Substantial Burden of Nonmedically Attended RSV Infection in Healthy-Term Infants: An International Prospective Birth Cohort Study
Sarah F. Hak, Roderick P Venekamp, Marie‐Noëlle Billard, Marlies A. van Houten, Andrew J. Pollard, Terho Heikkinen, Steve Cunningham, Margaret Millar, Federico Martinón‐Torres, Ana Dacosta-Urbieta, Louis Bont, Joanne Wildenbeest, PROMISE Investigators, Sarah Hak, Roderick P Venekamp, Joanne Wildenbeest, Marie‐Noëlle Billard, Marlies van Houten, Louis Bont, Andrew J. Pollard, Ana Dacosta-Urbieta, Federico Martinón‐Torres, Terho Heikkinen, Steve Cunningham, Harish Nair, Margaret A. Miller, Peter Openshaw, Philippe Beutels, Hannah Nohynek, Anne Teirlinck, John Paget, Leyla Kragten, Carlo Giaquinto, Javier Díez‐Domingo, Rafael Mikolajczyk, Gaël Dos Santos, Tin Tin Htar, Jeroen Aerssens, Charlotte Vernhes, Rolf Kramer, Veena Kumar, Bahar Ahani, Eva Molero
Abstract
BACKGROUND: During the first year of life, 1 in 4 infants develops a symptomatic respiratory syncytial virus (RSV) infection, yet only half seek medical attention. The current focus on medically attended RSV therefore underrepresents the true societal burden of RSV. We assessed the burden of nonmedically attended RSV infections and compared with medically attended RSV. METHODS: We performed active RSV surveillance until the age of 1 year in a cohort (n = 993) nested within the Respiratory Syncytial Virus Consortium in EUrope (RESCEU) prospective birth cohort study enrolling healthy term-born infants in 5 European countries. Symptoms, medication use, wheezing, and impact on family life were analyzed. RESULTS: For 97 of 120 (80.1%) nonmedically attended RSV episodes, sufficient data were available for analysis. In 50.5% (49/97), symptoms lasted ≥15 days. Parents reported impairment in usual daily activities in 59.8% (58/97) of episodes; worries, 75.3% (73/97); anxiety, 34.0% (33/97); and work absenteeism, 10.8% (10/93). Compared with medically attended RSV (n = 102, 9 hospital admissions), Respiratory Syncytial Virus NETwork (ReSViNET) severity scores were lower (3.5 vs 4.6, P < .001), whereas duration of respiratory symptoms and was comparable. CONCLUSIONS: Even when medical attendance is not required, RSV infection poses a substantial burden to infants, families, and society. These findings are important for policy makers when considering the implementation of RSV immunization. Clinical Trials Registration. ClinicalTrials.gov (NCT03627572).