Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections and hospitalisations among young children and is globally responsible for many deaths in young children, especially in infants aged <6 months. Furthermore, RSV is a common cause of severe respiratory disease and hospitalisation among older adults. The development of new candidate vaccines and monoclonal antibodies highlights the need for reliable surveillance of RSV. In the European Union (EU), no up-to-date general recommendations on RSV surveillance are currently available. Based on outcomes of a workshop with 29 European experts in the field of RSV virology, epidemiology and public health, we provide recommendations for developing a feasible and sustainable national surveillance strategy for RSV that will enable harmonisation and data comparison at the European level. We discuss three surveillance components: active sentinel community surveillance, active sentinel hospital surveillance and passive laboratory surveillance, using the EU acute respiratory infection and World Health Organization (WHO) extended severe acute respiratory infection case definitions. Furthermore, we recommend the use of quantitative reverse transcriptase PCR-based assays as the standard detection method for RSV and virus genetic characterisation, if possible, to monitor genetic evolution. These guidelines provide a basis for good quality, feasible and affordable surveillance of RSV. Harmonisation of surveillance standards at the European and global level will contribute to the wider availability of national level RSV surveillance data for regional and global analysis, and for estimation of RSV burden and the impact of future immunisation programmes.

Dept of Clinical Research Nordsjaellands Hospital Hilleroed Denmark

Dept of Global Health and Infectious Diseases University of Southern Denmark Odense Denmark

European Centre for Disease Prevention and Control Stockholm Sweden

Finnish National Institute for Health and Welfare Helsinki Finland

Foundazione PENTA Onlus Padova Italy

HCL and University of Lyon Lyon France

Health Protection Surveillance Centre Dublin Ireland

Institut Pasteur UMR 3569 CNRS University of Paris Paris France

Instituto de Salud Carlos 3 Madrid CIBER de Epidemiología y Salud Pública Madrid Spain

National Institute for Public Health and the Environment Centre for Infectious Disease Control Bilthoven The Netherlands

National Institute of Health Lisbon Portugal

National Institute of Public Health Praha Czech Republic

National Institute of Public Health Warsaw Poland

Netherlands Institute for Health Services Research Utrecht The Netherlands

Norwegian Institute of Public Health Oslo Norway

Public Health Agency Stockholm Solna Sweden

Public Health Institute Ljubljana Slovenia

Riga East University Hospital Riga Latvia

Robert Koch Institute Berlin Germany

Santé Publique France Saint Maurice France

Statens Serum Institut Copenhagen Denmark

Usher Institute University of Edinburgh Edinburgh UK

World Health Organization Geneva Switzerland

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New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemic