specialized white blood cells that are one of the front-line defenses against viral infections.
What about the COVID shots? Can they explain the rise of RSV in adults?
A preprint study by multiple authors from the Radboud University Medical Center in the Netherlands, Hannover Medical School, and the University of Bonn in Germany showed that the Pfizer BNT162b2 mRNA vaccine could reprogram both adaptive and innate immune responses.[4]
They summarized their results in the abstract. (emphasis added)
Here we confirmed that BNT162b2 vaccination of healthy individuals induced effective humoral and cellular immunity against several SARS-CoV-2 variants.
Interestingly, however, the BNT162b2 vaccine also modulated the production of inflammatory cytokines by innate immune cells upon stimulation with both specific (SARS-CoV-2) and non-specific (viral, fungal and bacterial)stimuli.
The response of innate immune cells to TLR4 and TLR7/8 ligands was lower after BNT162b2 vaccination, while fungi-induced cytokine responses were stronger.
In conclusion, the mRNA BNT162b2 vaccine induces complex functional reprogramming of innate immune responses, which should be considered in the development and use of this new class of vaccines
More epidemiologic studies should be made for more definitive answers.
The Cleveland Clinic has a web page on how to comfort your child when they have RSV.
Never give aspirin to a child, as it may lead to Reye’s syndrome.
If the RSV in a child or adult gets severe, they should be treated in the hospital.
Viral infections can be prevented by making your immune system stronger.
- Echinacea for the Prevention and Treatment of Viral Respiratory Infections and COVID-19
- Melatonin’s Multiple Actions Against COVID-19
- Nigella Sativa or Black Seed, Black Cumin for COVID-19
- The anti-COVID-19 properties of Quercetin
- Adequate Vitamin D Prevents Severe COVID-19
- Vitamin C and COVID-19
- Any Science behind Elderberry for Influenza and COVID-19?
- Zinc Deficiency Impairs the Immune System
- Vitamin B1 or Thiamine in Infections
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References:
- Wang et al. Disruption in seasonality, patient characteristics, and disparities of respiratory syncytial virus infection among young children in the US during and before the COVID-19 pandemic: 2010-2022.
- Yilmaz H et al. Investigation of respiratory tract coinfections in Coronavirus disease 2019 infected and suspected cases. North Clin Istanb. 2022 Oct 20;9(5):421-428. doi: 10.14744/nci.2022.82608. PMID: 36447585; PMCID: PMC9677056.
- Bortolotti D, et al. SARS-CoV-2 Spike 1 Protein Controls Natural Killer Cell Activation via the HLA-E/NKG2A Pathway. Cells. 2020 Aug 26;9(9):1975. doi: 10.3390/cells9091975. PMID: 32859121; PMCID: PMC7563485.
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