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Respiratory syncytial virus (RSV) is considered the most common pathogen causing severe lower respiratory tract infections among infants and young children. We describe the seasonality and geographical spread of RSV infection in 15 countries of the European Union and European Economic Area. We performed a retrospective descriptive study of weekly laboratory-confirmed RSV detections between weeks 40/2010 and 20/2016, in patients investigated for influenza-like illness, acute respiratory infection or following the clinician’s judgment. Six countries reported 4,230 sentinel RSV laboratory diagnoses from primary care and 14 countries reported 156,188 non-sentinel laboratory diagnoses from primary care or hospitals. The median length of the RSV season based on sentinel and non-sentinel surveillance was 16 (range: 9–24) and 18 (range: 8–24) weeks, respectively. The median peak weeks for sentinel and non-sentinel detections were week 4 (range: 48 to 11) and week 4.5 (range: 49 to 17), respectively. RSV detections peaked later (r = 0.56; p = 0.0360) and seasons lasted longer with increasing latitude (r = 0.57; p = 0.0329). Our data demonstrated regular seasonality with moderate correlation between timing of the epidemic and increasing latitude of the country. This study supports the use of RSV diagnostics within influenza or other surveillance systems to monitor RSV seasonality and geographical spread.


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  1. Simoes EA. Respiratory syncytial virus infection. Lancet. 1999;354(9181):847-52.  https://doi.org/10.1016/S0140-6736(99)80040-3  PMID: 10485741 
  2. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545-55.  https://doi.org/10.1016/S0140-6736(10)60206-1  PMID: 20399493 
  3. Heikkinen T, Ojala E, Waris M. Clinical and socioeconomic burden of respiratory syncytial virus infection in children. J Infect Dis. 2017;215(1):17-23.  https://doi.org/10.1093/infdis/jiw475  PMID: 27738052 
  4. Stein RT, Bont LJ, Zar H, Polack FP, Park C, Claxton A, et al. Respiratory syncytial virus hospitalization and mortality: Systematic review and meta-analysis. Pediatr Pulmonol. 2017;52(4):556-69.  https://doi.org/10.1002/ppul.23570  PMID: 27740723 
  5. Reeves RM, Hardelid P, Gilbert R, Warburton F, Ellis J, Pebody RG. Estimating the burden of respiratory syncytial virus (RSV) on respiratory hospital admissions in children less than five years of age in England, 2007-2012. Influenza Other Respi Viruses. 2017;11(2):122-9.  https://doi.org/10.1111/irv.12443  PMID: 28058797 
  6. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352(17):1749-59.  https://doi.org/10.1056/NEJMoa043951  PMID: 15858184 
  7. Zwaans WA, Mallia P, van Winden ME, Rohde GG. The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease—a systematic review. J Clin Virol. 2014;61(2):181-8.  https://doi.org/10.1016/j.jcv.2014.06.025  PMID: 25066886 
  8. Bloom-Feshbach K, Alonso WJ, Charu V, Tamerius J, Simonsen L, Miller MA, et al. Latitudinal variations in seasonal activity of influenza and respiratory syncytial virus (RSV): a global comparative review. PLoS One. 2013;8(2):e54445.  https://doi.org/10.1371/journal.pone.0054445  PMID: 23457451 
  9. Haynes AK, Manangan AP, Iwane MK, Sturm-Ramirez K, Homaira N, Brooks WA, et al. Respiratory syncytial virus circulation in seven countries with Global Disease Detection Regional Centers. J Infect Dis. 2013;208(Suppl 3):S246-54.  https://doi.org/10.1093/infdis/jit515  PMID: 24265484 
  10. Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: the ups and downs of a seasonal virus. Pediatr Infect Dis J. 2003;22(2) Suppl;S21-32.  https://doi.org/10.1097/00006454-200302001-00004  PMID: 12671449 
  11. Yusuf S, Piedimonte G, Auais A, Demmler G, Krishnan S, Van Caeseele P, et al. The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect. 2007;135(7):1077-90.  https://doi.org/10.1017/S095026880600776X  PMID: 17346359 
  12. Meerhoff TJ, Paget JW, Kimpen JL, Schellevis F. Variation of respiratory syncytial virus and the relation with meteorological factors in different winter seasons. Pediatr Infect Dis J. 2009;28(10):860-6.  https://doi.org/10.1097/INF.0b013e3181a3e949  PMID: 20118684 
  13. Mullins JA, Lamonte AC, Bresee JS, Anderson LJ. Substantial variability in community respiratory syncytial virus season timing. Pediatr Infect Dis J. 2003;22(10):857-62.  https://doi.org/10.1097/01.inf.0000090921.21313.d3  PMID: 14551484 
  14. Mizuta K, Abiko C, Aoki Y, Ikeda T, Matsuzaki Y, Itagaki T, et al. Seasonal patterns of respiratory syncytial virus, influenza A virus, human metapneumovirus, and parainfluenza virus type 3 infections on the basis of virus isolation data between 2004 and 2011 in Yamagata, Japan. Jpn J Infect Dis. 2013;66(2):140-5.  https://doi.org/10.7883/yoken.66.140  PMID: 23514911 
  15. Haynes AK, Prill MM, Iwane MK, Gerber SICenters for Disease Control and Prevention (CDC). Respiratory syncytial virus--United States, July 2012-June 2014. MMWR Morb Mortal Wkly Rep. 2014;63(48):1133-6. PMID: 25474034 
  16. Anestad G. Surveillance of respiratory viral infections by rapid immunofluorescence diagnosis, with emphasis on virus interference. Epidemiol Infect. 1987;99(2):523-31.  https://doi.org/10.1017/S0950268800068023  PMID: 2824225 
  17. Waris M. Pattern of respiratory syncytial virus epidemics in Finland: two-year cycles with alternating prevalence of groups A and B. J Infect Dis. 1991;163(3):464-9.  https://doi.org/10.1093/infdis/163.3.464  PMID: 1995719 
  18. Eriksson M, Bennet R, Rotzén-Ostlund M, von Sydow M, Wirgart BZ. Population-based rates of severe respiratory syncytial virus infection in children with and without risk factors, and outcome in a tertiary care setting. Acta Paediatr. 2002;91(5):593-8.  https://doi.org/10.1111/j.1651-2227.2002.tb03282.x  PMID: 12113331 
  19. White LJ, Waris M, Cane PA, Nokes DJ, Medley GF. The transmission dynamics of groups A and B human respiratory syncytial virus (hRSV) in England & Wales and Finland: seasonality and cross-protection. Epidemiol Infect. 2005;133(2):279-89.  https://doi.org/10.1017/S0950268804003450  PMID: 15816153 
  20. Mlinaric-Galinovic G, Welliver RC, Vilibic-Cavlek T, Ljubin-Sternak S, Drazenovic V, Galinovic I, et al. The biennial cycle of respiratory syncytial virus outbreaks in Croatia. Virol J. 2008;5(1):18.  https://doi.org/10.1186/1743-422X-5-18  PMID: 18226194 
  21. Jepsen MT, Trebbien R, Emborg HD, Krause TG, Schønning K, Voldstedlund M, et al. Incidence and seasonality of respiratory syncytial virus hospitalisations in young children in Denmark, 2010 to 2015. Euro Surveill. 2018;23(3):17-00163.
  22. Terletskaia-Ladwig E, Enders G, Schalasta G, Enders M. Defining the timing of respiratory syncytial virus (RSV) outbreaks: an epidemiological study. BMC Infect Dis. 2005;5(1):20.  https://doi.org/10.1186/1471-2334-5-20  PMID: 15801975 
  23. Choi EH, Lee HJ. Genetic diversity and molecular epidemiology of the G protein of subgroups A and B of respiratory syncytial viruses isolated over 9 consecutive epidemics in Korea. J Infect Dis. 2000;181(5):1547-56.  https://doi.org/10.1086/315468  PMID: 10823752 
  24. Jiménez-Jorge S, Delgado-Sanz C, de Mateo S, Pozo F, Casas I, Larrauri ASistema de Vigilancia de Gripe en España (SVGE). [Monitoring respiratory syncytial virus through the Spanish influenza surveillance system, 2006-2014]. Enferm Infecc Microbiol Clin. 2016;34(2):117-20. https://doi.org/10.1016/j.eimc.2014.12.012  PMID: 25703209 
  25. Groothuis JR, Hoopes JM, Hemming VG. Prevention of serious respiratory syncytial virus-related illness. II: Immunoprophylaxis. Adv Ther. 2011;28(2):110-25.  https://doi.org/10.1007/s12325-010-0101-y  PMID: 21318605 
  26. Homaira N, Rawlinson W, Snelling TL, Jaffe A. Effectiveness of palivizumab in preventing RSV hospitalization in high risk children: a real-world perspective. Int J Pediatr. 2014;2014:571609.
  27. Higgins D, Trujillo C, Keech C. Advances in RSV vaccine research and development - A global agenda. Vaccine. 2016;34(26):2870-5.  https://doi.org/10.1016/j.vaccine.2016.03.109  PMID: 27105562 
  28. Roberts JN, Graham BS, Karron RA, Munoz FM, Falsey AR, Anderson LJ, et al. Challenges and opportunities in RSV vaccine development: Meeting report from FDA/NIH workshop. Vaccine. 2016;34(41):4843-9.  https://doi.org/10.1016/j.vaccine.2016.07.057  PMID: 27566900 
  29. Modjarrad K, Giersing B, Kaslow DC, Smith PG, Moorthy VSWHO RSV Vaccine Consultation Expert Group. WHO consultation on respiratory syncytial virus vaccine development. Report from a World Health Organization meeting held on 23-24 March 2015. Vaccine. 2016;34(2):190-7.  https://doi.org/10.1016/j.vaccine.2015.05.093  PMID: 26100926 
  30. Melero JA, Moore ML. Influence of respiratory syncytial virus strain differences on pathogenesis and immunity. Curr Top Microbiol Immunol. 2013;372:59-82.  https://doi.org/10.1007/978-3-642-38919-1_3  PMID: 24362684 
  31. Meerhoff TJ, Mosnier A, Schellevis F, Paget WJEISS RSV Task Group. Progress in the surveillance of respiratory syncytial virus (RSV) in Europe: 2001-2008. Euro Surveill. 2009;14(40):19346. PMID: 19822120 
  32. European Commission. Commission Decision of 28 April 2008 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. 2008/426/EC. Official Journal of the European Union. 2008; L 159/46. Available from: https://publications.europa.eu/en/publication-detail/-/publication/3e53de24-26d6-4645-b9ab-3931f3874c9e/language-en
  33. Eurostat. GEOSTAT 1 km2 population grid, period 2011, version date 01/02/2016. Luxembourg: European Commission. [Accessed: 29 Mar 2017]. Available from: http://ec.europa.eu/eurostat/web/gisco/geodata/reference-data/population-distribution-demography/geostat
  34. Swinscow TDV. Correlation and regression 2016 In: Statistics at square one. 9th ed. London: BMJ Publishing Group Ltd; 1997. Available from: http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one/11-correlation-and-regression
  35. Bruden DJ, Singleton R, Hawk CS, Bulkow LR, Bentley S, Anderson LJ, et al. Eighteen years of respiratory syncytial virus surveillance: changes in seasonality and hospitalization rates in southwestern Alaska native children. Pediatr Infect Dis J. 2015;34(9):945-50.  https://doi.org/10.1097/INF.0000000000000772  PMID: 26065863 
  36. World Health Organization (WHO). WHO informal consultation on surveillance of RSV on the Global Influenza Surveillance and Response System (GISRS) platform 2015. Meeting report. Geneva: WHO; 2017. Available from: http://www.who.int/influenza/resources/publications/report_rsv_meeting/en/
  37. Iwane MK, Farnon EC, Gerber SI. Importance of global surveillance for respiratory syncytial virus. J Infect Dis. 2013;208(Suppl 3):S165-6.  https://doi.org/10.1093/infdis/jit484  PMID: 24265473 
  38. Donker GA. NIVEL primary care databases - sentinel practices. ISBN/EAN 9789461223791. Utrecht: Nederlands instituut voor onderzoek van de gezondheidszorg; 2016. Available from: http://www.nivel.nl/node/2430?database=ChoicePublicat&priref=1003052
  39. Rijksinstituut voor Voksgezondheid en Milieu (RIVM). Virologische weekstaten. [Weekly virological data [Accessed: 29 Mar 2017]. Dutch. Available from: http://www.rivm.nl/Onderwerpen/V/Virologische_weekstaten
  40. Health Protection Surveillance Centre (HPSC). Case definitions for notifiable diseases. 2012 Version 1.8. Dublin: HPSC; 2012. Available from: http://www.hpsc.ie/NotifiableDiseases/CaseDefinitions/File,823,en.pdf

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