Recommendations for respiratory syncytial virus surveillance at the national level

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.

FIGURE 1

Testing and diagnostic algorithm for respiratory syncytial virus (RSV) surveillance: active community surveillance and active hospital surveillance. ARI: acute respiratory infection; SARI: severe acute respiratory infection. ^#: sepsis defined as fever >37.5°C or hypothermia, shock or seriously ill without apparent cause; ^¶: using nasopharyngeal swab, within 10 days after onset of disease but ideally within 4 days after onset, by quantitative reverse transcriptase PCR (qRT-PCR) or molecular point-of-care tests (mPOCT), ideally distinguishing by type A and B; ⁺: note that (background) denominator data are needed; ^§: note that additional variables (e.g. vaccination coverage) are needed.

FIGURE 2

Respiratory syncytial virus genomic overall structure of genes coding for proteins. NS: nonstructual protein; SH: small hydrophobic protein.