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Correlations and Timeliness of Respiratory Syncytial Virus Surveillance Indicators-United States, 2018-2024
Erin L Anderson1, Erica Billig Rose1, Amber Winn1
1Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Pediatric surveillance indicators signal the start of respiratory syncytial virus (RSV) season earlier than all-age indicators. While national RSV surveillance systems show strong correlations, regional variations exist, impacting local prevention strategies.
Area of Science:
- Epidemiology
- Public Health Surveillance
Background:
- Respiratory syncytial virus (RSV) significantly impacts young children and older adults, causing substantial hospitalizations.
- Effective monitoring of RSV activity is crucial for timely implementation of preventive measures and healthcare system preparedness.
Purpose of the Study:
- To analyze and compare pediatric and all-age respiratory syncytial virus (RSV) surveillance indicators.
- To understand the relationships and time lags between different RSV surveillance systems before, during, and after the COVID-19 pandemic.
Main Methods:
- Analysis of respiratory syncytial virus (RSV) data from six surveillance years (2018-2024) using multiple national systems (NREVSS, NSSP, NVSN, RSV-NET).
- Characterization of RSV seasonality and comparison of pediatric versus all-age indicators (positivity, ED visits, hospitalizations).
- Estimation of cross-correlations and lags between surveillance systems relative to NREVSS.
Main Results:
- Pediatric indicators consistently exceeded all-age indicators at RSV season onset, peak, and offset.
- High national correlations (ρ > 0.92) and short lags (0-1 weeks) were observed between systems during prepandemic and postdisruption periods.
- Regional correlations and lags showed variability (ρ = 0.48–0.99; 0-6 weeks) across different time windows.
Conclusions:
- Pediatric surveillance data offers the earliest detection of respiratory syncytial virus (RSV) season onset.
- Complementary CDC surveillance systems demonstrate strong national and regional correlations for RSV activity.
- Local RSV trends crucial for prevention optimization may not be fully captured by current national surveillance systems.
Background:
Respiratory syncytial virus (RSV) is a major cause of hospitalizations in young children and older adults in the United States. Monitoring seasonal RSV activity through national surveillance systems and understanding the relationships among RSV surveillance indicators can help ensure timely administration of prevention products and improve preparedness among healthcare systems and public health programs.
Methods:
We analyzed RSV data across six surveillance years from the National Respiratory and Enteric Virus Surveillance System (NREVSS), National Syndromic Surveillance Program (NSSP), commercial laboratories, New Vaccine Surveillance Network (NVSN), and Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET). We characterized RSV seasonality and compared pediatric and all-age surveillance indicators (percent positivity, percentage of ED visits, and hospitalization rates) at key points during the RSV season. We then estimated cross-correlations and lags between each system and NREVSS before, during, and after the COVID-19 pandemic.
Results:
Five RSV seasons occurred between 2018 and 2024. Pediatric indicators were greater than all-age indicators at NREVSS season onset (range: 1.4-6.3 times greater), peak (1.3-5.8), and offset (1.1-4.7). Nationally, indicators were highly correlated across systems (ρ > 0.92) during the prepandemic and postdisruption periods, with minimal lags (0-1 weeks). However, correlations (ρ = 0.48-0.99) and lags (0-6 weeks) varied across regions and time windows during these periods.
Conclusions:
Pediatric surveillance indicators provide the earliest indications of RSV season onset. CDC systems that provide complementary data on RSV activity and associated outcomes are highly correlated at the national and regional levels but may not capture local trends that are important for optimizing prevention.
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