An epidemic of respiratory syncytial virus in elderly people: Clinical and serological findings

Abstract

In 1984-1985, an outbreak of respiratory syncytial virus (RSV) infection occurred in two geriatric wards. Among 68 patients (mean age +/- SD = 82.5 +/- 12.5 with respiratory signs, 52 had signs caused by RSV infection. Among all patients, the clinical and serological attack rates were 61.2% and 75.0%, respectively. The most frequent clinical presentation was intensive coughing (96.1%) and fever (96.1%) associated with expectorate (63.5%). The duration of the respiratory symptoms was 5 to 7 days. The disease gradually resolved, although in eight (15.4%) patients complications occurred. For periods of up to 1 year after infection, 172 sera were obtained and tested by complement fixation test (CFT), fluorescent assays for titrating specific IgG, IgA, and IgM, and Western blotting. Specific IgM appeared in six (11.5%) of the infected patients and peaked 2 to 6 months after infection, and there was no significant correlation with severity of clinical symptoms. However, higher peak G and A antibody responses were observed in persons with rales (CFT: P = 0.008; IgG: P = 0.042; IgA: P = 0.020), cough (IgG: P = 0.034), sputum (IgG: P = 0.030), dyspnea (CFT: P = 0.024), conjunctivitis (CFT: P = 0.025), and bronchitis (CFT: P = 0.018). The temporal patterns of IgA and CFT results were found to be similar, whereas IgG peaked later, i.e., between 2 and 6 months. The patients with the most severe symptoms had the highest antibody titers obtained by conventional tests and by Western blots. Thus, RSV can be an epidemic pathogen among elderly persons, although this illness is usually mild.

Age related differences in humoral immune response to respiratory syncytial virus infection in adults

“…However, in our study both young and old subjects had similar ratios of neutralizing to EIA binding antibody in pre-and postinfection serum suggesting that the qualitative function of the antibodies produced was similar in the two groups. In a study of nursing home residents infected with RSV, it was noted that those with the most severe symptoms had higher peak antibody levels, measured by complement fixation assay, than persons with milder illness [Agius et al, 1990]. Our study is too small to adequately address severity of illness and the nature or magnitude of the antibody response since only two subjects were hospitalized and one had radiographic pneumonia.…”

Comparison of respiratory syncytial virus humoral immunity and response to infection in young and elderly adults

“…Older persons appear to mount a variable IgM response, with 11-81% of elderly having RSV IgM detected in the serum during acute infection [Vikerfors et al, 1988;Agius et al, 1990]. This study is the first to examine if older persons have a qualitative defect in RSV antibody by comparing baseline RSV neutralizing titers and the response to acute infection to young subjects.…”

“…Several reports indicate that all older adults have measurable RSV-specific IgG in their serum and that most infected individuals will develop a Նfourfold increase in IgG EIA [Agius et al, 1990;Falsey and Walsh, 1992]. Older persons appear to mount a variable IgM response, with 11-81% of elderly having RSV IgM detected in the serum during acute infection [Vikerfors et al, 1988;Agius et al, 1990].…”

Improved detection of respiratory syncytial virus in nasal aspirates by seminested RT-PCR

“…Respiratory syncytial virus (RSV) is one of the most important respiratory pathogens, causing severe infections of the lower respiratory tract in infants, small children, the elderly, and in immunosuppressed patients, often requiring hospitalization [Kim et al, 1973;Whimbey et al, 1995;Agius et al, 1990;Falsey et al, 1992;Fleming et al, 1993]. Previous infection does not confer immunity and reinfections are very common [McIntosh et al, 1993;Henderson et al, 1979].The virus is highly contagious, causing yearly outbreaks of respiratory tract infections and spreads very rapidly, especially in hospital wards and nursing homes [Falsey et al, 1990.…”