Viral etiology of acute respiratory infections in Sub-Saharan Africa during the pre-COVID-19 period (2006–2019): a systematic review and meta-analysis

Kaboré, B.W.O., Gouba, N., Ilboudo, A.K., Lingani, M., Savadogo, M., Ouedraogo, E., Cissé, A., Simonis, V. and Tarnagda, Z. 2025. Viral etiology of acute respiratory infections in Sub-Saharan Africa during the pre-COVID-19 period (2006–2019): a systematic review and meta-analysis. BMC Infectious Diseases 25 (1):1799.

Objective: This systematic review and meta-analysis aimed to estimate the prevalence of respiratory viruses among people with acute respiratory infections (ARI) in Sub-Saharan Africa.

Methods: We performed an electronic search through the PubMed, EMBASE, Medline, and Scopus databases to identify observational (cross-sectional and cohort), and randomized controlled trial studies published in English and French between January 2006, and December 2019. We used a random-effects meta-analysis to estimate the pooled prevalence of major respiratory viruses across studies. Heterogeneity (I2) was assessed via the chi-square test of Cochran’s Q statistic. A p-value < 0.05 was considered statistically.

Results: This meta-analysis included 73 studies (199,393 participants). Human rhinovirus (HRV) was the most commonly detected virus at 21.2% (95% CI [16.76; 25.75]). The second predominant virus was respiratory syncytial virus (RSV) at 16% (95% CI [12.51; 19.59]), followed by human adenovirus (AdV) at 14.3% (95% CI [10.13; 18.57]), and influenza at 13.9% (95% CI [11.27; 16.62]). Other detected viruses included human parainfluenzavirus (HPIV) 8.9% (95% CI [6.08; 11.83]), human coronavirus (HCoV) 7.2% (95% CI [3.77; 10.67]), enterovirus (EV) 7% (95% CI [4.2; 9.81]), human metapneumovirus (HMPV) 4.6% (95% CI [3.53; 5.78]), and human bocavirus (HBoV) 4.1% (95% CI [1.99; 6.34]). Significant heterogeneity was observed across the overall prevalence and within subgroups for all viruses. Notable variations in respiratory virus prevalence were identified according to age, clinical presentation, setting, and Africa region.

Conclusion: The present study has shown that HRV is the most common respiratory virus detected among ARI in Sub-Saharan Africa, followed by RSV, AdV, and influenza virus. Ongoing surveillance is important to monitor changes in the etiology, seasonality, and severity of pathogens of interest.