Respiratory Syncytial Virus Transmission in Closed Community Settings That Include Children: A Systematic Review and Meta‐Analysis

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BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of severe respiratory infections in children and is predominantly acquired and spread in community settings such as households and early childhood education centres. This review aims to synthesise the available evidence on RSV transmission in closed community settings that include children, with a focus on secondary attack rates (SAR). METHODS: We conducted a systematic review informed by Cochrane guidelines. We searched Ovid Medline, Ovid Embase Classic and Embase, Ovid Global Health, Cochrane Library, Web of Science, and Scopus from inception to March 2025. Grey literature was searched through Google Scholar and relevant websites. We included articles reporting primary data on RSV SAR or other attack rates in closed community settings that included children aged under 18 years. Two reviewers independently screened articles, extracted data, and assessed study quality using a modified Newcastle-Ottawa Scale. Random-effects meta-analysis was performed for SAR and attack rates. Subgroup analyses explored outcomes by study design, study setting and participant age. RESULTS: A total of 38 articles were eligible and reported data from 30 unique study populations from 1956 to 2023 spanning 12 countries. Study settings included households (n = 19), early childhood education and care (n = 6) and residential care (n = 5). Pooled household SAR was 23.8% (95% CI: 16.5-30.0%) across all ages and 26.8% (95% CI: 15.5-38.2%) for children aged less than 5 years. Pooled outbreak attack rate among children in early childhood education and residential care was 59.2% (95% CI: 31.7-86.8%). There was substantial heterogeneity of methods, reporting and outcomes across studies. CONCLUSION: Risk of RSV transmission in closed community settings that include children is substantial, yet current evidence is limited. Well-designed transmission studies, particularly in early childhood education and care settings, are needed to support disease prevention and control, and to optimise population-level modelling.

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