New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemic

Abstract

The emergence of SARS-CoV-2 and the resulting coronavirus disease 2019 (COVID-19) pandemic has led to the reconsideration of surveillance strategies for respiratory syncytial virus (RSV) and other respiratory viruses. The COVID-19 pandemic and the non-pharmaceutical interventions for COVID-19 had a substantial impact on RSV transmission in many countries, with close to no transmission detected during parts of the usual season of 2020–2021. Subsequent relaxation of social restrictions has resulted in unusual out-of-season resurgences of RSV in several countries, causing a higher healthcare burden and often a higher proportion of hospitalisations than usual among children older than 1 year in age [1]. In case of an emerging infectious disease with pandemic potential, preparedness to scale up surveillance for the emerging disease while continuing the maintenance of surveillance activities of pre-existing seasonal diseases is necessary. The COVID-19 pandemic demonstrated, however, a lack of surge capacity in respiratory surveillance [2]. Many of the existing respiratory surveillance systems across Europe were affected by the COVID-19 pandemic. Usual healthcare seeking routes, that are often the source of the sentinel surveillance, were altered for patients with respiratory symptoms to be diagnosed elsewhere for SARS-CoV-2 in many countries. Additionally, there were initially major reductions in testing availability, workforce numbers and access to test consumables due to repurposing of human and material resources to SARS-CoV-2 diagnostics and surveillance in the first half of 2020 [3, 4]. To help countries prioritise efforts towards construction of resilient and sustainable surveillance systems, the World Health Organization (WHO) European region and European Centre for Disease Prevention and Control (ECDC) convened Member State consultations to develop a strategic surveillance framework for a broader respiratory pathogen surveillance in the post-acute phase of the COVID-19 pandemic [5, 6]. It is important for RSV surveillance to be aligned and integrated within this broad respiratory surveillance framework for increased efficiency and sustainability of RSV surveillance. We here address the specific needs of RSV surveillance, based on the set of recommendations we proposed in 2019 [7], which we revised during a virtual workshop in October 2021, with 40 participants from 16 EU/EEA countries, representing expertise within RSV epidemiology, virology and public health. We take into consideration the need for robust surveillance of RSV to inform healthcare planning and appropriate timing of RSV prophylaxis and other preventive measures, and the lessons learned from the COVID-19 pandemic (table 1).