Molecular epidemiology of respiratory syncytial virus in children with acute respiratory illnesses in Africa: A systematic review and meta-analysis

Abstract

Background Globally, the respiratory syncytial virus (RSV) is the most common etiologic agent of acute respiratory illnesses in children. However, its burden has not been well addressed in developing countries. We aimed to estimate the molecular epidemiology of RSV in children less than 18 years of age with acute respiratory infections in Africa by conducting a systematic review and meta-analysis. Methods We systematically searched PubMed, Scopus, CINAHL, and Global Index Medicus databases to identify studies published from January 1, 2002, to April 27, 2022, following the PRISMA 2020 guideline. We assessed the study quality using the Joanna Brigg’s Institute (JBI) critical appraisal checklists. We conducted a qualitative synthesis by describing the characteristics of included studies and performed the quantitative synthesis with random effects model using STATA-14. We checked for heterogeneity with Q statistics, quantified by I 2 , and determined the prediction interval. We performed subgroup analyses to explain the sources of heterogeneity and assessed publication biases by funnel plots augmented with Egger’s test. Results Eighty-eight studies with 105 139 participants were included in the review. The overall pooled prevalence of RSV in children <18 years of age was 23% (95% confidence interval (CI) = 20, 25%). Considerable heterogeneity was present across the included studies. The adjusted prediction interval was found to be 19%-27%. Heterogeneities were explained by subgroups analyses. The highest prevalence of RSV was found among inpatients, 28% (95% CI = 25, 31%) compared with inpatients/outpatients and outpatients, with statistically significant differences ( P < 0.01). The RSV estimate was also highest among those with acute lower respiratory tract illnesses (ALRTIs), 28% (95% CI = 25, 31%) compared with acute upper respiratory tract illnesses (AURTIs) and both acute upper/lower respiratory manifestations, with statistically different prevalence ( P < 0.01). RSV infection estimates in each sub-region of Africa were statistically different ( P < 0.01). There were no statistically significant differences in RSV infections by designs, specimen types, and specimen conditions, despite them contributing to heterogeneity. Conclusions We found a high prevalence of RSV in pediatric populations with acute respiratory tract illnesses in Africa, highlighting that the prevention and control of RSV infections in children deserve more attention. Registration PROSPERO CRD42022327054

Impact of Nonpharmaceutical Interventions during the COVID-19 Pandemic on the Prevalence of Respiratory Syncytial Virus in Hospitalized Children with Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

“…Remarkably, our observations are similar to those of the meta-analysis conducted by Regassa et al [ 26 ], which studied RSV prevalence in hospitalized children with LRTIs in Africa and reported a pooled prevalence of 23% [95% CI: 20.0; 25.0]. Similarly, a systematic review conducted by Pratt et al [ 27 ] in hospitalized children with community-acquired pneumonia covering the pre-pandemic era showed an RSV pooled prevalence of 22.7% [95% CI: 20.9; 24.5], closely aligning with our results for the same period.…”

“…Moreover, the use of nasopharyngeal secretions and sputum specimens was linked to a higher prevalence of RSV compared to other sample types, possibly due to the higher viral load present in the nasopharynx [ 43 , 44 ]. These findings are consistent with a systematic review by Regassa et al [ 26 ] involving African children, which supports the importance of sample types in estimating RSV prevalence. This observation underscores the significance of diagnostic techniques in accurately assessing RSV prevalence and suggests that molecular assays could be more reliable for surveillance and clinical management.…”

“…Although random-effects models accounted for this heterogeneity, it is vital to interpret the findings cautiously. Our data demonstrated significant similarity to five systematic reviews and meta-analyses that focused on the prevalence of RSV in hospitalized children with LRTIs [26,27,[45][46][47]. These studies also reported high heterogeneity, with I 2 values ranging from 90% to 99%, consistent with our findings.…”

Impact of Nirsevimab Immunization on Pediatric Hospitalization Rates: A Systematic Review and Meta-Analysis (2024)

“…A highly contagious and diffusive pathogen [ 18 , 25 ], at the global level, RSV causes approximately 33 million cases of ARIs and LRTIs in infants aged 5 years old or less every year [ 4 , 5 , 26 ], with high hospitalization rates [ 27 , 28 , 29 , 30 , 31 ] leading to around 3.5 million hospital admissions [ 3 , 5 ]. Even though RSV can result in a high case fatality ratio in children affected by pre-existing comorbidities [ 4 , 5 , 19 , 21 , 26 , 32 , 33 ], most of the cases occur in otherwise healthy infants [ 4 , 34 ] and are usually clustered in seasonal epidemics (i.e., “RSV season”) associated with seasonal climate that forces individuals in enclosed spaces, increasing the likelihood for the inter-human spreading of the pathogen [ 35 , 36 , 37 , 38 ]. Therefore, the RSV season in the Northern Hemisphere has historically been associated with the winter season, peaking between December and January [ 4 , 26 ], extensively overlapping with other respiratory viruses such as influenza and adenovirus [ 39 , 40 ] and, more recently, with SARS-CoV-2 [ 41 , 42 ], as well as with the hot, humid, and rainy climates of the summer season in tropical countries [ 36 , 37 , 43 , 44 ].…”