The burden of RSV: How the scientific community can help
25 October 2022
EHMA has been focussing on Respiratory Syncytial Virus (RSV) because of its major disruption to health systems across Europe, and worldwide, making it a key area of interest for health management. RSV is the most common cause of lower respiratory tract infections, including bronchiolitis and pneumonia, in infants. Globally, in 2019, there were approximately 33 million cases of acute lower respiratory infections leading to more than three million hospitalisations. In 2021-2022 we conducted a survey that outlined the burden of this common virus, and with RSV season commencing makes it an important time to review response efforts. Our Executive Director, George Valiotis teamed up with Michelle Roberts, MD to share some of the key survey findings.
Written by George Valiotis, Executive Director at EHMA, in collaboration with Michelle Roberts, Global Medical Brand Lead Vaccines (RSV) at Sanofi. This article first appeared on LinkedIn on 25 October 2022.
In the last two and a half years, the world has seen and felt the immense effect of respiratory viruses – drawing attention to the impact of viral circulation and the importance of disease prevention. In our roles within Sanofi and the European Health Management Association (EHMA), we have had the distinct privilege of working in the field of respiratory syncytial virus (RSV), a very common and highly transmissible virus that causes seasonal epidemics each year. (1-3)
As we enter the RSV season in the northern hemisphere (November through March), we hope to shed light on the burden RSV places on not only infants and their families, but on our healthcare systems worldwide. Within the scientific and healthcare community, we collectively have an essential part to play in broadening the understanding of RSV among parents and caregivers, pushing to improve diagnostic capability, and working to set in place more effective management processes for RSV infections as we look forward to the potential for new preventative options on the horizon.
Global impact of RSV
RSV is a seasonal virus commonly seen in infants and young children worldwide. (4,5) As a contagious virus, it’s typically spread by other children and siblings through oral or nasal secretions. (4-6) RSV is the most common cause of lower respiratory tract infections (LRTI), such as bronchiolitis and pneumonia, with virtually all children contracting RSV before the age of two and almost 70% contracting the virus before they turn one. (7-9) Globally, in 2019, there were approximately 33 million cases of RSV-related acute lower respiratory infections leading to more than three million hospitalizations in infants and children. (10)
While many infants experience mild, cold-like symptoms such as a cough or runny nose, RSV disease can be unpredictable and has the potential to become severe, with around 40% of infants developing LRTI, such as bronchiolitis and pneumonia. (5,11,12) RSV is a leading cause of hospitalization in all infants. (13,14) What is hard to predict, is which infants will develop a more severe form of disease that will require medical attention, and in fact, most hospitalizations occur in infants born healthy and at term. (11,15,16)
The rate of RSV-related outpatient and emergency care visits is a significant burden through the first year of life, with approximately three out of four infants requiring outpatient care due to RSV. (17-20) RSV disease can also have long-term effects and may be linked to the development of recurrent wheezing. (21)
Hearing from healthcare providers: RSV’s burden on healthcare systems
In temperate regions, RSV typically spreads during the fall and winter months. (22) Because of this, healthcare systems typically see a peak rise in infections within a four-to-six-week period toward the end of the year. (23) This surge can impact healthcare systems, with significant disruptions in patient care — leading to less than optimal working conditions for healthcare professionals. (23)
RSV-related direct medical costs alone — including hospital, outpatient, and follow-up care — were estimated at €4.82 billion worldwide in 2017. (24)
In 2022, EHMA published a survey of healthcare workers in 20 European countries that identified the true burden experienced by healthcare systems each year. What the EHMA found is that pediatric RSV places a significant burden on healthcare systems and healthcare workers each season, with disruption across all care settings. (23)
Of the 380 hospital or community-based healthcare professionals surveyed, 89% confirmed that RSV causes moderate to severe disruption to the healthcare system. (23) Respondents also reported a 30% increase in visits to primary care offices for respiratory illnesses, a 20% increase in follow-ups due to RSV-related complications, and a 52.2% increase in patient intake in emergency departments. (23)
These seasonal spikes can cause increased patient waiting time in emergency departments and reduced bed capacity in pediatric wards and intensive care units, which can overwhelm healthcare professionals and systems within the short season when cases peak. (23)
What is also difficult for healthcare workers is the fact that there has been no preventative option available for all infants, and for those infected who require treatment, it is limited to only supportive care. (5,25) Seventy-five percent of respondents across care settings consider access to RSV preventative options important to help reduce the burden of RSV on healthcare systems, but remain limited to what is currently available in the meantime. (23)
How we can broaden the understanding of RSV’s impact
Though RSV is common and widespread, its greatest impact is seen in infants under one year of age. (4,5,13) And yet despite this, as previously mentioned, a preventative option against RSV disease for all infants has not been available and any treatment needed is supportive once infants are infected. (5,25) Only behavioral measures – like handwashing and disinfecting toys and surfaces – are available to help protect the infant population. (5)
As we enter the RSV season, let’s work together to minimize RSV’s disruptive effect on healthcare systems. One important step we can take now across the scientific community is to broaden the understanding and awareness of RSV.
Parents and caregivers should not only be made aware of RSV but be equipped with critical disease information like common symptoms of RSV-related illness, how RSV spreads, and the behavioral measures that can be taken to help prevent infection. While seemingly simple, these behavioral measures are the most effective tools we have available to help protect all infants, and their utilization can help control RSV transmission to ensure as many infants are protected as possible. (23)
We also must take it upon ourselves as a scientific community to improve and expand our use of testing such as point-of-care tests (POCT) which can allow us to better track RSV’s spread during the season. (23) This goes hand-in-hand with standardizing the management of RSV as all too often non-evidence-based practices such as the use of antibiotics or corticosteroids are used in an effort to combat infection. (23)
We as a scientific community can also look forward to potential preventative approaches on the horizon that may one day help protect against RSV in all infants and potentially change the way that we collectively handle RSV each season.
As previously mentioned, like many respiratory viruses, RSV’s impact is felt each season throughout healthcare systems worldwide. We believe a collaborative commitment as a scientific community to improve education and discussions on this global health priority can help everyone better prepare for the RSV season ahead, as well as for the seasons to come.
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