# The Epidemiology of Healthcare‐Acquired Respiratory Syncytial Virus Infection Among Hospitalised Paediatric Patients: a Systematic Review and Meta‐Analysis

## TL;DR

This study finds that hospital-acquired RSV is a major but under-recognized cause of illness and death in hospitalized children, with higher mortality than community-acquired RSV.

## Contribution

The study provides the first comprehensive meta-analysis of incidence and mortality rates of healthcare-acquired RSV in hospitalized children.

## Key findings

- The pooled incidence rate of HA-RSV was 10.86 cases per 1000 person-years.
- The mortality rate was 11.34 deaths per 1000 person-years with a case-fatality rate of 13.30%.
- HA-RSV accounted for 22.48% of all healthcare-acquired infections in hospitalized children.

## Abstract

Hospital‐acquired respiratory syncytial virus (HA‐RSV) infections pose a substantial risk to hospitalised children, previously described as composing a fifth of RSV‐related deaths worldwide. Despite this, the epidemiology of HA‐RSV remains under‐characterised, with limited meta‐analytical evidence quantifying its incidence, morbidity and mortality.

We conducted a systematic review and meta‐analysis of English language papers published between January 1975 and March 2024 searching EMBASE, MEDLINE and CABI Global Health. We included studies with primary data on paediatric HA‐RSV cases among either all patients, patients with RSV or patients with healthcare‐acquired infections (HAIs). Outbreak reports were excluded for the purposes of this analysis. Using random‐effects meta‐analyses, we synthesised the HA‐RSV incidence rate (IR) and mortality rate (MR) among patient groups, reported as cases and deaths per 1000 person‐years respectively. HA‐RSV cumulative incidence and case‐fatality rate (CFR) are also reported as percentages. The Joanna‐Briggs Institute critical appraisal tool was used for quality assessment.

Twenty‐seven studies from 11 countries were included. The pooled HA‐RSV IR among all paediatric patients was 10.86 cases (95% confidence interval, 3.83–17.89) per 1000 person‐years. The MR was 11.34 (5.57–17.11) deaths per 1000 person‐years, and the pooled CFR was 13.30% (3.21%–23.40%). HA‐RSV comprised 15.57% of RSV hospitalisations and 22.48% of all HAIs.

HA‐RSV is a serious and under‐recognised cause of morbidity and mortality in hospitalised paediatric patients, with significantly higher mortality than community‐acquired RSV. These findings underscore the need for strengthened infection control, standardised diagnostic criteria and targeted preventative strategies to mitigate its impact globally.