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Meta-Analysis
. 2025 Oct;19(10):e70179.
doi: 10.1111/irv.70179.

Burden of RSV in Young Children in High-Income Countries: Incidence Estimates From a Multilevel Meta-Analysis in Primary and Emergency Care

Susanne Heemskerk  1   2 , Lotte van Heuvel  1 , Peter Spreeuwenberg  1 , Louis J Bont  2 , Foekje F Stelma  1 , Saverio Caini  1 , Jojanneke van Summeren  1
Affiliations
Meta-Analysis

Burden of RSV in Young Children in High-Income Countries: Incidence Estimates From a Multilevel Meta-Analysis in Primary and Emergency Care

Susanne Heemskerk et al. Influenza Other Respir Viruses. 2025 Oct.

Abstract

Background: Most respiratory syncytial virus (RSV) infections in children are managed in primary care settings, including ambulatory care and emergency departments (EDs). This study provides adjusted pooled RSV incidence estimates for children under 5 years in primary care settings in high-income countries (HICs).

Methods: We used population-based RSV incidence rates from 27 studies collected in a previous systematic review as input parameters. To adjust for heterogeneity in study design, we assessed the impact of four key factors: 1) age, 2) primary care setting (ambulatory care or EDs), 3) data collection period (year-round or seasonal), and 4) study methodology (cohort studies with laboratory-confirmed RSV, healthcare databases, surveillance data). In the final model, we corrected for age, primary care setting, and study methodology. Adjusted pooled RSV incidence estimates were calculated using a multilevel logit-logistic regression model.

Results: For children < 5 years, the adjusted pooled RSV incidence estimate in primary care settings was 62.8 per 1000 population (95% CI 45.3-86.6). Incidence was higher in ambulatory care (108.1 per 1000; 95% CI 78.0-148.0) compared to EDs (35.8 per 1000; 95% CI 25.3-50.3). Age-stratified incidence estimates declined with increasing age, showing 86.5 (95% CI 61.6-120.2), 80.3 (95% CI 57.1-111.8), 60.7 (95% CI 43.2-84.6), and 36.5 (95% CI 25.4-52.2) per 1000 for children aged < 6 months, 0-1 year, 0-2 years, and 0-5 years, respectively.

Conclusions: This is the first multilevel meta-analysis estimating the RSV-related burden in primary care settings, including both ambulatory and emergency care. These results can be used by decision makers for the introduction of RSV immunization programs.

Keywords: child; emergency department; global burden of disease; primary health care; respiratory syncytial virus.

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Conflict of interest statement

SH, LvH, PS, SC, FFS, and JvS declare that Nivel has received unrestricted grants from WHO, Sanofi, GSK, and the Foundation for Influenza Epidemiology outside the submitted work and that Nivel has received a grant from the Preparing for RSV Immunisation and Surveillance in Europe (PROMISE) project of the “Innovative Medicines Initiative 2 Joint Undertaking” Grant Agreement No. 101034339. This Joint Undertaking gets support from the “European Union's Horizon 2020 research and innovation programme” and the “European Federation of Pharmaceutical Industries and Associations”. LJB has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. University Medical Centre Utrecht (UMCU) has received major funding (> €100,000 per industrial partner) for investigator‐initiated studies from AbbVie, MedImmune, AstraZeneca, Sanofi, Janssen, Pfizer, MSD, and MeMed Diagnostics. UMCU has received major funding for the RSV GOLD study from the Bill & Melinda Gates Foundation. UMCU has received major funding as part of the public‐private partnership IMI‐funded RESCEU and PROMISE projects with partners GSK, Novavax, Janssen, AstraZeneca, Pfizer, and Sanofi. UMCU has received major funding by Julius Clinical for participating in clinical studies sponsored by MedImmune and Pfizer. UMCU received minor funding (€1000–25,000 per industrial partner) for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, GSK, Novavax, Pfizer, Moderna, AstraZeneca, MSD, Sanofi, Genzyme, and Janssen. LJB is the founding chairman of the ReSViNET Foundation.

References

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