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Hospitalisation trends of respiratory syncytial virus (RSV) infection in adults, six European countries, before and during COVID-19, 2016 to 2023
- Arantxa Urchueguía-Fornes1,2 , Richard Osei-Yeboah3 , Ombeline Jollivet4 , Caroline Klint Johannesen5,6 , Toni Lehtonen7 , Michiel van Boven8,9 , David Gideonse8 , Rachel A Cohen10 , Alejandro Orrico-Sánchez1,2,11 , Rolf Kramer4 , Thea K Fischer6 , Terho Heikkinen12 , Harish Nair3 , Harry Campbell3 , on behalf of the PROMISE investigators13
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View Affiliations Hide AffiliationsAffiliations: 1 Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain 2 CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain 3 Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom 4 Sanofi, Lyon, France 5 Department of Virology and Microbiological Preparedness, Statens Serum Institut, Copenhagen, Denmark 6 Department of Clinical Research, North Zealand University Hospital, Capital Region, Copenhagen, Denmark 7 Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland 8 Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands 9 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands 10 GSK, Rockville, United States 11 Catholic University of Valencia, Valencia, Spain 12 Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland 13 The members of the PROMISE investigators are listed under AcknowledgementsRichard Osei-YeboahRichard.Osei-Yeboah ed.ac.uk
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Citation style for this article: Urchueguía-Fornes Arantxa, Osei-Yeboah Richard, Jollivet Ombeline, Johannesen Caroline Klint, Lehtonen Toni, van Boven Michiel, Gideonse David, Cohen Rachel A, Orrico-Sánchez Alejandro, Kramer Rolf, Fischer Thea K, Heikkinen Terho, Nair Harish, Campbell Harry, on behalf of the PROMISE investigators. Hospitalisation trends of respiratory syncytial virus (RSV) infection in adults, six European countries, before and during COVID-19, 2016 to 2023. Euro Surveill. 2025;30(25):pii=2400624. https://doi.org/10.2807/1560-7917.ES.2025.30.25.2400624 Received: 19 Sept 2024; Accepted: 29 Mar 2025
Abstract
Respiratory syncytial virus (RSV) is a major cause of morbidity in older adults.
We aimed to investigate the epidemiology of RSV in adults in five European countries and one region before and during the COVID-19 era.
We conducted a retrospective analysis using national hospital admission data from Denmark, England, Finland, the Netherlands, Scotland and regional prospective surveillance data from the Spain-Valencia region. We included patients aged ≥ 18 years hospitalised for respiratory tract infections (RTIs) 2016–2023 and assessed RSV-coded and laboratory-confirmed hospitalisations, intensive care unit (ICU) admissions and mortality.
Hospitalisations associated with RSV varied by country and year but increased with increasing age regardless of the use of RSV-coded or RSV-confirmed data, the country or year. The highest hospitalisation rates were in patients aged ≥ 85 years. We found that RSV-coded hospitalisations underestimated the case numbers when compared with laboratory-confirmed cases by an average of 1.9 (standard deviation (SD): ± 0.9). Admissions to ICU associated with RSV in England and CFR in England and Finland displayed different patterns post-COVID-19 pandemic peak but were not notably higher compared with RTI admissions.
Our findings reveal a consistency of RSV hospital admission patterns between European countries in the study period, with higher incidence rates among older patients. The differences between the numbers of RSV-coded and laboratory-confirmed cases highlight the critical need for improved surveillance, diagnostic practices and coding guidelines to better assess the incidence. Our findings could be vital for guiding public health strategies, particularly with the introduction of RSV vaccines for older adults.

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