Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023

Abstract

Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.

FIGURE 1

Underlying medical conditions^, among patients hospitalized with laboratory-confirmed respiratory syncytial virus infection — Respiratory Syncytial Virus–Associated Hospitalization Surveillance Network, 12 states, October 2022–April 2023 Abbreviation: COPD = chronic obstructive pulmonary disease. * With 95% CIs indicated by error bars. ^† Congestive heart failure includes cardiomyopathy; coronary artery disease includes history of coronary artery bypass graft and myocardial infarction; cerebrovascular accident includes history of stroke or transient ischemic attack; dementia includes Alzheimer disease and other types of dementia. ^§ Data are from a weighted sample of hospitalized adults with completed medical record abstractions. Sample sizes presented are unweighted with weighted percentages. ^¶ Select counties in California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Tennessee, and Utah.

FIGURE 2

Age distribution among persons aged ≥60 years residing in the surveillance network catchment area and among laboratory-confirmed respiratory syncytial virus–associated hospitalizations, intensive care unit admissions, and in-hospital deaths — Respiratory Syncytial Virus–Associated Hospitalization Surveillance Network, 12 states, October 2022–April 2023 Abbreviations: ICU = intensive care unit; RSV = respiratory syncytial virus; RSV-NET = Respiratory Syncytial Virus–Associated Hospitalization Surveillance Network. * With 95% CIs indicated by error bars. ^† The RSV catchment area includes select counties in California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Tennessee, and Utah. RSV-associated hospitalizations among RSV-NET catchment area residents have hospital admission dates from October 1, 2022 through April 30, 2023. Those with severe RSV disease might be more likely to receive RSV testing; therefore, these data could potentially overestimate the proportion of severe outcomes among hospitalized patients.