Comparative incidence and burden of respiratory viruses associated with hospitalization in adults in New York City

Abstract

Background Although the burden of influenza is well characterized, the burden of community‐onset non‐influenza respiratory viruses has not been systematically assessed. Understanding the severity and seasonality of non‐influenza viruses, including human coronaviruses, will provide a better understanding of the overall disease burden from respiratory viruses that could better inform resource utilization for hospitals and highlight the value of preventative strategies, including vaccines. Methods From October 2017 to September 2019, a retrospective study was performed in a pre‐defined catchment area to estimate the population‐based incidence of community‐onset respiratory viruses associated with hospitalization. Included patients were ≥18 years old, resided in New York City, were hospitalized for ≥24 hours, and had a respiratory virus detected within 3 calendar‐days of admission. Disease burden was measured by hospital length of stay (LOS), intensive care unit (ICU) admissions, and in‐hospital mortality and compared among those with laboratory‐confirmed influenza versus those with laboratory‐confirmed non‐influenza viruses (human coronaviruses, parainfluenza viruses, respiratory syncytial virus, human metapneumovirus, and adenovirus). Results During the study period, 4232 eligible patients were identified of whom 50.9% were ≥65 years of age. For each virus, the population‐based incidence was highest for those ≥80 years of age. When compared to those with influenza viruses detected, those with non‐influenza respiratory viruses detected (combined) had higher population‐based incidence, significantly more ICU admissions, and higher in‐house mortality. Conclusions The burden of non‐influenza respiratory viruses for hospitalized adults is substantial. Prevention and treatment strategies are needed for non‐influenza respiratory viruses, particularly for older adults.

Risk Factors and Medical Resource Utilization of Respiratory Syncytial Virus, Human Metapneumovirus and Influenza Related Hospitalizations in Adults – A Global Study During the 2017-2019 Epidemic Seasons (Hospitalized Acute Respiratory Tract Infection [HARTI] Study)

“…Other authors have noted similar findings when comparing RSV and influenza hospitalizations [ 10 , 23 , 24 ]. Tseng et al (2020) reported high levels of MRU for RSV patients during hospitalization, with 21.4% of patients requiring ventilation support and 17.9% admitted to the ICU, as well as hospital readmissions within the first 30 days postdischarge exceeding 15% and substantial health care services utilization postdischarge [ 25 ].…”

“…In Bruyndonckx et al (2020), the odds of having unresolved symptoms after 28 days and illness deterioration were significantly associated with age in RSV patients but not in influenza patients [ 16 ]. Furthermore, Sieling et al (2021) found that RSV and hMPV were both associated with a longer median LOS (4.4 and 4.8 days, respectively) compared with influenza (3.9 days), with higher crude mortality [ 24 ]. In the current study, hMPV infections presented similar trends toward higher MRU compared with influenza.…”

Risk factors and medical resource utilization in US adults hospitalized with influenza or respiratory syncytial virus in the Hospitalized Acute Respiratory Tract Infection study

“… 27 Another retrospective claims study found that, among hospitalized adults in New York City, patients with RSV required a longer hospital LoS than patients with influenza (median: 4.4 vs. 3.9 days, respectively). 28 Patients with RSV also more frequently experienced acute exacerbation of asthma or COPD, exacerbation of CHF, and hypoxemia; this may parallel the association between RSV infections early in life and development of bronchospastic diseases such as asthma and recurrent wheezing in childhood. 29 , 30 …”

Respiratory syncytial virus disease burden in adults aged 60 years and older in high‐income countries: A systematic literature review and meta‐analysis

“…The articles from Tseng et al 36 and Sieling et al 37 were not included as they reported the same data as in Ackerson et al 20 and Branche et al, 23 respectively. More detailed characteristics of included studies are summarized in Table S2.…”