Burden of Respiratory Syncytial Virus in the European Union: estimation of RSV-associated hospitalizations in children under 5 years

Background: To date, no overall estimate of RSV-associated hospitalisations in children under 5 years has been published for the European Union (EU). We aimed to estimate the RSV hospitalisation burden in children under 5 years in EU countries and Norway, by age group and country.
Methods: We collated national RSV-associated hospitalisation estimates calculated using linear regression models via the RESCEU project for Denmark, England, Finland, Norway, the Netherlands and Scotland during 2006-2018. A systematic review was conducted to collect additional estimates. Using the multiple imputation and nearest neighbour matching methods, we estimated overall RSV-associated hospitalisations and rates in the EU.
Results: Additional estimates for only two countries (France and Spain) were found in the literature. In the EU, an average of 245,244 (95%CI 224,688-265,799) hospital admissions with a respiratory infection per year were associated with RSV in children under the age of 5, with most cases occurring among children aged less than 1 year (75%). Infants aged less than 2 months represented the most affected group (71.6 per 1,000 children; 66.6-76.6). The hospitalisation rates varied widely across countries: in children aged 0-2 months, they ranged from 47.4 (37.5-57.3) per 1,000 in the Netherlands to 98.3 (88.5-108.1) per 1,000 in France.
Conclusion: This is the first attempt to estimate the overall RSV hospitalisation burden in children under the age of 5 years in the EU. Our findings will help support decisions regarding prevention efforts and represent an important benchmark to understand changes in the RSV burden following the introduction of RSV immunisation programs in Europe.