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Cough, Shortness of Breath Among Common Manifestations of RSV


Results of a new review confirm an association between respiratory syncytial virus (RSV) and wheezing in infants.

A new review published in World Journal of Pediatrics shows that respiratory syncytial virus (RSV) infection was associated with cough and shortness of breath. These findings suggest that infants and areas with low human development index (HDI) levels should be given more attention.

RSV is a frequently diagnosed virus of the lower respiratory tract in children 5 years and younger. Clinical manifestations of RSV have been hard to pinpoint and therefore pose an obstacle to timely treatment in children. RSV has been linked to wheezing in the past and could be a risk factor for wheezing illness after recovery. This systematic review aimed to evaluate the clinical manifestations of RSV by age group and HDI levels. It also aimed to define the association between RSV and wheezing.

The study authors searched in PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database. Studies that were published from January 1, 2010, to June 2, 2022, were included in the review.

Data extracted from the studies included author, survey period, region or country, study design, sample size, and outcomes. All studies were evaluated for their quality based on the Newcastle-Ottawa Scale. There were 35 studies that reported manifestations of RSV infection that covered 24,822,974 participants overall. Seven studies that included 3035 participants found an association between RSV and wheezing illness and another 7 studies, which included 228,301 participants, found an association between early childhood RSV and the development of recurrent wheezing illness.

The pooled incidence of mild manifestations was 51% compared with moderate (37%) and severe (7%). Cough was the most common manifestation in the mild category (92%), with nasal congestion (58%), rhinorrhea (53%), and fever (41%) also frequent mild manifestations. Shortness of breath (50%) was the most common moderate clinical manifestation, followed by dyspnea (47%), wheezing (39%), pneumonia (28%), and oxygen supplementation (26%). Respiratory failure was the most common severe clinical manifestation (29%).

All participants were split into 2 groups: aged 0 to 1 year and 0 to 2 years. The pooled incidences of mild, moderate, and severe clinical manifestations in the group aged 0 to 1 year were 55%, 50%, and 9%, respectively, and in the group aged 0 to 2 years, 51%, 39%, and 6%. Both groups had cough (90% and 93%) and shortness of breath (60% and 57%) as their top 2 clinical manifestations.

Countries that had a very high HDI had pooled incidences of mild, moderate, and severe clinical manifestations of 56%, 25%, and 6%. In countries that had a high HDI, the pooled incidences for mild, moderate, and severe clinical manifestations were 49%, 47%, and 5%. Medium HDI countries had pooled incidences of 76% and 31% for mild and moderate clinical manifestations, respectively.

The RSV-positive group was more likely to develop wheezing compared with the control group (odds ratio [OR], 3.12; 95% CI, 2.59-3.76) and to develop recurrent wheezing vs the control group (OR, 2.60; 95% CI, 2.51-2.70).

There were some limitations to this study. A limited number of original studies met the inclusion criteria, and different methods were used to assess the outcome in each of the original studies. In addition, subanalyses could not be performed for all clinical manifestations due to the limited number of studies and there were few studies that reported on clinical manifestations for children aged 2 to 5 years.

Cough and shortness of breath were found to be the most common clinical manifestations for RSV in infants. The researchers concluded that more focus should be given to children aged 0 to 1 year and to areas that had lower development levels.


Jiang MY, Duan YP, Tong XL, et al. Clinical manifestations of respiratory syncytial virus infection and the risk of wheezing and recurrent wheezing illness: a systematic review and meta-analysis. World J Pediatr. Published online August 2, 2023. doi:10.1007/s12519-023-00743-5

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