Systematic literature review of the signs and symptoms of respiratory syncytial virus

Abstract

Respiratory syncytial virus (RSV) is responsible for over 30 million lower respiratory tract infections (LRTIs) and 3 million hospitalizations worldwide each year. Despite the risk RSV poses to young children, older adults, and individuals with comorbidities or suppressed immunity, there is limited understanding of RSV symptom presentation across these at‐risk groups, and there is no vaccine for RSV. We conducted two systematic literature reviews (SLRs) of studies that document signs and symptoms (S&S) of RSV in (1) children aged ≤5 years and (2) immunocompromised adolescents and adults, and adults at high risk for severe RSV due to age or comorbidities. Symptom duration and hospital length of stay (LOS) were explored. Electronic database searches were performed following PRISMA guidelines. Studies captured RSV S&S across community and hospital settings. Clinicians and caregivers reported ( n = 25 studies) nasal discharge/congestion, cough, shortness of breath, feeding abnormalities, and fever in ≥40% of children across studies and settings. Median hospital stays for children ranged from 2 days in the United States to 7.5 days in China. High‐risk adults with RSV ( n = 6 studies) commonly (≥40% of adults) reported cough, sputum, dyspnea, and fever/feverishness. Median length of hospital stay in adults ranged from 6 to 15 days across studies. Caregivers and clinicians reported similar RSV S&S in young children, including upper and lower respiratory and systemic symptoms. In high‐risk and immunocompromised adults, the most frequent (in multiple publications) and commonly reported RSV S&S were primarily LRTI symptoms. RSV symptoms could last for weeks and are variable based on geography.

SARS-CoV-2, influenza A/B and respiratory syncytial virus positivity and association with influenza-like illness and self-reported symptoms, over the 2022/23 winter season in the UK: a longitudinal surveillance cohort

“…Although we confirmed previous findings of high rates of cough in test-negatives [ 14 ], we also found evidence of particularly high rates in older RSV-positives. This was the only symptom that approached rates of 50% amongst RSV-positives and confirms prior findings of cough’s relevance to RSV discrimination [ 12 , 42 , 43 ]. In contrast, fever was rarely reported amongst RSV-positives across all ages.…”

Respiratory syncytial virus: A new era

“…A 2017 American review [ 61 ] supports these data, stating that RSV could be implicated in 12% of acute respiratory illnesses in older adults requiring medical care, with an admission of 3-6 days and a mortality of 6-8%.…”

From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults

“…However, the symptomatology is non-specific, with an average incubation time of 4–6 days. An asymptomatic infection, a mild infection with symptoms of an upper respiratory tract infection, and a more severe infection with symptoms of a lower respiratory tract infection that can also lead to decompensation of chronic pulmonary and cardiac diseases can be considered the main spectrum of RSV infection presentation ( Figure 2 ) [ 7 , 85 , 86 ].…”