Prevalence of Respiratory Syncytial Virus in Adult Patients with Respiratory Illnesses in Low to Middle‑Income Countries: A Systematic Review and Meta‑Analyses
Digant Gupta · Amandeep Kaur · Vikas Verma · Désirée A. M. Van Oorschot ·Yolanda Penders · Adriana Guzman‑Holst
Introduction: There is a gap in the understanding of the burden of respiratory syncytial virus (RSV) among adults in low, lower‑middle, and upper‑middle income countries, particularly with regard to up‑to‑date epidemiological data. Meta‑analyses were conducted to determine pooled estimates of RSV prevalence among high‑risk 18–59‑year‑old adults and ≥50‑year‑old adults with or without risk factors or comorbidities, who present with respiratory illnesses in low, lower‑middle, and upper‑middle income countries.
Methods: Using studies identified from a previously described systematic literature review, a random‑effects model was used to determine pooled prevalence for each study population. Subgroup analyses and meta‑regression were conducted using the moderator variables deemed most relevant a priori and a mixed‑effects approach.
Results: Pooled RSV prevalence estimates were 5.1% (95% confidence interval [CI] 3.9–6.6%) and 3.9% (95% CI 3.3–4.7%) across 33 studies in 18–59‑year‑old high‑risk adults with respiratory illnesses and 66 studies in ≥50‑year‑old adults with respiratory illnesses, respectively. Subgroup analyses for 18–59‑year‑old high‑risk adults found geography, study setting, and respiratory illness to collectively explain ~ 54%of the variation in RSV prevalence estimates. The diagnostic method for RSV was found to explain ~ 8% of the variation in RSV prevalence estimates in ≥50‑year‑old adults; no other factors explored via subgroup analyses for ≥50‑year‑old adults had a notable effect on variation. For both populations, a substantial level of residual heterogeneity was observed using Higgin’s I2 when studies were split for subgroup analyses.
Conclusions: Overall, there is a considerable disease burden associated with RSV among 18–59‑year‑old high‑risk and ≥50‑year‑old adults with respiratory illnesses in low, lower‑middle, and upper‑middle income countries, highlighting the need for improved prevention programs for RSV in these populations.
