RSV More Severe, Affected Older Children in Colorado During the Pandemic


A recent study compared hospitalizations and ages of children with respiratory syncytial virus (RSV) infection before the pandemic and afterwards.

A research letter published in JAMA Pediatrics described hospitalizations in children related to respiratory syncytial virus (RSV) infection during 4 time periods in Colorado as well as theit age distributions to look at the possible effects of the pandemic.

A global resurgence of RSV occurred during the COVID-19 pandemic as hospitalization rates in young children surged. However, comparisons in the children hospitalized for RSV from before and after the COVID-19 pandemic has not been done. The research letter aimed to compare the age distributions and disease severity of RSV in children from Colorado who were infected between 2018 and 2023.

Public health surveillance data from the CDC Emerging Infections Program (EIP) RSV Hospitalization Surveillance Network was used for this study. Residents of the Colorado EIP catchment who were younger than 18 years and hospitalized at the Children’s Hospital Colorado with polymerase chain reaction (PCR)–confirmed infection of RSV were included in the analysis.

There were 4 periods analyzed when comparing age distribution of children who were hospitalized with RSV: 2018-2019, 2019-2020, 2021-2022, and 2022-2023; the 2020-2021 period only had 1 infection and was therefore excluded. All children who went to the Children’s Hospital Colorado after October 2021 had a combination of COVID-19/influenza/RSV PCR testing. Length of hospital stay and median age were also compared.

There were 2809 children who were included in the analysis; the children had a mean (SD) age of 21.6 (25.6) months and 53.3% were boys. The researchers found that 97.5% and 98.8% of hospitalizations were directly related to RSV infection in the 2021-2022 and 2022-2023 periods respectively.

The researchers also found that the age distributions of the children differed in these periods; a median (IQR) age of 11.0 (3.0-26.0) months was found in the months prior to 2022-2023 compared with a median age of 18.5 (6.0-37.8) months in the first 6 weeks of the 2022-2023 period. Children hospitalized for RSV in 2022-2023 were more frequently aged 2 to 5 years (34.2% in 2022-2023 vs 23.4% in prior years) and aged 5 to 12 years (9.7% in 2022-2023 and 5% in prior years respectively).

A total of 27.1% of hospitalized children were transferred to the intensive care unit in 2021-2022 vs 36.0% in 2022-2023; the median length of stay was 3.0 and 3.8 days respectively.

Data from a single region and variation in testing were 2 of the limitations on this research.

The researchers concluded that infections of RSV in children affected hospitalizations. The age demographic for hospitalizations for RSV were slightly altered when comparing the years. The researchers said that “these data may help inform the introduction of imminent new RSV prevention strategies, including vaccines and monoclonal antibodies, to minimize disease burden in this age group.”


Rao S, Armistead I, Messacar K, et al. Shifting epidemiology and severity of respiratory syncytial virus in children during the COVID-19 pandemic. JAMA Pediatr. Published online May 15, 2023. doi:10.1001/jamapediatrics.2023.1088

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