Burden of respiratory syncytial virus infection in community-dwelling older adults in Europe (RESCEU): an international prospective cohort study

Abstract

BackgroundRespiratory syncytial virus (RSV) infection in older adults is recognized as an important health issue. We aimed to assess the community burden of RSV in Europe in older adults aged ≥60 years.MethodsThis international prospective observational cohort study is part of REspiratory Syncytial virus Consortium in EUrope (RESCEU). Participants were recruited before two independent RSV-seasons through general practitioner's offices. Participants reported weekly about symptoms of acute respiratory tract infection (ARTI) during one RSV-season. . ARTI patients were tested for RSV during home visits and completed a daily symptom diary. RSV-illness included PCR-confirmed ARTI and those showing seroconversion over the season. RSV-ARTI was based on PCR alone (ClinicalTrials.gov, NCT03621930).ResultsWe recruited 1040 participants (527 in season 2017–2018, 513 in season 2018–2019) with a median age of 75 years (range 60–100). 1023 (99%) lived independently at home at baseline. RSV-illness incidence was 4.2% (22/527) and 7.2% (37/513) in the respective seasons. RSV-illness did not affect frailty or cardiopulmonary status during the course of the study. No patients were hospitalized or died from RSV-illness. In the 36 patients with PCR confirmed RSV-ARTI, symptom duration averaged 19 days, while a doctor's visit took place in 11/36 (31%) of cases. RSV-ARTI could not clinically be differentiated from all other ARTI based on symptoms.ConclusionThis European study showed that RSV is prevalent in community-dwelling older adults and rarely causes severe disease. This suggests that watchful waiting, using a continuity of care approach to identify those who do need more intensive care is often justified when RSV is suspected in family practice.

Distinct patterns of within-host virus populations between two subgroups of human respiratory syncytial virus

“…Nasopharyngeal swabs were collected from patients with respiratory symptoms under 1 year old or over 60 years old, from London and Oxford, United Kingdom, Santiago de Compostela, Spain and Utrecht, the Netherlands, during 2017–2020. These patients were enrolled in three clinical studies of the REspiratory Syncytial virus Consortium in EUrope project (RESCEU, ClinicalTrials.gov identifiers: NCT03627572 44 , NCT03756766 45 and NCT03621930 46 ), a European multicentre project investigating epidemiological, virological and immunological characteristics of RSV infection. None of these participants had received any RSV monoclonal antibody or investigational vaccine.…”

Occurrence and disease burden of respiratory syncytial virus and other respiratory pathogens in adults aged ≥65 years in community: A prospective cohort study in Japan

“…21 Another study conducted in EU confirmed that RSV is prevalent in community-dwelling older adults. 5 Hence, there is a need for vaccine This study has following limitations: the study was designed for only 1 RSV season in 2019 with 1000 participants, resulting that the relatively low numbers of cases reported in each pathogen make it difficult to compare disease characteristics among subgroups or pathogens; the impact of COVID-19 pandemic occurred in March 2020 was unknown on the occurrence of ARD by respiratory pathogens and the study site visits; there could be an underestimation of severe ARD cases requiring hospitalization given that 90% of participants were enrolled from general practitioner sites and a participant with severe symptoms could visit a hospital site other than study sites and such case was not recorded in the study.…”

“…4 Another prospective observational cohort study in Europe (EU) during 2018 to 2019 showed that RSV infection is prevalent in community-dwelling older adults (≥60 years) with an annual incidence of 2.1%-4.9%; however, it rarely causes severe disease. 5 In long-term care facilities, RSV is estimated to infect 5%-10% of residents per year with significant rates of pneumonia (10%-20%) and death (2%-5%). 6 In the EU and the US, RSV is increasingly recognized, including impact on older adults; however, little is known about RSV infection in Japan.…”

Respiratory Syncytial Virus

“…In a recent international, prospective, observational cohort study in Europe, RSV illness was prevalent in community-dwelling elderly patients over the age of 75 with incidence of 4.2 to 5.2%. 57 RSV is the causative agent in up to 12% of medically attended acute respiratory illness. 58 While it is estimated that less than 1% of the infected adults require hospitalization, 59 RSV is the third most commonly identified viral illness, and there are an estimated 177,000 hospitalizations and 17,000 excess deaths due to RSV, mostly in adults over the age of 65.…”