Background Current understanding of severe RSV infections in adults is limited by clinical under-recognition. We compared the prevalence, clinical characteristics, and outcomes of RSV infections vs influenza in adults hospitalized with acute respiratory illnesses in a prospective national surveillance network. Methods Hospitalized adults who met a standardized ARI case definition were prospectively enrolled across three respiratory seasons from hospitals participating across all sites of the U.S. Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN, 2016-2019). All participants were tested for RSV and influenza by RT-PCR. Multivariable logistic regression was used to test associations between laboratory-confirmed infection and characteristics and clinical outcomes. Results Among 10,311 hospitalized adults, 6% tested positive for RSV (n=622), 18.8% positive for influenza (n=1,940), and 75.1% negative for RSV and influenza (n=7,749). Congestive Heart Failure (CHF) or Chronic Obstructive Pulmonary Disease (COPD) was more frequent among adults with RSV than influenza (CHF: 37.3% vs. 28.8%, p<0.0001; COPD: 47.6% vs. 35.8%, p<0.0001). Patients with RSV more frequently had longer admissions [OR=1.38 (95% CI: 1.06-1.80) for stays >one week] and mechanical ventilation [OR=1.45 (95% CI: 1.09-1.93)] compared with influenza, but not compared to the influenza negative group [OR=1.03 (95% CI: 0.82-1.28); OR=1.17 (0.91-1.49), respectively.] Conclusions The prevalence of RSV across three recent respiratory illness seasons was considerable. Our findings suggest those with RSV might incur worse outcomes than influenza in hospitalized adults and frequently have pre-existing cardiopulmonary conditions. This study informs future vaccination strategies and underscores a need for RSV surveillance among adults experiencing severe ARI.
Background: Respiratory syncytial virus (RSV) is under-recognized in hospitalized adults. We evaluated severity of acute respiratory illness (ARI) including intensive care unit (ICU) admission and mechanical ventilation in a national surveillance network. Methods: Hospitalized adults who met a standardized ARI case definition were prospectively enrolled across three respiratory seasons from hospitals participating across all sites of the U.S. Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN, 2016-2019). Multivariable logistic regression was used to test associations between lab-confirmed infection and characteristics and clinical outcomes. Results: Among 10,311 hospitalized adults, 6% tested positive for RSV (n=622), 18.8% positive for influenza (n=1,940), and 75.1% negative for RSV and influenza (n=7,749). The proportion of adults with Congestive Heart Failure (CHF) or Chronic Obstructive Pulmonary Disease (COPD) was higher among adults with RSV than influenza (CHF: 37.3% vs. 28.8%, p<0.0001; COPD: 47.6% vs. 35.8%, p<0.0001). Patients with RSV had higher odds of experiencing length of stay ≥8 days [OR=1.38 (95% CI: 1.06-1.80), p-value=0.02] and invasive or noninvasive mechanical ventilation [OR=1.45 (95% CI: 1.09-1.93), p-value=0.01] compared with influenza patients. Conclusions: Our findings suggest patients with RSV might incur worse outcomes than influenza in hospitalized adults, who are likely to have pre-existing cardiopulmonary conditions.
Background: RSV is a frequent cause of respiratory illness less often diagnosed outside hospital settings; thus, overall prevalence of RSV-associated illness is under-recognized. Information about presence of RSV among those with chronic conditions is especially needed with recent advances in vaccine development. Methods: Participants prospectively enrolled in an ambulatory surveillance study of respiratory illness (MFIVE) were tested by RT-PCR for RSV and influenza. Participant and illness characteristics were collected by in-person survey and EMR review. Chronic conditions were characterized by the Multimorbidity-weighted index (MWI). Viral factors, including subtype and viral load, were compared between RSV-A and RSV-B. Multivariate logistic regression models were used to compare participant and illness characteristics between those with RSV and those with influenza. Comparisons were also made across RSV subtypes. Results: Among 4,442 individuals enrolled in MFIVE from fall 2017 to spring 2020, 9.9% (n=441) had RSV detected. Participants with increased RSV viral load had increased odds of illness lasting at least 7 days (Adjusted OR=2.39 (95% CI: 1.03-5.51) p-value=0.04). Adults with RSV had higher median MWI scores compared to influenza and RSV/influenza-negative (1.62, 0.40, 0.64, respectively). Conclusions: Our findings support the need for ongoing RSV surveillance, particularly in older adults and those with multimorbidity. Our findings support a recognition of multimorbidity as a significant contributor to RSV-associated MAARI among outpatient adults, with particularly notable impacts among adults under 65.
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