Disruptions in viral transmission due to COVID-19 mitigation measures altered seasonality and burden of respiratory viruses including RSV, influenza, and others
Target Population
Children and adolescents under 18 years in Ontario, Canada
Care Setting
Hospital inpatient settings including intensive care units
Key Highlights
Sharp reduction in pediatric ARI hospitalizations during 2020/2021 due to COVID-19 mitigation measures.
Postpandemic seasons showed atypical timing and increased burden, especially for RSV and human metapneumovirus in 2022/2023.
Minimal contribution of COVID-19 to ARI hospitalizations in children under 5 years; seasonality trends began normalizing by 2023/2024.
Guideline-Based Recommendations
Diagnosis
Use validated ICD-10-CA virus-specific codes to identify ARI-related hospitalizations including RSV, influenza, SARS-CoV-2, and other respiratory viruses.
Consider viral syndromes such as bronchiolitis and bronchitis in clinical assessment.
Management
Prepare for variable seasonal peaks and increased hospital demand postpandemic, especially for RSV and metapneumovirus.
Implement public health interventions and immunization programs aligned with observed viral seasonality.
Monitoring & Follow-up
Monitor age- and sex-specific hospitalization rates to detect shifts in ARI epidemiology.
Track ICU admissions, mechanical ventilation, and mortality associated with ARI hospitalizations.
Risks
Postpandemic disruptions may lead to atypical viral seasonality and increased healthcare burden.
Older children showed increased admissions postpandemic; males had lower than expected admissions in 2022/2023.
Patient & Prescribing Data
Children and adolescents under 18 years hospitalized for viral ARIs in Ontario.
Minimal COVID-19-related hospitalizations in young children suggest targeted antiviral or supportive therapies should focus on predominant viruses like RSV and metapneumovirus during peak seasons.
Clinical Best Practices
Utilize population-based surveillance data to anticipate and prepare for shifts in pediatric ARI hospitalization patterns.
Maintain flexibility in healthcare resource allocation due to unpredictable postpandemic viral seasonality.
Incorporate comprehensive viral testing and coding to accurately capture ARI etiology and inform public health responses.
