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. 2023 Apr:161:105399.
doi: 10.1016/j.jcv.2023.105399. Epub 2023 Feb 14.

Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: Risk factors, symptomatology and clinical course compared to influenza A / B and the original SARS-CoV-2 strain

Andreas Ambrosch  1 , Doris Luber  2 , Frank Klawonn  3 , Michael Kabesch  4
Affiliations

Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: Risk factors, symptomatology and clinical course compared to influenza A / B and the original SARS-CoV-2 strain

Andreas Ambrosch et al. J Clin Virol. 2023 Apr.

Erratum in

Abstract

Background: The role and impact of RSV in the adult population is not well understood and comparative data of RSV infection, influenza A/B and SARS-CoV-2 in the elderly hospitalized for respiratory infections is limited.

Methods: In a retrospective, monocentric study we analyzed data of adult patients with respiratory infections tested positive by PCR for RSV, Influenza A/B and SARS-CoV-2 over a four-year period from 2017 to 2020. Symptoms on admission, laboratory results, and risk factors were assessed, and the clinical course and outcomes were studied.

Results: A total of 1541 patients hospitalized with respiratory disease and PCR positive for one of the 4 viruses were enrolled in the study. RSV was the second most prevalent virus before the COVID-19 pandemic and RSV patients represent the oldest group in this study with an average age of 75 years. Neither clinical nor laboratory characteristics differ clearly between RSV, Influenza A / B and SARS-CoV-2 infections. Up to 85% of patients had risk factors, with COPD and kidney disease found particularly frequently in RSV infections. Hospital stay was 12.66 days for RSV patients and thus significantly longer than for influenza A / B (10.88 and 8.86, respectively, p < 0.001), but shorter than for SARS-CoV-2 (17.87 days, p < 0.001). The risk for ICU admission and the rate of mechanical ventilation were also higher for RSV than for influenza A (OR 1.69 (p = 0.020) and 1.59 (p = 0.050)) and influenza B: (1.98 (p = 0.018) and 2.33 (p < 0.001)), but lower than for SARS-CoV-2 (0.65 (p < 0.001) and 0.59 (p = 0.035)). The risk of hospital mortality for RSV was increased compared with influenza A (1.55 (p = 0.050)) and influenza B (1.42 (p = 0.262)), but lower compared to SARs-CoV-2 (0.37 (p < 0.001).

Conclusion: RSV infections in elderly are frequent and more severe than those with influenza A/B. While the impact of SARS-CoV-2 most likely decreased in the elderly population due to vaccination, RSV can be expected to continue to be problematic for elderly patients, especially those with comorbidities and thus, more awareness on the disastrous impact of RSV in this age group is urgently needed.

Keywords: Elderly; Influenza A/B; RSV; SARS-CoCV-2; Severe respiratory infections.

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Conflict of interest statement

Declaration of Competing Interest None

Figures

Fig 1
Fig. 1
A. Time course relating to severe respiratory infections during the season 2017 – 2020 (cumulative hospitalized patients per day): the highest activity was found in 2018 with up to 78 patients / day. B. Time course of infections related to RSV, influenza A, influenza B and SARS-CoV-2. The highest activity was found during the second wave of the corona pandemic with up to 55 patients / day and during the season 2018 with a high influenza activity. The data show that the infection waves with RSV and Influenza usually overlap: peaks for RSV were found between week 7 and 9 / for Influenza A between 6 and 9 / for Influenza B beween 8 and 9. C. The stack bars show the distribution of PCR detection rates for RSV (black bar) compared to the other virus detections (Influenza A; deep gray bar; Influenza B: gray bar; SARS-CoV-2: hatched bar). The total number of tests / season is given above the respective year bar in the graph.
Fig 2
Fig. 2
Comparison of hospital stay of RSV patients to Influenza A / B and SARS-CoV-2 (box plots, days (log)). Patients with RSV infections stay longer at hospital compared to patients with Influenza A / B, and shorter compared to SARS-CoV-2 (mean days (standard deviations) of hospital stay are given framed below the box plot).
Fig 3
Fig. 3
A.The figure shows the proportion of patients with viral infections who had a severe clinical course characterized by having pneumonia, mechanical ventilation, bacterial superinfections and a fatal outcome (mortality). OR (95%CI, p) were calculated for RSV compared to other viruses (table). B.The figure shows the proportion of patients with viral infections who had to be transferred to intensive care units: Patients with RSV infections had a significantly higher risk (OR (95%CI, p) of intensive care than patients with Influenza A / B, but a lower risk than patients with SARS-CoV-2.
See this image and copyright information in PMC

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