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Respiratory Viral Infection Patterns in Hospitalised Children Before and After COVID-19 in Hong Kong
Jason Chun Sang Pun1,2,3, Kin Pong Tao1,2,3, Stacy Lok Sze Yam1,2,3
1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), 6/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
Insights
Public health measures during COVID-19 altered respiratory virus patterns in children. Post-restriction, higher rates of adenovirus (AdV) and respiratory syncytial virus (RSV) infections were observed, increasing childhood morbidity.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Virology
Background:
- COVID-19 restrictions significantly impacted respiratory virus circulation.
- Understanding post-pandemic viral epidemiology in children is crucial for public health.
- Immune responses to common respiratory viruses may be altered by reduced exposure.
Purpose of the Study:
- To analyze changes in respiratory virus epidemiology in Hong Kong pediatric patients before and after COVID-19 restrictions.
- To identify specific viruses with altered incidence and associated risk factors in children.
- To assess the impact of public health measures on children's susceptibility to respiratory infections.
Main Methods:
- Retrospective analysis of virological data from pediatric respiratory specimens (January 2015 - February 2024).
- Inclusion of adenovirus (AdV), influenza A/B, parainfluenza viruses (PIV), respiratory syncytial virus (RSV), and enterovirus/rhinovirus (EV/RV).
- Stratification of patients into five age groups and comparison of pre- and post-COVID-19 mask mandate periods.
Main Results:
- A significant increase in single-virus and co-infections was observed post-COVID-19 restrictions.
- Elevated odds ratios for adenovirus (AdV) across all age groups and respiratory syncytial virus (RSV) in children aged 3+ years.
- Mean age of hospitalized patients increased post-lockdown, suggesting delayed primary infections.
Conclusions:
- COVID-19 containment measures may have reduced children's natural exposure to respiratory viruses, potentially impairing immunity.
- Increased incidence of AdV and RSV post-pandemic could lead to heightened childhood morbidity.
- Further research is needed to understand long-term immunological consequences and optimize pediatric respiratory health strategies.
Abstract:
The study highlights the significant changes in respiratory virus epidemiology following the lifting of COVID-19 restrictions.
Method:
In this single-centre retrospective study, the virological readouts of adenovirus (AdV), influenza virus A (IAV), influenza virus B (IBV), parainfluenza viruses (PIV) 1, 2, 3, 4, respiratory syncytial virus (RSV), and coupled enterovirus and rhinovirus (EV/RV) were extracted from the respiratory specimens of paediatric patients in Hong Kong from January 2015 to February 2024. The subjects were stratified into five age groups.
Results:
The study included 18,737 and 6001 respiratory specimens in the pre-COVID-19 and post-COVID-19 mask mandate period, respectively. The mean age of hospitalised patients increased from 3.49 y ± 0.03 y to 4.37 y ± 0.05 y after the COVID-19 lockdown. The rates of single-virus infection and co-infection were significantly higher in the post-COVID-19 mask mandate period. The odds ratio for AdV for all age groups (OR: 4.53, 4.03, 2.32, 2.46, 1.31) and RSV in older children from 3 years old and above (OR: 1.95, 3.38, p < 0.01) were significantly elevated after the COVID-19 outbreak.
Conclusions:
Our findings suggest that public health measures to contain COVID-19 may have unintended consequences on children's natural exposure and immunity to other respiratory viruses, potentially increasing their morbidity in the post-pandemic era.
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