RSV information and awareness platform Türkçe Frequently asked questions

Scientific background

Preventable infant deaths

RSV-related infant deaths are largely preventable. But the ground of that preventability is not immunisation alone — it is the fact that deeper social conditions can be changed.

Key message Strategies to reduce RSV mortality must target structural conditions — poverty, housing, access and nutrition — alongside immunisation.

  • 101,400 RSV-associated deaths in children under five in 2019 Li et al., 2022
  • 97% Share of RSV deaths occurring in low- and middle-income countries WHO, 2025
  • 1 : 3 Community deaths for every RSV death recorded in hospital RESCEU, 2022
  • 2 / 3 Share of RSV-related infant deaths occurring in the community, without reaching a health facility Gill et al., 2022

That 97% of RSV deaths worldwide occur in low- and middle-income countries sets out clearly how unequally this burden is distributed.1 Current data indicate that most deaths occur where access to the health system is limited, and that they take place without ever entering health records.3

The RESCEU consortium found that for every RSV death recorded in hospital among children under five, three more occur in the community.4 This shows that estimates based only on health system records systematically underestimate the RSV burden.

Why "preventable"?

There is no approved specific antiviral treatment for RSV infection; management is essentially supportive.12 Palivizumab, approved for high-risk infants, has been used only in selected groups because of its repeat dosing requirement and cost.13 Today, maternal vaccination in pregnancy and monoclonal antibody administration to the infant are both available.14

The absence of an effective treatment, combined with how common and how preventable the disease is, shifts the weight of management towards early recognition and prevention — which in turn raises the importance of the structural conditions that determine access to health services.

The structural basis of preventability

Epidemiological evidence consistently shows that RSV-related infant deaths are not a biological inevitability but largely the consequence of modifiable living conditions.

  • Poverty

    The effects of income inequality are visible even in high-income countries: infants in low-income households carry more than twice the risk of RSV-related health service use and death compared with other children.17 Poverty is the structural determinant underlying undernutrition, difficulty heating the home, crowded housing and restricted access.

  • Crowding and housing conditions

    In crowded homes infants are exposed to higher viral loads; infection comes earlier and runs more severely.7 In Zambia, RSV deaths clustered significantly in poor, densely populated urban neighbourhoods (RR 2.00).5 In Argentina, living in informal settlements was identified as an independent risk factor for RSV mortality (OR 17.09).6

  • Access to health services

    The RSV GOLD-ICU Network study across ten low- and middle-income countries reported that only 53% of infants who died of RSV had been able to receive mechanical ventilation support.9 Studies show that two-thirds of RSV-related infant deaths occur in the community — without reaching any health facility.8

  • Nutritional status

    Undernutrition suppresses immunity and predisposes to more severe RSV. Infants whose growth falls below the median carry significantly higher risk of hospital admission.11 Mortality compounds in undernourished infants exposed simultaneously to multiple pathogens.6

Health literacy and care-seeking

A parent's or carer's ability to recognise the signs of illness and seek care in time is critical to infant survival. In low- and middle-income countries, maternal education and perceived severity of illness have been identified as determinants of care-seeking behaviour.10

The early signs of RSV — particularly wheezing and feeding difficulty — can be read as an ordinary cold, delaying care-seeking. Maternal education and adequate health literacy play a directly determining role.5

Access to care depends on multiple social factors beyond the existence of a service: recognising the signs, appreciating the risk, deciding to present, securing transport and physically reaching a facility.10

Treatment-oriented interventions are necessary but not sufficient on their own; real preventability depends on transforming the structural ground that limits what those interventions can do.

Related pages

Sources

  1. World Health Organization (WHO). (2025). Respiratory syncytial virus (RSV): Fact sheet. www.who.int/news-room/fact-sheets/detail/respiratory-syncytial-virus-(rsv)
  2. Li, Y., Wang, X., Blau, D. M., Caballero, M. T., Feikin, D. R., Gill, C. J., Madhi, S. A., Omer, S. B., Simões, E. A. F., Campbell, H., ve ark., & Nair, H. (2022). Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: A systematic analysis. The Lancet, 399(10340), 2047–2064. doi.org/10.1016/S0140-6736(22)00478-0
  3. Asseri, A. A. (2025). Respiratory syncytial virus: A narrative review of updates and recent advances in epidemiology, pathogenesis, diagnosis, management and prevention. Journal of Clinical Medicine, 14(11), 3880. doi.org/10.3390/jcm14113880
  4. RESCEU Consortium. (2022). RSV Global Disease Burden Study: Substantial RSV community morbidity and mortality burden in young children in LMICs. resc-eu.org/news/latest-news/resceus-rsv-global-disease-burden-study/
  5. Murphy, C., MacLeod, W. B., Forman, L. S., Mwananyanda, L., Kwenda, G., Pieciak, R. C., Mupila, Z., Thea, D., Chikoti, C., & Yankonde, B. (2021). Risk factors for respiratory syncytial virus–associated community deaths in Zambian infants. Clinical Infectious Diseases, 73(Suppl 3), S187–S192. doi.org/10.1093/cid/ciab165
  6. Caballero, M. T., Bianchi, A. M., Grigaites, S. D., De la Iglesia Niveyro, P. X., Nuño, A., Valle, S., Afarian, G., Esperante, S. A., Ferretti, A. J., & Jares Baglivo, S. (2021). Community mortality due to respiratory syncytial virus in Argentina: Population-based surveillance study. Clinical Infectious Diseases, 73(Suppl 3), S210–S217. doi.org/10.1093/cid/ciab183
  7. Zar, H. J., Cacho, F., Kootbodien, T., Mejias, A., Ortiz, J. R., Stein, R. T., & Hartert, T. V. (2024). Early-life respiratory syncytial virus disease and long-term respiratory health. The Lancet Respiratory Medicine, 12(10), 810–821. doi.org/10.1016/S2213-2600(24)00121-6
  8. Gill, C. J., Mwananyanda, L., MacLeod, W. B., Kwenda, G., Pieciak, R., Mupila, Z., Murphy, C., Chikoti, C., Forman, L., & Berklein, F. (2022). Infant deaths from respiratory syncytial virus in Lusaka, Zambia from the ZPRIME study: A 3-year, systematic, post-mortem surveillance project. The Lancet Global Health, 10(2), e269–e277. doi.org/10.1016/S2214-109X(21)00524-7
  9. Abdelrahman, D. N., Abdullahi, F. L., Abdu-Raheem, F., Abicher, L. T., Adelaiye, H., Badjie, A., Bah, A., Bista, K. P., Bont, L. J., & Boom, T. T. (2024). Respiratory syncytial virus infection among children younger than 2 years admitted to a paediatric intensive care unit with extended severe acute respiratory infection in ten Gavi-eligible countries: The RSV GOLD—ICU Network study. The Lancet Global Health, 12(10), e1611–e1619. doi.org/10.1016/S2214-109X(24)00244-6
  10. Sreeramareddy, C. T., Shankar, R. P., Sreekumaran, B. V., Subba, S. H., Joshi, H. S., & Ramachandran, U. (2006). Care seeking behaviour for childhood illness — a questionnaire survey in western Nepal. BMC International Health and Human Rights, 6(1), 7. doi.org/10.1186/1471-2458-6-7
  11. Paynter, S., Ware, R. S., Lucero, M. G., Tallo, V., Nohynek, H., Weinstein, P., Williams, G., Sly, P. D., & Simoes, E. A. (2014). Malnutrition: A risk factor for severe respiratory syncytial virus infection and hospitalization. The Pediatric Infectious Disease Journal, 33(3), 267–271. doi.org/10.1097/INF.0000000000000087
  12. Medscape. (2025). Respiratory syncytial virus (RSV) infection treatment & management. Erişim: 25.05.2026. emedicine.medscape.com/article/971488-treatment
  13. Caserta, M. T., O'Leary, S. T., Munoz, F. M., & Ralston, S. L. (2023). Palivizumab prophylaxis in infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics, 152(1), e2023061803. doi.org/10.1542/peds.2023-061803
  14. Feikin, D. R., Karron, R. A., Saha, S. K., Sparrow, E., Srikantiah, P., Weinberger, D. M., & Zar, H. J. (2024). The full value of immunisation against respiratory syncytial virus for infants younger than 1 year: Effects beyond prevention of acute respiratory illness. The Lancet Infectious Diseases, 24(5), e318–e327. doi.org/10.1016/S1473-3099(23)00657-3

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The information on this site is for general guidance only and does not replace examination, diagnosis or treatment by a clinician.