Respiratory Syncytial Virus: An Uncommon Cause of Febrile Seizures—Results from a Systematic Review and Meta-Analysis

Abstract

Human Respiratory Syncytial Virus (RSV) is a highly contagious viral pathogen. In infants, it is usually listed among the main causes of medical referrals and hospitalizations, particularly among newborns, and a considerable base of evidence associates RSV infections and bronchiolitis with long-term neurological sequelae. We specifically performed a systematic review and meta-analysis in order to ascertain whether RSV infections may be associated with an increased risk for febrile seizures (FS) in infected infants. According to the PRISMA statement, Pubmed, Embase, and pre-print archive medRxiv.og were searched for eligible observational studies published up to 1 July 2022. Raw data included the incidence of FS among children admitted for influenza-like illness (ILI) and/or bronchiolitis, with a confirmed diagnosis of RSV or seasonal influenza virus (SIV) infection. Data were then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 11 studies including 6847 cases of RSV infections were retrieved, with a pooled prevalence of 29.975 cases of FS per 1000 RSV cases (I2 = 88.5%). The prevalence was not substantially greater in studies performed in pediatric intensive care units (53.817 per 1000 RSV cases vs. 23.552, p = 0.12). Higher occurrence of FS was reported from studies performed after 2010 (Risk Ratio [RR] 1.429, 95% Confidence Interval [95%CI] 1.049–1.948), and in China (RR 2.105, 95%CI 1.356–3.266) and South Africa (RR 1.722, 95%CI 1.060–2.824) than in Europe, while a lower occurrence was reported form the USA (RR 0.414, 95%CI 0.265–0.649). Eventually, FS were less likely reported from RSV cases compared to subjects affected by seasonal influenza (RR 0.402; 95%CI 0.228–0.708). Although RSV is often associated with high risk of neurological complications, substantially less cases of FS are reported than in SIV infections. However, the paucity of available studies recommends a cautious appraisal of aforementioned results.

Rate of Hospitalizations and Mortality of Respiratory Syncytial Virus Infection Compared to Influenza in Older People: A Systematic Review and Meta-Analysis

“…Third, no study was made in Asia, limiting the generalization of our findings in these countries. Finally, the admission rate in ICU was not available for almost all studies included in our systematic review, but the admission in ICU represents an important risk factor for mortality, as shown in pediatric population [51]. However, it has been reported that ICU admission rate is similar for RSV and influenza older patients [25].…”

Infodemiology of RSV in Italy (2017–2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age?

“…In addition to the aforementioned critical issue represented by the limited representativity of ILI for actual RSV cases, our study is affected by several other limits that should be accurately addressed. First and foremost, although the InfluNet surveillance network has been designed in order to provide estimates that could be acknowledged as representative of the general Italian population [ 19 , 22 , 24 , 51 , 84 ], its original design specifically targeted influenza and influenza-like syndromes, and it can deliberately miss LRTIs because of its clinical features, which are far more representative of RSV than ILI themselves [ 1 , 2 , 20 , 29 , 85 ]. In this regard, it should be stressed that while the European data have identified a certain circulation of RSV at the national level, even after the end of conventional surveillance for ILI, Italy did not extend the surveillance season in 2020–2021 or in 2021–2022, compromising the capability of the InfluNet to properly track down RSV infections [ 58 , 86 , 87 ].…”

“…On the contrary, enforced surveillance systems may fail to properly track a pathogen such as RSV, the circulation of which is primarily based on local, low-rate transmission [ 88 , 89 , 90 , 91 ]. In this regard, while seasonal and pandemic influenza guarantee some sort of long-term immunity against their respective pathogens, as unexpectedly stressed by the recent A(H1N1)v pandemic [ 50 , 51 , 92 , 93 ], RSV infections elicit a short-lived mucosal immunity that reduces the risk for systemic complications in the subsequent months, but it does not abolish the risk for new, symptomatic infections, as stressed by the epidemic of 2021–2022 [ 1 , 2 , 53 , 54 , 55 , 61 , 62 , 63 , 85 ].…”

Prospective Attitudes towards Respiratory Syncytial Virus (RSV) Vaccination: Validation of a Survey Instrument among Young Females in Jordan Pending Vaccine Authorization

“…According to the Global Burden of Diseases, Injuries, and Risk Factors Study, RSV was implicated in 10.7 million cases of lower respiratory tract infections (LRTI) and over 41,000 deaths among children below the age of 5 years in the year 2016, despite the difficulty in obtaining accurate estimates [ 5 , 6 ]. The high burden of RSV infections is also manifested in its greater risk among infants compared to other respiratory viruses (e.g., influenza virus), highlighting the extensive burden of RSV on health care services and the need for effective preventive measures to reduce its burden [ 7 , 8 , 9 , 10 ]. In Jordan, previous studies showed the substantial burden of RSV disease in children in terms of severity, longer hospital stays, and financial costs [ 11 , 12 ].…”