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PONE-D-23-35302Generating the evidence to support the establishment of a Respiratory Syncytial Virus surveillance system in Cameroon: A study  protocolPLOS ONE

Dear Dr. Njuma Libwea,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Thank you for submitting your manuscript. The reviewers and I believe it is of potential value for our readers. However, the reviewers have raised a number of very important issues, and their excellent comments will need to be adequately addressed in a revision before the acceptability of your manuscript for publication in the Journal can be determined. We cannot guarantee that your revised paper will be chosen for publication; this would be solely based on how satisfactorily you have addressed the reviewer comments.

# The protocol is reported according to the PRISMA-P guidelines for writing systematic review protocols [10]. -> Please additionally cite the PRISMA 2020 guideline (DOI: https://doi.org/10.54724/lc.2022.e9).

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: No

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: PLOS Review 2023Dec10.RSV surveillance Cameroon

This paper describes plans for studies to determine the burden of Respiratory Syncytial Virus (RSV) in adults in Cameroon. The overarching goal is to generate evidence to support a RSV surveillance system for RSV in that country.

In the first phase a literature review will be done to determine the burden of illness of RSV in Cameroon. In the second phase a retrospective search for RSV isolates (reviewer paraphrase) identified in the laboratory register of the National Influenza Center will be obtained, and a hand search of patient Health Records located at hospitals associated with these virus isolations will be done. Data will be collected to describe the clinical course and patient demographics.

General comments:

RSV is recognized as an important pathogen for children, older adults and persons with certain co-morbidities. As there are preventive and therapeutic interventions increasingly available, it is important to understand country-level disease burden to inform health decision making about feasibility and cost of these interventions in one’s own setting.

The paper is describing what the investigators intend to do. This reviewer finds that there is insufficient detail in the current version of the paper to assess if the protocol is feasible or methodologically appropriate.

Specific comments:

Abstract

1. Goal of the study – Is it the purpose establish a surveillance system or determine if there is enough available data to evaluate if a surveillance system is needed to know the burden of disease?

2. What is the status of surveillance for infectious diseases in Cameroon, and of public health? Are there reportable diseases and feedback to health care providers and knowledge users about other communicable diseases? Is this endeavour starting from scratch or building on a strong foundation in which another virus will be added to an existing system?

3. Presumably the authors have done a quick landscape analysis to see if there are any peer-reviewed publication on RSV from Cameroon.

4. Methods: Medical records will be “explored”. Much more precise language is needed.

5. How is RSV burden defined. Are the authors looking at the severe end of the spectrum only (patients sick enough to be hospitalized and with access to care- i.e. would personal resources limit the likelihood of testing or of medical care?)

Introduction

1. Line 57. There are authorized vaccines/passive immunization products, add references as wording implies these are in late stage development.

2. There are no recommended therapies. (i.e. treatments)

3. Line 76. …when feasible a critical appraisal of the evidence…will be performed”. How could this step be justifiably not done?

4. Line 84 “an ever increasing disease burden” Is the burden increasing or are there just more data describing the burden

5. Line 97. What does "consulted for RSV" mean?

6. Suggest using epidemiologic terms that are generally understood, or define the terms when first used. For example the term “driver” is used, line 10. Is this a risk factor or a predictor. “Driver” seems to imply causal association.

Methods (4)

1. Is the intent to determine prevalence? What is the denominator?

2. Line 131/ personnel will carefully use personal identifiers (…full names, phone numbers…etc) There is is a threat to confidentiality and privacy. More details of measures to mitigate risks are needed. Have the investigators had preliminary conversations with authorities to assess feasibility of this design.

3. The study is described as a cohort study. Line 148 Please provide evidence that this is the case (what is the inception cohort, who is eligible, ineligible, how will outcome measures be ascertained etc)

The writing is sometimes wordy and repetitive and could be condensed.

Reviewer #2: -This research is short but shows great effort in demonstrating the medical situation of RSV in Cameroon. It offers evidence and great insight that may be used in future policy-making and further research in relevant fields. However, some concerns must be demonstrated by authors before publication.

-There are several style errors detected at first glance. English proofreading is vital.

-Information about RSV and ARI ought to be specified in the introduction.

-The authors assess the diffusion of innovation of this research in that the methods may be used for other contagious diseases such as SARS-CoV-2, flu, and human papillomavirus surveillance. Is there a specific reason the authors focused on RSV instead of other diseases?

-I would like to recommend the authors make a figure of the procedure of the search strategy to enhance the readability of readers.

-The authors wanted to discuss the burden of the adult population due to RSV. Considering that this study excluded young children, the main population suffering from RSV infection, is there a way to exclude the other major population, aged 65 and older, who suffer from RSV infection?

-The conclusion seems somewhat vague. Please specify the expected results in the conclusion.

-The paper needs more citations for the credibility of the study protocol.

- The authors discuss ways to address possible heterogeneity between studies. If heterogeneity occurs, what is the main cause of heterogeneity?

- Please define the risk factors in a more specified manner.

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Reviewer #1: No

Reviewer #2: No

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Generating the evidence to support the establishment of a Respiratory Syncytial Virus surveillance system in Cameroon: A study  protocol

PONE-D-23-35302R1

Dear Dr. Njuma Libwea,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Dong Keon Yon, MD, FACAAI, FAAAAI

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

This is an excellent paper. During production stage, please improve the quality and DPI of Figure 1.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: I thank the authors who have made a great effort to address all the aspects of my comments. The paper is ready to be published.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

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