Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

INTRODUCTION: The advent of genome amplification assays has allowed description of new respiratory viruses and to reconsider the role played by certain respiratory viruses in bronchiolitis. This systematic review and meta-analysis was initiated to clarify the prevalence of respiratory viruses in children with bronchiolitis in the pre-COVID-19 pandemic era. METHODS: We performed an electronic search through Pubmed and Global Index Medicus databases. We included observational studies reporting the detection rate of common respiratory viruses in children with bronchiolitis using molecular assays. Data was extracted and the quality of the included articles was assessed. We conducted sensitivity, subgroups, publication bias, and heterogeneity analyses using a random effect model. RESULTS: The final meta-analysis included 51 studies. Human respiratory syncytial virus (HRSV) was largely the most commonly detected virus 59.2%; 95% CI 54.7; 63.6). The second predominant virus was Rhinovirus (RV) 19.3%; 95% CI 16.7; 22.0) followed by Human bocavirus (HBoV) 8.2%; 95% CI 5.7; 11.2). Other reported viruses included Human Adenovirus (HAdV) 6.1%; 95% CI 4.4; 8.0), Human Metapneumovirus (HMPV) 5.4%; 95% CI 4.4; 6.4), Human Parainfluenzavirus (HPIV) 5.4%; 95% CI 3.8; 7.3), Influenza 3.2%; 95% CI 2.2; 4.3, Human Coronavirus (HCoV) 2.9%; 95% CI 2.0; 4.0), and Enterovirus (EV) 2.9%; 95% CI 1.6; 4.5). HRSV was the predominant virus involved in multiple detection and most codetections were HRSV + RV 7.1%, 95% CI 4.6; 9.9) and HRSV + HBoV 4.5%, 95% CI 2.4; 7.3). CONCLUSIONS: The present study has shown that HRSV is the main cause of bronchiolitis in children, we also have Rhinovirus, and Bocavirus which also play a significant role. Data on the role played by SARS-CoV-2 in children with acute bronchiolitis is needed. REVIEW REGISTRATION: PROSPERO, CRD42018116067.