Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis

PROMISE Investigators; Caroline Klint  Johannesen; David Gideonse; Richard Osei-Yeboah; Toni Lehtonen; Ombeline  Jollivet; Rachel A Cohen; Arantxa Urchueguía-Fornes; María  Herrero-Silvestre; Mónica López-Lacort; Rolf  Kramer; Thea K Fischer; Terho Heikkinen; Harish Nair; Harry Campbell; Michiel van Boven

doi:10.1016/j.lanepe.2025.101227

Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis

PROMISE Investigators, Caroline Klint Johannesen, David Gideonse, Richard Osei-Yeboah, Toni Lehtonen, Ombeline Jollivet, Rachel A Cohen, Arantxa Urchueguía-Fornes, María Herrero-Silvestre, Mónica López-Lacort, Rolf Kramer , Thea K Fischer, Terho Heikkinen, Harish Nair, Harry Campbell, Michiel van Boven

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	101227
Number of pages	30
Journal	Lancet
Volume	51
Early online date	5 Feb 2025
DOIs	https://doi.org/10.1016/j.lanepe.2025.101227
Publication status	Published - 1 Apr 2025

Keywords / Materials (for Non-textual outputs)

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

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10.1016/j.lanepe.2025.101227Licence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

Estimation of respiratory_JOHANNESEN_DOA16012025_VOR_CC-BY-NCFinal published version, 1.91 MBLicence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

https://www.sciencedirect.com/science/article/pii/S2666776225000195Licence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

PRomISE: Preparing for RSV Immunization and Surveillance in Europe
Nair, H. (Principal Investigator), Campbell, H. (Co-investigator), Cunningham, S. (Co-investigator) & Cunningham, S. (Co-investigator)
European Commission
1/11/21 → 30/04/24
Project: Research

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PROMISE Investigators, Johannesen, C. K., Gideonse, D., Osei-Yeboah, R., Lehtonen, T., Jollivet, O., Cohen, R. A., Urchueguía-Fornes, A., Herrero-Silvestre, M., López-Lacort, M., Kramer , R., Fischer, T. K., Heikkinen, T., Nair, H., Campbell, H., & van Boven, M. (2025). Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis. Lancet, 51, Article 101227. https://doi.org/10.1016/j.lanepe.2025.101227

@article{91c20c5355974e8b858b8670d9947899,

title = "Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis",

abstract = "BackgroundRespiratory 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.MethodsThe 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.FindingsThe 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.InterpretationRSV-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.",

keywords = "RSV, Respiratory tract infection, Hospital admissions, National register-based study, Time series analysis, Burden of disease",

author = "{PROMISE Investigators} and Johannesen, {Caroline Klint} and David Gideonse and Richard Osei-Yeboah and Toni Lehtonen and Ombeline Jollivet and Cohen, {Rachel A} and Arantxa Urchuegu{\'i}a-Fornes and Mar{\'i}a Herrero-Silvestre and M{\'o}nica L{\'o}pez-Lacort and Rolf Kramer and Fischer, {Thea K} and Terho Heikkinen and Harish Nair and Harry Campbell and {van Boven}, Michiel",

year = "2025",

month = apr,

day = "1",

doi = "10.1016/j.lanepe.2025.101227",

language = "English",

volume = "51",

journal = "Lancet",

issn = "0140-6736",

publisher = "Elsevier",

}

PROMISE Investigators, Johannesen, CK, Gideonse, D, Osei-Yeboah, R, Lehtonen, T, Jollivet, O, Cohen, RA, Urchueguía-Fornes, A, Herrero-Silvestre, M, López-Lacort, M, Kramer , R, Fischer, TK, Heikkinen, T, Nair, H , Campbell, H & van Boven, M 2025, 'Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis', Lancet, vol. 51, 101227. https://doi.org/10.1016/j.lanepe.2025.101227

TY - JOUR

T1 - Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis

AU - PROMISE Investigators

AU - Johannesen, Caroline Klint

AU - Gideonse, David

AU - Osei-Yeboah, Richard

AU - Lehtonen, Toni

AU - Jollivet, Ombeline

AU - Cohen, Rachel A

AU - Urchueguía-Fornes, Arantxa

AU - Herrero-Silvestre, María

AU - López-Lacort, Mónica

AU - Kramer , Rolf

AU - Fischer, Thea K

AU - Heikkinen, Terho

AU - Nair, Harish

AU - Campbell, Harry

AU - van Boven, Michiel

PY - 2025/4/1

Y1 - 2025/4/1

N2 - BackgroundRespiratory 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.MethodsThe 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.FindingsThe 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.InterpretationRSV-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.

AB - BackgroundRespiratory 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.MethodsThe 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.FindingsThe 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.InterpretationRSV-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.

KW - RSV

KW - Respiratory tract infection

KW - Hospital admissions

KW - National register-based study

KW - Time series analysis

KW - Burden of disease

U2 - 10.1016/j.lanepe.2025.101227

DO - 10.1016/j.lanepe.2025.101227

M3 - Article

SN - 0140-6736

VL - 51

JO - Lancet

JF - Lancet

M1 - 101227

ER -

Estimation of respiratory syncytial virus-associated hospital admissions in five European countries using attribution analysis

Abstract

Keywords / Materials (for Non-textual outputs)

Access to Document

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Projects

PRomISE: Preparing for RSV Immunization and Surveillance in Europe

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