EC Paediatrics

Background: Respiratory syncytial virus (RSV) is an RNA virus that affects respiratory epithelial cells. It is one of the major causes of acute lower respiratory tract infection (ALRI), especially in children under one year of age. This virus is one of the main pathogens of early childhood, affecting almost all children before two years of age. This illness is associated with global morbidity and mortality, and its severity ranges from mild and moderate to life-threatening respiratory failure.

Aim: To assess the risk factors and outcomes of respiratory syncytial virus in children under three years old by reviewing previous studies investigating this subject.

Methods: Scientific websites, including PubMed, Science Direct, Google Scholar, Scopus, and Springer, were used to search for related articles using several keywords and terms. The search process was limited to 2014 to 2024, including original English articles reporting RSV risk factors and/or outcomes among children under three years of age.

Results: Eight articles met the eligibility criteria and were included in this review with a total number of 8100 children less than three years old with RSV with an age range of ≤ 28 days of life and within two years of age. The findings included RSV risk factors, outcomes, and risk factors of specific outcomes.

Conclusion: There are several risk factors for RSV infection among children less than three years old, these include birth and discharge during RSV season, lower parity, and older mothers. Furthermore, there were various reported outcomes, including the requirement for intensive care, oxygen supplementation, mechanical ventilation, hospitalization, developing pneumonia, full recovery, and mortality.

 Keywords: RSV; Risk Factors; Outcomes; Neonates; Infants; Toddlers

1. Pellegrinelli L., et al. “Respiratory syncytial virus in influenza-like illness cases: Epidemiology and molecular analyses of four consecutive winter seasons (2014-2015/2017-2018) in Lombardy (Northern Italy)”. Journal of Medical Virology 12 (2020): 2999-3006.
2. Munro AP., et al. “The disease burden of respiratory syncytial virus in infants”. Current Opinion in Infectious Diseases5 (2023): 379-384.
3. Li Y., et al. “Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: A systematic analysis”. Lancet Global Health 8 (2019): e1031-e1045.
4. Taylor S., et al. “Modelling estimates of the burden of respiratory syncytial virus infection in children in the UK”. BMJ Open6 (2016): e009337.
5. Simões EAF., et al. “Challenges and opportunities in developing respiratory syncytial virus therapeutics”. Journal of Infectious Diseases 1 (2015): S1-S20.
6. World Health Organization. “WHO Strategy to Pilot Global Respiratory Syncytial Virus Surveillance Based on the Global Influenza Surveillance and Response System (GISRS)”. World Health Organization: Geneva, Switzerland (2017).
7. Zhao Y., et al. “Comparison of viral and epidemiological profiles of hospitalized children with severe acute respiratory infection in Beijing and Shanghai, China”. BMC Infectious Diseases 1 (2019): 729.
8. Andeweg SP., et al. “Population-based serology reveals risk factors for RSV infection in children younger than 5 years”. Scientific Reports 11 (2021): 8953.
9. Murray J., et al. “Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study”. PLoS One2 (2014): e89186.
10. Page MJ., et al. “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews”. British Medical Journal 372 (2021): n71.
11. Kalane SU., et al. “Clinical profile and outcome of respiratory syncytial virus-infected neonates—a single center experience”. Journal of Neonatology2 (2022): 95-98.
12. Ozkan H., et al. “Risk factors for respiratory syncytial virus infections in moderate/late premature infants in Turkey: a prospective multicenter epidemiological study”. American Journal of Perinatology14 (2021): 1540-1546.
13. Buchwald AG., et al. “Epidemiology, risk factors, and outcomes of respiratory syncytial virus infections in newborns in Bamako, Mali”. Clinical Infectious Diseases 1 (2020): 59-66.
14. Patel SM., et al. “Predictors of poor outcomes among infants with respiratory syncytial virus-associated acute lower respiratory infection in Botswana”. The Pediatric Infectious Disease Journal5 (2019): 525-527.
15. Chi H., et al. “Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan”. PLoS One5 (2018): e0197410.
16. Alan S., et al. “Outcome of the respiratory syncytial virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study”. The Journal of Maternal-Fetal and Neonatal Medicine13 (2016): 2186-2193.
17. Halasa N., et al. “Natural history and epidemiology of respiratory syncytial virus infection in the Middle East: Hospital surveillance for children under age two in Jordan”. Vaccine 47 (2015): 6479-6487.
18. Zhang XB., et al. “Clinical characteristics and risk factors of severe respiratory syncytial virus-associated acute lower respiratory tract infections in hospitalized infants”. World Journal of Pediatrics4 (2014): 360-364.
19. Shi T., et al. “Risk factors for poor outcome or death in young children with respiratory syncytial virus-associated acute lower respiratory tract infection: A systematic review and meta-analysis”. The Journal of Infectious Diseases1 (2022): S10-S16.
20. Shi T., et al. “Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: systematic review and meta-analysis”. Journal of Global Health 2 (2015): 020416.
21. Suleiman-Martos N., et al. “Prevalence and risk factors of respiratory syncytial virus in children under 5 years of age in the WHO European region: a systematic review and meta-analysis”. Journal of Personalized Medicine5 (2021): 416.
22. Checchia PA., et al. “Defining the risk and associated morbidity and mortality of severe respiratory syncytial virus infection among infants with congenital heart disease”. Infectious Diseases and Therapy 1 (2017): 37-56.
23. Paes B., et al. “Defining the risk and associated morbidity and mortality of severe respiratory syncytial virus infection among infants with chronic lung disease”. Infectious Diseases and Therapy 4 (2016): 453-471.
24. Löwensteyn YN., et al. “Respiratory syncytial virus-related death in children with down syndrome: The RSV GOLD Study”. Pediatric Infectious Disease Journal 8 (2020): 665-670.
25. Welliver RC Sr., et al. “Fatality rates in published reports of RSV hospitalizations among high-risk and otherwise healthy children”. Current Medical Research and Opinion 9 (2010): 2175-2181.
26. Wingert A., et al. “Burden of illness in infants and young children hospitalized for respiratory syncytial virus: a rapid review”. Canada Communicable Disease Report 9 (2021): 381-396.
27. Mauskopf J., et al. “Respiratory syncytial virus hospitalizations in healthy preterm infants: systematic review”. The Pediatric Infectious Disease Journal 7 (2016): e229-e238.
28. Hardelid P., et al. “The contribution of child, family and health service factors to respiratory syncytial virus (RSV) hospital admissions in the first 3 years of life: birth cohort study in Scotland, 2009 to 2015”. Eurosurveillance 1 (2019): 1800046.
29. Lee YI., et al. “Risk factors associated with death in patients with severe respiratory syncytial virus infection”. Journal of Microbiology, Immunology and Infection 5 (2016): 737-742.
30. Makari D., et al. “The underrecognized burden of respiratory syncytial virus among infants presenting to US emergency departments”. Clinical Pediatrics6 (2015): 594-597.