Project
Start
January 2019

GERi: Global Epidemiology of RSV in primary and secondary care, 2019 - continuously

Duration: Jan 2019 - ongoing

Rationale
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children. By the age of one, 60–70% of children have been infected by RSV (2%-3% of whom are hospitalized), and almost all children have been infected by two years of age. A global burden of disease study has recently shown that RSV is estimated to cause approximately 33.8 million new episodes of acute lower respiratory infections annually in children aged <5 years worldwide, resulting in 3.2 million hospital admissions and 59,600 in-hospital deaths in children aged <5 years in 2015. RSV is also recognized as a cause of illness in adults and high-risk adults, with a disease burden similar to that of seasonal influenza A.

Impact RSV
To support optimal immunization strategies to prevent and control RSV in the future, it is critically important to understand who develops symptoms which lead to seeking healthcare and to identify which groups are at risk of more severe RSV infection requiring hospitalization or intensive care, as well as the impact on community care. There are currently approximately 60 RSV vaccine candidates and monoclonal antibodies that are in pre-clinical to phase III clinical trials, with potential target groups including elderly people, pregnant women and infants. An RSV vaccine is expected to enter the market in the coming years.

Aims and research questions
Knowledge about the spatio-temporal timing of RSV epidemics will be very important as this information will allow for the optimization of the delivery of vaccines (or monoclonal antibodies) in community and hospitalized care. RSV infection is not notifiable in all countries, but many countries have a long tradition of reporting laboratory-confirmed RSV infections through surveillance networks (often linked to influenza) that are already in place. Whilst a fair amount is known about the epidemiology of RSV at country level, especially in the Northern Hemisphere, there is limited data on a global level and certain regions of the world (e.g. Central America, North Africa, Central Africa and the Middle East). In addition, very few studies have looked at the RSV burden (and spatio-temporal patterns) in the community versus hospitalized patients.

Participating countries
As of November 2020, 16 countries around the world have joined the project by providing their RSV surveillance data. Particiapting partners are:
- Bhutan: Ministry of Health (MoH), Thimphu
- Brazil: Ministry of Health (MoH), Rio de Janeiro
- Cameroon: Centre Pasteur du Cameroun, Yaounde
- Chile: Public Health Institute of Chile (ISPCH), Santiago
- Czech Republic: National Institute of Public Health (SZU), Prague
- Ecuador: National Institute of Public Health and Research (INSPI), Guayaquil
- Netherlands: National Institute for Public Health and the Environment (RIVM), Bilthoven
- New Zealand: Institute of Environmental Science and Research (ESR), Auckland
- Portugal: National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon
- Romania: National Institute for Infectious Diseases 'Prof. dr. Matei Bals', Bucharest
- Russia: Smorodintsev Research Institute of Influenza, Saint Petersburg
- Singapore: Ministry of Health (MoH), Singapore
- Spain: Institude of Health Carlos III, Madrid
- United States: National Institute for Communicable Diseases (NICD), Johannesburg, South AfricaCentre for Disease Control and Prevention (CDC), Atlanta
- Vietnam: National Institute of Hygiene and Epidemiology (NIHE), Hanoi


Methodology
The methodology of the GERi Study will be based on the Global Influenza B Study (GIBS) which was launched in 2012 (2012-2018) and collected information on the epidemiology and burden of disease of influenza B in the world since 2000 in order to support prevention policies. To achieve the GERi objective of including surveillance data from all world regions, we contact National Reference Centres in 40-50 countries around the world, with countries selected to represent all World Health Organization (WHO) regions. All countries will be asked to make data available from their national surveillance systems since 2000. Each participating country will be asked to provide the following data/information:
- virological data: weekly number of reported RSV cases reported by the national surveillance system, broken down by age group (0-5 months, 6-11 months, 1-2 years, 3-4 years, 5-17 years, 18-39 years, 40-64 years, and ≥65 years), RSV type (if available) and, importantly, the setting from where the case was reported (community care and hospitalized care). Data should be available for 3 (preferably 5) or more seasons to allow seasonality assessments.
- a short questionnaire on the main features of their national RSV surveillance system: the questionnaire includes questions on the methods used for the identification of the RSV influenza virus, patients sampling protocols, the RSV clinical case definition, the definition of inpatient and outpatient used in the country (including the existence of paediatricians in community care), the representativeness of the data and the population denominator.

For countries that extend over large areas, especially when stretched across different climate zones (such as China and Brazil), we will ask for data stratified by region/province, if they are available. For countries with year-round RSV activity, we will collect data throughout the year.

Results
We publish all the results of the project:
- publications
- posters and presentations (go to www.nivel.nl/en/geri)
Funding
Sanofi Pasteur, France
Project partners
Global Influenza and RSV Initiative (GIRI); Sanofi Pasteur Global Epidemiology Department, France; participating partners of 16 countries around the world providing their RSV surveillance data