RSV Monitoring in Germany: A Critical Overview of Available Surveillance Systems.

Respiratory syncytial virus (RSV) is a leading cause of respiratory infections in young children, elderly people, and patients with underlying diseases. Solid data on its epidemiology and burden of disease are essential for the implementation of preventive strategies. This review provides for the first time a comprehensive overview on publicly available RSV surveillance resources in Germany. Methods: Public RSV surveillance systems in Germany were identified and, where possible, exemplary data was extracted to provide an overview of the scope of available data, their strengths and limitations. Results: German RSV surveillance systems provide data on both outpatient and inpatient incidence rates, age distribution, and seasonality. Germany's public health institution, the Robert Koch Institute (RKI), documents RSV cases nationwide based on mandatory reporting. Further, sentinel surveillance by RKI captures outpatient RSV infections as well as severe hospitalized cases. Nationwide, data on inpatients is collected and reported by hospital discharge diagnostic codes. Additional surveillance systems (e.g., clinical-virology.net) provide data on RSV positivity rates stratified by age and gender. Regional surveillance efforts by ten German states provide data on the infection dynamics. Pediatric documentation of age distribution and severity of respiratory diseases via surveillance was initiated by the German Society for Pediatric Infectious Diseases. Reviewing all available sources and data underlines the high clinical burden, especially in infants and older adults during the winter season. Conclusions: Germany's RSV surveillance systems on the national and regional level support the tracking of incidence rates and seasonal patterns. Notably, pediatric data collection is more thorough, yielding a more comprehensive dataset than that available for adults. Contextualizing reported incidence rates in light of prospective or modeling studies suggests that the official documentation of RSV cases-particularly among adults-is underestimated.