The document discusses options for RSV surveillance in Europe presented by Eeva Broberg at a WHO meeting. It outlines 6 potential options for RSV surveillance including sentinel surveillance of GP cases and hospitalized cases, using national disease registries, and enhancing existing influenza surveillance systems. The objectives are to measure the impact of RSV vaccines, understand RSV seasonality and type prevalence, and estimate disease burden. Public health benefits of coordinated EU surveillance include evaluating vaccines, outbreak timing, burden assessment, and strain selection.

1. Options for RSV surveillance in Europe
Eeva Broberg, Senior Expert in Microbiology
10 April 2019, WHO Meeting to launch phase-2 of the RSV surveillance, Kathmandu, Nepal
European Centre for Disease Prevention and Control

2. ECDC RSV surveillance consultations
2015 Technical workshop: Burden of RSV
disease in Europe
2016 EISN Coordinating Committee
2017 RSV surveillance expert consultation
2017 ECDC Advisory Forum paper: Potential
options for RSV surveillance
…and multiple consultations in annual
influenza meetings
https://ecdc.europa.eu/en/news-events/technical-workshop-
burden-rsv-disease-europe
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3. RSV seasonality in 15 European countries, 2010 to 2016
Broberg Eeva K, et al. Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to
2016. Euro Surveill. 2018;23(5):pii=17-00284. https://doi.org/10.2807/1560-7917.ES.2018.23.5.17-00284
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4. RSV in ECDC Surveillance Atlas
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https://atlas.ecdc.europa.eu/public/index.aspx

5. Development of a proposal for aligning RSV surveillance
systems in Europe – RESCEU meeting, 20-21 March 2019
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6. Option 1: RSV surveillance in the community
Objectives: seasonality, intensity of seasons, age groups affected,
specimens for laboratory testing and virus characterization
GP-based, sentinel surveillance
Case definition: ARI-like, adapted to age groups (shortness of breath and
cough best indicators)
Sampling strategy: Systematic sampling with good geographic (country,
urban, rural) representation
Denominator: Population denominator or calculation-based
Frequency: weekly, year-round if feasible
Age groups: 0-5 months, 6 months-23 months, 2-4, 5-14, 15-64, 65+y
Qualitative indicators: Develop qualitative indicators: intensity, trend,
dominance of type; thresholds based on e.g. MEM
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7. Option 2: RSV surveillance in hospitals
Objectives: Trends in hospitalisation/severity before/after vaccine; vaccine
effectiveness studies; surveillance vs. burden analysis
Case definition: ARI + hospitalisation + tested for RSV
Sampling strategy: Comprehensive: All cases meeting the case definition
Age: All ages if resources; <2 years and > 60 years if restricted resources;
Strata: 0-<3, 3-6, 6-11, 12-24 months, >2-<5, 5-60, 60+years
Case-based, including ICU
Denominator: catchment areas for the hospitals or a calculated proxy
Frequency: weekly, year-round if feasible
Discussion points: special sampling strategy for <3m olds? Biased
admittance for smallest? Strategy for missed eligible patients?
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8. Option 3: RSV surveillance using national registries
Objective: Monitor trends and seasonality in real time
Case definition: All laboratory-confirmed cases of RSV detection
Denominator: total number of tests performed, population data
Frequency: weekly in RSV season, monthly thereafter
Strata: age in months for first year of life
Discussion points: Type of test performed? Risk factors reported?
Hospital discharge, GP or death registry data will not be used as non-
specific for RSV, unreliable diagnosis codes for RSV, not real-time
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9. Laboratory aspects
All detections and A/B typing RT-PCR based
Target genes for PCR: Mostly N, few G or combination with F; for
sequencing: F and G full gene (Sanger or NGS)
Discussion: agreement needed on grouping criteria and naming
Specimen type: Nasal aspirate, nasopharyngeal swab and
nasopharyngeal and pharyngeal swabs combined
Cultivation: very difficult
Antigenic characterization: Virus neutralisation using post-vaccination
sera and recently circulating RSV
Quality control for detection and A/B typing: current commercial
panels? WHO/UK NEQAS?
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10. Next steps
 Follow closely 2nd phase of WHO global RSV
surveillance pilot
 Consolidate and publish the
recommendations/options for national RSV
surveillance in Europe
 Wider consultation of the EU/EEA countries in
spring 2020
 Pilot RSV surveillance in the EU/EEA countries
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11. Thank you!
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12. Objectives for RSV surveillance
1. Measure the impact of RSV vaccination.
2. Determine the seasonality of RSV and monitor
trends of RSV detections within and across RSV
seasons.
3. Track the prevalence of the two RSV types and the
genetic diversity among circulating strains.
4. Support the estimation of healthcare burden of RSV
infection in the different age and target groups.
5. Contribute to the overall understanding of the role
of RSV in respiratory disease.
ECDC 49th Advisory Forum, Potential options for RSV surveillance

13. Public health benefits of EU/EEA level RSV
surveillance
• Evaluate the impact of the vaccine;
• Determine the timing of RSV epidemics;
• Differentiate RSV from influenza epidemics;
• Inform selection of vaccine strains to optimise vaccine
effectiveness;
• Provide data for assessment of morbidity and mortality;
• Provide data for assessment of burden of disease.
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14. ECDC Advisory Forum paper: Potential options for RSV
surveillance
1. RSV reporting through the existing influenza-like illness
(ILI)/acute respiratory infection (ARI) surveillance
systems
2. Enhance the existing ARI surveillance system
3. Use existing hospital surveillance system for severe
acute respiratory infection
4. Use existing intensive care unit (ICU) surveillance
system for influenza
5. New enhanced sentinel paediatric hospital surveillance
network
6. National registry-based retrieval and reporting of
laboratory confirmations