Burden of severe RSV disease among immunocompromised children and adults: a 10 year retrospective study

Abstract

BackgroundRespiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) recipients, with less known about other immunocompromised patients.MethodsTen-year retrospective cohort study of immunocompromised patients presenting with RSV disease documented at University Hospitals of Lausanne and Geneva. Severe RSV-related outcomes referred to RSV documented respiratory conditions requiring hospital admission, presenting as lower respiratory tract infection (LRTI) or pneumonia. We used multivariable logistic regression to assess clinical and laboratory correlates of severe RSV disease.ResultsFrom 239 RSV-positive immunocompromised in and out-patients 175 were adults and 64 children of whom 111 (47.8%) presented with LRTI, which resulted in a 38% (89/239) admission rate to hospital. While immunocompromised children were more likely to be admitted to hospital compared to adults (75% vs 62.9%, p = 0.090), inpatients admitted to the intensive care unit (17/19) or those who died (11/11) were mainly adults. From multivariable analyses, adults with solid tumors (OR 5.2; 95% CI: 1.4–20.9 P = 0.015) or those requiring chronic immunosuppressive treatments mainly for rheumatologic conditions (OR 4.1; 95% CI: 1.1–16.0; P = 0.034) were significantly more likely to be admitted to hospital compared to hematopoietic stem cell (HSCT) recipients. Bacterial co-infection was significantly and consistently associated with viral LRTI and pneumonia.ConclusionsFrom our findings, RSV-related disease results in a significant burden among adults requiring chronic immunosuppressive treatments for rheumatological conditions and those with solid tumors. As such, systematic screening for respiratory viruses, should be extended to other immunocompromised populations than HSCT recipients.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3002-3) contains supplementary material, which is available to authorized users.

Comparative global epidemiology of influenza, respiratory syncytial and parainfluenza viruses, 2010–2015

“…It has also been shown that RSV is also an important cause of hospitalization and death in some adults. 41 This further supports the WHO's recent BraVe initiative in tackling some of the non-influenza respiratory viruses (NIRVs). 7 Whilst we acknowledge that the nature and pattern of this data will be affected by the specific populations fitting the individual testing criteria at each contributing site, the widely recognised universality of RSV as a major cause of pediatric morbidity makes such testing criteria likely similar at each site, such that the patterns of RSV incidence obtained from these INSPIRE network laboratories are very likely globally generalizable and real.…”

Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections

“…Care should be taken when interpreting specimens that are positive for multiple targets, and laboratorians should have a sense of the coinfection rates within their settings. Coinfection rates may vary widely between adult and pediatric patient populations and may account for over 10% of all specimens in some pediatric populations (229)(230)(231). Environmental swipe tests should be considered to monitor workspaces for contamination from current or recently circulating viruses as well as control materials, and they can be used to detect widespread amplicon contamination events (232); however, sporadic contamination events may be missed due to sampling bias.…”

Epidemiology and outcomes of hospitalized adults with respiratory syncytial virus: A 6‐year retrospective study

“…The burden of RSV infections in immunocompromised adults that are non‐HSCT is not well known . Most epidemiologic studies of RSV in hospitalized adults have been retrospective single‐center studies covering a single or few seasons .…”

“…15 The burden of RSV infections in immunocompromised adults that are non-HSCT is not well known. 16 Most epidemiologic studies of RSV in hospitalized adults have been retrospective single-center studies covering a single or few seasons. 2,17,18 This retrospective cohort study was conducted to better define the epidemiology and outcomes of RSV in hospitalized adults over multiple seasons.…”