RSV in Children: Molecular POC Testing and New Prevention Strategies Reshape Clinical Management
This Lancet Series paper reviews the global burden of RSV lower respiratory tract infection in young children, which causes 33 million episodes, 3.6 million hospitalisations, and 118,200 deaths annually. The advent of molecular point-of-care testing now enables rapid, accurate RSV confirmation and may reduce unnecessary antibiotic prescriptions. With newly approved long-acting monoclonal antibodies and maternal vaccines, RSV has become vaccine-preventable, though equitable access in low-income settings remains a priority.
The original study
Severe respiratory syncytial virus infection in children: burden, management, and emerging therapies.
- Authors
- Mazur NI, Caballero MT, Nunes MC
- Journal
- Lancet (London, England)
- Type
- Journal Article, Review, Research Support, Non-U.S. Gov't
- PMID
- 39265587
Original abstract
The global burden of respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) in young children is high. The RSV prevention strategies approved in 2023 will be essential to lowering the global disease burden. In this Series paper, we describe clinical presentation, burden of disease, hospital management, emerging therapies, and targeted prevention focusing on developments and groundbreaking publications for RSV. We conducted a systematic search for literature published in the past 15 years and used a non-systematic approach to analyse the results, prioritising important papers and the most recent reviews per subtopic. Annually, 33 million episodes of RSV LRTI occur in children younger than 5 years, resulting in 3·6 million hospitalisations and 118 200 deaths. RSV LRTI is a clinical diagnosis but a clinical case definition and universal clinical tool to predict severe disease are non-existent. The advent of molecular point-of-care testing allows rapid and accurate confirmation of RSV infection and could reduce antibiotic use. There is no evidence-based treatment of RSV, only supportive care. Despite widespread use, evidence for high-flow nasal cannula (HFNC) therapy is insufficient and increased paediatric intensive care admissions and intubation indicate the need to remove HFNC therapy from standard care. RSV is now a vaccine-preventable disease in young children with a market-approved long-acting monoclonal antibody and a maternal vaccine targeting the RSV prefusion protein. To have a high impact on life-threatening RSV infection, infants at high risk, especially in low-income and middle-income countries, should be prioritised as an interim strategy towards universal immunisation. The implementation of RSV preventive strategies will clarify the full burden of RSV infection. Vaccine probe studies can address existing knowledge gaps including the effect of RSV prevention on transmission dynamics, antibiotic misuse, the respiratory microbiome composition, and long-term sequalae.