Respiratory syncytial virus‐ and human metapneumovirus‐associated emergency department and hospital burden in adults

Abstract

Background Little is known about the burden of illness associated with respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) in adults, especially young adults. Methods We prospectively enrolled Middle Tennessee residents ≥18 years old evaluated in the emergency department (ED) or hospitalized for respiratory symptoms May 2009 through April 2010. We collected samples for RSV and HMPV reverse-transcriptase polymerase chain reaction (RT-PCR) testing and obtained demographic and clinical data. Rates of ED visits and hospitalizations were calculated using the proportion of enrolled patients positive for each virus multiplied by the number of Middle Tennessee residents evaluated in EDs and/or hospitalized in Tennessee for acute respiratory illness during the study period. Results 3256 patients were eligible; 1477 (45.4%) were enrolled; 1248 (84.5%) of these consented to additional testing and had adequate samples. RT-PCR identified 32 (2.6%) patients with RSV and 33 (2.6%) with HMPV. The median duration of symptoms before ED presentation was 3.3 days with RSV and 2.8 days with HMPV, and before hospital admission was 4.5 days with RSV and 3.5 days with HMPV. The annual hospitalization and ED visit rates were similar for RSV and HMPV. The hospitalization rate associated with each virus was about 10 per 10000 persons aged ≥50 years; ED rates were approximately 2 times higher. Hospitalization rates were about 2 per 10000 persons aged 18–49 years, with ED rates 5 to 6 times higher. Conclusion RSV and MPV are associated with substantial disease in adults, with hospitalization and ED visits rates increasing with age.

Correlation between Infection with Multiple Respiratory Viruses and Length of Hospital Stay in Patients from Cheonan, Korea

“…the LOS for patients infected with INF A was reported to be 6.9 days, whereas LOS for patients infected with ADV or hCoV OC43 was 8.2 days and 8.1 days, respectively [14]. In another study, RSV and hMPV infections reportedly resulted in LOS of 4 days and 3 days, respectively [15].…”

RSV vaccine use – the missing data

“…In addition, recent data from the United States shows that RSV disease burden in elderly adults is comparable to influenza. [3,4] Clearly, an effective RSV vaccine could result in a huge reduction in this burden of disease.…”

Infection Control Implications of Protracted Lengths of Stay With Noninfluenza Viral Influenza-Like Illnesses in Hospitalized Adults During the 2015 Influenza A (H3N2) Epidemic

“…Since hMPV, RSV, and HPIV-3 have been implicated in serious nosocomial outbreaks in adults, we placed patients with hMPV, RSV, or HPIV-3 on standard, contact, and droplet precautions for cough duration and used single rooms when available. [8][9][10] Early in the influenza epidemic here, influenza and ILI patients were given single rooms. Influenza patients had single room priority and cohorting was performed whenever possible.…”

“…Because some viral ILIs (eg, hMPV, RSV, HPIV-3) have potential for nosocomial spread and serious hospital outbreaks, we thought it prudent to put these ILI patients in single rooms. 9,10 Since the viral etiology of ILIs was known by PCR, it was thought that cohorting would decrease the bed burden, but cohorting was of limited value because ILIs of the same type were not in hospital at the same time. Single room availability was further limited by the prolonged LOS of some ILI viruses-for example, RSV (8.1 days) and R/E (8 days).…”