Heng Luo, Tingting Yang, Sejung Kwon, Mingzhang Zuo, Wenhao Li, Ikseon Choi
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respiratory syncytial virus rsv represents substantial global health challenge disproportionately high disease burden lowincome middleincome countries rsv exhibits seasonality areas globally comprehensive understanding withincountry variations rsv seasonality could help define timing rsv immunisation programmes study focused china aimed describe geographical distribution rsv seasonality identify distinct rsv transmission zones evaluate potential suitability seasonal rsv prevention strategy systematic analysis rsv seasonality china use data rsv activity extracted systematic review studies published embase medline web science china national knowledge infrastructure wanfang data chongqing vip information sinomed database inception may 5 2023 included studies design china reporting least 25 rsv cases aggregated rsv case number calendar month week province level data covering least 12 consecutive months year 2020 prior covid19 pandemic studies used serology rsv testing excluded also included weekly data rsv activity openaccess online databases taiwan national infection disease statistics system hong kong centre health protection applying eligiblity requirements across datasets excluded data rsv activity jan 1 2020 onwards estimated rsv seasonal epidemic onset duration using annual average percentage aap approach summarised seasonality provincial level used pearsons partial correlation analysis assess correlation rsv season duration latitude longitude individual provinces define transmission zones used two independent approaches infantpassiveimmunisationdriven approach moving interval approach 6month interval datadriven approach kmeans identify groups provinces similar rsv seasonality systematic review registered prospero crd42022376993 total 157 studies included along two online datasets reporting data 194 596 rsv cases 442 studyyears covering period jan 1 1993 dec 31 2019 52 sites 23 provinces among 21 provinces sufficient data 100 reported cases median duration rsv seasonal epidemics 46 months iqr 4154 significant latitudinal gradient r069 p00007 provinces near tropic cancer longest epidemic duration found correlation longitude epidemic duration r015 p053 15 71 21 provinces rsv epidemics november march 13 62 21 provinces clear rsv seasonality epidemic duration 5 months moving interval approach categorised 21 provinces four rsv transmission zones first zone consisting five provinces fujian guangdong hong kong taiwan yunnan assessed unsuitable seasonal rsv immunisation strategies three zones considered suitable seasonal rsv immunisation strategies optimal start month varying september hebei october anhui chongqing henan hubei jiangsu shaanxi shandong shanghai sichuan xinjiang november beijing gansu guizhou hunan zhejiang kmeans approach identified two rsv transmission zones primarily differentiated whether province near tropic cancer fujian guangdong hong kong taiwan yunan hunan remaining 15 provinces although substantial variations rsv seasonality observed across provinces china study identified distinct transmission zones shared rsv circulating patterns findings could important implications decision making rsv passive immunisation strategy furthermore methodological framework study defining rsv seasons identifying rsv transmission zones potentially applicable countries regions nanjing medical university chinese translation abstract see supplementary materials section