The burden of RSV: How the scientific community can help

25 October 2022

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)

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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.

References

1. Piedimonte G, Perez MK., Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev. 2014; 35:519-53.
2. Oymar K, et al. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med. 2014; 22:23.
3. Shi T, et al., 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. Lancet 2017; 390: 946–58.
4. Respiratory Syncytial Virus (RSV). Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/index.html. Accessed September 2022.
5. Respiratory Syncytial Virus Infection (RSV): Infants and Young Children. Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/high-risk/infants-young-children.html. Accessed September 2022.
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8. Glezen WP et al., Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986; 140(6):543-546.
9. Collins et al., Host Factors in Human Respiratory Syncytial Virus Pathogenesis. Journal of Virology. 2008:2040–2055.
10. Li Y, 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 2022; 399:92047–64.
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12. Paes BA, Mitchell I, Banerji A, Lanctôt KL, Langley JM., A decade of respiratory syncytial virus epidemiology and prophylaxis: translating evidence into everyday clinical practice. Canadian respiratory journal. 2011; 18(2):e10-9.
13. Leader S, Kohlhase K. Respiratory syncytial virus-coded pediatric hospitalizations, 1997 to 1999. The Pediatric infectious disease journal. 2002; 21(7):629-32.
14. McLaurin KK, Farr AM, Wade SW, Diakun DR, Stewart DL., Respiratory syncytial virus hospitalization outcomes and costs of full-term and preterm infants. Journal of Perinatology: official journal of the California Perinatal Association. 2016; 36(11):990-6.
15. Rha B et al., Respiratory Syncytial Virus–Associated Hospitalizations Among Young Children: 2015–2016. Pediatrics. 2020; 146(1):e20193611.
16. Arriola CS, Kim L, Langley G, Anderson EJ, Openo K, Martin AM, et al., Estimated Burden of Community-Onset Respiratory Syncytial Virus-Associated Hospitalizations Among Children Aged <2 Years in the United States, 2014-15. Journal of the Pediatric Infectious Diseases Society. 2020; 9(5):587-95.
17. Rainisch G, Adhikari B, Meltzer MI, Langley G., Estimating the impact of multiple immunization products on medically-attended respiratory syncytial virus (RSV) infections in infants. Vaccine. 2020 Jan 10; 38(2):251-257. doi: 10.1016/j.vaccine.2019.10.023. Epub 2019 Nov 16. PMID: 31740097; PMCID: PMC7029767.
18. Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, Poehling KA, Szilagyi PG, Griffin MR, Williams JV, Zhu Y, Grijalva CG, Prill MM, Iwane MK., Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013 Aug; 132(2):e341-8. doi: 10.1542/peds.2013-0303. Epub 2013 Jul 22. PMID: 23878043.
19. Lively JY, Curns AT, Weinberg GA, Edwards KM, Staat MA, Prill MM, Gerber SI, Langley GE., Respiratory Syncytial Virus-Associated Outpatient Visits Among Children Younger Than 24 Months. J Pediatric Infect Dis Soc. 2019 Jul 1; 8(3):284-286. doi: 10.1093/jpids/piz011. PMID: 30840770.
20. Burden of Acute Respiratory Infections (BARI) study. Longitudinal Patient Data 2017/2018, 2021 Data On File.
21. Driscoll AJ, Arshad SH, Bont L, Brunwasser SM, Cherian T, Englund JA, Fell DB, Hammitt LL, Hartert TV, Innis BL, Karron RA, Langley GE, Mulholland EK, Munywoki PK, Nair H, Ortiz JR, Savitz DA, Scheltema NM, Simões EAF, Smith PG, Were F, Zar HJ, Feikin DR., Does respiratory syncytial virus lower respiratory illness in early life cause recurrent wheeze of early childhood and asthma? Critical review of the evidence and guidance for future studies from a World Health Organization-sponsored meeting. Vaccine. 2020 Mar 4; 38(11):2435-2448. doi: 10.1016/j.vaccine.2020.01.020. Epub 2020 Jan 20. PMID: 31974017; PMCID: PMC7049900.
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