ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2024
Increased Pediatric Respiratory Syncytial Virus Case Counts Following the Emergence of SARS-CoV-2 Can Be Attributed to Changes in Testing.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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35 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Co-circulating pathogens of humans: a systematic review of mechanistic transmission models.Proceedings. Biological sciences · 2025Pooled it
- Postpandemic Trends in Pediatric Respiratory Virus Hospitalizations: A Multicenter Study, 2019-2025.Influenza and other respiratory viruses · 2026Article
- Respiratory Syncytial Virus Suppression through Public Health and Social Measures, Hong Kong, China, 2020-2023.Emerging infectious diseases · 2026Article
- Correlations and Timeliness of Respiratory Syncytial Virus Surveillance Indicators-United States, 2018-2024.Influenza and other respiratory viruses · 2026Article
- Respiratory Syncytial Virus Seasonality and Disease Severity Among Children Under 5 in Atlanta, Georgia, United States, 2018-2023.Open forum infectious diseases · 2026Article
- Evaluating Analytic Approaches to Determining Respiratory Syncytial Virus Seasonality-United States, 2014-2024.Influenza and other respiratory viruses · 2026Article
- Common respiratory virus spectrum and epidemiological trends among children in Northwest China during the post-COVID-19 era.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- RSV Prevention Products and Severe RSV-Associated Disease Among Infants.JAMA network open · 2026Article
- Paediatric infection hospital admissions in England before, during, and after the COVID-19 pandemic.Epidemiology and infection · 2026Article
- Characteristics of Young Children Hospitalized With Acute Respiratory Failure From Infection With Respiratory Syncytial Virus, SARS-CoV-2, or Both, November 2023-March 2024.Open forum infectious diseases · 2026Article
- Viral Immunity in Immunoglobulin Products: Global Immunity Debt and Autoimmunity in the Postpandemic Era.European journal of immunology · 2026Article
- Corrected and republished from: "Clinical validation of an RSV neutralization assay and analysis of cross-sectional sera associated with 2021-2023 RSV outbreaks to investigate the immunity debt hypothesis".Microbiology spectrum · 2026Article
- Epidemiological diversity of seasonal influenza and post-COVID-19 pandemic changes in the UK, 2015-2025: a surveillance-based analysis.BMC public health · 2026Article
- Comparative Diagnostic Performance of the 36-Minute STANDARD M10 Fast Assay for Molecular Diagnosis of SARS-CoV-2, Influenza A and B, and Respiratory Syncytial Virus in Near-Patient Settings.Infectious diseases and therapy · 2026Article
- Changes in the Epidemiology of Influenza and Respiratory Syncytial Virus During 2020-2022 Relative to the Pre-COVID-19 Pandemic Period (2017-2020) From Systematic Sentinel Syndromic Surveillance in South Africa.Influenza and other respiratory viruses · 2026Article
- Observational
- Healthcare costs and resource utilization for acute respiratory syncytial virus pediatric hospitalizations in Canada: a population-based study.Lancet regional health. Americas · 2025Article
- Epidemiology and Burden of Human Metapneumovirus Among Italian Adults in Outpatient and Inpatient Settings, 2014-2025.Influenza and other respiratory viruses · 2025Article
- Pediatric Acute Respiratory Virus Hospitalizations: A Population-Based Cohort Study, 2017-2024.The Journal of infectious diseases · 2025Article
- Shifts in Influenza and Respiratory Syncytial Virus Infection Patterns in Korea After the COVID-19 Pandemic Resulting From Immunity Debt: Retrospective Observational Study.JMIR public health and surveillance · 2025Observational
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4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundRespiratory syncytial virus (RSV) circulation dropped markedly early in the COVID-19 pandemic, followed by a resurgence with heightened case counts. The "immunity debt" hypothesis proposes that the RSV-naїve pediatric population increased during the period of low transmission. However, the evidence supporting this hypothesis is limited, and the role of changing testing practices in the perceived surge has not been comprehensively evaluated.
methodsWe conducted a multicenter, retrospective analysis of 342 530 RSV encounters and 980 546 RSV diagnostic tests occurring at 32 US pediatric hospitals in 2013-2023. We used interrupted time series analysis to estimate pandemic-associated changes in RSV patient and test volume and to quantify changes in the proportions of patients requiring hospitalization, intensive care, or mechanical ventilation. We quantified the fraction of the shifts in case counts and in the age of diagnosed patients attributable to changes in testing.
resultsRSV patient volume increased 2.4-fold (95% confidence interval [CI]: 1.7, 3.5) in 2021-2023 relative to the pre-pandemic phase and was accompanied by an 18.9-fold increase (95% CI: 15.0, 23.9) in RSV test volume. Shifts in patient volume and in patient age were largely attributable to increased testing. The proportions of patients with RSV that required hospitalization, intensive care, or mechanical ventilation declined significantly across all patient age groups.
conclusionsA surge in RSV testing, rather than in viral circulation, likely underlies the increased case counts observed in 2021-2023. These findings warrant a critical assessment of the immunity debt hypothesis and highlight the importance of considering the testing denominator when surveillance strategies are dynamic.
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