August 15, 2025Open Access

Changes in Pediatric RSV Hospitalizations after the COVID-19 Pandemic, 2022-2023, Canada: An Active Surveillance Study

ALAgnaldo José LopesUniversity Center Augusto Motta JEJoanne EmbreéAlberta Children's Hospital TJTaj JadavjiUniversity of Calgary

Key Points

In 2022-2023, there were 5362 RSV-associated hospitalizations in Canada, more than double the pre-pandemic averages.
Children under 6 months accounted for 62% of ICU admissions, highlighting their vulnerability during outbreaks.
The study utilized active surveillance across 13 centers to assess changes in RSV epidemiology due to the pandemic.
Findings suggest that updated RSV immunization strategies may significantly impact public health outcomes for infants.

Abstract

Abstract Background The COVID-19 pandemic impacted RSV epidemiology. We describe Canadian pediatric tertiary care RSV hospitalizations in 2022-2023 and assess pandemic-related changes. Methods Active surveillance of hospitalized children aged 0-16 years was conducted at 13 Immunization Monitoring Program, Active (IMPACT) centres. RSV hospitalizations in 2022-2023 were compared to those in the pre-pandemic period (2017-2018 through 2019-2020). Province-specific and age-stratified proportions of all-cause hospitalizations with RSV detection and age-stratified proportions of RSV-associated intensive care unit (ICU) admission were calculated. Changes in seasonality were assessed using Seasonal Autoregressive Integrated Moving Average (SARIMA) modelling. Results In 2022-2023, there were 5362 RSV-associated hospitalizations including 1260 (23.5%) ICU admissions, both more than double pre-pandemic yearly averages. Overall, median (IQR) age increased from 6 months (1-20) to 9 months (2-27; P<0.001). The proportion of RSV hospitalizations among all-cause hospitalizations increased by 3.5 percentage points (95% CI 3.3-3.7 percentage points), to 6.8% (95% CI 6.6%-7.0%). While 41.5% of RSV hospitalizations were among children <6 months old, they accounted for 62% of ICU admissions. Overall, ICU proportion remained constant; however, odds of ICU admission among infants <6 months old increased (adjusted OR 1.35, 95% CI 1.2-1.52) compared to the pre-pandemic period. National weekly incidence in 2022-2023 peaked earlier, higher and persisted longer than expected by SARIMA. Interpretations In 2022-2023, the number of RSV hospitalizations and ICU admissions increased dramatically in Canadian pediatric hospitals. Despite an older age distribution, the greatest burden remained in children <6 months old. RSV immunization strategies for young infants will likely have substantial potential public health impact.

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