Atypical causes of respiratory virus infections in Sub-Saharan Africa from 2013- 2023: a systematic review and meta-analysis.

Background: Atypical respiratory viruses (ARVs) are a diverse group of pathogens that cause respiratory infections through less common mechanisms or in unique epidemiological patterns, unlike the typical viruses like respiratory syncytial virus, influenza and human rhinoviruses. They sometimes present as unusual respiratory illnesses in vulnerable populations with near-fatal outcomes. Several viruses are involved, such as Human metapneumovirus (HMPV), Human Bocavirus (HBoV), Enteroviruses (EVs), Parechovirus (PeV) and Influenza C virus (ICV). This review was done to shed light on ARVs and their possible role in respiratory illness or infections based on studies in Sub-Saharan Africa from 2013 to 2023.

Methods: We systematically reviewed atypical causes of respiratory virus infections in Sub-Saharan Africa (SSA) in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. We searched PubMed, Web of Science, Google Scholar and Cochrane Library to include studies published from 2013 to 2023 with reports on ARV. The protocol was registered in PROSPERO (ID: CRD42024611183).

Results: The review covered 46 SSA countries, with five eligible for the systematic review. The search yielded 548 publications, with only six studies meeting the inclusion criteria. Studies included children and individuals of all age groups. The prevalence of ARVs detected in SSA was as follows: HMPV pooled prevalence was 1.52% (95% CI: 1.07-2.00), EVs pooled prevalence was 15.0% (95% CI: 14.1-15.9), HBoV prevalence was 0.4%, PeV was 20%, and ICV was 1.3% in individuals with respiratory tract infection(s).

Conclusion: Our findings suggest testing or diagnostics for ARV infections are very low in SSA. Therefore, surveillance of people suffering from respiratory tract infections, which is lacking, needs to be improved to monitor the prevalence of ARVs and the role they play in respiratory disease outcomes.