American Review of Respiratory Medicine - Volumen 25, Número 1 - March 2025

Editorials

Respiratory Syncytial Virus: Redefining Priorities from the Primary Care Level

Virus Sincicial Respiratorio: redefiniendo prioridades desde el primer nivel de atención

The natural history of the respiratory syncytial virus (RSV) has been closely associated with the pediatric field for decades. In the clinical mind­set, it is still considered “an infant infection”. However, in recent years, especially after the COVID-19 pandemic, a paradigm shift has oc­curred: the RSV is not only ubiquitous but also responsible for causing an important burden in older adults and patients with respiratory or cardiovascular comorbidities. This clinical and epidemiological re-emergence forces us to review our diagnostic and preventive strategies and to integrate the management of RSV across all lev­els of the healthcare system, starting with the primary care level.

In this context, the work done by a group of experts from the city of Mexico, published in this issue of the American Review of Respiratory Medicine (RAMR) is a significant contribution. Not only for its methodological robustness (a real-time Delphi consensus) but also for its practical and regional approach. The authors succeeded in integrating a group of key recommendations to optimize the RSV diagnosis from the primary care level, without ignoring the reality of Latin American healthcare systems.

One of the most important aspects of the docu­ment is the central role of primary care as a de­tection point. The inclusion of rapid antigen tests along with defined clinical criteria is proposed as a cost-effective and especially feasible strategy. The recommendation to perform molecular testing (real- time polymerase chain reaction) in hospital­ized patients or patients at a high risk adequately complements this tiered approach. Ultimately, it serves as a guide to rationalize the use of resources, reduce antibiotic overuse and promote evidence-based clinical decision-making.

From my experience, I find it crucial to highlight a commonly overlooked fact: adults over the age of 65 are currently the age group with the highest mortality rate associated with the virus. A recent work by Ciapponi et al reported 0.6% mortality in children under two years old, compared to 23% in older adults. ¹ This epidemiological reality, which is often underestimated by the healthcare teams themselves, demands a paradigm shift also regard­ing prevention and vaccination.

In this regard, lack of awareness is not limited to patients. In an electronic survey conducted with 223 pulmonologists from 15 Latin American coun­tries regarding the perceived safety and effective­ness of influenza vaccines, although the majority acknowledged their benefits in preventing severe infections, a significant percentage was unaware of their impact on reducing cardiovascular and cere­brovascular events. Only one third of the surveyed pulmonologists had received specific training on these benefits, and more than 30% showed interest in doing so. This educational gap within the medi­cal field reinforces the need for continuous training to strengthen the preventive role of immunization in all its dimensions.^{2, 3}

The consensus presented here is more than a diagnostic algorithm: it is an invitation to rethink the way in which we manage the RSV, not only from a pediatric point of view but also through a comprehensive and preventive approach based on the reality of our healthcare systems. Initia­tives like this one, which are grounded on local experience and have a collaborative vision, are crucial for advancing towards a more equitable, proactive, and patient-centered respiratory healthcare.

Conflict of interest

Laura Pulido has received funding from Pfizer, GlaxoS­mithKline, Sanofi, MSD, and CSL Seqirus for medical education activities. This manuscript has not received any funding and solely represents the opinion of the author.

REFERENCES

1. Pulido L, Garcia Zamora S, Videla A, et al Más Allá de la In­fección: Percepción de los Neumólogos sobre la Vacunación Antigripal y su Impacto Cardiovascular. A ser presentado en Congreso ALAT julio 2025

2. Ciapponi A, Palermo MC, Sandoval MM, et al. Respiratory syncytial virus disease burden in children and adults from Latin America: a systematic review and meta-analysis. Front Public Health. 2024;12:1377968.

3. Garcia-Zamora S, Pulido L, Sosa-Liprandi Á. Perspectives on the efficacy and effectiveness of the recombinant herpes zoster vaccine.

Medicina (B Aires). 2025;85:473–5. https://doi.org/10.1055/a-2570-1048