RSV infections: five times as many hospital treatments for newborns and infants in winter 2022

02.03.2023 14:44

In newborns and infants, hospital treatments with the so-called RS virus have increased dramatically during the pandemic. The number of under-one-year-olds with respiratory syncytial virus (RSV) was five times higher in the fourth quarter of 2022 than in the same period in 2018. Extrapolated from all children living in Germany, around 17,000 newborns and infants had to be treated in hospital in winter 2022. The proportion in intensive care units increased by 350 percent.

This is shown by a representative DAK special analysis of the children and youth report. DAK-Gesundheit was the first health insurance company to examine the hospital treatment of children and adolescents with regard to RSV infections by the end of 2022. Doctors are observing significant catch-up effects after the corona pandemic. DAK boss Andreas Storm sees an acute need for political action.

For the DAK special analysis as part of the children and youth report, scientists from Vandage and Bielefeld University examined billing data from around 786,000 children and young people up to the age of 17 who are insured with DAK-Gesundheit. The years 2017 to 2022 were analyzed. This is the first time that the health insurance company is presenting current data on RSV infections and respiratory diseases. According to the analysis, hospital treatments for newborns and infants with RSV infection increased fivefold compared to the fourth quarters of 2022 and 2018. The increase also occurred in particularly severe cases: the number of treatments in intensive care units quadrupled.

Better prepare clinics and outpatient areas for waves of infection

“Our analysis paints a dramatic picture and makes it clear: There is an acute need for political action,” says Andreas Storm, CEO of DAK-Gesundheit. “We must be better prepared for waves of infection in the hospital and outpatient sector in the future. It cannot be the case that existing treatment places cannot be used due to a lack of staff. We absolutely have to avoid that in the future.” The immediate political measures, such as additional funding for children's clinics or the treatment of respiratory diseases by pediatricians in private practice, were in the right direction. Storm expressly welcomes these measures. However, the upcoming reforms must also lead to structural changes. “The measures adopted to improve care for children and young people must be implemented consistently and quickly,” said Storm. “The main thing is to protect the health of newborns and infants. We have to do everything we can to ensure that children in this country grow up well and healthy.”

Noticeably more children receive inpatient care

The DAK special analysis makes it clear that almost no children with RSV infections were treated in hospital during the Covid-19 pandemic. After the corona pandemic, the peak of the RSV wave has been postponed. And noticeably more children received inpatient care: the proportion of newborns and infants who were treated in hospital with RSV increased threefold in the 2021/22 season compared to the 2018/19 season. Extrapolated, around 30,000 newborns and infants nationwide had to be cared for in clinics in the 2021/22 season. Respiratory diseases are a comparatively common reason for hospital treatment in children and adolescents. In the 2021/22 season, a total of 64 percent of all hospital stays among children and adolescents were due to respiratory infections. 17 percent of all children treated in hospitals with respiratory diseases were newborns and infants under one year of age.

Significant catch-up effects as a result of the Corona measures

The results show exactly what we experienced in the practices,” says Dr. Thomas Fischbach, President of the Professional Association of Pediatricians and Adolescents. RSV infections are the cause of typical seasonal respiratory infections that occur in waves. These waves are unpredictably strong, which of course has a significant impact on the burden of disease, and not just in hospitals. “The 2020/21 season has almost been canceled due to the Corona protective measures. This failure of the 2020/21 wave and the bringing forward of the very strong 2021/22 wave lead to the conclusion that there have been significant catch-up effects as a result of the Corona measures.”

Corona measures have significantly reduced the incidence of infection in all age groups

This is also confirmed by Prof. Dr. med. Johannes G. Liese, Head of the Department of Pediatric Infectious Diseases and Immunology at the University Hospital of Würzburg: “The particularly heavy burden of disease caused by RSV diseases in autumn 2021 and autumn/winter 2022/23 has various reasons. First and foremost, the non-pharmaceutical measures during the corona pandemic such as contact bans or school closings should be mentioned. This led to an abrupt termination of the 2019/2020 RSV season in March 2020 and an almost complete cancellation of the RSV season in autumn/winter 2020/2021.” This would have significantly reduced the usual incidence of infection in all age groups. “The catching up or catching up of these RSV infections after the corona measures were relaxed led to an extremely strong increase in RSV diseases in all age groups,” said Liese. “This was particularly evident in the disease burden of newborns and infants, who often require hospital treatment.”

Many newborns and infants could not be admitted to hospital despite the significant burden of illness

For BVKJ President Fischbach, it is striking that an unusually large number of newborns and infants could not be admitted to hospital despite the considerable burden of illness because there was no more space in the clinics. This led to a significant amount of care and support in outpatient care, as close controls would have been necessary. “The clinics were working at their capacity limits, which was not least due to high staff absences due to corona. This also applied to the outpatient care area,” says Fischbach. The DAK special analysis shows how important infection surveillance is. “It is important to wait and see further developments and to closely monitor the RSV epidemiology in the coming years,” says Fischbach. “At the same time, bed capacity and staffing levels in children’s hospitals and departments need to be improved. We need more pediatric nurses, who must be recruited through specialist training. The same applies to the profession of medical assistant (MFA), which needs to become more attractive.”

Substantially better equipment for children's hospitals is required

Professor Liese also calls for more staff in the children's hospitals: “We need substantially better equipment in the children's hospitals, which also takes into account the seasonal fluctuations in occupancy - especially due to the RS virus - and continues to enable good care in these times of overload ", he says. Liese also suggests networking among children's hospitals. “A system is needed as quickly as possible to exchange clinics with free bed capacities, similar to Covid-19.” Better research funding is also important when it comes to the epidemiology, prevention and therapy of RS virus infections.

With 5.5 million insured people, DAK-Gesundheit is the third largest health insurance company in Germany and is particularly committed to child and youth health.