RSV: An Important Pathogen in Elderly and High-Risk Adults

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Summary and Comment

RSV: An Important Pathogen in Elderly and High-Risk Adults

Respiratory syncytial virus, an important pathogen in children, now is seen to cause serious illness in elderly and high-risk adults.

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in young children. To determine its medical importance and disease burden in elderly and high-risk adults, investigators conducted a community-based surveillance study in Rochester, New York, over four winters (1999–2003). They identified RSV infections in two prospective cohorts (608 healthy individuals $≥$ 65 years old; 540 high-risk individuals $≥$ 21 years old with chronic cardiopulmonary disease) and a cohort of 1388 hospitalized patients $≥$ 65 years old with acute cardiopulmonary conditions.

Of 2514 respiratory illnesses, RSV infection accounted for 244: 46 in the healthy cohort, 56 in the high-risk group, and 142 in hospitalized patients. By comparison, influenza A virus infection accounted for 24, 20, and 154 illnesses, respectively. Annually, RSV infections developed in 3% to 7% of the healthy elderly and 4% to 10% of the high-risk adults. In these cohorts, 89% of RSV and 91% of influenza A infections were symptomatic, and office visits were more frequent for influenza A than for RSV. In the hospitalized cohort, RSV infection was similar to influenza A infection in length of stay, development of pneumonia, use of intensive care, and mortality. Discharge diagnosis codes for these patients showed RSV to underlie 11% of hospitalizations for pneumonia, 11% for chronic obstructive pulmonary disease, 5% for congestive heart failure, and 7% for asthma.

Comment: RSV is now clearly established as a medically important pathogen among community-dwelling elderly and high-risk adult patients, accounting for a substantial disease burden during the winter among outpatients and those requiring hospitalization for acute cardiopulmonary conditions. Although RSV and influenza A illness rates were comparable, the rates for influenza A were probably reduced by vaccination programs. Development of an RSV vaccine is a worthy goal but is a complex task because infections occur repeatedly throughout life.

— Neil R. Blacklow, MD

Published in Journal Watch Infectious Diseases May 20, 2005