RSV Impact Assessment Survey Results

Insights into Burden and Clinical Practices in Primary Care and Private Settings

April 2025

Introduction

This report summarizes the findings from the RSV Impact Assessment Survey, conducted by the Excellence in Pediatrics Institute. The survey captures insights from pediatricians and primary care providers worldwide, shedding light on RSV's burden, diagnostic challenges, treatment approaches, and prevention strategies. By analyzing trends over multiple seasons, this report highlights key gaps in current practices and provides data-driven recommendations to improve RSV management in primary care settings.

Understanding these challenges is crucial for shaping effective healthcare policies, optimizing resource allocation, supporting medical professionals, and families affected by RSV. The findings emphasize the urgent need for enhanced preventive measures, including vaccination, improved diagnostic accessibility, and standardized treatment protocols to mitigate RSV's impact on young children and their caregivers.

Background

Respiratory Syncytial Virus (RSV) is a leading cause of bronchiolitis and pneumonia in infants and young children. While significant attention is given to the hospital burden, particularly during the RSV season, the impact on primary care and private practices remains insufficiently evaluated. These frontline settings bear substantial pressure, managing the initial wave of RSV cases and alleviating the strain on hospital facilities. Understanding this burden is critical to designing and implementing comprehensive prevention policies that address the needs of healthcare providers, families, and patients alike.

Survey Scopeand Methodology

The Excellence in Pediatrics Institute conducted a survey targeting its network of frontline pediatricians, general practitioners, and other primary care providers.

The survey aimed to: 1) analyze disease burden, 2) assess treatment and management practices, 3) understand diagnostic approaches, and 4) evaluate preventive measures and educational needs.

RSV: Bridging Gaps and Enhancing Care

Analyze Disease Burden

Evaluate the prevalence and severity of RSV-related respiratory illnesses across various pediatric age groups to better understand the disease's impact on health systems and family dynamics.

Analyze Treatment and Management

Investigate current treatment strategies and follow-up practices among healthcare providers to identify areas for improvement in managing RSV infections effectively.

Understand Diagnostic Practices

Examine the frequency and circumstances under which RSV is diagnosed in primary care settings and the use of home diagnostic tests by parents to evaluate the accessibility and usage of diagnostic resources.

Evaluate Preventive Measures & Educational Needs

Explore healthcare providers' awareness of RSV prevention solutions and their participation in continuing education regarding RSV management to assess the need for enhanced training and resources.

Survey Methodology:

A dual-method survey approach was employed to gather comprehensive insights into the landscape of RSV burden in primary care settings. First, an online survey was made available for 35 days, targeting child healthcare professionals directly involved in patient care. This study segment aimed to collect firsthand data on the experiences, challenges, and perceptions of those working on the frontlines of pediatric healthcare. Simultaneously, targeted mapping questionnaires were distributed to leading experts and academics across multiple countries. Due to their extensive experience and high-level understanding of national healthcare dynamics, these individuals provided invaluable contextual analysis. Their role was to offer a macro perspective on pediatric healthcare practices and systemic challenges during RSV seasons. More importantly, they reported on behalf of their local medical communities, offering aggregated insights that complemented the firsthand accounts gathered from practicing clinicians.

Demographics of Respondents:

Aiming to ensure a comprehensive understanding of the RSV burden, the survey included three targeted questions:

1. Professional Role:

Most respondents identified as pediatricians (94.95%), followed by general practitioners (5.05%).

2. Practice Setting:

Respondents worked across diverse settings, with 50% practicing in hospital-based pediatric clinics, 35.91% in private practices, and 14.09% in primary healthcare facilities.

3. Type of Practicing Area:

A significant proportion of respondents operated in urban areas (75.33%), while others were based in suburban (17.62%) and rural (7.05%) regions.

Elianne Vrijlandt

Head Patient Care, Beatrix Children's Hospital (BCH), University Medical Center Groningen (Netherlands)

"RSV prevention should be considered a vaccine-preventable disease for all infants globally." As noted during the 9th LifeCourse Immunisation Summit and RSV Expert Group

Current Season (2024/25)Trends

The Survey then on the burden of RSV during the current season, emphasizing prevalence, symptom duration and severity, school absences, and healthcare needs. By monitoring these factors, we gain insights into the immediate challenges providers and families face during peak RSV periods.

Prevalence:

36.94% of the responders stated that among children aged 6-12 months, 10-30% of visits for respiratory illnesses involved RSV-related conditions, while 25.48% and 16.56% said that RSV infections were involved in 30-50% and over 50% of cases, respectively.
For children older than 12 months, 39.49% responded that RSV infections were involved in 10-30% of the visits, while 19.11% and 7.01% said that RSV infections were involved in 30-50% and over 50% of cases, respectively.

The survey findings confirm that RSV constitutes a significant proportion of respiratory illnesses during the season, emphasizing its contribution to healthcare visits in primary care and private practices. Early identification and management strategies are crucial to mitigate its impact.

Duration of Symptoms:

In children aged 6-12 months, 42.48% of responders stated that symptoms lasted 7 days, while 35.29% estimated the duration to be 7-10 days and 22.22% to 10-14 days.
In children over 12 months, 49.67% of responders stated that symptoms lasted 7 days, while 38.56% estimated the duration to be 7-10 days and 11.76% to 10-14 days.

Prolonged symptoms place a significant strain on healthcare providers. These findings are consistent with existing studies documenting RSV recovery times, which underscore the need for improved symptom management protocols and support systems to reduce the load on healthcare practices.

Duration of Absence:

In children aged 6-12 months, 53.57% of responders estimated that absence from school/daycare lasted 7 days, while 28.57% estimated the duration to be 7-10 days and 17.86% to 10-14 days.
In children over 12 months, 63.12% of responders estimated that symptoms lasted 7 days, while 26.24% estimated the duration to be 7-10 days and 10.64% to 10-14 days.

Prolonged symptoms result in extended school and daycare absences, causing significant disruptions to family routines and reducing work productivity for parents and caregivers. This ripple effect highlights the far-reaching socioeconomic impact of RSV, extending beyond the immediate clinical burden. These results emphasize that the overall burden of RSV infections is not solely confined to healthcare metrics but includes considerable indirect costs and challenges at the community level, which are often overlooked in public health assessments.

Severity and Hospitalization Rates:

In children aged 6-12 months, 33.77% of responders estimated that cases that required hospitalization in their practice were less than 10%, while 24.50% estimated these cases to be 10-20% and 25.17% to 20-50%.

In children over 12 months, 43.54% of responders estimated that cases that required hospitalization in their practice were less than 10%, while 21.77% estimated these cases to be 10-20% and 22.45% to 20-50%.

Rising RSV prevalence in the community is expected to lead to an increased number of hospitalizations. This serves as a warning for healthcare systems to prepare for heightened demand during seasonal peaks. Proactive measures, including strengthening hospital capacities and prioritizing preventive care, are essential to mitigating RSV's systemic impact on healthcare infrastructure.

Additional Medical Examinations and Follow-ups:

In children aged 6-12 months, 45.75% of responders estimated that cases required additional examinations and follow-up visits were less than 25%, while 30.72% estimated these cases to be 25-50% and 14.38% to 50-70%.

In children over 12 months, 53.02% of responders estimated that cases required additional examinations and follow-up visits were less than 25%, while 26.85% estimated these cases to be 25-50% and 8.72% to 50-70%.

High rates of follow-up visits and additional examinations highlight RSV's prolonged impact on primary care and community practices. As the RSV burden is predominantly estimated using data from hospital facilities, where strain and associated costs are more readily monitored, many healthcare systems lack mechanisms to assess the situation within primary care and community settings. This oversight leaves the burden on these frontline providers largely unrecognized and unquantified.

Comparison withPrevious Seasons

Comparing current RSV trends with previous seasons helps identify shifts in prevalence and severity, aiding in developing prevention models and adaptive strategies. We asked the physicians to compare the current season's observed number of bronchiolitis or pneumonia cases and severe episodes with the previous one.

Number of bronchiolitis or pneumonia cases this season:

In children aged 6-12 months, about half (47.37%) of the responders estimated that cases this season have increased (30.92% slightly higher and 16.45% significantly higher). 26.32% reported that incidents of bronchiolitis or pneumonia in their practice were about the same as the previous season.

Similarly, in children over 12 months, half (48.32%) of the responders estimated that cases this season have increased (34.23% slightly higher and 14.09% significantly higher). 28.86% reported that incidents of bronchiolitis or pneumonia in their practice were about the same as in the previous season.

The Number of severe cases:

In children aged 6-12 months, the majority (58.66%) of the responders observed that severe cases this season have increased (51.33% slightly higher and 7.33% significantly higher). 28% observed severe incidents were the same as in the previous season.
In children over 12 months, half (50.67%) of the responders estimated that severe cases this season have increased (47.97% slightly higher and 2.70% significantly higher). 32.43% observed severe incidents were the same as in the previous season.

Comparing current RSV trends with the previous season reveals an increase in the number of bronchiolitis or pneumonia cases and severe episodes. This rise is consistent with global observations of heightened RSV activity and changes in seasonal patterns. While a significant proportion of respondents noted stability in case numbers compared to previous seasons, the majority highlighted a notable increase, underscoring the escalating burden of RSV on primary care settings.

These findings emphasize the urgent need for healthcare systems to adapt to rising RSV prevalence and severity. Understanding these shifts is crucial for forecasting healthcare demand, optimizing resource allocation, and mitigating the broader impact of RSV on families and healthcare providers. Consistent monitoring and data collection will be pivotal in shaping effective and sustainable public health responses as trends evolve.

Diagnosis of RSV inCommunity Settings

Effective diagnosis underpins successful RSV management. This section of the survey aimed to establish how many cases evaluated as RSV infections were confirmed with diagnostic tests and the test's availability and usage.

Diagnostic Testing in Practices:

Only 21.33% of the respondents reported that they always test children in their practice to confirm RSV Infections.
50% are testing children occasionally, while 28.66% reported that they never or rarely test children in their practice.

Diagnostic Testing by Parents:

71.52% of the physicians reported that parents visiting their practices with a child with a respiratory infection Never (45.03%) or Rarely (26.49%) had tested their child at home.

The reliance on clinical evaluation rather than diagnostic confirmation poses challenges for effective case management, public health reporting, and the timely implementation of preventive measures. These gaps point to a critical need for increased use of accurate diagnostic tools in primary care and for improving parental awareness and access to home testing options. Strengthening diagnostic capacity in community settings is essential to enhance early detection, reduce severe outcomes, and support data-driven public health interventions.

Management of RSV

This section of the survey aimed to understand the management practices followed by online physicians in primary care, including treatment protocols and referral strategies, that are critical for reducing RSV-related complications.

Primary Treatments:

Treatment categories: Supportive care (hydration, nutrition); Oxygen therapy; Medication (specify below); Referral to specialists.

Supportive care (91.95%) and oxygen therapy (97.64%) were common practices for children aged 6-12 months and older than 12 months, followed by 85.91% and 57.48% of the respondents, respectively.
90.55% of the respondents prescribe medications for managing symptoms in children aged 6-12 months, compared to 71.65% who also prescribe these medications to children older than 12 months.
87.50% of primary care physicians refer children aged 6-12 months to specialists, while this percentage drops to 45.45% for children older than 12 months.

Medication use:

Antipyretics and bronchodilators are commonly prescribed medications used by 89.40% and 72.19% of physicians, respectively.
Nasal decongestants are also frequently prescribed and utilized by 69.54% of physicians.
Only 15.86% reported prescribing antibiotics for managing RSV infections.

Referral Practices:

61.7% of primary care physicians reported referring patients to specialists if symptoms worsened at any point.

Additionally, 32.62% said they refer patients directly after the first consultation in severe cases.

Follow-Up Monitoring:

38.93% of respondents reported monitoring patients with RSV infection daily, while 30.78% monitored them every few days.

Additionally, 22.82% of the respondents indicated that they monitor patients as needed based on the condition's progression.

The findings highlight a comprehensive and structured approach to RSV management in primary care settings, emphasizing supportive care, symptom relief, and careful monitoring. Supportive care and oxygen therapy remain the cornerstone of RSV treatment, particularly for infants aged 6-12 months, aligning with established clinical guidelines. The frequent use of antipyretics, bronchodilators, and nasal decongestants suggests a symptomatic approach to treatment. In contrast, the minimal use of antibiotics reflects appropriate antimicrobial stewardship, reinforcing that RSV is a viral rather than bacterial infection.

Referral patterns indicate a cautious approach to escalation, with most physicians referring infants to specialists when symptoms worsen. However, referral rates drop significantly for children older than 12 months, suggesting that RSV cases in this age group are generally less severe or that providers feel confident managing them in primary care settings.

Follow-up monitoring practices further emphasize the burden RSV places on primary care providers. Nearly 40% of physicians conduct daily check-ups, underscoring the intensive nature of RSV case management. While this vigilance helps mitigate severe outcomes, it highlights RSV's significant demand for healthcare resources during peak seasons.

These results emphasize the need for continued education and standardization of RSV management strategies in primary care. Ensuring access to updated clinical guidelines, reinforcing best practices in symptom management, and optimizing referral pathways can help improve efficiency and patient outcomes.

Prevention

Prevention, particularly through vaccination and education, is crucial to mitigating RSV's healthcare burden.

Awareness:

89.47% of respondents reported being aware of the currently available solutions for preventing RSV infections in children.

Vaccination Recommendation:

While 25.17% of physicians recommended vaccination for the first two seasons from birth, 35.37% suggested it for children up to 12 months of age.
Additionally, 26 % would extend coverage to children up to 2 years, and another 14.29% would recommend vaccination up to 5 years.

The findings indicate a high awareness among physicians regarding RSV prevention strategies, reporting familiarity with available solutions. This awareness is a crucial foundation for improving RSV prevention efforts, yet it must translate into action through increased implementation of vaccination programs and patient education initiatives. Physician recommendations for RSV vaccination vary by age group, reflecting ongoing discussions in the medical community regarding the optimal age for protection. While a significant proportion supports vaccination up to 12 months, an additional 26% extends this recommendation to children up to 2 years.

Vaccine Coverage for RSV Infection

If a vaccine for RSV infection were made available, for which age groups should be recommend to provide coverage and protection against RSV infections

35.37%up to 12 months

25.17%Only for the first and second seasons from birth

25.17%up to 2 years

14.29%up to 5 years

Education

Identifying gaps in resources and training helps optimize RSV prevention and management strategies.

Susanna Esposito Director of Specialization School in Pediatrics, University of Parma and President of WAIDID, Italy “Monoclonal antibodies are an independent system of protection. They can be administered at birth directly from the neonatology unit to those born in the season, whereas to those born outside the season, they can be administered just before the beginning of the season with long-lasting protection. On the contrary, for maternal immunization, the limitation is that in the presence of delivery outside the season, for example, in March or April for the northern hemisphere, the possibility that transparent antibodies protect the infants during the season is quite limited. So, when you think about protection, you can see that the vaccination against RSV has limited development for protection very early after its administration; maternal immunization, apart from the coverage, has the limitation of the persistence of protective antibodies for those born outside the season whereas monoclonal antibodies guarantee at least five to six months protection when administered before the beginning of the season.” As noted during the 9th LifeCourse Immunisation Summit and RSV Expert Group

Continuing Education:

Only half of the physicians (48.99%) reported having participated in any training or educational sessions on managing RSV in the last two years, while 51.01% have not attended any educational activities.

Resource Needs:

A substantial 82.99% of respondents expressed a need for updated clinical guidelines, indicating a strong demand for current and comprehensive information to manage RSV.
Additionally, 40.14% requested workshops to enhance their understanding and skills, underscoring the importance of practical workshops.

Resource Needs

Additional resources or information needed for managing RSV infections more effectively in practices

82.99%More clinical guidelines

40.14%Training workshops

29.25%Case studies

19.05%Access to specialist consultations

Closing Summary andKey Takeaways

This report underscores RSV's significant burden on primary care and private practices, highlighting critical gaps in diagnosis, management, prevention, and resource availability. The survey findings reveal that RSV remains a leading cause of respiratory illnesses, with a notable increase in cases and severity compared to previous seasons. This rising trend reinforces the urgent need for enhanced surveillance, improved preparedness, and strengthened healthcare infrastructure to manage seasonal peaks effectively.

A key takeaway from the report is the disproportionate impact of RSV on infants aged 6-12 months, who experience higher prevalence rates, prolonged symptoms, and increased hospitalization risks. The substantial follow-up care and additional examinations required for these cases further illustrate RSV's strain on primary care settings, which is often overlooked in broader RSV burden assessments. The data also highlight the socioeconomic consequences of RSV, with extended school and daycare absences affecting families and workplaces, adding an indirect but significant burden to communities.

The report also identifies significant gaps in RSV diagnosis within community settings. Despite the importance of confirming RSV infections, diagnostic testing remains underutilized, both in clinical practice and by parents. This overreliance on clinical evaluation rather than laboratory confirmation poses challenges in disease management, public health tracking, and targeted interventions. Addressing this gap by increasing access to reliable, rapid, affordable diagnostic tests is crucial for improving RSV detection and response efforts.

Management practices remain largely aligned with established RSV treatment guidelines, emphasizing supportive care, oxygen therapy, and symptom relief. However, referral and follow-up monitoring practices vary significantly, suggesting more standardized protocols are needed to optimize patient outcomes while reducing unnecessary healthcare visits and resource strain.

While physician awareness of RSV preventive measures is high, vaccination recommendations remain inconsistent on the prevention front. A clear consensus on optimal vaccination age and implementation strategies is needed to maximize protection for high-risk infants. Additionally, the demand for improved education and training is evident, with most physicians expressing the need for updated clinical guidelines and practical workshops to enhance their knowledge and management strategies.

In conclusion, these findings highlight the growing urgency for a more structured and proactive approach to RSV management in primary care. Strengthening diagnostic capacity, standardizing treatment protocols, expanding prevention strategies—including vaccination efforts—and improving access to professional education are essential steps toward mitigating RSV's overall burden. Investing in these areas will not only enhance patient outcomes but also reduce the strain on healthcare providers and ensure more efficient resource allocation in managing RSV seasons.