COVID-19 Surveillance Strategies Prove Useful for RSV


Results of a review show that lessons learned from the pandemic apply to the respiratory syncytial virus.

The COVID-19 pandemic affected the transmission of respiratory syncytial virus (RSV) and other respiratory viruses, but during the 2020-2021 season, RSV transmissions were seldom reported, according to the results of a review published in the European Respiratory Journal.

RSV virus and DNA on the background of infant feet | Image Credit: Julia -

Julia -

Investigators noted that it is important for RSV surveillance to be integrated within a broader respiratory surveillance framework for better efficiency and sustainability.

By relaxing the social restrictions, there has been an unusual out-of-season resurgence of RSV, they said.

This can negatively affect health care systems, because of an increase in patients, and RSV has been affecting children older than aged 1 year.

It was also reported that there were changes in the usual routes of surveillance to accommodate COVID-19. Additionally, access to and reductions in testing, as well as workforce numbers, affected the surveillance.

In the acute COVID-19 pandemic stage, the European Centre for Disease Prevention and Control the WHO helped develop strategic surveillance frameworks for a broader respiratory pathogen surveillance.

Investigators suggested year-round surveillance for all countries based on the uncertainty of how fast a typical seasonal pattern will be restored. RSV has been surging during out-of-season conditions.

Surveillance is important to help guide prophylaxis treatment, including with monoclonal antibody, palivizumab, as well as nirsevimab. It will also be important for RSV immunization if a seasonal immunization schedule is adopted.

In the case of another pandemic, primary-care surveillance systems can be interrupted, so alternative community surveillance is needed for year-round surveillance.

Linking community data could help compensate for the loss of capacity and help gather the data for other clinical purposes and expand the network of general physicians and pediatricians, investigators said.

This would entail community members self-reporting and -testing for RSV.

Surveillance for RSV is typically more useful if the data are collected in a timely fashion, investigators said.

Further guidelines should be provided, especially because children aged younger than 2 years are most affected by RSV.

For immunization effectiveness and timely data, hospital surveillance would be most efficient, investigators said.

Furthermore, elderly and immunocompromised individuals should also be considered as susceptible to RSV.

Investigators recommended that data on the major respiratory pathogens, which include influenza, SARS-CoV-2, and RSV, should be included with both negative and positive test results.

They also suggested to identify the most detailed data of RSV to include typing and subtyping data.

It was suggested that because a large number of children not being admitted to the hospital, they should be assessed at the emergency department for all bronchiolitis cases, which has been in use in France and initiated in the United Kingdom.

This would be highly sensitive and low-cost, though it would not be exact before other respiratory viruses can cause bronchiolitis, investigators said.

New surveillance systems used for the COVID-19 pandemic, such as wastewater surveillance, could also be beneficial.

Multi-pathogen testing will be key for RSV, especially with the introduction of vaccinations, investigators said.


Teirlinck AC, Johannesen CK, Broberg EK, Penttinen P, et al. New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemic. Eur Respir J. 2023;61(4):2201569. doi:10.1183/13993003.01569-2022

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