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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

A Hidden Seasonal Epidemic of RSV in Older Adults

By Gary Evans, Medical Writer

Respiratory syncytial virus (RSV) is something of a contradiction — the leading cause of hospitalization of infants in the United States (58,000 annually) is largely unappreciated beyond the pediatric population.

Few realize that RSV causes 177,000 hospitalizations and 14,000 deaths in the United States annually in those age 65 years and older. In essence, this is a hidden seasonal epidemic that needs to be brought to light, according to a National Foundation for Infectious Diseases (NFID) call to action report on RSV.

“RSV is a well-known problem in young infants and toddlers — and certainly we know that adults can get it,” says Patsy Stinchfield, RN, MS, CPNP, president-elect of the NFID. “But I think the details of the number of hospitalizations and deaths attributable to RSV is not well known, even amongst us health care providers.”

This general lack of awareness of RSV as a potentially severe respiratory infection can be traced back to diagnostic challenges and underreporting — both of which lead to underappreciation and frank ignorance of its actual disease burden across the life span.

Over the last 10 to 15 years, there have been accumulating data showing that a lot of seasonal illness classified as “non influenza” was caused by RSV, says William Schaffner, MD, medical director at the NFID and a professor of preventive medicine and infectious diseases at Vanderbilt University.

“And so the impact of RSV, particularly in older adults, particularly in those with underlying illnesses such as heart disease and chronic obstructive pulmonary disease, is noteworthy, and still continues to be defined,” says Schaffner.

Although RSV largely has flown under the radar in adults, pediatric infections have pushed a research agenda that is close to bearing fruit. RSV is the most common cause of bronchiolitis and pneumonia in children younger than one year of age. “Among children age five years and younger, RSV is associated with an estimated 100 to 500 deaths per year,” the NFID report states.

Fortunately there has been ongoing research on vaccines, monoclonal antibodies, and antivirals that can better prevent and treat the virus. With the expectation that some of this research will yield positive results in two to five years, the NFID decided to begin raising awareness about RSV, Scaffner explains.

It is hoped that heightened awareness can give the NFID campaign some momentum, particularly in the creation of inexpensive and widely available tests for the virus.

“One of the hang ups is that doctors respond to what they can test for, and testing for RSV is not nearly as widely available or as inexpensive as we would like,” Schaffner says.

The conundrum is the lack of testing undermines accurate surveillance and effectively masks the full burden of RSV, which is sometimes diagnosed by a process of eliminating other respiratory viruses.

It is difficult to raise awareness about an infection you cannot accurately identify and measure, but if the testing problem could be solved, the medical community might begin to buy in on the issue even before an RSV vaccine or therapies are available.

“If they see it documented in their own patients, [clinicians] will begin to appreciate the extent of the RSV problem,” Schaffner says.

For more on this topic, see the next issue of Hospital Infection Control & Prevention.

Gary Evans, BA, MA, has written numerous articles on infectious disease threats to both patients and healthcare workers. These include stories on HIV, SARS, SARS-CoV-2, pandemic influenza, MERS, and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.