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. 2025 Feb 5:51:101227.
doi: 10.1016/j.lanepe.2025.101227. eCollection 2025 Apr.

Estimation of respiratory syncytial virus-associated hospital admissions in five European countries: a modelling study

Caroline Klint Johannesen  1   2 , David Gideonse  3 , Richard Osei-Yeboah  4 , Toni Lehtonen  5 , Ombeline Jollivet  6 , Rachel A Cohen  7 , Arantxa Urchueguía-Fornes  8   9 , María Herrero-Silvestre  8 , Mónica López-Lacort  8   9 , Rolf Kramer  6 , Thea K Fischer  1   2   10 , Terho Heikkinen  11 , Harish Nair  4 , Harry Campbell  4 , Michiel van Boven  3   12 ; PROMISE investigators
Collaborators, Affiliations

Estimation of respiratory syncytial virus-associated hospital admissions in five European countries: a modelling study

Caroline Klint Johannesen et al. Lancet Reg Health Eur. .

Abstract

Background: Respiratory syncytial virus (RSV) can cause severe disease, notably among infants, older adults, and individuals with comorbidities. Non-systematic testing and differences in coding practices affect direct measures of the hospital disease burden. We aim to tackle this issue and estimate RSV-associated respiratory hospital admissions through time series modelling of hospital admissions.

Methods: The number of RSV hospital admissions in Denmark, England, Finland, the Netherlands, and Spain were estimated with attribution analyses, using age-specific respiratory tract infection (RTI) admissions combined with virological data, both from routinely collected healthcare data. Analyses covered the years 2016-2023.

Findings: The attributed incidence of RSV per 100,000 children 0-2 months ranged from 1715 in Denmark to 3842 in England. In older adults, substantial differences in the incidence of ICD-10 coded RSV hospitalisations were found, while the attributed RSV incidence was more comparable, ranging from approximately 100 per 100,000 in adults 65-74 years to 200 per 100,000 persons 75-84 years and 500 per 100,000 persons 85 years and older.

Interpretation: RSV-attributed time series exhibit a high degree of synchronicity between participating countries, suggesting that this method for attribution addresses the known issues with underdiagnosis and misclassification. In the older age groups, a substantial proportion of RTI hospitalisations is attributed to RSV, underscoring the relevance of RSV as a cause of severe respiratory infections.

Funding: This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement 101034339. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA.

Keywords: Burden of disease; Hospital admissions; National register-based study; RSV; Respiratory tract infection; Time series analysis.

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Conflict of interest statement

This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement 101034339. This Joint Undertaking received support from the European Union's Horizon 2020 research and innovation programme and EFPIA. MvB, TKF, TL, MHS, AUF, and DG reports no conflicts of interest. CKJ reports a research grant from Nordsjællands Hospital, travel grants from the University of Copenhagen, William Demants Fond in Denmark, and the European Society of Clinical Virology and expert consultation fees from Sanofi outside of the submitted work. ROY reports grants or contracts from AstraZeneca. OJ and RK are Sanofi employees and may hold stock shares. RAC is an employee of GSK and holds financial equities in GSK. ML-L has attended several congresses whose registration, travel, and accommodation costs were covered by MSD, GSK, AZ, and Sanofi. HN reports grants to institution from MSD, Pfizer, Icosavax, consulting fees to institution from WHO, Pfizer, Bill and Melinda Gates Foundation, and Sanofi, payments for lectures made to institution from Astra Zeneca, GSK, and Pfizer, Support for meetings from Sanofi and Pfizer, and board participation at GSK, Sanofi, Merck, Icosavax, Pfizer, ResViNET, and WHO, with payments to institution and the latter two unpaid. TH reports payments for academic lectures from MSD, Sanofi, and Pfizer, and board member participation with Sanofi, Enanta, MSD, Moderna, Shionogi, and Pfizer. HC reports grants or contracts from NIHR Global Health Unit funding and Baszucki Brain Research Foundation, consulting fees from WHO Geneva, support for travelling and meetings from Baszucki Brain Research Foundation and WHO Geneva, and leadership or fiduciary roles as Membership of academic/educational committees of RSE, Acad MedSci, and UK Research Excellence Framework.

Figures

Fig. 1
Fig. 1
Weekly incidence of RSV-coded hospital admissions in four European countries using main diagnoses over the period 2017–2023. Notice that the period covered differs between countries. Also note the range differences on the y-axes. Dots represent the data and lines represent the trend (fitted to the log (1+ incidence) transformed data using cubic splines).
Fig. 2
Fig. 2
Attribution of hospital admissions for respiratory tract infections (RTIs) to RSV laboratory-confirmed in Denmark (2017–2022, 6 years). Shown are the total weekly number of RTI hospital admissions (grey dots), the fitted overall numbers of RTIs (grey lines, shaded bands represent 95% CIs), and RSV-attributed RTI admissions (coloured lines).
Fig. 3
Fig. 3
Attribution of hospital admissions for respiratory tract infections (RTIs) to RSV in England (2017–2023, 7 years). Shown are the total weekly number of RTI hospital admissions (grey dots), the fitted overall numbers of RTIs (grey lines, shaded bands represent 95% CIs), and RSV-attributed RTI admissions (coloured lines).
Fig. 4
Fig. 4
Attribution of hospital admissions for respiratory tract infections (RTIs) to RSV in Finland (2017–2023, 7 years). Shown are the total weekly number of RTI hospital admissions (grey dots), the fitted overall numbers of RTIs (grey lines, shaded bands represent 95% CIs), and RSV-attributed RTI admissions (coloured lines).
Fig. 5
Fig. 5
Attribution of hospital admissions for respiratory tract infections (RTIs) to RSV in the Netherlands (2013–2021, 9 years). Shown are the total weekly number of RTI hospital admissions (grey dots), the fitted overall numbers of RTIs (grey lines, shaded bands represent 95% CIs), and RSV-attributed RTI admissions (coloured lines).
Fig. 6
Fig. 6
Attribution of hospital admissions for respiratory tract infections (RTIs) to RSV in Spain (Valencia region) (2016–2019, 4 years). Shown are the total weekly number of RTI hospital admissions (grey dots), the fitted overall numbers of RTIs (grey lines, shaded bands represent 95% CIs), and RSV-attributed RTI admissions (coloured lines). Notice that RSV laboratory-confirmed hospital admissions are used as a proxy for RSV-coded hospital admissions and influenza-like illness (ILI) diagnosed admissions are used as a proxy for RTI-coded admissions.
See this image and copyright information in PMC

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