Respiratory syncytial virus-associated illness in adults with advanced chronic obstructive pulmonary disease and/or congestive heart failure

Abstract

Background: Respiratory syncytial virus (RSV) is recognized as a serious pathogen in people with chronic cardiopulmonary conditions. Immunoprophylaxis might be considered for adults at high-risk for frequent and severe RSV infection. Thus, we studied the incidence of RSV-related medically attended acute respiratory illness (MARI) in adults with severe chronic obstructive pulmonary disease (COPD) and/or congestive heart failure (CHF).

Methods: Subjects ≥50 years of age with Gold Class III/IV COPD and/or American Heart Association class III/IV CHF and exposure to children ≥once per month were recruited. Subjects were evaluated over 1.5 to 2.5 years for RSV-associated MARI, defined as polymerase chain reaction (PCR) and/or seroresponse.

Results: Four hundred forty-five subjects were enrolled between October 2011 and May 2012. Overall, 99 RSV infections were documented by PCR or serology for a cumulative incidence of 22.2%. Of these, 42 (9.4%) subjects had protocol-specified RSV-MARI for an incidence of 4.68/100 patient-seasons. All-cause MARI was common (63.85/100 patient-seasons) with rhinovirus most commonly identified.

Conclusion: RSV infection was common in adults with severe COPD and/or advanced CHF. Given the severity of underlying cardiopulmonary diseases in the study population, most illnesses were surprisingly mild. Thus, active immunization rather than passive immunoprophylaxis with monoclonal antibodies may be a more cost-effective strategy.

Keywords: disease control; epidemiology; immunoprophylaxis; respiratory syncytial virus (RSV); seasonal incidence; virus classification.

Figure 1

Disposition of subjects enrolled in the trial

Figure 2

Cases of RSV‐MARI per 100 person‐years distributed by preseason antibody titers. Antibody titers against F, N, Ga, and Gb are divided into quartiles with quartile 1 representing subjects with titers in the lowest 25th percentile and subjects in quartile 4 with the highest titers. In season 2 (gray bars), 21 subjects experienced RSV‐MARI of whom 20 had preseason serology and in season 3 (black bars), 9 subjects had RSV‐MARI of whom 8 had preseason serum. MARI, medically attended acute respiratory illness; RSV, respiratory syncytial virus

Figure 3

The positive rate for respiratory viruses detected by PCR during scheduled (A) and illness (B) visits. FLU A, influenza A; FLU B, influenza B; HMPV, human metapneumovirus; HRV, rhinovirus; PIV, Parainfluenza viruses; RSV, respiratory syncytial virus