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. 2017 Aug 10;12(8):e0182321.
doi: 10.1371/journal.pone.0182321. eCollection 2017.

The epidemiology of medically attended respiratory syncytial virus in older adults in the United States: A systematic review

Ann D Colosia  1 , Jin Yang  1 , Eric Hillson  2 , Josephine Mauskopf  1 , Catherine Copley-Merriman  1 , Vivek Shinde  2 , Jeffrey Stoddard  2
Affiliations

The epidemiology of medically attended respiratory syncytial virus in older adults in the United States: A systematic review

Ann D Colosia et al. PLoS One. .

Abstract

Objective: This review was undertaken to assess the historical evidence of the disease incidence and burden of laboratory-confirmed respiratory syncytial virus (RSV) in medically attended older adults.

Design: A qualitative systematic literature review was performed; no statistical synthesis of the data was planned, in anticipation of expected heterogeneity across studies in this population.

Methods: A literature search of PubMed, Embase, and the Cochrane Library was conducted for studies of medically attended RSV in older adults (≥ 50 years) published in the last 15 years. Two independent reviewers screened titles and abstracts based on predefined inclusion and exclusion criteria.

Results: From 10 studies reporting incidence proportions, RSV may be the causative agent in up to 12% of medically attended acute respiratory illness in older adults unselected for comorbidities, with variations in clinical setting and by year. In multiple studies, medically attended-RSV incidence among older adults not selected for having underlying health conditions increased with increasing age. Of prospectively followed lung transplant recipients, 16% tested positive for RSV. In hospitalized adults with chronic cardiopulmonary diseases, 8% to 13% were infected with RSV during winter seasons (8%-13%) or metapneumovirus season (8%). Hospitalizations for RSV in older adults typically lasted 3 to 6 days, with substantial proportions requiring intensive care unit admission and mechanical ventilation. Among older adults hospitalized with RSV, the mortality rate was 6% to 8%.

Conclusions: Protection of older adults against RSV could reduce respiratory-related burden, especially as age increases and the prevalence of comorbidities (especially cardiopulmonary comorbidities) grows.

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Conflict of interest statement

Competing Interests: VS is and EH and JS were full-time employees of Novavax, Inc., a company engaged in latestage development of RSV vaccines. ADC, JY, CCM, and JM are employees of RTI International, a nonprofit consulting company that received funding from Novavax for this project. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA diagram.
PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Fig 2
Fig 2. Incidence rates for medically attended RSV for age-specific populations by type of RSV medical encounter.
CAP = community-acquired pneumonia; ED = emergency department; HCP = health care provider; RSV = respiratory syncytial virus. a In Fowlkes et al. [17], surveillance was conducted in 57 HCP practices in 12 sites, including nine states (Florida, Iowa, Minnesota, New Jersey, North Dakota, Oregon, Utah, Virginia, and Wisconsin) and three jurisdictions (Los Angeles County, New York City, and Philadelphia).
Fig 3
Fig 3. Mortality due to RSV in older adults from special populations, by population and clinical setting.
ARI = acute respiratory illness; ED = emergency department; LTC = long-term care; RSV = respiratory syncytial virus. Note: The case fatality ratio in the bottom right panel of the figure shows the proportion of RSV-positive older adults who died. a Two deaths and one patient discharged to hospice. b Sample size not reported.
See this image and copyright information in PMC

References

    1. Hall CB, Simoes EA, Anderson LJ. Clinical and epidemiologic features of respiratory syncytial virus. Curr Top Microbiol Immunol. 2013; 372: 39–57. doi: 10.1007/978-3-642-38919-1_2 - DOI - PubMed
    1. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010; 375 (9725): 1545–1555. doi: 10.1016/S0140-6736(10)60206-1 - DOI - PMC - PubMed
    1. Branche AR, Falsey AR. Respiratory syncytial virus infection in older adults: an under-recognized problem. Drugs Aging. 2015; 32 (4): 261–269. doi: 10.1007/s40266-015-0258-9 - DOI - PubMed
    1. Falsey AR, McCann RM, Hall WJ, Tanner MA, Criddle MM, Formica MA, et al. Acute respiratory tract infection in daycare centers for older persons. J Am Geriatr Soc. 1995; 43 (1): 30–36. - PMC - PubMed
    1. Falsey AR, Treanor JJ, Betts RF, Walsh EE. Viral respiratory infections in the institutionalized elderly: clinical and epidemiologic findings. J Am Geriatr Soc. 1992; 40 (2): 115–119. - PMC - PubMed

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