What 'case definition' for respiratory syncytial virus infection? Results of a systematic literature review to improve surveillance among the adults

Abstract

Background: Human respiratory syncytial virus (hRSV) is a leading cause of acute lower respiratory tract infection in frail individuals, including children, the elderly and immunocompromised people, with mild to severe symptoms. World Health Organization claims hRSV causes most elderly influenza-like illnesses (ILI) and severe acute respiratory infections (SARI). In this study, different case definitions for hRSV surveillance were examined for accuracy.

Methods: The following search query ('Respiratory Syncytial Virus' OR 'RSV' OR 'hRSV' AND 'case definition') was used on PubMed/MEDLINE and Scopus with a 15-year-old baseline age restriction to conduct a systematic literature review.

Results: Of 12 records, 58% employed the SARI definition, 50% the ILI definition and 42% the acute respiratory infection (ARI) definition, with some overlap. In young adults (18-64 years old), most studies show RSV prevalence between 6.25 and 72.54 cases per 1000 per year, and 19.23 to 98.5 in older adults. The outpatient ARI and hospitalized SARI criteria are particularly sensitive and specific.

Conclusions: Disease burden measurement requires a clear case definition; however, current literature is questionable. Currently, hRSV surveillance uses numerous case definitions with debatable accuracy. The epidemiology, clinical characteristics, and disease burden of hRSV are difficult to characterize without a standard surveillance case definition.

Keywords: adult; case definition; elderly; hRSV; surveillance.

Fig. 1

Flowchart representing PRISMA flow diagram of studies’ screening and selection.

Fig. 2

Prevalence of hRSV cases in the young adult population.

Fig. 3

Prevalence of hRSV cases among the over 50 years old population.

Fig. 4

Sensitivity, specificity and accuracy of case definitions.