Cough and shortness of breath are frequently occurring symptoms of respiratory syncytial virus (RSV) infection in pediatric patients aged 5 years and younger, according to study findings published in the World Journal of Pediatrics.
The systematic review and meta-analysis assessed the common clinical manifestations of RSV infection by age group and human development index (HDI) level as well as the association between RSV infection and wheezing or recurrent wheezing illness.
A literature search for relevant articles published between January 1, 2010, and June 2, 2022, was performed in 7 databases. Eligible studies reported common clinical manifestations of RSV-infected children aged 5 years of age or younger. Common clinical manifestations were evaluated with pooled estimates of 1-group meta-analyses, and the ratio-based effect was estimated for children with and without RSV infection who had wheezing.
Among the 47 included studies, 35 reported clinical manifestations of RSV infection in 24,822,974 participants. An association between RSV infection and wheezing illness was reported in 7 studies (3035 participants), and 7 studies (228,301 participants) found an association between early childhood RSV infection and recurrent wheezing illness.
The pooled incidence of mild clinical manifestations was 51%, which was significantly higher than moderate (37%) and severe (7%) clinical manifestations. Cough was the most frequently occurring mild clinical manifestation (92%), followed by nasal congestion (58%), rhinorrhea (53%), and fever (41%). The most common severe clinical manifestation was respiratory failure (29%), followed by sepsis (10%).
Respiratory tract infection symptoms, such as cough and shortness of breath, are the most common clinical manifestations of RSV infection, and the incidence of fever is low.
In children aged 0 to 1 year, the pooled incidences of mild, moderate, and severe clinical manifestations were 55%, 50%, and 9%, respectively. Clinical manifestations associated with RSV included cough (90%), shortness of breath (60%), and need for oxygen supplementation (54%). The pooled incidences of mild, moderate, and severe clinical manifestations in those aged 0 to 2 years were 51%, 39%, and 6%, respectively. The most common RSV-associated clinical manifestations were cough (93%), shortness of breath (57%), and fever (45%).
Among countries with very high HDI, the pooled incidences of mild, moderate, and severe clinical manifestations were 56%, 25%, and 6%, respectively. For countries with high HDI, the pooled incidences of mild, moderate, and severe clinical manifestations were 49%, 47%, and 5%, respectively. For medium-HDI countries, the pooled incidences of mild and moderate clinical manifestations were 76% and 31%, respectively. No data were available for low-HDI countries.
The association between RSV infection and wheezing was evaluated in 7 studies. Participants who were RSV-positive were more likely to have wheezing vs the control group (odds ratio [OR], 3.12; 95% CI, 2.59-3.76).
The association between early childhood RSV infection and subsequent recurrent wheezing illness was investigated in 7 studies. The RSV-positive group was more likely to have recurrent wheezing illness compared with the control group (OR, 2.60; 95% CI, 2.51-2.70).
The researchers noted that their analysis was based on a limited number of studies, resulting in large confidence intervals. Also, different methods were used to assess the outcomes, a subanalysis was not performed on all clinical manifestations, and substantial heterogeneity occurred in the studies for the association between RSV infection and recurrent wheezing. “Respiratory tract infection symptoms, such as cough and shortness of breath, are the most common clinical manifestations of RSV infection, and the incidence of fever is low,” concluded the researchers. “This suggests that surveillance based on the influenza-like illnesses, which takes fever as the surveillance symptom, might not be a suitable surveillance strategy for identifying patients with RSV infection.”