Respiratory syncytial virus hospitalization and mortality: Systematic review and meta‐analysis

Abstract

SummaryBackground: Respiratory syncytial virus (RSV) is a major public health burden worldwide. We aimed to review the current literature on the incidence and mortality of severe RSV in children globally. Methods: Systematic literature review and meta‐analysis of published data from 2000 onwards, reporting on burden of acute respiratory infection (ARI) due to RSV in children. Main outcomes were hospitalization for severe RSV‐ARI and death. Results: Five thousand two hundred and seventy‐four references were identified. Fifty‐five studies were included from 32 countries. The global RSV‐ARI hospitalization estimates, reported per 1,000 children per year (95% Credible Interval (CrI), were 4.37 (2.98, 6.42) among children <5 years, 19.19 (15.04, 24.48) among children <1 year, 20.01 (9.65, 41.31) among children <6 months and 63.85 (37.52, 109.70) among premature children <1 year. The RSV‐ARI global case‐fatality estimates, reported per 1,000 children, (95% Crl) were 6.21 (2.64, 13.73) among children <5 years, 6.60 (1.85, 16.93) for children <1 year, and 1.04 (0.17, 12.06) among preterm children <1 year. Conclusions: A substantial proportion of RSV‐associated morbidity occurs in the first year of life, especially in children born prematurely. These data affirm the importance of RSV disease in the causation of hospitalization and as a significant contributor to pediatric mortality and further demonstrate gestational age as a critical determinant of disease severity. An important limitation of case‐fatality ratios is the absence of individual patient characteristics of non‐surviving patients. Moreover, case‐fatality ratios cannot be translated to population‐based mortality. Pediatr Pulmonol. 2017;52:556–569. © 2016 The Authors. Pediatric Pulmonology. Published by Wiley Periodicals, Inc.

Respiratory syncytial virus acute respiratory infection‐associated hospitalizations in preterm Mexican infants: A cohort study

“…As a result, we cannot determine if the incidence rates in preterm infants are higher than those of term infants. However, the incidence or RSV‐confirmed (62.6 per 1000 child‐years) and RSV‐attributable admissions (94.1 per 1000 child‐years) in our study are similar to those reported worldwide during the first year of life in preterm infants (63.85, 95% CI 37.52‐109.7, hospitalizations per 1000 children per year) . In contrast, the global incidence of RSV hospitalizations in all children <1 year of age was estimated at 19.19 (95% CI 15.05‐24.48) per 1000 children per year.…”

Respiratory syncytial virus is an “opportunistic” killer

“…CFR meta‐estimates for 2015 in infants 0‐5 and 6‐11 months of age in developing countries were 2.2 (1.8‐2.7) and 2.4 (1.9‐3.2), respectively . A second meta‐analysis identified the highest case fatality rates in Kenya, Morocco, South Africa, and Mozambique …”

Staphylococcus aureus colonization and non-influenza respiratory viruses: Interactions and synergism mechanisms

“…RSV disease manifestations can vary from mild URTI to severe pneumonia or bronchiolitis, which can lead to hospitalization and serious complications like respiratory failure [86]. Despite the high incidence of bacterial and RSV co-infection in both children and adults, only few studies aimed to investigate the possible interactions between S. aureus and this virus [87–90].…”