RSV-Related Healthcare Burden: A Prospective Observational Study in a resource-constrained setting

Background: Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations globally, impacting overstretched health systems. Comprehensive data is vital for informing RSV vaccination policies. Methods: From January to December 2019, a prospective study was conducted at Bangladesh's largest pediatric hospital to evaluate RSV's burden on the health system. We analyzed hospitalization rates, lengths of stay, and outcomes for children under five using WHO criteria and qPCR testing. We also examined survival probability for children denied admission due to bed shortages, compared with those admitted using the Kaplan-Meier method, and estimated the effects of a maternal vaccine using Monte-Carlo simulations. Findings: Out of 40,664 children admitted, 31,692 were under five. Of these, 19,940 were eligible for study inclusion with 7,191 meeting inclusion criteria; 6,149 (86%) had samples taken, with 1,261 (21%) testing positive for RSV. The hospital incidence rate was 465 per 10,000 admissions. The median age of RSV patients was 3 months, with a median stay of 5 days. RSV accounted for 8,274 bed days of the total 151,110 observed bed days. In-hospital mortality was 1.9%, increasing to 9.9% during a 90-day follow-up over telephone. Additionally, 9,169 children were denied admission during the study period; of these, 5,969 under-five children were approached, and outcomes of 2,850 admitted versus 3,928 refused were followed. The hazard ratio for death was 1.37 for refused versus admitted children, highest within neonates at 1.7. A 70% efficacious vaccine would equate to adding 50 hospital beds and averting 195 deaths. Interpretation: RSV significantly contributes to pediatric hospitalizations in Bangladesh, exacerbating healthcare burdens and increasing mortality risks. Maternal vaccination could significantly reduce both direct and indirect RSV burdens, enhancing healthcare capacity benefiting overall child health in resource-limited settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by the Bill and Melinda Gates Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the ethical review board of the Bangladesh Shishu Hospital and Institute (BSHI). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript