Respiratory Syncytial Virus Epidemiology and Clinical Burden in High-Risk and ≥ 50-Year-Old Adults in Low- to Middle-Income Countries: An Artificial-Intelligence-Enabled Systematic Literature Review.

Abstract

Introduction: Limited data are available on the epidemiology and clinical burden of respiratory syncytial virus (RSV) among adults with underlying medical or immunocompromising conditions ("high-risk adults") and ≥ 50-year-old adults in developing countries.

Methods: To better understand the impact of RSV in these populations, a systematic literature review of articles published from the year 2000 onward reporting RSV data among high-risk 18-59-year-old adults and ≥ 50-year-old adults in low, lower-middle, upper-middle, and selected high-income countries was undertaken. Searches were run on Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica DataBASE (EMBASE), and were supplemented by additional searches (e.g., congress abstracts, gray literature). A combination of artificial intelligence models was used for title/abstract screening. After this, full-text screening of inclusions was conducted, followed by prioritization.

Results: Overall, 77 citations were selected for final inclusion. Of these, 69 reported outcomes related to RSV epidemiology and clinical burden, and are reported in this article. There were limited data on RSV incidence, prevalence, disease severity, and subtype distribution. Adequate evidence was available for RSV positivity among patients with respiratory illnesses, seasonality, complications, and mortality. Incidence in ≥ 65-year-olds was in the range of ~10-178 episodes per 1000 person-years across studies. Ranges for RSV positivity among patients with different underlying respiratory conditions were 1.5-31.9% and 0-9.1%, in high-risk and ≥ 50-year-old adults, respectively. Case fatality rates of up to 15.2% and 27.0% were reported across studies for high-risk and > 60-year-old adults, respectively.

Conclusions: Overall, there were considerable evidence gaps for RSV epidemiology among high-risk and ≥ 50-year-old adults in developing countries. However, available data indicate a substantial negative health impact of RSV on these populations, highlighting the need for further data generation.