Recommendations for respiratory syncytial virus surveillance at the national level

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Abstract

Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections and hospitalisations among young children and is globally responsible for many deaths in young children, especially in infants aged <6 months. Furthermore, RSV is a common cause of severe respiratory disease and hospitalisation among older adults. The development of new candidate vaccines and monoclonal antibodies highlights the need for reliable surveillance of RSV. In the European Union (EU), no up-to-date general recommendations on RSV surveillance are currently available. Based on outcomes of a workshop with 29 European experts in the field of RSV virology, epidemiology and public health, we provide recommendations for developing a feasible and sustainable national surveillance strategy for RSV that will enable harmonisation and data comparison at the European level. We discuss three surveillance components: active sentinel community surveillance, active sentinel hospital surveillance and passive laboratory surveillance, using the EU acute respiratory infection and World Health Organization (WHO) extended severe acute respiratory infection case definitions. Furthermore, we recommend the use of quantitative reverse transcriptase PCR-based assays as the standard detection method for RSV and virus genetic characterisation, if possible, to monitor genetic evolution. These guidelines provide a basis for good quality, feasible and affordable surveillance of RSV. Harmonisation of surveillance standards at the European and global level will contribute to the wider availability of national level RSV surveillance data for regional and global analysis, and for estimation of RSV burden and the impact of future immunisation programmes.

Abstract

Recommendations for developing a feasible and sustainable national surveillance strategy for respiratory syncytial virus that will enable harmonisation and data comparison at the European level. https://bit.ly/3rWUOOI

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Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study

Ting Shi, David McAllister, Katherine L O'Brien … (2017)

Summary Background We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. Methods We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. Findings We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6–50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7–3·8) hospital admissions, and 59 600 (48 000–74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2–1·7) hospital admissions, and 27 300 (UR 20 700–36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600–149 400). Incidence and mortality varied substantially from year to year in any given population. Interpretation Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group. Funding The Bill & Melinda Gates Foundation.

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Latitudinal Variations in Seasonal Activity of Influenza and Respiratory Syncytial Virus (RSV): A Global Comparative Review

Kimberly Bloom-Feshbach, Wladimir J Alonso, Vivek Charu … (2013)

Background There is limited information on influenza and respiratory syncytial virus (RSV) seasonal patterns in tropical areas, although there is renewed interest in understanding the seasonal drivers of respiratory viruses. Methods We review geographic variations in seasonality of laboratory-confirmed influenza and RSV epidemics in 137 global locations based on literature review and electronic sources. We assessed peak timing and epidemic duration and explored their association with geography and study settings. We fitted time series model to weekly national data available from the WHO influenza surveillance system (FluNet) to further characterize seasonal parameters. Results Influenza and RSV activity consistently peaked during winter months in temperate locales, while there was greater diversity in the tropics. Several temperate locations experienced semi-annual influenza activity with peaks occurring in winter and summer. Semi-annual activity was relatively common in tropical areas of Southeast Asia for both viruses. Biennial cycles of RSV activity were identified in Northern Europe. Both viruses exhibited weak latitudinal gradients in the timing of epidemics by hemisphere, with peak timing occurring later in the calendar year with increasing latitude (P<0.03). Time series model applied to influenza data from 85 countries confirmed the presence of latitudinal gradients in timing, duration, seasonal amplitude, and between-year variability of epidemics. Overall, 80% of tropical locations experienced distinct RSV seasons lasting 6 months or less, while the percentage was 50% for influenza. Conclusion Our review combining literature and electronic data sources suggests that a large fraction of tropical locations experience focused seasons of respiratory virus activity in individual years. Information on seasonal patterns remains limited in large undersampled regions, included Africa and Central America. Future studies should attempt to link the observed latitudinal gradients in seasonality of viral epidemics with climatic and population factors, and explore regional differences in disease transmission dynamics and attack rates.

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Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis

You Li, Rachel Reeves, Xin. Wang … (2019)

Influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus are the most common viruses associated with acute lower respiratory infections in young children (<5 years) and older people (≥65 years). A global report of the monthly activity of these viruses is needed to inform public health strategies and programmes for their control.

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Author and article information

Journal

Journal ID (nlm-ta): Eur Respir J

Journal ID (iso-abbrev): Eur Respir J

Journal ID (publisher-id): ERJ

Journal ID (hwp): erj

Title: The European Respiratory Journal

Publisher: European Respiratory Society

ISSN (Print): 0903-1936

ISSN (Electronic): 1399-3003

Publication date Collection: September 2021

Publication date (Electronic): 30 September 2021

Volume: 58

Issue: 3

Electronic Location Identifier: 2003766

Affiliations

[1 ]National Institute for Public Health and the Environment (RIVM) – Centre for Infectious Disease Control, Bilthoven, The Netherlands

[2 ]European Centre for Disease Prevention and Control, Stockholm, Sweden

[3 ]Norwegian Institute of Public Health, Oslo, Norway

[4 ]Usher Institute, University of Edinburgh, Edinburgh, UK

[5 ]Public Health Agency Stockholm, Solna, Sweden

[6 ]HCL & University of Lyon, Lyon, France

[7 ]Riga East University Hospital, Riga, Latvia

[8 ]Finnish National Institute for Health and Welfare, Helsinki, Finland

[9 ]Statens Serum Institut, Copenhagen, Denmark

[10 ]Robert Koch Institute, Berlin, Germany

[11 ]Instituto de Salud Carlos III Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

[12 ]Health Protection Surveillance Centre, Dublin, Ireland

[13 ]Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands

[14 ]National Institute of Public Health, Warsaw, Poland

[15 ]Santé Publique France (SpFrance), Saint-Maurice, France

[16 ]Public Health Institute, Ljubljana, Slovenia

[17 ]Foundazione PENTA Onlus, Padova, Italy

[18 ]National Institute of Public Health, Praha, Czech Republic

[19 ]National Institute of Health, Lisbon, Portugal

[20 ]World Health Organization, Geneva, Switzerland

[21 ]Institut Pasteur, UMR 3569 CNRS, University of Paris, Paris, France

[22 ]Dept of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark

[23 ]Dept of Global Health and Infectious Diseases, University of Southern Denmark, Odense, Denmark

Author notes

Anne C. Teirlinck ( anne.teirlinck@ 123456rivm.nl )

Author information

Anne C. Teirlinck https://orcid.org/0000-0002-1172-8975

Rachel M. Reeves https://orcid.org/0000-0002-8949-1568

Sylvie van der Werf https://orcid.org/0000-0002-1148-4456

Article

Publisher ID: ERJ-03766-2020

DOI: 10.1183/13993003.03766-2020

PMC ID: 8485062

PubMed ID: 33888523

SO-VID: 9657fa9b-93af-4b2d-9cec-315c5f6a3b09

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This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org

History

Date received : 7 October 2020

Date accepted : 8 February 2021

Funding

Funded by: Innovative Medicines Initiative, open-funder-registry 10.13039/501100010767;

Recommendations for respiratory syncytial virus surveillance at the national level

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European Respiratory Society: COVID-19

Most cited references 82

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study

Latitudinal Variations in Seasonal Activity of Influenza and Respiratory Syncytial Virus (RSV): A Global Comparative Review

Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis

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