The Burden of Respiratory Syncytial Virus in Children With Acute Otitis Media: A Systematic Review and Meta‐Analysis

TL;DR

This study finds that respiratory syncytial virus is a significant cause of ear infections in young children and often occurs alongside bacterial infections.

Contribution

The study provides the first comprehensive meta-analysis of RSV's role in acute otitis media in children under 5.

Findings

RSV was found in 16.9% of children with acute otitis media.

RSV was more common in younger children and during peak RSV seasons.

Most RSV-positive cases also had bacterial co-detections like Streptococcus pneumoniae.

Abstract

Acute otitis media (AOM) affects over 709 million individuals globally each year, more than half of whom are children < 5 years. Respiratory syncytial virus (RSV) is a leading viral cause of pediatric respiratory illness. We aimed to estimate the burden of RSV in children < 5 years with AOM

We performed a systematic review of studies reporting RSV identified through laboratory testing in children < 5 years with AOM. We searched eight databases from January 1, 1996, to May 9, 2025. We extracted data on RSV proportion in AOM and on co‐detection of bacterial pathogens. We reported pooled proportions using random‐effects meta‐analysis.

We included 27 studies encompassing 8342 children with AOM. The pooled proportion of RSV in children with AOM was 16.9% (95% CI 11.0–23.8, I
2 = 94.9%). RSV proportion was higher in inpatient‐based studies, in studies conducted during peak RSV seasons, and in children aged < 12 months. Among RSV‐positive AOM cases, an estimated 67.4% (95% CI 15.4–100) had at least one bacterial co‐detection. The most frequent bacteria co‐detected were
Streptococcus pneumoniae
, followed by
Haemophilus influenzae
and
Moraxella catarrhalis
.

RSV is a common contributor to AOM in children < 5 years. Our findings indicate that RSV‐associated AOM often involves concurrent bacterial detection. These results highlight the potential impact of recently introduced passive RSV immunization, such as maternal immunization and long‐acting monoclonal antibody, in reducing AOM incidence and its complications. Preventing RSV in early childhood could lower the overall burden of AOM and decrease the need for antibiotics.

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