Incidence of Respiratory Syncytial Virus Infection Among Hospitalized Adults, 2017–2020

Abstract

Background Respiratory syncytial virus (RSV) infection causes acute respiratory illness and triggers exacerbations of cardiopulmonary disease. Estimates of RSV incidence in hospitalized adults range widely, and few data exist on incidence in adults with comorbidities that increase the risk of severe disease. We conducted a prospective, population-based, surveillance study to estimate incidence of RSV hospitalization among adults overall and those with specific comorbidities. Methods Hospitalized adults ≥18 years residing in the surveillance area with ≥2 ARI symptoms or exacerbation of underlying cardiopulmonary disease were screened for eligibility during the 2017-2018, 2018-2019, and 2019-2020 RSV seasons in three hospital systems in Rochester, NY and New York City. Respiratory specimens were tested for RSV using PCR assays. RSV incidence per 100,000 was adjusted by market share. Results During three winter seasons a combination of active and passive surveillance identified 1,099 adults hospitalized with RSV at three medical centers. Annual incidence during three seasons ranged from 44.2-58.9/100,000. Age-group specific incidence ranged from 7.7-11.9/100,000, 33.5-57.5/100,000, and 136.9-255.6/100,000 in patients 18-49, 50-64, and >65-years of age, respectively. Incidence rates in patients with chronic obstructive pulmonary disease, coronary artery disease, and congestive heart failure were 3-13, 4-7, 4-33 times the incidence in patients without these conditions. Conclusions We found a high burden of RSV hospitalization in this large prospective study. Notable was the high incidence of RSV hospitalization among older patients and those with cardiac conditions. These data confirm the need for effective vaccines to prevent RSV infection in older and vulnerable adults.

Respiratory Syncytial Virus: New Challenges for Molecular Epidemiology Surveillance and Vaccination Strategy in Patients with ILI/SARI

“…This was consistent with previously published data [19,[35][36][37] corroborating the leading role of hRSV in respiratory infections among younger children. However, in our series, nearly 5% were patients ≥50 years of age, thus exhibiting the impact of this virus also in adults and the elderly [38,39], which may consequently represent important targets for vaccination [40].…”

“…Modelling studies have shown greater rates of hospitalization due to hRSV in adults with high-risk conditions [49,50]. In this context, Prasad et al [38] in New Zealand and Branche et al [39] in USA reported significantly higher hRSV hospitalization rates among adults with chronic diseases affecting the cardiovascular system, or chronic obstructive pulmonary disease, diabetes, or end-stage renal disease, as compared with adults of similar age without each corresponding condition. Nevertheless, to the best of our knowledge, there are still no data that recognized any potential difference in the prevalence of specific hRSV subgroups and the presence of underlying medical conditions.…”

COVID-19, Influenza and RSV: Surveillance-informed prevention and treatment – Meeting report from an isirv-WHO virtual conference

“…There are currently no licensed RSV vaccines. The burden of disease in older adults is substantial, and in the USA, 137 to 256 hospitalized RSV cases have been reported per 100,000 population in ≥65-years old ( Branche et al, 2021 ). Efficacy and immunogenicity data were presented for an adenovirus-based RSV vaccine in a randomized, double-blind, placebo-controlled Phase 2b trial in patients aged ≥65 years old (CYPRESS (NCT03982199)).…”

Cost determinants among adults hospitalized with respiratory syncytial virus in the United States, 2017–2019

“…6 Patient-level cost data from prospective studies in which all suspect RSV cases are tested and ascertainment of RSV is complete could reduce bias and improve generalizability, but there are no published data using this approach. We designed a nested study within a large, prospective, multi-center, multi-season, populationbased, active surveillance study of RSV-associated hospitalization in adults ≥ 18 years of age 4 and collected epidemiologic and cost data, to estimate the cost of RSV-associated hospitalizations and determine factors associated with higher costs.…”

“…Respiratory syncytial virus (RSV) causes upper and lower respiratory tract infections, with severe disease primarily in infants and older adults. The annual burden of RSV in adults in the United States is high, with an estimated 600,000–1,000,000 medically attended visits, 1 , 2 , 3 130,000–177,000 hospitalizations, 3 , 4 and 11,000–17,000 deaths 3 , 5 , 6 , 7 , 8 resulting in substantial healthcare resource utilization and cost.…”