Defining the Burden of Disease of RSV in Europe: estimates of RSV-associated hospitalisations in children under 5 years of age. A systematic review and modelling study

Abstract

Background: Respiratory syncytial virus (RSV) infections cause an estimated 22-50 million episodes of acute lower respiratory infections (ALRI) every year in children younger than 5 years. To date, no overall estimate of RSV-associated hospitalisations in children under 5 years has been published for the European Union (EU). Through statistical modelling, we estimated the RSV hospitalisation burden in children under 5 years of age in EU countries and Norway, by age group and country. Methods: We collated national RSV-associated hospitalisation estimates calculated using linear regression models in children under 5 years via the RESCEU project for Denmark, England, Finland, Norway, the Netherlands and Scotland during 2006-2018. A systematic literature review was conducted to collect additional estimates. Using the multiple imputation and nearest neighbor matching extrapolation methods, we estimated RSV-associated hospitalisation rates in all EU countries. Results: Additional estimates for Spain and France were found in the literature and added to the analysis. We estimated that an average of 245,244 (95%CI 224,688-265,799) hospital admissions with a respiratory infection per year were associated with RSV in children under the age of 5, with most cases occurring among children aged less than 1 year (75%). Infants aged less than 2 months represented the most affected group (71.6 per 1,000 children; 95%CI: 66.6-76.6). The hospitalisation rates varied widely across countries: for example, estimated rates in the 0-2 months age group ranged from 47.4 (37.5-57.3) per 1,000 in the Netherlands to 98.3 (88.5-108.1) per 1,000 in France. Conclusion: To our knowledge, this is the first attempt to estimate the overall RSV hospitalisation burden in children under the age of 5 years in the EU. Our findings will help support decisions regarding prevention efforts, and they will also represent an important benchmark to understand changes in the RSV burden following the introduction of RSV immunisation programs in Europe.

Estimation of the number of RSV-associated hospitalisations in adults in the European Union

“…The highest annual count of RSV-associated hospitalisations occurred among adults aged 75-84 years and the highest rate of RSV-associated hospital admissions occurred among adults over 85 years. It is important to note that for a condition which was considered in the past to be primarily a disease of young children, the average RSV-associated hospitalisation estimate in adults was lower, but of a similar magnitude to that in children aged 0-4 years: 158 229 (95%CI: 140 865 – 175 592) versus 245 244 (95%CI: 224 688 – 265 799) hospitalisations per year [25]. Indeed, taking the estimates for children aged 0-4 years into account; we estimate that 39% (145 604 out of 371 299) of the annual number of RSV-associated hospitalisations in the EU occurred in persons aged 65 years and older.…”

Clinical and economic inpatient burden of respiratory syncytial virus (RSV) infections in children < 2 years of age in Germany, 2014-2019: a retrospective health claims analysis

“…Compared to estimates by Li (2021) (2) in industrialized countries, who estimates a disease burden of 38/1,000, disease burden estimates in Germany remain relatively low. A modelling study estimating RSV-associated hospitalizations in the European Union using time-series estimates by Johannesen (2022) (24), also reported substantially higher RSV-associated hospitalization incidence rates of 72.5 in children between 1-2 months old, 38.6 in children 3-6 months old and 17.5 per 1,000 in children aged 6-11 months for Germany (Del Riccio 2023) (25).…”

Adapting COVID-19 research infrastructure to capture Influenza and Respiratory Syncytial Virus alongside SARS-CoV-2 in UK healthcare workers Winter 2022/23 and beyond: protocol for a pragmatic sub-study

“…These viruses contribute to waves of illness, hospitalisation and death across all ages but particularly, in the case of RSV, infants and the elderly. 3-5 Relaxation of non-medical interventions such as social distancing, in Australasia during Winter 2022 resulted in a significant rise in Influenza cases, hospital admissions and deaths, compared to previous seasons. 6 Surveillance data from the UK showed an early start to the 2022/23 Influenza season, alongside persistently high rates of RSV throughout the pre-winter months.…”