RSV Infection in Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript submitted by Ricco M et al, provide insights into the epidemiology of RSV infections and associated risk such as living conditions in refugee camps. However, minor revisions could be addressed to improve the quality of this study.

The summury of key fundings could be moved to the results section

Limits could be adressed as short, mid and long-term perspectives

Author Response

Estimated Reviewer, 

thank you for your collaborative approach to our systematic review and meta-analysis. We substantially agreed with your recommendations, and we've amended the main text as follows:

1) Limits could be adressed as short, mid and long-term perspectives

We have amended limits section by implementing a final paragraph that contains the following text:

In other words, from a short-term perspective, the evidence we were able to recollect could be therefore only limitedly applicable in the current context of ongoing refugee crisis, particularly when dealing with the Ukraine migratory crisis in Eastern and Central Europe [8]. On the other hand, from a long-term perspective the potential differences in size and composition of refugee camps urge for the appropriate tailoring of preventive measures. For instance, American Centers for Disease Control and Prevention did recently recommend RSV vaccines for adults 60 years of age and older at highest risk for severe RSV disease [58,95,96]. Similar recommendations have been issued for pregnant people to protect their babies from severe RSV disease by means of a single dose of bivalent RSVpreF vaccine during weeks 32 through 36 of pregnancy during September through January [59,97]. This strategy may be considered as a complimentary one for other interventions, including the delivery of mAb (e.g. Palivizumab or Nirsevimab) to either high-risk newborns [98], or more extensive population groups [99]. However, all options should be accurately taken into account in accord with underlying settings and available resources.

2) The summury of key fundings could be moved to the results section

Even though we agree about the large extent of quantitive results conveyed by this section, as the summary of key findings is recommended by PRISMA statement (see checklist), and due to the large amount of data we were able to collect, we have deliberately retained the section in the discussion section. We would stress that we agree with this criticism, and that maintaining the current organization of the main text was a deliberate choice for improving the readability of the discussion.

Again, we warmly thank you for your comments and valuable suggestions.

On the behalf of all Authors,

MR

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have chosen a very current topic, and of great importance in the context of the continuous increase in population migration. The systematic review of specialized literature, selected from the most important databases, reveals the magnitude of the problem and the importance of its knowledge in order to implement effective prevention and control measures. The article meets the necessary qualities for approval through the consistency of the scientific content, the complex statistical processing of the data, and especially the relevant analysis of the practical aspects arising from the exploitation of the results.

Author Response

Estimated Reviewer,

we warmly thank you for the very positive appraisal of our study.

On the behalf of all Authors,

MR

Reviewer 3 Report

Comments and Suggestions for Authors

This systematic review examines the prevalence of human respiratory syncytial virus (RSV) infections among refugees and asylum seekers in refugee camps. The study found that individuals in refugee camps have a higher rate of RSV infections compared to other respiratory pathogens, underscoring the importance of developing tailored prevention strategies for these high-risk groups. The article has a sound methodology and the results are clearly presented; I only have a few suggestions to make the article more reader-friendly:

It is recommended to expand on the description of the global disease burden of RSV, especially its prevalence among vulnerable populations and its comprehensive impact on health and finances, in the introduction section.

It is suggested to include insights into public health policy implications, specific recommendations, and how the findings of this study can be extended to a broader refugee population in the discussion section.

Author Response

Estimated Reviewer, 

thank you for your collaborative approach and for your valuable comments. In accord with your suggestions, we've amended the main text as follows:

1) It is recommended to expand on the description of the global disease burden of RSV, especially its prevalence among vulnerable populations and its comprehensive impact on health and finances, in the introduction section.

REPLY: the following section was included in the introduction:

In fact, available global estimates hint at around 33 million cases of ARI and LRTI in infants aged 5 years or less every year [22,23,27], with high hospitalization rates [28–32] leading to around 3.5 million hospital admissions [21,23]. When dealing with the global burden of RSV, and with RSV-associated direct and indirect costs, it is important to stress that RSV also affects older individuals [33–36]. In European Union alone it causes around 160,000 hospitalizations annually in adults aged ≥ 18 years, 92% from adults aged ≥ 65 years [37], for a corresponding hospitalization rate of around 157 per 100,000 [38], but these figures are reasonably underestimate because of the low rate of testing in adults elderly.

2) It is suggested to include insights into public health policy implications, specific recommendations, and how the findings of this study can be extended to a broader refugee population in the discussion section.

REPLY: the following section was included in the discussion by amending and replacing the final section of the limitation section:

In other words, from a short-term perspective, the evidence we were able to recollect could be therefore only limitedly applicable in the current context of ongoing refugee crisis, particularly when dealing with the Ukraine migratory crisis in Eastern and Central Europe [8]. On the other hand, from a long-term perspective the potential differences in size and composition of refugee camps urge for the appropriate tailoring of preventive measures. For instance, American Centers for Disease Control and Prevention did recently recommend RSV vaccines for adults 60 years of age and older at highest risk for severe RSV disease [58,95,96]. Similar recommendations have been issued for pregnant people to protect their babies from severe RSV disease by means of a single dose of bivalent RSVpreF vaccine during weeks 32 through 36 of pregnancy during September through January [59,97]. This strategy may be considered as a complimentary one for other interventions, including the delivery of mAb (e.g. Palivizumab or Nirsevimab) to either high-risk newborns [98], or more extensive population groups [99]. However, all options should be accurately taken into account in accord with underlying settings and available resources.

In summary, we are confident that the amendments we have performed may allow to consider the current stage of development of our paper consistent with the quality of Epidemiology, allowing its eventual acceptance for publication.

On the behalf of all Authors,

MR