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

Susanne Heemskerk1,2, Lotte van Heuvel1, Peter Spreeuwenberg1

  • 1Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands.

Influenza and Other Respiratory Viruses
|October 27, 2025
PubMed

Insights

This study estimates respiratory syncytial virus (RSV) incidence in children under 5 in primary care settings. The overall incidence was 62.8 per 1000, with higher rates in ambulatory care than emergency departments.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Respiratory syncytial virus (RSV) infections are commonly managed in primary care, including ambulatory care and emergency departments (EDs).
  • Accurate incidence data in these settings is crucial for understanding disease burden in children.
  • This study focuses on high-income countries (HICs).

Purpose of the Study:

  • To provide adjusted pooled incidence estimates for RSV in children under 5 years old within primary care settings.
  • To compare RSV incidence between ambulatory care and ED settings.
  • To inform the development of RSV immunization programs.

Main Methods:

  • A systematic review and meta-analysis of 27 population-based studies was conducted.
  • A multilevel logit-logistic regression model was used to adjust for age, primary care setting, and study methodology.
  • Data from previous systematic review on RSV incidence rates were used as input parameters.

Main Results:

  • The adjusted pooled RSV incidence estimate for children under 5 in primary care was 62.8 per 1000 population.
  • Incidence was significantly higher in ambulatory care (108.1 per 1000) compared to EDs (35.8 per 1000).
  • Incidence decreased with age, with the highest rates observed in children under 6 months (86.5 per 1000).

Conclusions:

  • This is the first multilevel meta-analysis to estimate the RSV burden in primary care, encompassing both ambulatory and emergency care.
  • The findings provide valuable data for policymakers considering the implementation of RSV immunization strategies.
  • Understanding incidence variations across settings and age groups is key for targeted public health interventions.
Abstract

Keywords:
childemergency departmentglobal burden of diseaseprimary health carerespiratory syncytial virus

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