Global Burden of Respiratory Syncytial Virus in Children, Infants

Respiratory syncytial virus (RSV) was associated with significant global morbidity and mortality in children and infants younger than 5 years, according to findings published in The Lancet.

Researchers conducted a systematic literature review of studies published between January 2017 and December 2020 that reported estimates of morbidity and mortality among children younger than 5 years with RSV-associated acute lower respiratory infection (LRI). The primary outcomes were RSV-attributable mortality and RSV-associated all-cause mortality, as well as mortality due to acute LRI. Overall, 481 studies were included in the final analysis.

In meta-analyses performed at the regional level in 2019, the estimated global rate of RSV-associated acute LRI among children younger than 5 years was 33.0 million (uncertainty range [UR], 25.4-44.6 million). Of note, 1 in 5 of these infections occurred in infants and children aged between 0 and 6 months.

The researchers also estimated that the global number of hospitalizations among children younger than 5 years with RSV-associated acute LRI was 3.6 million (UR, 2.9-4.6 million), with an estimated 1.4 million (39%) hospitalizations occurring in infants between 0 and 6 months.

The researchers estimated that the global rate of in-hospital mortality due to RSV-associated acute LRI was 26,300 (UR 15,100-49,100) in children between 0 and 60 months vs 13,300 (UR, 6800-28,100) for those between 0 and 6 months.

Of 52 million cases of all-cause mortality, an estimated 1.040 million (2.0%) were attributable to RSV in children between 0 and 60 months vs an estimated 1.872 million in those aged 28 days to 6 months.

The researchers found 97% of all cases of RSV-attributable mortality occurred among children from low- and middle-income countries, regardless of age group.

Study limitations included potential heterogeneity, and that data used to estimate mortality due to RSV were scarce and sourced primarily from under-resourced settings. Furthermore, data were obtained before the COVID-19 pandemic, which may affect RSV disease burden estimates in the long term.

According to the researchers, “[these findings] highlight the striking overall mortality burden of RSV disease worldwide, with [1] in every 50 deaths in children aged 0 [to] 60 months and [1] in every 28 deaths in children aged 28 days to 60 months attributable to RSV.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Li Y, Wang X, Blau DM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. Published online May 19, 2022. doi: 10.1016/S0140-6736(22)00478-0