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Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia
  1. David Anthony Foley1,2,
  2. Linny Kimly Phuong3,
  3. Joseph Peplinski4,
  4. Selina Mei Lim5,
  5. Wei Hao Lee4,
  6. Asifa Farhat4,
  7. Cara A Minney-Smith1,
  8. Andrew C Martin4,
  9. Ariel O Mace4,
  10. Chisha T Sikazwe1,6,
  11. Huong Le2,
  12. Avram Levy1,6,
  13. Tobias Hoeppner7,
  14. Meredith L Borland7,8,
  15. Briony Hazelton1,5,
  16. Hannah C Moore2,
  17. Christopher Blyth1,2,9,
  18. Daniel K Yeoh5,
  19. Asha C Bowen2,5
  1. 1Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
  2. 2Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
  3. 3Murdoch Children’s Research Institute, Infection and Immunity, Parkville, Victoria, Australia
  4. 4Department of General Paediatrics, Perth Children’s Hospital, Nedlands, Western Australia, Australia
  5. 5Infectious Diseases Department, Perth Children’s Hospital, Perth, Western Australia, Australia
  6. 6Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
  7. 7Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
  8. 8Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
  9. 9School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
  1. Correspondence to Dr David Anthony Foley, Microbiology, PathWest Laboratory Medicine, Perth, WA 6009, Australia; dfoley3{at}


Background Following a relative absence in winter 2020, a large resurgence of respiratory syncytial virus (RSV) detections occurred during the 2020/2021 summer in Western Australia. This seasonal shift was linked to SARS-CoV-2 public health measures. We examine the epidemiology and RSV testing of respiratory-coded admissions, and compare clinical phenotype of RSV-positive admissions between 2019 and 2020.

Method At a single tertiary paediatric centre, International Classification of Diseases, 10th edition Australian Modification-coded respiratory admissions longer than 12 hours were combined with laboratory data from 1 January 2019 to 31 December 2020. Data were grouped into bronchiolitis, other acute lower respiratory infection (OALRI) and wheeze, to assess RSV testing practices. For RSV-positive admissions, demographics and clinical features were compared between 2019 and 2020.

Results RSV-positive admissions peaked in early summer 2020, following an absent winter season. Testing was higher in 2020: bronchiolitis, 94.8% vs 89.2% (p=0.01); OALRI, 88.6% vs 82.6% (p=0.02); and wheeze, 62.8% vs 25.5% (p<0.001). The 2020 peak month, December, contributed almost 75% of RSV-positive admissions, 2.5 times the 2019 peak. The median age in 2020 was twice that observed in 2019 (16.4 vs 8.1 months, p<0.001). The proportion of RSV-positive OALRI admissions was greater in 2020 (32.6% vs 24.9%, p=0.01). There were no clinically meaningful differences in length of stay or disease severity.

Interpretation The 2020 RSV season was in summer, with a larger than expected peak. There was an increase in RSV-positive non-bronchiolitis admissions, consistent with infection in older RSV-naïve children. This resurgence raises concern for regions experiencing longer and more stringent SARS-CoV-2 public health measures.

  • virology
  • respiratory medicine
  • child health

Data availability statement

Data may be obtained from a third party and are not publicly available. De-identified data may be obtained upon request through the Perth Children's Hospital ethic and governance system.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data may be obtained from a third party and are not publicly available. De-identified data may be obtained upon request through the Perth Children's Hospital ethic and governance system.

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  • Funding This was an investigator-initiated project supported by a clinician–scientist partnership grant from the Wesfarmers Centre for Vaccines and Infectious Diseases (2020). DY is supported by an Australian Government Research Training Program Postgraduate Scholarship. AOM is supported by an NHMRC Postgraduate Scholarship (1191465) and an Australian Government Research Training Program Fees Offset. ACM is supported by a Raine Clinician Research Fellowship. CB is supported by an NHMRC Career Development Fellowship (GNT1111596). HCM is supported by a Telethon Kids Institute Emerging Research Leader Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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