12 Dec 2022
Since the end of October 2022 and as of week 47, several EU/EEA countries have indicated an increase in paediatric hospitalisations due to RSV infections causing bronchiolitis, amidst concurrent circulation of other respiratory pathogens, such as influenza and SARS-CoV-2 viruses. As a result, there is a high risk of significant pressure on the EU/EEA healthcare systems in the coming weeks and months, warns the European Centre for Disease Prevention and Control (ECDC) according to a Risk Assessment published today.
Several EU/EEA countries are experiencing high respiratory syncytial virus (RSV) circulation, and the number of severe acute respiratory infections (SARI) due to RSV infection is also increasing. RSV infections at this time of the year are not unusual, but higher and earlier this year than in the pre-pandemic period, also proportionately affecting more children. The EU/EEA countries are also experiencing an early influenza season and a possible resurgence of COVID-19 after weeks of decline in cases and hospitalisations.
ECDC Director Dr. Andrea Ammon stated:
The end-of-year festive season is associated with activities such as social gatherings, shopping and travelling, which pose significant additional risks for transmission of RSV and other respiratory viruses. Reinforcement of healthcare systems and support of healthcare workers should be prioritised due to the risk of severe pressure on our healthcare systems in the coming weeks and months. Vaccination against influenza and COVID-19 should also be a priority among risk groups.
In addition to an increased number of hospitalisations, the co-circulation of RSV, influenza virus, SARS-CoV-2 and other respiratory viruses may lead to staff shortages due to sick leave. Maintaining an adequate ratio of staff to patients, especially in ICUs, is critical to maintaining patient safety and quality of care. In order to manage the expected higher number of cases, an increase in capacity should be considered and re-assessed frequently according to the epidemiological situation.
ECDC presents EU/EEA Member States with the following options for response:
- Implement risk communication activities for the public including active promotion of vaccinations against seasonal influenza and COVID-19;
- Increase awareness among healthcare professionals to timely diagnose cases and enhance hospital preparedness to manage increased patient load in outpatient and inpatient settings. This is particularly important for paediatric hospitals and intensive care units, and long-term care facilities (LTCFs);
- Ensure RSV prophylaxis to high-risk infants in accordance with national guidelines;
- Implement appropriate infection prevention and control (IPC) measures based on the local epidemiological situation, particularly for vulnerable groups within healthcare facilities, including LTCFs;
- Promote good hygienic practices in the community and consider appropriate non-pharmaceutical interventions (NPIs), such as staying home when ill, good hand and respiratory hygiene including appropriate use of face masks, appropriate ventilation of indoor spaces, use of teleworking where possible, and avoiding crowded public spaces;
- Where possible, implement and improve surveillance of RSV and testing for respiratory pathogens.
RSV is a major contributor to lower respiratory tract infections (LRTI) worldwide. By the age of two years, almost all children have been infected, but natural infection does not provide long-lasting immunity. Reinfection is common but usually affects only the upper respiratory tract. RSV clinical manifestations vary among different age groups. Symptoms range from mild influenza-like presentations to severe LRTIs, including bronchiolitis and pneumonia, that might require acute care admissions and mechanical ventilation.
Children below five years of age (particularly infants below six months), and adults over 65 years of age are the most affected by RSV-associated severe disease. An average of 213 000 children under five are admitted to hospital each year with RSV in the EU, Norway and United Kingdom.
RSV is a leading cause of acute LRTIs in infants and young children, but it is also considered an important cause of morbidity and mortality in older adults and high-risk individuals. RSV outbreaks in long-term care facilities (LTCFs) have significant case-fatality ratios.
Source – ECDC
Intensified circulation of respiratory syncytial virus (RSV) and associated hospital burden in the EU/EEA
12 Dec 2022
In recent weeks, respiratory syncytial virus (RSV) circulation in the EU/EEA has intensified, with increasing transmission rates in all population groups and an earlier-than-usual start of the season. Several EU/EEA countries are experiencing high RSV circulation and the number of severe acute respiratory infections (SARI) due to RSV is increasing. At this time of the year RSV infections are not unusual, however this year there is more RSV activity and it began earlier than in pre-COVID-19 seasons.
Executive summary
In recent weeks, respiratory syncytial virus (RSV) circulation in the EU/EEA has intensified, with increasing transmission rates in all population groups and an earlier-than-usual start of the season. Several EU/EEA countries are experiencing high RSV circulation and the number of severe acute respiratory infections (SARI) due to RSV is increasing. At this time of the year RSV infections are not unusual, however this year there is more RSV activity and it began earlier than in pre-COVID-19 seasons.
RSV infection generally causes mild disease, but the severity of clinical manifestations varies considerably. Those most affected by RSV-associated severe disease are children below five years (particularly infants under six months), adults aged 65 years and above and individuals with specific comorbidities. Hospitalisations caused by RSV and other respiratory pathogens, such as influenza virus and SARS-CoV-2, are increasing in a number of Member States, and are already placing pressure on healthcare systems.
Although several vaccine candidates are in clinical development for infants, pregnant women and older adults, there are currently no licensed vaccines available to prevent RSV infection. Effective passive immune prophylaxis is available and this is recommended for high-risk infants. At present, there are no specific therapeutic options for RSV infection, and treatment of hospitalised patients is mainly supportive.
Combining the probability of infection and the impact of the associated disease, the risk from RSV infection is assessed as low for the general population, and high for infants under six months, adults 65 years and above and individuals with specific comorbidities.
The risk that co-circulating RSV, influenza virus and SARS-CoV-2 will place pressure on EU/EEA healthcare systems in the coming weeks is assessed as high.
Given the increased circulation of respiratory viruses, including RSV, the main options for response for EU/EEA national public health authorities are set out below.
- Implement risk communication activities for the public, including active promotion of vaccinations against seasonal influenza and COVID-19.
- Increase awareness among healthcare professionals to ensure timely diagnosis of cases and enhance hospital preparedness to manage increased patient load in outpatient and inpatient settings. This is particularly important for paediatric hospitals and intensive care units, but also for long-term care facilities (LTCF).
- Provide RSV prophylaxis for high-risk infants in accordance with national guidelines.
- Implement appropriate infection prevention and control (IPC) measures based on the local epidemiological situation, particularly for vulnerable groups within healthcare facilities, including LTCFs.
- Promote good hygienic practices in the community and consider appropriate non-pharmaceutical interventions (NPIs), including targeted guidance for risk groups and care-givers of vulnerable groups. This includes staying home when ill; good hand and respiratory hygiene, including appropriate use of face masks; appropriate ventilation of indoor spaces; use of teleworking where possible, and avoiding crowded public spaces, including public transportation, to reduce the spread of RSV and other respiratory viruses.
Where possible, implement and improve surveillance of RSV and testing for respiratory pathogens. ECDC encourages Member States to continue reporting influenza, SARS-CoV-2, and RSV infection and hospitalisation data from sentinel and non-sentinel sources.
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