Social, Economic, and Health Impact of the Respiratory Syncytial Virus

A Systematic Search

Javier Díez-Domingo; Eduardo G Pérez-Yarza; José A Melero; Manuel Sánchez-Luna; María Dolores Aguilar; Antonio Javier Blasco; Noelia Alfaro; Pablo Lázaro

Disclosures

BMC Infect Dis. 2014;14(544)

Abstract and Introduction

Abstract

Background Bronchiolitis caused by the respiratory syncytial virus (RSV) and its related complications are common in infants born prematurely, with severe congenital heart disease, or bronchopulmonary dysplasia, as well as in immunosuppressed infants. There is a rich literature on the different aspects of RSV infection with a focus, for the most part, on specific risk populations. However, there is a need for a systematic global analysis of the impact of RSV infection in terms of use of resources and health impact on both children and adults. With this aim, we performed a systematic search of scientific evidence on the social, economic, and health impact of RSV infection.

Methods A systematic search of the following databases was performed: MEDLINE, EMBASE, Spanish Medical Index, MEDES-MEDicina in Spanish, Cochrane Plus Library, and Google without time limits. We selected 421 abstracts based on the 6,598 articles identified. From these abstracts, 4 RSV experts selected the most relevant articles. They selected 65 articles. After reading the full articles, 23 of their references were also selected. Finally, one more article found through a literature information alert system was included.

Results The information collected was summarized and organized into the following topics: 1. Impact on health (infections and respiratory complications, mid- to long-term lung function decline, recurrent wheezing, asthma, other complications such as otitis and rhino-conjunctivitis, and mortality; 2. Impact on resources (visits to primary care and specialists offices, emergency room visits, hospital admissions, ICU admissions, diagnostic tests, and treatments); 3. Impact on costs (direct and indirect costs); 4. Impact on quality of life; and 5. Strategies to reduce the impact (interventions on social and hygienic factors and prophylactic treatments).

Conclusions We concluded that 1. The health impact of RSV infection is relevant and goes beyond the acute episode phase; 2. The health impact of RSV infection on children is much better documented than the impact on adults; 3. Further research is needed on mid- and long-term impact of RSV infection on the adult population, especially those at high-risk; 4. There is a need for interventions aimed at reducing the impact of RSV infection by targeting health education, information, and prophylaxis in high-risk populations.

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Abstract and Introduction
Background
Methods
Results
Discussion
Conclusions
References

Table 1. Study design according to SIGN classifying algorithm and SIGN quality of evidence scale
Study design and quality of evidence	N	%	References
Systematic review or Meta-analyses	21	23.6
High quality	8		[4,42,46,61,62,65,71,72]
Acceptable	13		[18,19,28,33,41,43,5,64,67,73–76]
Economic evaluation	6	6.7
High quality	6		[55,57–60,63]
Acceptable	0
Controlled trial	4	4.5
High quality	4		[52,77,78,106]
Acceptable	0
Cohort studies	18	20.2
High quality	11		[45,69,86,87,89,9,93–95,97,105]
Acceptable	7		[44,85,88,91,10,102,103]
Case-control study	5	5.6
High quality	3		[47,79,92]
Acceptable	2		[39,99]
Cross-sectional study*	35	39.8	[20–27,29–32,34–38,48,49,51,53,54,56,66,68,7,80–84,96,98,101,104]
Total	89	100

*The scientific quality of cross-sectional studies was not evaluated because it is not required by the SIGN scale.

Table 2. List of topics within the areas of social, economic, and health impact of respiratory syncytial virus and corresponding references
Topics		References*
Incidence		[18,2,21,23–26,29,31,32,43,54,55]
Prevalence		[23,7,75]
Impact on health	Respiratory infections	[21,25–27,29,31,32,35,36,75,84]
	Wheezing and asthma	[2,22,28,41–45,51,67,75,79,83,85–95,105]
	Allergic rhinoconjunctivitis	[41,45,79,95]
	Mortality	[18,2,22,24,46,47,49–51,63,67,82]
	Acute otitis media	[51–53]
	Apneas	[31,33,67,73]
	Neurological involvement	[48,73]
	Cardiac involvement	[73]
	COPD	[35–40]
	Other	[28,31,41,42,45,48,51,52,56,67,73,79,84]
Risk factors		[2,21,41,47,7,8,103]
Impact on use of resources	Primary care visits	[2,22,34,51]
	Emergency room visits	[22,34,51]
	Hospital visits	[22,34,41,51]
	Hospital admissions	[18,20–26,29,3,32,34,41,46,47,49,51,54–56,63,65,66,77,78,8,81,96–101]
	UCI admissions	[20–22,24,29,32,34,41,47,48,52,56,63,65,77,78,101]
	Diagnostic tests	[21,22,3,56]
	Ventilation	[22,24,29,31,48,49,56,63,77,78,101]
	Treatment	[22,26,3,34,74,77,102]
Impact on costs	Direct costs	[34,41,51,55,57–63,70]
Impact on costs	Indirect costs	[41,59–63]
Strategies to reduce impact	Hygienic measures	[41,49,71,104]
Strategies to reduce impact	Prophylactic treatment	[19,21,34,41,46,48,49,52,55,57–65,69,7,72,74,76–78,105,106]
Spain		[21,25,26,29,3,41,47,48,58–6,63,64,77,80]
Adults		[22,24,35–4,5,54,75]

*The 23 references obtained from the full reading of the articles selected by the experts on the systematic search were only classified within the topic mentioned in the article [83–105], similarly with the article included last [106].