The Evolution of Respiratory Syncytial Virus (RSV) Epidemiology and Burden in UK Children Following the COVID-19 Pandemic from March 23, 2020 to July 30, 2025: A Systematic Literature Review
Dima Ayash, Feyera Gemeda.
Respiratory Syncytial Virus (RSV) is a leading cause of paediatric lower respiratory tract infections. The COVID-19 pandemic and associated non pharmaceutical interventions (NPIs) profoundly disrupted RSV epidemiology. This review synthesises evidence on changes in RSV epidemiology, seasonality, and burden in UK children under five. A systematic literature review was conducted following PRISMA guidelines. Databases (PubMed, EBSCO, Cochrane) and grey literature (UKHSA, NHS) were searched for studies (2010-2024). Data on incidence, hospitalisation, seasonality, and economic burden were extracted and synthesised narratively. Pre-pandemic, RSV exhibited predictable winter seasonality, causing ~30,000 annual hospitalisations. NPIs led to a near-elimination of RSV in 2020-21. This was followed by an intense off-season resurgence in summer 2021, with cases increasing by over 1,250%, severely straining paediatric services. The annual economic burden is substantial (~£80 million). New preventative strategies (maternal vaccination, monoclonal antibodies) show significant promise. The pandemic caused a fundamental shift in RSV epidemiology in the UK, validating the ‘immunity debt’ hypothesis. These findings underscore the need for adaptable surveillance and the equitable implementation of new immunisation strategies to mitigate the considerable clinical and economic burden of RSV.
