Respiratory Syncytial Virus Epidemiology During and After Covid-19 Pandemic in Africa: Systematic Review and...

Respiratory syncytial virus (RSV) is a major agent of acute respiratory infections in children and the elderly. RSV epidemiology has been changed by the since Covid-19 pandemic and this review aimed to assess the extent of this change in Africa.

We searched Medline, Embase, Global Health, Web of Science, and Africa Index Medicus for studies reporting RSV epidemiology during and after the pandemic. We assessed heterogeneity using the I² statistic and evaluated study quality with the Hoy et al. checklist for prevalence studies. Publication bias was assessed with the Egger test. Pooled estimates of prevalence and incidence were calculated using a random-effects model. Analyses were stratified by pandemic era.

Nineteen studies from 12 African countries, including 53,550 patients, met the inclusion criteria. The pooled prevalence of RSV infection was 13.0% (95% CI 9.5-17.1), with substantial heterogeneity (I² = 99.2% [99.1-99.3]). The Egger test showed no evidence of publication bias (p = 0.745). Prevalence was highest in children (29.8% [18.8-42.1]) compared with all-age populations (5.9%; p < 0.001), and in hospitalized patients compared with outpatients (21.3% vs. 11.3%; p < 0.001). In the post-pandemic period, prevalence rose significantly to 30.6% (12.4-52.5), compared with 8.8% (3.7-15.7) during the pandemic (p = 0.071). The overall incidence of RSV infection was 3.0 per 1000 (1.8-4.2) person-year.

This systematic review highlights a marked resurgence of RSV in Africa following the easing of COVID-19 restrictions, particularly among children. These findings underscore the urgent need for strengthened RSV surveillance, targeted prevention strategies, and expanded access to new vaccines and monoclonal antibodies.