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Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 111-112

COVID-19 and outbreak of other respiratory infections: Call for national registries

Department of Pediatrics, All India Institute of Medical Sciences Patna, Bihar, India

Date of Submission16-Jun-2022
Date of Acceptance22-Jun-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Dr. Lokesh Tiwari
Department of Pediatrics, All India Institute of Medical Sciences Patna, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcc.jpcc_54_22

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How to cite this article:
Tiwari L. COVID-19 and outbreak of other respiratory infections: Call for national registries. J Pediatr Crit Care 2022;9:111-2

How to cite this URL:
Tiwari L. COVID-19 and outbreak of other respiratory infections: Call for national registries. J Pediatr Crit Care [serial online] 2022 [cited 2023 Feb 8];9:111-2. Available from: http://www.jpcc.org.in/text.asp?2022/9/4/111/351519

The current issue of Journal of Pediatric Critical Care comes out with an interesting paper reporting the outbreak of respiratory syncytial virus (RSV) infection in a tertiary care center in the months of August and September 2021 when we were recovering from the second peak of the COVID-19 pandemic in India.[1] 31% (36 out of 115) of all pediatric intensive care unit admissions during these 2 months were RSV positive, and two-thirds of them (n = 24) developed acute respiratory distress syndrome. Although the study is primarily not designed for the investigation of an outbreak, it is interesting in two aspects; first, the timing of the outbreak, and second, the severity of the disease. Annual epidemic outbreaks of RSV in India usually occur during winters, i.e., between October and March.[2] Low RSV load circulates during the whole year in susceptible adults and immunodeficient children which allows a continuous, low-level, and asymptomatic replication of the virus. When environmental factors are favorable for RSV, it erupts as an outbreak or local epidemics.[3]

While the whole healthcare system was busy handling the COVID-19 outbreak, it is interesting to understand what happened to seasonal or endemic infections and how the epidemiology got affected by the COVID-19 virus or by the nonpharmaceutical interventions (NPIs) implemented to control the spread of COVID-19 pandemic. Furthermore, it is critical to understand what is the possible trajectory of RSV infection in children in the coming season. In contrary to the RSV outbreak report from eastern India, many countries have reported a drastic fall in the number of children with RSV infection during the COVID-19 epidemic. It can be hypothesized that the restrictive measures such as lockdown, social distancing, use of face masks, and improved hand hygiene practices adopted to reduce SARS-CoV-2 transmission had an impact on other respiratory viruses including RSV that spreads through droplets, fomites, and surface contact.[4] As we do not have any RSV surveillance system in place in India, there are no national data to see the trend of RSV infection during the years 2020–2021 when COVID-19 pandemic peaks were unfolding in India and restrictive measures were stricter. The second wave of COVID-19 in India was seen from April to June 2021, and the case load became stable from July 2021.[5] It is likely that compliance to COVID-appropriate behavior decreased with time, resulting in the surge of RSV and other similar viral infections.

A recent paper from Australia showed a significant increase in RSV cases from September 2020 in Western Australia, where the usual peak is seen from June to September. It was greater than the average seasonal peak registered from 2012 to 2019.[6] The median age of the infected children was 18.4 months, which is significantly higher than in the previous epidemic seasons.[6]

Understanding the trajectory of RSV cases, it may be postulated that due to restrictive measures and NPIs used as part of COVID-19–appropriate behavior, RSV transmission was reduced during the COVID-19 pandemic, resulting in the increase of a susceptible pediatric cohort. The herd immunity of mothers to RSV would reduce and their infants remain unprotected. Recirculation of RSV among this larger cohort of immunologically naïve individuals will cause major and more severe epidemics as compared to seasonal trends of the infection. A mathematical model predicted that the longer the control measures will reduce the RSV diffusion, the larger the future epidemics will be.[7] The trends may be true, not only for RSV but also for other respiratory infections that spread through the respiratory route in Indian settings. Respiratory infections being one of the most common causes of childhood mortality, a robust surveillance system for these infections is the need of the hour. Till the organized registries and disease-specific surveillance systems are established, researchers and clinicians should be vigilant on changing trends of seasonal infections and the magnitude of respiratory pathogens in their practice.

  References Top

Mandal B, Roychowdhoury S, Barui P, Konar MC, Bhakta S, Nandi M, et al. Outbreak of respiratory syncytial virus infection in Eastern India during COVID-19 pandemic: An observational study from a single pediatric intensive care unit. J Pedaitr Crit Care 2002,9:124-130.  Back to cited text no. 1
Broor S, Parveen S, Maheshwari M. Respiratory syncytial virus infections in India: Epidemiology and need for vaccine. Indian J Med Microbiol 2018;36:458-64.  Back to cited text no. 2
[PUBMED]  [Full text]  
Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: The ups and down of a seasonal virus. Pediatr Infect Dis J 2003;22:S21-32.  Back to cited text no. 3
Di Mattia G, Nenna R, Mancino E, Rizzo V, Pierangeli A, Villani A, et al. During the COVID-19 pandemic where has respiratory syncytial virus gone? Pediatr Pulmonol 2021;56:3106-9.  Back to cited text no. 4
Coronavirus in India: Latest Map and Case Count. Available from: https://www.covid19india.org. [Last accessed on 2022 Jun 12].  Back to cited text no. 5
Foley DA, Yeoh DK, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, et al. The interseasonal resurgence of respiratory syncytial virus in Australian children following the reduction of coronavirus disease 2019-related public health measures. Clin Infect Dis 2021;73:e2829-30.  Back to cited text no. 6
Baker RE, Park SW, Yang W, Vecchi GA, Metcalf CJ, Grenell BT. The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections. Proc Natl Acad Sci USA 2020;117:30547-53.  Back to cited text no. 7


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