The clinical impact of serious respiratory disease in children under the age of two during the 2021-2022 bronchiolitis season in the United Kingdom and Ireland
medrxiv(2023)
Abstract
Background Interventions introduced in 2020 to reduce the spread of SARS-CoV-2 led to a widespread reduction in childhood infections, including respiratory syncytial virus (RSV), in the subsequent year. However, from the spring of 2021 onwards the United Kingdom and Ireland began to experience an unusual out of season epidemic of childhood respiratory disease.
Methods We conducted a prospective observational cohort study (BronchStart), enrolling children aged 0-23 months presenting with clinician-diagnosed bronchiolitis, lower respiratory tract infection or first episode of wheeze in 59 Emergency Departments (ED) across England, Scotland and Ireland from 1 May 2021 to 30 April 2022. We collected baseline data on patient demographics and clinical presentation, and follow-up data at 7 days. We used high-granularity BronchStart clinical data together with national English and Scottish admission datasets to infer the impact of RSV disease in a typical year before the Covid-19 pandemic, and to provide an up-to-date estimate of the annual impact of disease to inform implementation of anti-RSV interventions.
Findings The BronchStart study collected data on 17,899 ED presentations for 17,179 children. Of these, 6,825 (38.1%) were admitted to hospital for further observation or treatment, 458 (2.6%) required care in a high dependency unit (HDU), and 154 (0.9%) were admitted to a paediatric intensive care unit (PICU). Of the 5,788 children admitted and tested for RSV, 41.8% of the overall study cohort, and 48.7% of those 0-11 months of age, were positive. Risk factors for hospital admission included prematurity and congenital cardiac disease. Patients with these risk factors were also more likely to receive oxygen therapy, or be admitted to a HDU or PICU. However, 84.5% of those admitted to an observation unit, 78.1% of those admitted to a ward, 67.7% of those admitted to HDU and 50.0 % of those admitted to PICU had no identified comorbidity. Using admissions data for England and Scotland we estimate that every year 12,167 infants with RSV infection receive low flow oxygen, 4,998 high flow oxygen and 6,198 a course of antibiotic therapy in secondary care.
Interpretation Although RSV was the major pathogen in this cohort, 51.3% of admissions for serious respiratory viral infections in those aged <1 year of age were not associated with the virus. Whilst prematurity and congenital cardiac disease were risk factors for admission to hospital, HDU and PICU, the majority of these admissions, for all levels of care except PICU, were in previously healthy term born infants.
### Competing Interest Statement
The authors have declared no competing interest.
### Clinical Protocols
### Funding Statement
This study received financial and administrative support from the Respiratory Syncytial Virus Consortium in Europe (RESCEU).
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The study was initially exempted from ethical review in keeping with the Control of Patient Information Notice (COPI) under a Covid-19 Notice (Regulation 3(4) of the Health Service Control of Patient Information Regulations 2002) with University Hospitals of Leicester NHS Trust as the Study Sponsor. Following a query raised about the study being adopted onto the English National Institute for Health Research (NIHR) Clinical Research Network (CRN) portfolio the study was formally reviewed by the London City and East Ethics Committee and granted permission to recruit patients without formal consent (Reference 21/REC/1844). The study is registered on ClinicalTrials.gov ([NCT04959734][1]). The use of Hospital Episode Statistics data was approved by the Health and Social Care Information Centre/NHS Digital (DARS-NIC-393510-D6H1D-v1.11). SMR01 data was provided by Public Health Scotland. Statistical disclosure control was applied to ensure patient confidentiality in line with the PHS Statistical Disclosure Protocol.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
All data produced in the present study are available upon reasonable request to the authors
[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04959734&atom=%2Fmedrxiv%2Fearly%2F2023%2F02%2F23%2F2023.02.22.23285616.atom
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