Intensified circulation of respiratory syncytial virus (RSV) and associated hospital burden in the EU/EEA

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.