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Multicenter Study
. 2023 Jun 8;76(11):1980-1988.
doi: 10.1093/cid/ciad031.

Prevalence and Clinical Outcomes of Respiratory Syncytial Virus vs Influenza in Adults Hospitalized With Acute Respiratory Illness From a Prospective Multicenter Study

Katherine M Begley  1 , Arnold S Monto  1 , Lois E Lamerato  2 , Anurag N Malani  3   4 , Adam S Lauring  5 , H Keipp Talbot  6 , Manjusha Gaglani  7   8 , Tresa McNeal  8   9 , Fernanda P Silveira  10 , Richard K Zimmerman  10 , Donald B Middleton  10 , Shekhar Ghamande  8   11 , Kempapura Murthy  12 , Lindsay Kim  13   14 , Jill M Ferdinands  15 , Manish M Patel  15 , Emily T Martin  1
Affiliations
Multicenter Study

Prevalence and Clinical Outcomes of Respiratory Syncytial Virus vs Influenza in Adults Hospitalized With Acute Respiratory Illness From a Prospective Multicenter Study

Katherine M Begley et al. Clin Infect Dis. .

Abstract

Background: Current understanding of severe respiratory syncytial virus (RSV) infections in adults is limited by clinical underrecognition. We compared the prevalence, clinical characteristics, and outcomes of RSV infections vs influenza in adults hospitalized with acute respiratory illnesses (ARIs) in a prospective national surveillance network.

Methods: Hospitalized adults who met a standardized ARI case definition were prospectively enrolled across 3 respiratory seasons from hospitals participating across all sites of the US Hospitalized Adult Influenza Vaccine Effectiveness Network (2016-2019). All participants were tested for RSV and influenza using real-time reverse-transcription polymerase chain reaction assay. Multivariable logistic regression was used to test associations between laboratory-confirmed infection and characteristics and clinical outcomes.

Results: Among 10 311 hospitalized adults, 6% tested positive for RSV (n = 622), 18.8% for influenza (n = 1940), and 75.1% negative for RSV and influenza (n = 7749). Congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) was more frequent with RSV than influenza (CHF: 37.3% vs 28.8%, P < .0001; COPD: 47.6% vs 35.8%, P < .0001). Patients with RSV more frequently had longer admissions (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.06-1.80) for stays >1 week) and mechanical ventilation (OR, 1.45; 95% CI, 1.09-1.93) compared with influenza but not compared with the influenza-negative group (OR, 1.03; 95% CI, .82-1.28 and OR, 1.17; 95% CI, .91-1.49, respectively).

Conclusions: The prevalence of RSV across 3 seasons was considerable. Our findings suggest that those with RSV have worse outcomes compared with influenza and frequently have cardiopulmonary conditions. This study informs future vaccination strategies and underscores a need for RSV surveillance among adults with severe ARI.

Keywords: adults; hospitalization; influenza; respiratory syncytial virus.

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Conflict of interest statement

Potential conflicts of interest. L. E. L. reports grant support paid to institution from the CDC and funding from Janssen Scientific Affairs paid to institution. E. T. M. reports institutional grant support from the CDC, CDC-Abt Associates, and Merck and grants or contracts unrelated to this work from the NIH, Merck, and FluLab. A. N. M reports a role as member of the Society of Healthcare Epidemiology of America Board of Trustees. F. P. S. reports a research grant paid to institution and unrelated to this work from Ansun and payment to author for honoraria for lectures, presentations, speakers bureaus, manuscript writing, or education events from Janssen. M. J. G. reports institutional grant support or contracts from the CDC; funding from the CDC, CDC-Abt Associates, MedImmune, Janssen, and Pfizer; and a role as co-chair of the Infectious Diseases and Immunization Committee and as chair of the Texas RSV Taskforce for the Texas Pediatric Society, Texas Chapter of American Academy of Pediatrics. A. S. L. reports grants or contracts unrelated to this work from the CDC, Burroughs Wellcome Fund, and National Institute of Allergy and Infectious Diseases (NIAID) and consulting fees from Sanofi and from Roche as a paid member of the baloxavir trial steering committee. R. K. Z. reports a research grant to their university from Sanofi Pasteur. D. B. M. reports consulting fees (advisory group payment to author) from Moderna, Seqirus, Sanofi Pasteur, Novavax, and Valneva and lecture payment to author from Merck and Pfizer. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Modified Hospitalized Adult Influenza Vaccine Effectiveness Network RSV influenza epidemic curve. Abbreviation: RSV, respiratory syncytial virus.
Figure 2.
Figure 2.
Violin plot comparing RSV and influenza participant Charlson comorbidity index stratified by age. Abbreviation: RSV, respiratory syncytial virus.
See this image and copyright information in PMC

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