Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France

Loubet, Paul; Lenzi, N.; Valette, Martine; Foulongne, Vincent; Krivine, Anne; Houhou, N.; Lagathu, Gisèle; Rogez, S.; Alain, Sophie; Duval, Xavier; Galtier, Florence; Postil, D.; Tattevin, Pierre; Vanhems, Philippe; Lina, Bruno; Launay, Odile; Seddik, Kenza; Lesieur, Zineb; Bonmarin, Isabelle; Loulergue, Pierre; Bodilis, Hélène; Servera-Miyalou, M.; Sadler, Ian J.; Momčilović, Stefan; Kanaan, R.; Coolent, N.; Boun, K. Tan; Blanche, Paul; Charpentier, Julien; Daviaud, Fabrice; Mongardon, Nicolas; Bretagnol, Anne; Claessens, Yann-Érick; Rozenberg, Flore; Yazdanpanah, Y.; Burdet, Charles; Harent, S.; Lachâtre, Marie; Rioux, C.; Bleibtreu, Alexandre; Casalino, Enrique; Choquet, Christophe; Leleu, A.; Belghalem, K.; Colosi, Lisa M.; Ranaivoson, M.; Verry, V.; Pereira, Laurent; Dupeyrat, E.; Bernard, Julie; Emeyrat, N.; Chavance, P.; Debit, Ahmed; Aubier, M; Pradère, Pauline; Justet, A.; Mal, Hervé; Brugière, Olivier; Papo, Thomas; Goulenok, Tiphaine; Boisseau, Martial; Jouenne, R.; Alexandra, Jean-François; Raynaud-Simon, A.; Lilamand, Matthieu; Cloppet-Fontaine, A.; Becheur, K.; Pelletier, A; Fidouh, Nadhira; Ralaimazava, Pascal; Beaumale, F.; Costa, Yago Pessoa; Munier, E.; Betend, F.; Amour, Sélilah; Loeffert, Sabine; Francourt, K.; Merle, Corinne; Letois, F.; Géraud, Philippe; Driss, V.; Noslier, S.; Ray, M.; Sebbane, Mustapha; Konaté, A.; Bourdin, Alain; Klouche, Kada; Leglise, Marie-Suzanne; Couvé-Deacon, Elodie; Fruit, Dorothée; Fenerol, C.; Vallejo, Christine; Jouneau, S.; Lainé, Fabrice; Thébault, Elise; Fillâtre, Pierre; Pape, Cynthia; Beuzit, Luc; Carrat, Fabrice; Chau, Françoise; Goderel, Isabelle

doi:10.1016/j.cmi.2016.11.014

Cited by 70 publications

(83 citation statements)

References 23 publications

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“…This may suggest that influenza infection results in hospitalization for a relatively healthier group of adults 50-64 years old while RSV infection is more likely to result in hospitalization for those with multiple chronic conditions. A similarly designed study conducted in France over 3 seasons found that RSV cases were more likely to have cancer or be on immunosuppressive therapy than influenza cases [10]. Our findings provide evidence in support of focused development of RSV vaccines and therapies targeted toward an expanded age group of adults, particularly those 50-64 and those of any age with chronic comorbidities.…”

Section: Discussionsupporting

confidence: 71%

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Respiratory syncytial virus hospitalization in middle-aged and older adults

Malosh

Martin

Callear

et al. 2017

Journal of Clinical Virology

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Background The importance of Respiratory Syncytial Virus (RSV) is increasingly recognized in hospitalized adults, but mainly in those ≥ 65 years. Objectives We sought to describe the epidemiology and clinical severity of RSV compared to influenza in hospitalized adults ≥18 years. Study Design Adults hospitalized with acute respiratory illnesses (ARI) of ≤10 days duration were prospectively enrolled from two Michigan hospitals during two influenza seasons. Collected specimens were tested for RSV and influenza by real-time, reverse transcription polymerase chain reaction (RT-PCR). Viral load and subtype were determined for RSV-positive specimens. We evaluated factors associated with RSV and outcomes of infection using multivariable logistic regression. RSV-positive patients were separately compared to two reference groups: RSV-negative and influenza-negative, and influenza-positive patients. Results RSV was detected in 84 (7%) of 1259 hospitalized individuals (55 RSV-B, 29 RSV-A). The highest prevalence was found in 50-64 year olds (40/460; 8.7%); 98% of RSV cases in this age group had at least one chronic comorbidity. RSV detection was associated with obesity (OR: 1.71 95% CI: 0.99-3.06, p=0.03). Individuals with RSV were admitted to the hospital later in their illness and had a higher median Charlson comborbidity index (3 vs 2 p < 0.001) compared to those with influenza. Clinical severity of RSV-associated hospitalizations was similar to influenza-associated hospitalizations. Discussion In this study we observed the highest frequency of RSV-associated hospitalizations among adult 50-64 years old; many of whom had chronic comorbidities. Our results suggest the potential benefit of including these individuals in future RSV vaccination strategies.

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Section: Discussionsupporting

confidence: 71%

“…However, unlike influenza, in which serious morbidity has been clearly recognized for years, the relative impact of RSV infection in adults has more recently gained widespread recognition [9,10]. While primary RSV infections in infancy can result in severe disease, subsequent infections are often comparatively mild.…”

Section: Introductionmentioning

confidence: 99%

Respiratory syncytial virus hospitalization in middle-aged and older adults

Malosh

Martin

Callear

et al. 2017

Journal of Clinical Virology

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“…Mortality was equivalent between groups, with a similar percentage to that reported in previous studies. 7 The study has some limitations. It reflects only one winter season of analysis at a single healthcare center.…”

Section: Discussionmentioning

confidence: 98%

“…were hospitalized with a median length of stay of 5 days (IQR, [3][4][5][6][7][8][9][10][11][12]. The infection was healthcare related in 19% and nosocomial in 21% of cases.…”

Section: Characteristics Of Rsv-positive Patientsmentioning

confidence: 99%

“…5,6 The impact of RSV infections in healthy adults has not been widely studied; nevertheless, it has recently gained widespread recognition. 7,8 In this population RSV illness is generally mild, 9 whereas in elderly people and those with chronic cardiopulmonary illnesses, the disease can be severe. 10,11 Efforts have been made to distinguish between symptoms of severe RSV and severe influenza, as well as to establish differences in hospitalization rates of both infections.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory syncytial virus infection among adults during influenza season: A frequently overlooked diagnosis

Martínez‐Sanz

Reyzábal

Hernando

et al. 2019

Journal of Medical Virology

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Our objective is to assess the characteristics of respiratory syncytial virus (RSV) infection in adult patients and to establish differences with influenza viruses. Fiftyfour patients diagnosed with RSV and 198 with influenza were prospectively included. Compared with influenza, empirical antimicrobial therapy was more frequent in patients diagnosed with RSV, whereas antibiotic withdrawal at the time of diagnosis confirmation was lower (OR, 0.12; CI, 95% 0.01-0.90; P = 0.040). RSVpositive patients were more likely to need hospital readmission (OR, 3.00; CI, 95% 0.98-9.09; P = 0.053). The role of RSV infection in adults is often overlooked, leading to inappropriate use of antibiotics and a probable increase in nosocomial RSV transmission. K E Y W O R D Sinfluenza virus, respiratory infection, respiratory syncytial virus, seasonal incidence

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Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Woodruff,

Melgar,

Pham

et al. 2024

JAMA Intern Med

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ImportanceRespiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection.ObjectiveTo describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection.Design, Setting, and ParticipantsThis cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events.ExposuresAcute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review.Main Outcomes and MeasuresSevere disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events.ResultsThe study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).Conclusions and RelevanceIn this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.

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Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France

Cited by 70 publications

References 23 publications

Respiratory syncytial virus hospitalization in middle-aged and older adults

Respiratory syncytial virus hospitalization in middle-aged and older adults

Respiratory syncytial virus infection among adults during influenza season: A frequently overlooked diagnosis

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

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