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Review
. 2023 Jun;12(6):1487-1504.
doi: 10.1007/s40121-023-00802-4. Epub 2023 May 23.

Incidence of Respiratory Syncytial Virus Infection in Older Adults: Limitations of Current Data

Mark H Rozenbaum  1 , Elizabeth Begier  2 , Samantha K Kurosky  3 , Jo Whelan  4 , Danai Bem  4 , Koen B Pouwels  5 , Maarten Postma  6 , Louis Bont  7
Affiliations
Review

Incidence of Respiratory Syncytial Virus Infection in Older Adults: Limitations of Current Data

Mark H Rozenbaum et al. Infect Dis Ther. 2023 Jun.

Abstract

Introduction: Respiratory syncytial virus (RSV) is an important cause of severe respiratory illness in older adults and adults with respiratory or cardiovascular comorbidities. Published estimates of its incidence and prevalence in adult groups vary widely. This article reviews the potential limitations affecting RSV epidemiology studies and suggests points to consider when evaluating or designing them.

Methods: Studies reporting the incidence or prevalence of RSV infection in adults in high-income Western countries from 2000 onwards were identified via a rapid literature review. Author-reported limitations were recorded, together with presence of other potential limitations. Data were synthesized narratively, with a focus on factors affecting incidence estimates for symptomatic infection in older adults.

Results: A total of 71 studies met the inclusion criteria, most in populations with medically attended acute respiratory illness (ARI). Only a minority used case definitions and sampling periods tailored specifically to RSV; many used influenza-based or other criteria that are likely to result in RSV cases being missed. The great majority relied solely on polymerase chain reaction (PCR) testing of upper respiratory tract samples, which is likely to miss RSV cases compared with dual site sampling and/or addition of serology. Other common limitations were studying a single season, which has potential for bias due to seasonal variability; failure to stratify results by age, which underestimates the burden of severe disease in older adults; limited generalizability beyond a limited study setting; and absence of measures of uncertainty in the reporting of results.

Conclusions: A significant proportion of studies are likely to underestimate the incidence of RSV infection in older adults, although the effect size is unclear and there is also potential for overestimation. Well-designed studies, together with increased testing for RSV in patients with ARI in clinical practice, are required to accurately capture both the burden of RSV and the potential public health impact of vaccines.

Keywords: Epidemiology; Health policy; Respiratory syncytial virus; Vaccination.

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Conflict of interest statement

Mark H. Rozenbaum, Elizabeth Begier and Samantha Kurosky are employees of Pfizer and hold Pfizer stock and/or stock options. Jo Whelan was an employee of HEOR Ltd and Danai Bem is an employee of HEOR Ltd, which received fees from Pfizer in relation to this study, including the development of this manuscript. Keon B. Pouwels has no disclosures. Maarten Postma holds stock in Pharmacoeconomics Advice Groningen (Groningen, NL) and Health-Ecore (Zeist, NL). Louis Bont: UMC Utrecht has received compensation for advisory work and trial participation, or support for academic research by Louis Bont from Pfizer, Janssen, Novavax and GSK. He is a lead of the IMI funded RESCEU and PROMISE consortia.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram illustrating the study selection process
See this image and copyright information in PMC

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