Abstract / Summary
Background/Objectives: Pandemic non-pharmaceutical interventions virtually eliminated respiratory syncytial virus (RSV) circulation in 2020–2021, and their relaxation was followed by unprecedented off-season resurgences. This narrative review, informed by a structured literature search, synthesizes current evidence on healthcare-associated RSV (HA-RSV), including transmission dynamics, vulnerable inpatient populations, and integrated prevention strategies, in the post-pandemic era. Methods: We searched PubMed/MEDLINE and Europe PMC (January 2000–October 2025) using two complementary strategies, supplemented by WHO and CDC guidance. Primary hospital-based studies reporting laboratory-confirmed HA-RSV cases formed the core evidence set; surveillance reports, systematic reviews, and guidance were used as labeled contextual evidence and synthesized narratively. Results: Twenty-nine primary studies from neonatal, pediatric, adult, geriatric, and immunocompromised settings provided direct evidence on HA-RSV, which accounted for 3–15% of RSV hospitalizations depending on setting and case definition and was associated with prolonged stay, escalation of respiratory support, higher costs, and, in children, higher mortality than community-onset infection. Universal masking and pre-admission screening were followed by reductions in HA-RSV in most before–after studies. Post-pandemic surveillance shows earlier, less predictable RSV activity and periods of concurrent circulation with influenza and SARS-CoV-2. RSV spreads mainly through short-range respiratory particles and contaminated hands and surfaces; asymptomatic or mildly symptomatic healthcare workers are one potential source of introduction. Conclusions: Prevention of HA-RSV rests on hand hygiene, transmission-based precautions, environmental disinfection, rapid molecular diagnostics, and supportive healthcare-worker and visitor policies, escalated according to local surveillance rather than the calendar. Immunoprophylaxis and vaccination reduce severe RSV disease in eligible groups, but direct evidence that they prevent healthcare-associated transmission is lacking.