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

Abstract

Objective: Determine the burden of illness associated with respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) in adults, especially young adults.

Design: Prospective surveillance study using RT-PCR for the diagnosis of RSV and HMPV.

Setting: One academic Emergency Department (ED), one academic hospital and three middle Tennessee community hospitals.

Sample: 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 nose/throat specimens for RSV and HMPV reverse-transcriptase polymerase chain reaction (RT-PCR) testing and obtained demographic and clinical data.

Main outcome measures: 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: Three thousand two hundred and fifty six 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 10 000 persons aged ≥50 years; ED rates were approximately 2 times higher. Hospitalization rates were about 2 per 10 000 persons aged 18-49 years, with ED rates 5-6 times higher.

Conclusion: RSV and MPV are associated with substantial disease in adults, with hospitalization and ED visits rates increasing with age.

Keywords: Burden of illness; hospitalizations; human metapneumovirus; older adults; respiratory syncytial virus.

Figure 1

Eligibility and enrollment: 3256 were approached for enrollment, 1477 agreed to testing of specimens for influenza alone, and of those, 1262 agreed to further testing for other viruses; 1248 had adequate samples to test for RSV and HMPV.

Figure 2

Number of adults enrolled with ARI-associated ED visit or hospitalization with RSV or HMPV identified by month, May 2009 through April 2010.