COVID-19 Lesson for Respiratory Syncytial Virus (RSV): Hygiene Works

Abstract

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (LRTIs) in infants worldwide. The global direct medical cost associated with RSV LRTIs reaches billions of dollars, with the highest burden in low–middle-income countries. Many efforts have been devoted to improving its prevention and management, including both non-pharmaceutical and pharmaceutical strategies, often with limited routine use in high-income countries due to high costs. During the ongoing COVID-19 pandemic, a dramatic decrease in RSV infections (up to 70–90%) has been reported around the globe, directly related to the implementation of containment measures (face masks, hand hygiene, and social distancing). Primary prevention has demonstrated the highest cost effectiveness ratio in reducing the burden of a respiratory infection such as RSV, never reached before. Thus, we emphasize the importance of non-pharmaceutical preventive hygiene measures that should be implemented and maintained even after the COVID-19 outbreak.

Preventing Respiratory Syncytial Virus in Children in France: A Narrative Review of the Importance of a Reinforced Partnership Between Parents, Healthcare Professionals, and Public Health Authorities

“…NPI cannot reasonably be applied throughout childhood and throughout the period of intense RSV circulation; however, behavioural changes among household contacts of newborns and young infants (i.e. increased hand washing, covering the mouth when coughing, and avoidance of large gatherings and close contact with sick people) are likely to assist in decreasing the incidence of infection in infants aged 3 months or younger [ 25 , 27 ] and, therefore, ongoing promotion of these measures is recommended [ 25 , 36 ].…”

“…During the first 2 years of the COVID-19 pandemic, the benefits of non-pharmaceutical measures on RSV infection in infants have been obvious, although temporary, since the benefits were suspended when the restrictions were lifted [ 25 ]. Now, the impetus should be to prevent the onset of pandemic restriction “fatigue” and encourage people to maintain certain long-term non-pharmaceutical hygiene measures.…”

“…In particular, appropriate use of masks, physical distancing, avoiding close contact with sick people, covering the mouth when coughing, and hand and surface hygiene measures should remain a major public health priority to prevent RSV infection and illness. These measures should be actively promoted in the families of all children up to 1 year of age (but particularly in those who have children younger than 3 months) in France, and other countries, for the foreseeable future, at least during the classical period of RSV seasonal epidemics [ 25 , 27 , 47 ]. Healthcare systems need to be prepared for future annual outbreaks of RSV infections as public health interventions and international travel restrictions are inevitably relaxed [ 29 , 48 – 50 ].…”

Respiratory Syncytial Virus: Knowledge, Attitudes and Beliefs of General Practitioners from North-Eastern Italy (2021)

“…Human RSV is associated with a substantial burden of disease in children and elders [ 7 , 10 , 35 , 38 , 42 , 50 , 51 ]. NPI, due to the SARS-CoV-2 pandemic, have led to the substantial disappearance of the conventional seasonal trend for RSV infections [ 1 , 24 , 29 , 30 , 31 , 52 , 53 , 54 , 55 , 56 , 57 ], that have been in turn followed by an unprecedented surge in incident cases [ 29 , 30 , 31 , 52 , 58 , 59 ]. Accurate statistics are unavailable, but GPs and pediatricians usually manage up to 97% of yearly incident cases as outpatients [ 16 , 60 , 61 ], representing a substantial burden for primary practitioners still struggling with the requirements of the SARS-CoV-2 pandemic.…”

Age-dependent rebound in asthma exacerbations after COVID-19 lockdown

“…Recently, some authors have suggested that viral mitigation measures such as masking may be an effective approach for managing asthma and COPD going forward based on the dramatic reductions in disease exacerbations during lockdown. 1,19 However, our data would suggest caution in applying viral mitigation strategies to young children with asthma because withdrawal of these measures led to an overcorrection in viral positivity and asthma cases. Such an overcorrection is biologically plausible because young children are immunologically naive.…”