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Observational Study
. 2019 Jan;91(1):65-71.
doi: 10.1002/jmv.25285. Epub 2018 Sep 24.

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

Ann R Falsey  1 , Edward E Walsh  1 , Mark T Esser  2 , Kathryn Shoemaker  2 , Li Yu  2 , M Pam Griffin  2
Affiliations
Observational Study

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

Ann R Falsey et al. J Med Virol. 2019 Jan.

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.

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Figures

Figure 1
Figure 1
Disposition of subjects enrolled in the trial
Figure 2
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
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
See this image and copyright information in PMC

References

    1. Hall CB, Simőes EAF, Anderson LJ. Clinical and epidemiologic features of respiratory syncytial virus. Curr Top Microbiol Immunol. 2013;372:39‐57. - PubMed
    1. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high‐risk adults. N Engl J Med. 2005;352(17):1749‐1759. - PubMed
    1. Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, Talbot HK. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206(1):56‐62. - PMC - PubMed
    1. Thompson WW. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179‐186. - PubMed
    1. Sundaram ME, Meece JK, Sifakis F, Gasser RA, Jr. , Belongia EA. Medically attended respiratory syncytial virus infections in adults aged >/=50 years: clinical characteristics and outcomes. Clin Infect Dis. 2014;58(3):342‐349. - PMC - PubMed

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