RSV clinical, societal burden in primary care differs in five European countries
Key takeaways:
- Depending on the country, the number of primary care visits per child, prescribed medication use and number of workdays missed differed.
- The prevalence of some factors also changed based on age.
In primary care settings, the burden of RSV on young children and their guardians often varied between the countries of Belgium, Italy, Spain, the Netherlands and the U.K., according to results published in The Lancet Respiratory Medicine.
“Although most of the childhood RSV infections that were followed up for 30 days did not require hospitalization, parents reported notable symptomatology, health care and medication use, and work absence, with differences between countries,” Sarah F. Hak, MD, PhD candidate in pediatric infectious diseases (RSV group) at University Medical Center Utrecht, and colleagues wrote.
In the prospective cohort RSV ComNet study including Belgium, Italy, Spain, the Netherlands and the U.K., Hak and colleagues assessed 3,414 children aged younger than 5 years with acute respiratory tract infection symptoms who sought treatment in primary care settings during an RSV season (2020-2021 only in U.K., 2021-2022 and 2022-2023) and underwent testing for RSV to determine RSV burden in this patient population over the course of 30 days.
A positive RSV test was observed in 32.9% (n = 1,124) of the cohort. When divided by age, the study noted that children aged younger than 1 year had a greater RSV positivity rate vs. children aged between 1 and younger than 5 years (38.9% vs. 25.9%).
Within the group of children positive for RSV, researchers had day 1 data for 878 children (median age, 11.1 months; 50.9% boys), day 14 parent-reported questionnaire data for 819 children and day 30 parent-reported questionnaire data for 731 children.
A little over a week and a half (11.7 days) was the average length of RSV, according to the study.
Based on questionnaire data, researchers noted a higher proportion of children with symptoms on day 14 vs. day 30 (56.1% vs. 36%).
Depending on the country, the average number of primary care visits per child differed. In Spain, the average was three visits, whereas in the Netherlands, the average was 1.4 visits. The remaining three countries had averages in between these two values (Belgium, 2.5 visits; Italy, 2.4 visits; U.K., 1.8 visits).
This number also changed based on age, with an average of 2.7 visits among those aged younger than 1 year and an average of 2.1 visits among those aged between 1 and younger than 5 years, according to the study.
Researchers reported similar findings when evaluating hospitalization rates in that they differed by country (Belgium, 43.7%; Spain, 14.6%; U.K., 5.2%; Italy, 4.1%; the Netherlands, 3.7%) and by age (younger than 1 year, 20.3% vs. 1 to younger than 5 years, 6.7%).
When continuing the assessment of health care resource utilization, researchers observed the greatest proportion of children with prescribed medication use in Italy at 76.8%, followed by Spain (68.4%), the Netherlands (36.8%), Belgium (31.7%) and the U.K. (26%).
Despite the above differences in the prevalence of medication use, all five countries had the same most prescribed medications: bronchodilators and antibiotics.
The proportion of children with prescribed medication use also differed by age group, with 49.7% in the younger than age 1 year group and 61.7% in the between ages 1 and younger than 5 years group, according to the study.
In terms of the societal impact of RSV, 45.7% of parents had to miss work. Depending on the country, the average number of workdays missed changed. In Belgium, the average was 4.1 days, whereas in Spain, the average was 1.3 days. The remaining three countries had averages in between these two values (Italy, 3.2 days; the Netherlands, three days; U.K., 2.1 days).
“Notable differences in RSV burden existed across countries, likely due to differences in primary health care systems, clinical practice, and health care-seeking behavior,” Hak and colleagues wrote. “This study emphasizes the importance of considering country-specific primary care burden estimates when considering the implementation of RSV immunizations programs.”
Perspective
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The RSV ComNet study highlights a significant but not surprising burden of RSV infections in young children within primary care. Most providers will recognize the described health care use, including multiple return visits and varying use of supportive care, bronchodilators or antibiotics. Families will relate to substantial time off work while children recover. While anecdotally familiar, this study provides clear evidence of ambulatory care utilization for a viral infection impacting nearly all children by age 2.
Notably, health care utilization and prescribing practices varied across countries, reflecting differences in clinical approaches and systems. As monoclonal antibodies and maternal vaccines are utilized, they will differentially impact outpatient care, making these baseline data invaluable for future comparisons. This variation highlights for clinicians the need to understand which interventions improve outcomes vs. those that lack proven benefit, contributing to unnecessary costs.
The study’s broader implications are somewhat limited. Between-country variation underscores that one region’s baseline rates cannot be applied elsewhere, and regions lacking such data cannot retroactively collect it, given the use of testing in this study design. Additionally, the studied seasons were atypical, complicating future comparisons. As prevention measures become standard, reliable metrics of disease burden will be essential to demonstrate their value — whether for individual children, health care systems through reduced resource use or families facing fewer health care visits and less time off work.
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