High burden of acute respiratory tract infections leading to hospitalization at German pediatric hospitals: fall/winter 2022–2023
Authors: Doenhardt Maren , Armann Jakob P. , Diffloth Natalie , Gano Christin , Schneider Josephine , Schneider Dominik T. , Tenenbaum Tobias , Trotter Andreas , Berner Reinhard ,   the DGPI Ad hoc-ARI-register working group, Aderhold Martina , Althaus Jürgen , Andree Theresa , Ankermann Tobias , Apel Nils , Arens Stefan , Aumann Ulrich , Austgen Thomas , Baier Rebekka , Baresi Lisa , Baschin Marcel , Beil Stefanie , Bell Christiane , Bender Giulia , Bergmann Bernd , Bernlochner Sonja , Bettinger Silke , Biering Adina , Block Leonie , Böhme Henning , Bölke Carsten , Boßlet Timon , Bullmann Reinhard , Dobrianska Iryna , Ehrsam Christoph , Enders Martin , Erler Anna-Lisa , Evers Inge , Fiedler Andreas , Fingerloos Elisa , Pavlíková Veronika Galajda , Geerdts Lars , Glas Katharina , Gottschalk Julia , Grimm Anne , Gröger Katrin , Grosse Volkmar , Grotheer Anneke , Hecker Katharina , Heine Maik , Heubner Georg , Horakova Aneta , Horn Jennifer , Hubert Daniel , Jähnert Kristin , Jedwilayties Simone , Jehn Andrea , Jeyaweerasinkam Sumathy , Joiko Jasmin , Kalhoff Hermann , Kania Marcus , Kautzky Veronika , Keller Thomas , Kellerer Margit , Kersten Mandy , kinkelin Karoline , Klein Andreas , Kluthe Christof , Kobelt Louise , Kremsreiter Susanne , Kretzschmar Benno , Kriewitz Merten , Kuhl Sophia , Lautner Gerrit , Leone Vincenzo , Lohmeier Klaus , Lubitz Daniela , Mahncke Sabine , Mayer Anja , Meißner Peter , Meyer Egbert , Mohorovicic Marko , Müksch Barbara , Naust Barbara , Nippes Michael , Özdemir Esra , Penfold Denisa , Pindur Ursula , Pütz Daniela , Rappen Anke , Reichert Friedrich , Rosahl Marie-Charlotte , Ryba Miriam , Safarova Shahana , Salapata Asimina , Schick Christoph , Schlegel Anna , Schmeja Norbert , Schmid Juliane , Schmitz Robert , Schneider Dominik , Schneider Florian , Schrafstetter Anna , Schulteß Leonie , Schulze Johannes , Schunke Kerstin , Seidel Lavinia , Ghiath Shamdeen M , Sonntag Josef , Steidl Michael , Stiefel Tobias , Tabatabai Julia , Thurner Maren , Trapp Sandra , Ungerechts Mirjam , Unrath Manja , van den Heuvel Alijda Ingeborg , Vehse Kai , Verleysdonk Joshua , von Schnakenburg Christian , Wagner Simone , Wemhöner Andreas , Wichmann Barbara , Wiethoff Christiane Maria , Wollbrink Thomas , Wroblewski Andreas , Zügge Ulrich 
Published: November 2023

Abstract
Purpose
Given reduced immunity levels for seasonally occurring respiratory infections and the experience of an unusually early, severe wave of RSV infections during 2021, a preexisting clinician-led reporting system (CLRS) was updated to prospectively monitor the anticipated high burden of respiratory infections (ARI) in German pediatric hospitals during fall/winter 2022–2023.

Methods
From September 13, 2022 through March 31, 2023, children hospitalized with ARI as a primary diagnosis were monitored via a national CLRS established by the German Society for Pediatric Infectious Diseases (DGPI). Once a week, the CLRS collected overall number of new hospital admissions, ARI-related admissions according to pathogen (SARS-CoV-2, RSV, influenza, and other), plus number of patients admitted to ICU with ARI as a primary diagnosis.

Results
With a high participation among children's hospitals across Germany (22.8%), 76 centers submitted 1,053 survey reports. ARI-related hospital admissions showed a steep rise starting in late September 2022 and reached their highpoint in early December 2022 (50.1% of all admissions). In parallel, the average number of newly admitted patients (aNA) with RSV (3.6) peaked, as did those with influenza (2.1) one week later. The average highpoint of ARI patients on ICU (aICU) (2.9) was reached shortly thereafter. Again, RSV (1.6) und influenza (1.2) were predominant pathogens.

Conclusion
In fall/winter 2022–2023, German hospitals reported a sharp increase in patients with ARIs. While RSV and influenza represented the greatest proportion of ARI, SARS-CoV-2 played a less significant role. Systematic, dynamic collection of ARI data is critical for assessing real burdens on the health care system.