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. 2023 Mar 1;10(4):ofad111.
doi: 10.1093/ofid/ofad111. eCollection 2023 Apr.

Respiratory Syncytial Virus Disease Burden in Community-Dwelling and Long-Term Care Facility Older Adults in Europe and the United States: A Prospective Study

Sílvia Narejos Pérez  1 , Josep María Ramón Torrell  2 , Airi Põder  3 , Isabel Leroux-Roels  4 , Lina Pérez-Breva  5 , Katie Steenackers  6 , Corinne Vandermeulen  7 , Sandra Meisalu  8 , Damien McNally  9 , Jordan S T Bowen  10 , Amardeep Heer  11 , Adrian Beltran Martinez  12 , Laura L Helman  13 , Amit Arora  14 , Robert G Feldman  15 , Rajul Patel  16 , Amit Shah  17 , Raghavendra Devadiga  18 , Silvia Damaso  19 , Sean Matthews  20 , Jean-Yves Pirçon  19 , Dominique Luyts  19
Affiliations

Respiratory Syncytial Virus Disease Burden in Community-Dwelling and Long-Term Care Facility Older Adults in Europe and the United States: A Prospective Study

Sílvia Narejos Pérez et al. Open Forum Infect Dis. .

Abstract

Background: Data on respiratory syncytial virus (RSV) disease burden in adults remain scarce. We assessed the burden of confirmed RSV-acute respiratory infections (cRSV-ARIs) in community-dwelling (CD) adults and those in long-term care facilities (LTCFs).

Methods: In this prospective cohort study covering 2 RSV seasons (October 2019-March 2020 and October 2020-June 2021), RSV-ARIs were identified through active surveillance, in medically stable CD-adults ≥50 years (Europe) or adults ≥65 years in LTCFs (Europe and the United States). RSV infection was confirmed by polymerase chain reaction from combined nasal and throat swabs.

Results: Of 1981 adults enrolled, 1251 adults in CD and 664 LTCFs (season 1) and 1223 adults in CD and 494 LTCFs (season 2) were included in the analyses. During season 1, overall incidence rates ([IRs] cases/1000 person-years) and attack rates (ARs) for cRSV-ARIs were 37.25 (95% confidence interval [CI], 22.62-61.35) and 1.84% in adults in CD and 47.85 (CI, 22.58-101.4) and 2.26% in adults in LTCFs. Complications occurred for 17.4% (CD) and 13.3% (LTCFs) of cRSV-ARIs. One cRSV-ARI occurred in season 2 (IR = 2.91 [CI, 0.40-20.97]; AR = 0.20%), without complications. No cRSV-ARIs led to hospitalization or death. Viral pathogens were codetected in ≤17.4% of cRSV-ARIs.

Conclusions: RSV is an important cause of disease burden in adults in CD and LTCFs. Despite the observed low severity of cRSV-ARI, our results support the need for RSV prevention strategies among adults ≥50 years old.

Keywords: care facilities; community-dwelling; incidence/burden of disease; older adults; respiratory syncytial virus infection.

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Conflict of interest statement

Potential conflicts of interest. RD, SD, J-YP, and DL are employees of the GSK group of companies. SD, J-YP, and DL hold shares in the GSK group of companies as part of their employee remuneration. JMRT declares lectures for Pfizer and attending meetings for GSK and Pfizer. IL-R declares funding from GSK, ICOSAVAX, and Virometix to her institution for conducting RSV clinical trials and participation on Janssen advisory boards for RSV vaccines. CV reports grant/research support from GSK to her institution for the conduct of the current study and is currently an employee of the GSK group of companies. KS, JSTB, and LLH declares research funding received by their institution from GSK. RGF declares lectures for GSK. SM works as a freelance consultant on behalf of the GSK group of companies. All other authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Participant flowchart. ARI, acute respiratory infection; CD, community-dwelling; cRSV-ARI, confirmed RSV-ARI episode; LTCF, long-term care facility; N, number of participants; RSV, respiratory syncytial virus.
Figure 2.
Figure 2.
Incidence rate (IR) and attack rate (AR) for confirmed respiratory syncytial virus-acute respiratory infection episode (cRSV-ARI) in the community-dwelling (CD) (A) and long-term care facility (LTCF) (B) cohorts during season 1, overall, by RSV type and by age group at enrollment (analysis set). Note: Error bars represent 95% confidence intervals (CIs). For IRs, Wald 95% CIs accounting for clustered data were calculated using Poisson regression with Rao-Scott transformation; when the design effect was either ≤1 or could not be estimated, the exact Poisson 95% CIs were calculated instead. For ARs, extended Clopper-Pearson exact 95% CIs accounting for clustered data were calculated; when the adjusted effective sample size was greater than the actual sample size or the design effect could not be estimated, Clopper-Pearson exact 95% CIs not extended for clustered data were calculated instead. LL, lower limit; N, number of participants in the analysis set; n, number of participants with cRSV-ARI; UL, upper limit.
Figure 3.
Figure 3.
Proportions of complications, hospitalizations, and fatalities among adults with acute respiratory infection episode (ARI) in the community-dwelling (CD) (A) and long-term care facility (LTCF) (B) cohorts during season 1, by respiratory syncytial virus (RSV) status (analysis set). Notes: Error bars represent 95% confidence intervals (CIs). Extended Clopper-Pearson exact 95% CIs accounting for clustered data were calculated; when the adjusted effective sample size was greater than the actual sample size or the design effect could not be estimated, Clopper-Pearson exact 95% CIs not extended for clustered data were calculated instead. cRSV-ARI, participants with confirmed RSV-ARI episode (by reverse-transcriptase polymerase chain reaction [RT-PCR]); missing data, participants with missing and/or invalid RT-PCR RSV results for at least 1 ARI episode and without any RT-PCR RSV-positive ARI episode; N, number of participants in the analysis set; non-cRSV, participants with ARI episodes with either no respiratory viral pathogen or a non-RSV viral pathogen identified by RT-PCR.
Figure 4.
Figure 4.
Proportion of confirmed respiratory syncytial virus-acute respiratory infection episode (cRSV-ARI) episodes with codetection of other viral pathogens during season 1, overall and by age group at enrollment (analysis set for cRSV-ARI). Notes: The age groups for which no other viral pathogens were codetected are not shown. The numbers in the brackets are cRSV-ARI episodes with codetection of other viral pathogens. *Seasonal coronaviruses: 229E, OC43, NL63, and HKU1. CD, community-dwelling; LTCF, long-term care facility.
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