By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University

Dr. Deresinski reports no financial relationships relevant to this field of study.

SYNOPSIS: Respiratory syncytial virus is a significant cause of morbidity and mortality in the elderly.

SOURCE: Tseng HF, Sy LS, Ackerson B, et al. Severe morbidity and short- and mid- to long-term mortality in older adults hospitalized with respiratory syncytial virus infection. J Infect Dis 2020; Jun 27. doi: 10.1093/infdis/jiaa361. [Online ahead of print].

Tseng and colleagues examined the rates of morbidity and mortality in individuals older than 60 years of age with documented respiratory syncytial virus (RSV) infection who were hospitalized in the Kaiser Permanente Southern California system. Of the 664 patients, 64.1% were > 75 years of age, 60.5% were female, > 30% had chronic underlying illness, and 35% were current smokers. Only 2.6% had coinfection with another virus.

The most frequent presenting respiratory features were cough, tachypnea (> 20 breaths per minute), and shortness of breath. Fifty-six percent of patients had very severe tachypnea, with respiratory rates > 26 breaths per minute. Approximately one-half of patients had radiographically confirmed pneumonia, with possible pneumonia in 10.5% and 13.8% of those ages 60-74 years and 75 years, respectively. Ventilatory support was required by 20.4%, with a similar proportion requiring intensive care. Eighteen patients had documented bacteremia. The overall in-hospital mortality was 5.6%, while the 30-day mortality was 8.6%. Among survivors, there was a frequent need for home health services or placement in a nursing home after discharge.

COMMENTARY

RSV infection is frequently thought of as a pediatric disease, which it is. However, data such as this confirm that RSV also affects adults and frequently is severe and may be life-threatening. Tseng and colleagues cited publications indicating that there are an estimated 61,000 to 177,000 hospitalizations in the United States each year, with 10,000 to 14,000 deaths attributed to RSV in individuals 65 years of age.

Underlying cardiopulmonary conditions are common in the elderly, and these are exacerbated by superimposed RSV infection. It has been reported that the frequency of complications and severe outcomes due to RSV in the elderly is similar to that observed in association with influenza virus infection. Patients with severe immunocompromise are at high risk of death from RSV infections.

We have vaccines (albeit imperfect) for the prevention of influenza, as well as modestly effective antiviral therapy. Although these are not available for dealing with RSV infection, both currently are under investigation.