Previous COVID-19 infection was associated with a significantly increased risk for respiratory syncytial virus (RSV) infection in children aged 0 to 5 years in 2022, researchers reported in Family Medicine and Community Health.
Researchers conducted a retrospective cohort study to examine potential linkage between previous COVID-19 infection in children aged 0 to 5 years and the 2022 surge in pediatric RSV and related diseases. The study used data from the TriNetX platform, which includes electronic health records (EHRs) of 1.7 million children aged 0 to 5 years from 34 health care organizations in the US.
For the assessment of the association of previous COVID-19 infection with first-time RSV infection in the peak 2022 RSV season (October 2022-December 2022), the sample included 228,940 children aged 0 to 5 years who had a medical encounter with a health care organization in October 2022 and no previous medically attended RSV infection. A total of 14,493 children had COVID-19 before August 2022 (COVID-19-positive cohort), and 214,447 children had no EHR-documented COVID-19 infection (COVID-19-negative cohort). Propensity-score matching was used to balance the 2 study cohorts (14,488 children in each; mean [SD] age, 2.4 [1.6] years; 46.8% female). Both cohorts were followed for 60 days.
From October 2022 to December 2022, the overall risk for an initial medically attended RSV infection was 6.04% for the COVID-19-positive group vs 4.30% for the matched COVID-19-negative group (relative risk [RR], 1.40; 95% CI, 1.27-1.55).
“
Our study supports that prior COVID-19 infection was associated with a significantly increased risk for RSV infection and may have been a driving force for the 2022 surge of severe pediatric RSV cases in the USA.
Among children aged 0 to 1 year, the overall RSV risk from October 2022 to December 2022 was 7.90% in the COVID-19-positive group compared with 5.64% in the matched COVID-19-negative group (RR, 1.40; 95% CI, 1.21-1.62).
The results were replicated in a separate cohort of children from 2021, which included 370,919 children aged 0 to 5 years (July 2021-August 2021), of whom 6309 had COVID-19 before June 2021 (COVID-19-positive cohort) and 364,610 children had no documented COVID-19 infection (COVID-19-negative cohort). After propensity-score matching, both cohorts had 14,488 children (mean age, 2.2 [1.6] years; 46% female).
Previous COVID-19 infection was associated with an increased risk for first-time medically attended RSV infection in the 2021 RSV season (July 2021-December 2021) in children aged 0 to 5 years (RR, 1.32; 95% CI, 1.12-1.56) and children aged 0 to 1 year (RR, 1.47; 95% CI, 1.18-1.82). A previous COVID-19 infection was associated with a significantly higher risk for clinically diagnosed RSV disease, confirmed RSV from a positive laboratory test, and unspecified bronchiolitis in 2021.
Limitations include the focus on medically attended RSV infection and the inclusion of participants only from the TriNetX network. Also, the actual prevalence of COVID-19 in children is unknown, and there is potential that electronic health records could reflect overdiagnosis, misdiagnosis, or underdiagnosis of RSV infection and other diseases.
“Our study supports that prior COVID-19 infection was associated with a significantly increased risk for RSV infection and may have been a driving force for the 2022 surge of severe pediatric RSV cases in the USA and this should be further investigated,” stated the study authors. “Prevention measures such as vaccines would be beneficial in preventing both COVID-19 infection and COVID-19- associated diseases including RSV infection.”
