RSV resulting in more pediatric hospitalizations than COVID-19, flu

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The respiratory disease known as respiratory syncytial virus (RSV) has led to more emergency hospitalizations than the flu and the Omicron variant of COVID-19, according to recent findings in JAMA. 

Retroactively analyzing data from about 500,000 under-18 patients from August 2021 to September 2022, researchers found that the hospitalization rate for children testing positive for RSV was 81.7%. That compares to 31.5% for Omicron and just 27.7% for the flu.

WHAT'S THE IMPACT?

According to the data, pneumonia is the largest infectious cause of pediatric mortality, and respiratory viruses – RSV, the influenza virus, and SARS-CoV-2 – can be detected in more than 80% of community-acquired infections.

Omicron is typically linked to lower severity compared to its prior variants. 

Hospitalization rates were higher in patients with RSV as compared to Omicron in all age groups, though no differences were observed between influenza and Omicron. Patients with the flu tended to be older, which made it somewhat difficult to compare those patient populations.

Hospitalization rates were similar across all age strata, likely due to the high burden of comorbidities among adolescents and the recent resurgence of influenza and RSV. ICU admissions and mortality were low, data showed.

"Our findings suggest that RSV infections more often require hospitalization and respiratory support, underscoring the importance of preventive measures, such as recently approved RSV vaccines," authors wrote.

THE LARGER TREND

A sharp rise in respiratory illnesses, including RSV, COVID-19 and the flu, has caused severe working conditions for hospitals in Fresno County, California, which as of last month were operating at between 20-40% capacity.

Calling the number of admitted patients "historic," Fresno County Emergency Medical Services Director Dan Lynch said hospitals in the county are holding admitted patients in the ER for up to four days and are using conference rooms and other non-patient areas to hold patients.

Emergency department wait times can regularly exceed 10 hours for patients not experiencing medical emergencies, officials said, and ambulances are often waiting one to two hours to turn over patients at the hospital. If conditions in the hospitals don't improve, hospitals may need to temporarily divert patients for a time until it's safe to reopen, which the county's Department of Public Health said would place significant pressure on other local hospitals that remain open.

Currently, the fastest-spreading COVID-19 variant in the U.S. is JN.1, representing about 21% of new cases, according to the Centers for Disease Control and Prevention.

The variant is closely related to the prior variant BA.2.86. It has just one additional change in its spike protein. This small change, the L455S mutation, may make it more apt to evade immune system responses, the CDC said.

JN.1 was first detected in the U.S. in September, and for the first month or so only accounted for 0.1% of coronavirus transmissions. The fact that it has continued to grow, and the rate at which it's growing, suggests that it's either more transmissible or is better at working around people's immune systems. Still, the CDC didn't find evidence that the variant presents an increased risk to public health compared to other current variants.

A new study in JAMA shows that people who have been hospitalized with COVID-19 perform worse on cognitive and neurological tests, suggesting impaired brain function. These cognitive struggles persist 18 months after the hospitalization, the data shows. Patients diagnosed with the coronavirus often had new psychiatric diagnoses, fatigue and impaired olfaction compared to the control group.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com