How has the SARS-CoV-2 pandemic changed the epidemiology and management
of acute bronchiolitis?
Abstract
Objective: SARS-COV-2 pandemic had a profound impact on acute
bronchiolitis epidemiology, especially in RSV diffusion and the burden
of disease with implications on the management of prophylaxis and health
resources. We aimed to compare clinical and epidemiological
characteristics of bronchiolitis before and during the SARS-CoV-2
pandemic. Methods: We conducted an observational study
involving children aged 0-2 years with bronchiolitis admitted to a
tertiary children’s hospital during the last 5 years. Demographic,
clinical, microbiological, and outcome data were collected. Comparison
between pre- and post-pandemic period, RSV positive versus non-RSV
patients, and SARS-CoV-2 positive vs negative patients were carried
out. Results: A total of 647 patients admitted for
bronchiolitis were included (264 female,40.8%, median age 78 days).
Molecular diagnostic tests were performed in 617 patients (95.4%) with
RSV detected in 62.5% of patients. SARS-CoV-2 was found in 3.9% of
hospitalized bronchiolitis (3.9%). We observed a progressive increase
in bronchiolitis admissions and a statistically significant increase
over the years in the need for respiratory support. Conversely, this was
not true for mechanical ventilation, duration of respiratory support,
ICU admission, and length of stay. During the pandemic period children
with prematurity increased, although only 1 child had an indication for
prophylaxis. Discussion: We confirm the stronger impact of
bronchiolitis in the 2021-22 season, which is likely explained by the
higher prevalence of RSV and the immunity debt theory. However, our
findings were conflicting in terms of worsening clinical severity. The
increase of children with prematurity and the inter-seasonal spread of
RSV highlight the importance of epidemiological surveillance systems
that monitor RSV circulation.