RSV-Related Healthcare Burden: A Prospective Observational Study in a Resource-Constrained Setting

Abstract Background Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations worldwide, straining health systems. Data gaps in resource-limited settings and limited RSV immunization impact estimates hinder policymaking. Methods From January to December 2019, we conducted a prospective study at Bangladesh’s largest pediatric hospital to assess RSV’s burden on the health system. Outcomes for RSV-positive under-five children were analyzed. We followed outcomes of children denied hospitalization due to bed shortages. Adjusted hazard ratios for children denied admission versus admitted were estimated using survival analysis. Monte Carlo simulations with a queuing model were used to estimate effects of RSV interventions on admission denials and mortality. Findings Of 40,664 children admitted, 31,692 were under-five; 19,940 were in study wards. Among 7,191 admitted with possible respiratory infections, 6,149 (86%) had samples taken, with 1,261 (21%) testing RSV-positive. Median age of RSV cases was 3 months, with a median hospital-stay of 5 days; 24 (1.9%) died in hospital. RSV cases accounted for 8,274 of 151,110 bed days. Additionally, of 9,169 children denied admission, outcomes were tracked for 3,928 and compared with 2,845 admitted. The hazard ratio for death was 1.56 [95%CI:1.34-1.81] for children denied versus admitted, highest within neonates at 2.27 [95%CI:1.87-2.75]. RSVpreF maternal vaccine or Nirsevimab could have reduced denials by 677 [95%PI:63-1347] and 1,289 [95%PI:684-1865], respectively, potentially preventing 130 [95%PI:-60-322] and 258 [95%PI:32-469] deaths. Interpretation RSV strains healthcare in Bangladesh, increasing mortality risks. Preventive interventions could lessen its impact, boosting healthcare capacity and child health in resource-limited settings.