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The majority of respiratory syncytial virus (RSV) infections in young children are managed in primary care, however, the disease burden in this setting remains poorly defined. We did a prospective cohort study in primary care settings in Belgium, Italy, Spain, the Netherlands, and the UK during the RSV seasons of 2020–21 (UK only; from Jan 1, 2021), 2021–22, and 2022–23. Children aged younger than 5 years presenting to their general practitioner or primary care paediatrician with symptoms of an acute respiratory tract infection were eligible for RSV testing. Children who tested positive for RSV were consented and followed up for 30 days via a physician clinical report (initial primary care visit on day 1) and two parent-report questionnaires (days 14 and 30). We assessed the burden of RSV in terms of clinical course (symptoms, illness duration, and complications), health-care resource utilisation (primary care visits, emergency department visits, hospitalisation rate, and medication use), and societal impact (daycare or school absence and parental work absence) for the 30-day follow-up period. Among 3414 tested children, 1124 (32·9%; 95% CI 31·3–34·5) tested positive for RSV. Among children with data on age, RSV positivity rate was 38·9% (36·1–41·7; n=466 of 1198) in children younger than 1 year and 25·9% (24·0–27·9; n=513 of 1979) in those aged 1 to <5 years. Of the 1124 RSV-positive children, 878 (78·1%) were enrolled and had day 1 data collected (median age 11·1 months [IQR 6·0–22·0]; 446 [50·9%] boys and 431 [49·1%] girls [N=877]). RSV illness lasted a mean of 11·7 days (95% CI 11·2–12·2; n=794). At day 14 and day 30, any remaining symptoms were reported in 451 of 804 (56·1% [95% CI 52·6–59·6]) and 261 of 724 (36·0% [32·6–39·7]) children. The mean number of primary care visits per child ranged from 1·4 (95% CI 1·2–1·6; the Netherlands) to 3·0 (2·8–3·3; Spain), and was higher in children younger than 1 year (2·7 visits [2·4–2·9]) than in those aged 1 to <5 years (2·1 [1·9–2·2]). Prescribed medication use varied, from 25 of 96 children (26·0% [95% CI 17·6–36·0]; the UK) to 228 of 297 children (76·8% [71·5–81·5]; Italy), with bronchodilators and antibiotics being the most commonly prescribed medicines across all countries. Prescribed medication use was reported in 258 of 418 children aged 1 to <5 years (61·7% [56·9–66·4]) and 196 of 394 children younger than 1 year (49·7% [44·7–54·8]). Missed working days by parents due to their child's RSV illness were reported in 340 of 744 cases (45·7% [42·1–49·4]); the mean number of missed workdays ranged from 1·3 days (95% CI 0·5–2·2) in Spain to 4·1 days (3·3–5·0) in Belgium. RSV infections in children younger than 5 years in primary care are associated with substantial symptomatology, health-care utilisation, and parental work absence. Notable differences in RSV burden existed across countries, likely due to differences in primary health-care systems, clinical practice, and health-care-seeking behaviour. This study emphasises the importance of considering country-specific primary care burden estimates when considering the implementation of RSV immunisations programmes. Sanofi and AstraZeneca. [ABSTRACT FROM AUTHOR]

Introduction Trachoma is the most important infectious cause of blindness. (1) Repeated conjunctival infection (2) with particular strains of Chlamydia trachomatis (3-5) results, in some people, in conjunctival scarring, trichiasis [...], A simplified grading system for trachoma was published by the World Health Organization (WHO) in 1987. Intended for use by non-specialist personnel working at community level, the system includes five signs, each of which can be present or absent in any eye: (i) trachomatous trichiasis; (ii) corneal opacity; (iii) trachomatous inflammation--follicular; (iv) trachomatous inflammation--intense; and (v) trachomatous scarring. Though neither perfectly sensitive nor perfectly specific for trachoma, these signs have been essential tools for identifying populations that need interventions to eliminate trachoma as a public health problem. In 2018, at WHO's 4th global scientific meeting on trachoma, the definition of one of the signs, trachomatous trichiasis, was amended to exclude trichiasis that affects only the lower eyelid. This paper presents the amended system, updates its presentation, offers notes on its use and identifies areas of ongoing debate. [phrase omitted] [phrase omitted] En 1987, l'Organisation mondiale de la Sante a publie un systeme de codage simplifie du trachome. Destine au personnel non qualifie travaillant au sein des communautes, il comporte cinq signes, chacun pouvant etre present ou absent dans l'un ou l'autre reil: (i) le trichiasis trachomateux; (ii) l'opacite corneenne; (iii) l'inflammation trachomateuse --folliculaire; (iv) l'inflammation trachomateuse--intense; et enfin, (v) la cicatrice trachomateuse. Bien qu'ils ne soient ni parfaitement precis, ni totalement specifiques au trachome, ces signes constituent des outils essentiels pour identifier les populations qui necessitent une intervention afin d'eliminer le trachome en tant que probleme de sante publique. En 2018, lors de la quatrieme reunion scientifique mondiale sur le trachome, la definition de l'un des signes, le trichiasis trachomateux, a ete modifiee pour exclure du systeme de codage le trichiasis qui n'affecte que la paupiere inferieure. Ce document expose le nouveau systeme, actualise sa presentation, formule des remarques sur son utilisation et identifie les domaines qui font encore l'objet de debats. [phrase omitted] En 1987, la Organizacion Mundial de la Salud (OMS) publico un sistema de clasificacion simplificado para el tracoma. Este sistema fue disenado para que lo utilice el personal no especializado que trabaja a nivel comunitario e incluye cinco signos, cada uno de los cuales puede estar presente o ausente en los ojos: i) la triquiasis tracomatosa; ii) la opacidad corneal; iii) la inflamacion tracomatosa-folicular; iv) la inflamacion tracomatosa-intensa; y v) la cicatrizacion tracomatosa. Si bien no son perfectamente sensibles ni muy especificos del tracoma, estos signos han sido herramientas esenciales para identificar a las poblaciones que requieren intervenciones para eliminar el tracoma como problema de salud publica. En 2018, se modifico la definicion de uno de los signos, la triquiasis tracomatosa, en la 4.a Reunion Cientifica Mundial sobre el Tracoma de la OMS, para descartar la triquiasis que solo afecta al parpado inferior. En el presente documento se describe el sistema modificado, se actualiza su presentacion, se ofrecen observaciones sobre su aplicacion y se identifican los ambitos de debate en curso.

Respiratory syncytial virus (RSV) is the most common cause of acute respiratory infections in young children. Limited data are available on RSV disease burden in primary care and emergency departments (EDs). This review synthesizes the evidence on population‐based incidence rates of RSV infections in young children (< 5 years) in primary care and EDs. A systematic literature review was performed in PubMed and Embase. Studies reporting yearly population‐based RSV incidence rates in primary care and EDs were included. A total of 4244 records were screened and 32 studies were included, conducted between 1993 and 2019. Studies were mainly performed in high‐income countries (n = 27), with 15 studies in North America and 10 studies in Europe. There was significant variability in study methodology and setting among studies, resulting in considerable variability in reported incidence rates. Incidence rates were higher in primary care—ranging from 0.8 to 330 (median = 109) per 1000 population—compared to EDs (7.5–144.0, median = 48). The highest incidence rates were reported in infants. Additionally, incidence rates were higher in high‐income countries and in studies using laboratory‐confirmed RSV cases compared to studies using bronchiolitis ICD‐codes (non–laboratory confirmed). Our study found that a substantial number of children under 5 years of age attend primary care settings and EDs, every year for RSV infections. Due to the considerable heterogeneity in study methodology, it was impossible to draw definitive conclusions regarding factors explaining differences in reported incidence rates. Additionally, more studies in low‐ and middle‐income countries are recommended. [ABSTRACT FROM AUTHOR]

Background Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in adults that can result in hospitalizations. Estimating RSV-associated hospitalization is critical for planning RSV-related healthcare across Europe. Methods We gathered RSV-associated hospitalization estimates from the RSV Consortium in Europe (RESCEU) for adults in Denmark, England, Finland, Norway, Netherlands, and Scotland from 2006 to 2017. We extrapolated these estimates to 28 European Union (EU) countries using nearest-neighbor matching, multiple imputations, and 2 sets of 10 indicators. Results On average, 158 229 (95% confidence interval [CI], 140 865–175 592) RSV-associated hospitalizations occur annually among adults in the EU (≥18 years); 92% of these hospitalizations occur in adults ≥65 years. Among 75–84 years, the annual average is estimated at 74 519 (95% CI, 69 923–79 115) at a rate of 2.24 (95% CI, 2.10–2.38) per 1000. Among ≥85 years, the annual average is estimated at 37 904 (95% CI, 32 444–43 363) at a rate of 2.99 (95% CI, 2.56–3.42). Conclusions Our estimates of RSV-associated hospitalizations in adults are the first analysis integrating available data to provide the disease burden across the EU. Importantly, for a condition considered in the past to be primarily a disease of young children, the average annual hospitalization estimate in adults was lower but of a similar magnitude to the estimate in young children (0–4 years): 158 229 (95% CI, 140 865–175 592) versus 245 244 (95% CI, 224 688–265 799). [ABSTRACT FROM AUTHOR]

Background No overall estimate of respiratory syncytial virus (RSV)-associated hospitalizations in children aged under 5 years has been published for the European Union (EU). We aimed to estimate the RSV hospitalization burden in children aged under 5 years in EU countries and Norway, by age group. Methods We collated national RSV-associated hospitalization estimates calculated using linear regression models via the RESCEU project for Denmark, England, Finland, Norway, the Netherlands, and Scotland, 2006–2018. Additional estimates were obtained from a systematic review. Using multiple imputation and nearest neighbor matching methods, we estimated overall RSV-associated hospitalizations and rates in the EU. Results Additional estimates for 2 countries (France and Spain) were found in the literature. In the EU, an average of 245 244 (95% confidence interval [CI], 224 688–265 799) yearly hospital admissions with a respiratory infection per year were associated with RSV in children aged under 5 years, with most cases occurring among children aged under 1 year (75%). Infants aged under 2 months represented the most affected group (71.6 per 1000 children; 95% CI, 66.6–76.6). Conclusions Our findings will help support decisions regarding prevention efforts and represent an important benchmark to understand changes in the RSV burden following the introduction of RSV immunization programs in Europe. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children and is of considerable burden on healthcare systems. Our study aimed to evaluate ALRI hospitalizations related to RSV in children in Portugal. Methods: We reviewed hospitalizations potentially related to RSV in children aged <5 years from 2015 to 2018, using anonymized administrative data covering all public hospital discharges in mainland Portugal. Three case definitions were considered: (a) RSV‐specific, (b) (a) plus unspecified acute bronchiolitis (RSV‐specific & Bronchiolitis), and (c) (b) plus unspecified ALRI (RSV‐specific & ALRI). Results: A total of 9697 RSV‐specific hospitalizations were identified from 2015 to 2018—increasing to 26 062 for RSV‐specific & ALRI hospitalizations—of which 74.7% were during seasons 2015/2016–2017/2018 (November–March). Mean hospitalization rates per season were, for RSV‐specific, RSV‐specific & Bronchiolitis, and RSV‐specific & ALRI, respectively, 5.6, 9.4, and 11.8 per 1000 children aged <5 years and 13.4, 22.5, and 25.9 in children aged <2 years. Most RSV‐specific hospitalizations occurred in healthy children (94.9%) and in children aged <2 years (96.3%). Annual direct costs of €2.4 million were estimated for RSV‐specific hospitalizations—rising to €5.1 million for RSV‐specific & ALRI—mostly driven by healthy children (87.6%). Conclusion: RSV is accountable for a substantial number of hospitalizations in children, especially during their first year of life. Hospitalizations are mainly driven by healthy children. The variability of the potential RSV burden across case definitions highlights the need for a universal RSV surveillance system to guide prevention strategies. [ABSTRACT FROM AUTHOR]