The burden of respiratory syncytial virus associated with acute lower respiratory tract infections in Chinese children: a meta-analysis

BACKGROUND: Respiratory syncytial virus (RSV), which is associated with acute lower respiratory tract infection (ALRTI), is highly common among children. The burden of RSV varies between countries. In China, the actual burden remains unclear. Thus, this meta-analysis aimed to quantify the positive rate of ALRTI-related RSV infections among Chinese children in recent years. METHODS: The PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and Chinese BioMedical (CBM) databases were searched to identify relevant cross-sectional studies published between January 1, 2015 and December 31, 2018. Subsequently, a meta-analysis was performed using R software. RESULTS: A total of 18 studies involving 66,799 ALRTI cases were finally included in the meta-analysis. Among those ALRTIs cases, the overall positive rate of RSV infection was 16.0% (95% CI: 12.9–19.6%). The rate was significantly higher in children <3 years (19.5%, 95% CI 13.3–27.6%) compared to those ≥3 years (5.6%, 95% CI: 2.3–13.2%; P<0.01). Moreover, stratified analysis revealed that RSV infection was most frequent in children <6 months (31.1%, 95% CI: 21.0–43.5%). The positive detection rate of RSV infection was significantly associated with season (P<0.01), with winter having the highest detection rate (29.0%, 95% CI: 21.3–38.2%), followed by autumn (20.9%, 95% CI: 10.5–37.3%), and summer having the lowest rate (6.4%, 95% CI: 2.3–16.9%). The rate of RSV infection was highest and lowest in November (49.4%, 95% CI: 29.0–70.0%) and June (1.3%, 95% CI: 0.6–2.8%), respectively. When stratified according to geographical region, RSV infections peaked in winter (South: 24.8%, 95% CI: 12.9–42.3%; North: 36.3%, 95% CI: 30.8–42.1%), followed by autumn (South: 13.9%, 95% CI: 6.5–27.4%; North: 32.7%, 95% CI: 20.2–48.3%). CONCLUSIONS: In conclusion, our meta-analysis showed that among Chinese children with ALRTI, 16.0% had RSV infection. RSV infection frequently occurred in children under the age of 3 years, especially in those under 6 months. The rate of RSV infections was highest in winter, followed by autumn.