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Meta-Analysis
. 2023 Jan;17(1):e13031.
doi: 10.1111/irv.13031. Epub 2022 Nov 11.

Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: A systematic literature review and meta-analysis

Miloje Savic  1 , Yolanda Penders  1 , Ting Shi  2 , Angela Branche  3 , Jean-Yves Pirçon  1
Affiliations
Meta-Analysis

Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: A systematic literature review and meta-analysis

Miloje Savic et al. Influenza Other Respir Viruses. 2023 Jan.

Abstract

Background: Respiratory syncytial virus (RSV)-associated acute respiratory infection (ARI) is an underrecognized cause of illness in older adults. We conducted a systematic literature review and meta-analysis to estimate the RSV disease burden in adults ≥60 years in high-income countries.

Methods: Data on RSV-ARI and hospitalization attack rates and in-hospital case fatality rates (hCFR) in adults ≥60 years from the United States, Canada, European countries, Japan, and South Korea were collected based on a systematic literature search (January 1, 2000-November 3, 2021) or via other methods (citation search, unpublished studies cited by a previous meta-analysis, gray literature, and an RSV-specific abstract booklet). A random effects meta-analysis was performed on estimates from the included studies.

Results: Twenty-one studies were included in the meta-analysis. The pooled estimates were 1.62% (95% confidence interval [CI]: 0.84-3.08) for RSV-ARI attack rate, 0.15% (95% CI: 0.09-0.22) for hospitalization attack rate, and 7.13% (95% CI: 5.40-9.36) for hCFR. In 2019, this would translate into approximately 5.2 million cases, 470,000 hospitalizations, and 33,000 in-hospital deaths in ≥60-year-old adults in high-income countries.

Conclusions: RSV disease burden in adults aged ≥60 years in high-income countries is higher than previously estimated, highlighting the need for RSV prophylaxis in this age group.

Keywords: acute respiratory infection; disease burden; high-income countries; meta-analysis; older adults; respiratory syncytial virus.

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Conflict of interest statement

M Savic, Y Penders and JY Pirçon are employees of the GSK group of companies. M Savic and JY Pirçon hold shares in the GSK group of companies as part of their employee remuneration. A Branche was a paid consultant for the GSK group of companies during the conduct of the work reported in the manuscript and has received grants from Merck, Janssen, Cyanvac and Pfizer outside the submitted work. All authors declare no other financial or non‐financial relationships and activities.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of the systematic literature review. ARI, acute respiratory infection; RSVVW'21, RSV Vaccine for the World 2021 conference
FIGURE 2
FIGURE 2
Attack rate (Attack rate was defined as the number of new cases of RSV‐associated acute respiratory infection during a specified time interval divided by the size of the population at risk. 1Canada, Mexico, Belgium, Czech Republic, Estonia, France, Germany, Norway, Poland, Romania, Russia, the Netherlands, the United Kingdom, and Taiwan; 2The United States, Belgium, Germany, Estonia, Spain, and the United Kingdom; 3Events, number of RSV‐associated acute respiratory infection cases; 4Total, total sample size of the study.) of RSV‐associated acute respiratory infections in adults aged 60 years and older. CD, community‐dwelling adults; CI, confidence interval; df, degrees of freedom; LTCF, adults living in long‐term care facilities; RE, random effects; RSV, respiratory syncytial virus; UK, United Kingdom; US, United States
FIGURE 3
FIGURE 3
Hospitalization rate (Modeled as attack rate [defined as the number of new hospitalizations of RSV‐associated acute respiratory infection during a specified time interval divided by the size of the population at risk]. 1Canada, Mexico, Belgium, Czech Republic, Estonia, France, Germany, Norway, Poland, Romania, Russia, the Netherlands, the United Kingdom, and Taiwan; 2Events, number of hospitalizations for RSV‐associated acute respiratory infection; 3Total, total sample size of the study.) of RSV‐associated acute respiratory infections in adults aged 60 years and older. CI, confidence interval; df, degrees of freedom; NYC, New York City; R, Rochester (New York); RE, random effects; RSV, respiratory syncytial virus; UK, United Kingdom; US, United States.
FIGURE 4
FIGURE 4
In‐hospital case fatality rate among RSV‐associated acute respiratory infections in adults aged 60 years and older. 1Based on the proportion of patients aged 50–64 and ≥65 years, one death was estimated in adults aged ≥60 years. This was rounded down in order to not overestimate the deaths in the ≥65 age group. 2Events, number of in‐hospital deaths among RSV‐associated acute respiratory infection cases; 3Total, number of individuals hospitalized for RSV‐associated acute respiratory infection in the study. CI, confidence interval; df, degrees of freedom; NYC, New York City; R, Rochester (New York); RE, random effects; RSV, respiratory syncytial virus; US, United States
FIGURE 5
FIGURE 5
Estimated cases, hospitalizations, and in‐hospital deaths due to RSV‐associated acute respiratory infections among adults aged 60 years and older per region, 2019 population (Population data obtained from the United Nations [UN] Department of Economic and Social Affairs and the United States Census Bureau. High‐income countries were defined as “More developed regions” by the UN.). ARI, acute respiratory infection; CI, confidence interval; hCFR, in‐hospital case fatality rate; RSV, respiratory syncytial virus
FIGURE 6
FIGURE 6
Plain language summary. RSV, respiratory syncytial virus
See this image and copyright information in PMC

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