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. 2022 Aug 15;226(Suppl 2):S195-S212.
doi: 10.1093/infdis/jiac201.

A Systematic Literature Review of the Burden of Respiratory Syncytial Virus and Health Care Utilization Among United States Infants Younger Than 1 Year

Mina Suh  1 , Naimisha Movva  1 , Lauren C Bylsma  1 , Jon P Fryzek  1 , Christopher B Nelson  2
Affiliations

A Systematic Literature Review of the Burden of Respiratory Syncytial Virus and Health Care Utilization Among United States Infants Younger Than 1 Year

Mina Suh et al. J Infect Dis. .

Abstract

Background: The burden and health care utilization (HCU) of respiratory syncytial virus (RSV) in US infants aged <1 year across health care settings are not well characterized.

Methods: We systematically reviewed studies of RSV and bronchiolitis published 2000-2021 (data years, 1979-2020). Outcomes included RSV hospitalization (RSVH)/bronchiolitis hospitalization rates, emergency department (ED)/outpatient (OP) visit rates, and intensive care unit (ICU) admissions or mechanical ventilation (MV) use among RSV-/bronchiolitis-hospitalized infants. Study quality was determined using standard tools.

Results: We identified 141 good-/fair-quality studies. Five national studies reported annual average RSVH rates (range, 11.6 per 1000 per year among infants aged 6-11 months in 2006 to 50.1 per 1000 per year among infants aged 0-2 months in 1997). Two national studies provided RSVH rates by primary diagnosis for the entire study period (range, 22.0-22.7 per 1000 in 1997-1999 and 1997-2000, respectively). No national ED/OP data were available. Among 11 nonnational studies, RSVH rates varied due to differences in time, populations (eg, prematurity), and locations. One national study reported that RSVH infants with high-risk comorbidities had 5-times more MV use compared to non-high-risk infants in 1997-2012.

Conclusions: Substantial data variability was observed. Nationally representative studies are needed to elucidate RSV burden and HCU.

Keywords: RSV; emergency department; infants; intensive care unit admission; lower respiratory tract infection; mechanical ventilation; outpatient; respiratory syncytial virus; respiratory syncytial virus hospitalization; systematic literature review.

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Conflict of interest statement

Potential conflicts of interest. EpidStrategies received a grant from Sanofi for this research. M. S., N. M., L. C. B., and J. P. F. are employees of EpidStrategies. C. B. N. is an employee of Sanofi and may hold shares and/or stock options in the company. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the study selection process. aPubMed, Embase, Web of Science databases. bExcluded for not meeting PECOS criteria. Abbreviations: PECOS, population, exposure, comparator, outcomes, and study design; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RSV, respiratory syncytial virus.
Figure 2.
Figure 2.
Histograms of included studies (n = 141): (A) data years versus publication years; (B) by health care setting. A, The numbers for study data years do not sum to 141 studies because each study can report multiple data years. B, Numbers do not sum to 141 because studies including multiple settings were counted more than once. Health care setting is based on the burden of disease or health care utilization outcomes reported in each study. Abbreviations: ED, emergency department; IP, inpatient; NR, setting not reported; OP, outpatient; UC, urgent care.
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