Full length articleRespiratory syncytial virus hospitalization in middle-aged and older adults
Section snippets
Background
Respiratory Syncytial Virus (RSV), commonly regarded as a childhood infection, is also an important contributor to respiratory illness among adults [1], [2], [3], [4], [5], [6], [7], [8]. 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
Objectives
Establishing the burden of severe RSV has added urgency given the accelerating development of RSV vaccines; a major issue for vaccination programs will be identifying target populations for rational use. We sought to characterize the frequency and clinical severity of RSV among hospitalized adults ≥18 years, overall and by subtype, for two respiratory illness seasons in two large Southeast Michigan hospitals.
Study design
We used specimens and data from a prospective study of adults hospitalized with ARI meeting a standardized case definition [19]. The ongoing, case-test negative study was designed to estimate influenza vaccine effectiveness (VE) in the prevention of influenza-associated hospitalization. Patients ≥18 years old hospitalized with ARI at one of two hospitals were prospectively identified from November 2014–March 2015 and November 2015–April 2016. These hospitals are two large tertiary care centers
Detection of RSV and influenza
1306 patients hospitalized for ARI were enrolled in the study between November 2014–March 2015 and November 2015–April 2016 (Fig. 1). Subsequent enrollments of individuals enrolled multiple times (n = 42) and subjects with missing or inconclusive influenza testing results (n = 3) were excluded, resulting in a study population of 1261 patients (726 in 2014–2015, 535 in 2015–2016). Fig. 1 presents RSV and influenza epidemic curves by season. Overall, RSV was detected in 86 (7%) and influenza was
Discussion
Adults ≥65 years old have long been the focus of targeted efforts to reduce the burden of hospitalization due to severe respiratory illness. Even now that yearly influenza vaccination recommendations have been extended to adults of all ages, efforts still continue to improve vaccines for older individuals including the introduction of high dose formulations. Thus, it is no surprise that recent initiatives to develop an RSV vaccine for adults have targeted those 60–65 years and older. However,
Fundings
This work was supported by the Centers for Disease Control and Prevention (CDC) through two co-operative agreements with the University of Michigan [grant numbers U01IP000474 and U01 IP000974].
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or funding agency.
Acknowledgements
REM, ETM and ASM report a grant from MUGAS outside the current work. ETM reports grants from Merck and Pfizer outside the current work. ASL reports grants from the Doris Duke Charitable Foundation outside the current work. ASM reports grants and personal fees from Sanofi-Pasteur, and personal fees from Novartis and Protein Sciences outside the submitted work.
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Authors REM and ETM contributed equally to this manuscript.