Respiratory syncytial virus-associated hospitalisation in children aged ≤5 years: a scoping review of literature from 2009 to 2021

Abstract

IntroductionFollowing the easing of COVID-19 restrictions in many countries, a surge in respiratory syncytial virus (RSV) hospitalisations was reported, surpassing yearly trends pre-pandemic. The changes to RSV epidemiology may have unforeseen effects on healthcare systems and populations globally, adding to the burden generated during the pandemic and placing increased demand on resources. Here we aim to identify recent global trends of RSV hospitalisation amongst children aged ≤5 years, to help inform policy makers in the planning of preventative interventions.MethodsWe conducted a scoping review of published literature between January 2009 and May 2021. Using keywords “Hospital admissions, Respiratory syncytial virus, RSV, Bronchiolitis, Children” we located studies using Medline, EMCARE, CINAHL and HMIC. Studies were eligible if they reported on trends/data for RSV hospitalisation amongst children aged ≤5 years. The articles were reviewed by two independent reviewers.FindingsWe assessed 3310 abstracts, reviewed 70 studies and included 56 studies in the final review. Findings were categorised into themes. The review highlighted that, although RSV incidence has been steadily increasing since 2009, the number of reported RSV hospitalisations decreased during lockdown. The highest numbers of hospitalisations were reported in children <1 years of age, particularly 0–2-month-old infants. Globally, RSV hospitalisations tend to peak in the winter months, however, since COVID-19 restrictions have eased, countries are reporting incidence peaks at different times, in contrast to the trends of previous years.ConclusionWith greater physical interactions due to the relaxation of COVID-19 restriction measures, RSV-related hospitalisations can be seen to increase amongst children aged ≤5 years, possibly surpassing the numbers reported in previous RSV seasons.

Respiratory syncytial virus: desperately seeking solutions

“…RSV infection is almost inevitable: more than 80% of infants contract the virus at least once by two years of age 4 . About four to six days after RSV infection, symptoms such as cough, sneezing, runny nose, fever, appetite loss and wheezing emerge and generally persist for a couple of weeks 5 .…”

“…The occasional patient develops severe RSV. But because RSV is ubiquitous in the population, the virus is responsible for about 80% of hospitalised bronchiolitis cases among children younger than one year of age in England 4 …”

“…The reasons underlying the seasonality are unclear. Suggested explanations include cold air inhibiting defences in the nasal passages, a link between temperature and RSV infection, and susceptible people crowding indoors 4 . To look at the latter from another angle: during Australia's COVID‐19 restrictions, such as handwashing, social distancing and lockdown, the number of RSV cases was 94.3% lower than predicted 4 .…”

“…Suggested explanations include cold air inhibiting defences in the nasal passages, a link between temperature and RSV infection, and susceptible people crowding indoors 4 . To look at the latter from another angle: during Australia's COVID‐19 restrictions, such as handwashing, social distancing and lockdown, the number of RSV cases was 94.3% lower than predicted 4 . “Social distancing is clearly highly effective in reducing cases of RSV, but it is neither socially acceptable nor feasible longer term,” Dr Williams comments.…”

“…So, how close are we to a highly effective RSV intervention? 4 About four to six days after RSV infection, symptoms such as cough, sneezing, runny nose, fever, appetite loss and wheezing emerge and generally persist for a couple of weeks. 5 The occasional patient develops severe RSV.…”