Seasonal epidemics of respiratory syncytial virus (RSV) cause a clinically significant burden of disease among young children. Non-pharmaceutical interventions targeted at SARS-CoV-2 have affected the activity of other respiratory pathogens. We describe changes in the epidemiology of RSV among children younger than 5 years in England since 2020.

Surveillance data on RSV infections, comprising laboratory-confirmed cases, proportion of positive tests, hospital admissions for RSV-attributable illness, and syndromic indicators for RSV-associated disease (emergency department attendances for acute bronchitis or bronchiolitis, non-emergency health advice telephone service [NHS 111] calls for cough, general practitioner [GP] in-hours consultations for respiratory tract infections, and GP out-of-hours contacts for acute bronchitis or bronchiolitis) were analysed from Dec 29, 2014 to March 13, 2022, for children younger than 5 years. Data were extracted from national laboratory, clinical, and syndromic surveillance systems. Time-series analyses using generalised linear models were used to estimate the effect of non-pharmaceutical interventions targeting SARS-CoV-2 on RSV indicators, with absolute and relative changes calculated by comparing observed and predicted values.

RSV-associated activity was reduced for all RSV indicators during winter 2020–21 in England, with 10 280 (relative change –99·5% [95% prediction interval –100·0 to –99·1]) fewer laboratory-confirmed cases, 22·2 (–99·6%) percentage points lower test positivity, 92 530 (–80·8% [–80·9 to –80·8]) fewer hospital admissions, 96 672 (–73·7% [–73·7 to –73·7]) fewer NHS 111 calls, 2924 (–88·8% [–90·4 to –87·2]) fewer out-of-hours GP contacts, 91 304 (–89·9% [–90·0 to –89·9]) in-hours GP consultations, and 27 486 (–85·3% [–85·4 to –85·2]) fewer emergency department attendances for children younger than 5 years compared with predicted values based on winter seasons before the COVID-19 pandemic. An unprecedented summer surge of RSV activity occurred in 2021, including 11 255 (1258·3% [1178·3 to 1345·8]) extra laboratory-confirmed cases, 11·6 percentage points (527·3%) higher test positivity, 7604 (10·7% [10·7 to 10·8]) additional hospital admissions, 84 425 (124·8% [124·7 to 124·9]) more calls to NHS 111, 409 (39·0% [36·6 to 41·8]) more out-of-hours GP contacts, and 9789 (84·9% [84·5 to 85·4]) more emergency department attendances compared with the predicted values, although there were 21 805 (–34·1% [–34·1 to –34·0]) fewer in-hours GP consultations than expected. Most indicators were also lower than expected in winter 2021–22, although to a lesser extent than in winter 2020–21.

The extraordinary absence of RSV during winter 2020–21 probably resulted in a cohort of young children without natural immunity to RSV, thereby raising the potential for increased RSV incidence, out-of-season activity, and health-service pressures when measures to restrict SARS-CoV-2 transmission were relaxed.

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