Hospitalizations for Respiratory Syncytial Virus Among Adults in the United States, 1997–2012

Abstract

Background.Respiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in children, but the burden in adults is less well studied.Methods.We conducted a retrospective study of hospitalizations among adults ≥20 years from the 1997–2012 National Inpatient Sample. Trends in RSV admissions were described relative to unspecified viral pneumonia admissions. Hospitalization severity indicators were compared among immunocompromised RSV, non-immunocompromised RSV, and influenza admissions.Results.An estimated 28237 adult RSV hospitalizations occurred, compared with 652818 influenza hospitalizations; 34% were immunocompromised individuals. Respiratory syncytial virus and influenza patients had similar age, gender, and race distributions, but RSV was more often diagnosed in urban teaching hospitals (73.0% for RSV vs 34.6% for influenza) and large hospitals (71.9% vs 56.4%). Respiratory syncytial virus hospitalization rates increased from 1997 to 2012, particularly for those ≥60, increasing from 0.5 to 4.6 per 100000, whereas unspecified pneumonia admission rates decreased significantly (P < .001). Immunocompromised patients with RSV hospitalization had significantly higher inpatient mortality (P = .013), use of mechanical ventilation (P = .016), mean length of stay (LOS) (P < .001), and mean cost (P < .001) than non-immunocompromised RSV hospitalizations. Overall, RSV hospitalizations were more severe than influenza hospitalizations (6.2% mortality for RSV vs 3.0% for influenza, 16.7% vs 7.2% mechanical ventilation, mean LOS of 6.0 vs 3.6 days, and mean cost of $38828 vs $14519).Conclusions.Respiratory syncytial virus hospitalizations in adults are increasing, likely due to increasing recognition and diagnosis. The burden of RSV in adults deserves attention. Although there are fewer hospitalizations than influenza, those that are diagnosed are on average more severe.

Phase 1 First‐in‐Human, Single‐ and Multiple‐Ascending Dose, and Food Effect Studies to Assess the Safety, Tolerability, and Pharmacokinetics of Presatovir for the Treatment of Respiratory Syncytial Virus Infection

“…The simulated mean presatovir plasma concentration‐vs‐time profiles are shown in Figure . Given the lack of established pharmacokinetic/pharmacodynamic (PK/PD) relationships for RSV fusion inhibitors, the doses were selected based on the experience with other antiviral programs including oseltamivir carboxylate . The 5‐day, high‐dose regimen (an initial dose of 50 mg followed by 4 additional once‐daily doses of 25 mg) was expected to maintain the daily minimum plasma presatovir concentrations (C min ) above 4 to 5 times the paEC 95 .…”

“…RSV infection represents a leading cause of hospitalization and mortality in infants under 1 year of age. It is also responsible for a growing number of hospitalizations in adults, particularly those aged ≥60 years, and immunocompromised individuals . Therefore, development of effective treatment options for these patient populations is a significant unmet need.…”

“…Given the lack of established pharmacokinetic/pharmacodynamic (PK/PD) relationships for RSV fusion inhibitors, the doses were selected based on the experience with other antiviral programs including oseltamivir carboxylate. 30,33 The 5-day, high-dose regimen (an initial dose of 50 mg followed by 4 additional oncedaily doses of 25 mg) was expected to maintain the daily minimum plasma presatovir concentrations (C min ) above 4 to 5 times the paEC 95 . The 5-day low-dose regimen (an initial dose of 10 mg followed by 4 additional once-daily doses of 5 mg) would maintain presatovir C min above 3 to 4 times the paEC 50 but not above paEC 95 throughout 120 hours postdose.…”

The Drug–Drug Interaction Profile of Presatovir

“…In particular, children under 24 months of age are at increased risk of RSV‐related hospitalization and mortality . Although more commonly reported in infants and young children, immunocompromised and elderly adults are also known to be susceptible to RSV infections . There is a definite seasonality associated with RSV infections, which occur more frequently in the winter months in the United States, but the timing can vary by region…”

“…[3][4][5][6] Although more commonly reported in infants and young children, immunocompromised and elderly adults are also known to be susceptible to RSV infections. 5,[7][8][9][10] There is a definite seasonality associated with RSV infections, which occur more frequently in the winter months in the United States, but the timing can vary by region. 11 There is no vaccine against RSV, and treatment options continue to be limited.…”