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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.