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. 2023 Oct 20;10(11):ofad513.
doi: 10.1093/ofid/ofad513. eCollection 2023 Nov.

Systematic Literature Review of Risk Factors for Poor Outcomes Among Adults With Respiratory Syncytial Virus Infection in High-Income Countries

Annete Njue  1 , Weyinmi Nuabor  1 , Matthew Lyall  1 , Andrea Margulis  2 , Josephine Mauskopf  3 , Daniel Curcio  4 , Samantha Kurosky  4 , Bradford D Gessner  4 , Elizabeth Begier  4
Affiliations

Systematic Literature Review of Risk Factors for Poor Outcomes Among Adults With Respiratory Syncytial Virus Infection in High-Income Countries

Annete Njue et al. Open Forum Infect Dis. .

Abstract

Identification of risk factors for severe respiratory syncytial virus (RSV) disease in adults could facilitate their appropriate vaccine recommendations. We conducted a systematic literature review (last 10 years in PubMed/Embase) to identify quantitative estimates of risk factors for severe RSV infection outcomes in high-income countries. Severe outcomes from RSV infection included hospitalization, excess mortality, lower respiratory tract infection, or a composite measure: severe RSV, which included these outcomes and others, such as mechanical ventilation and extended hospital stay. Among 1494 articles screened, 26 met eligibility criteria. We found strong evidence that the following increased the risk of severe outcomes: age, preexisting comorbid conditions (eg, cardiac, pulmonary, and immunocompromising diseases, as well as diabetes and kidney disease), and living conditions (socioeconomic status and nursing home residence). The frequency of severe outcomes among younger adults with comorbidities was generally similar to that experienced by older adults, suggesting that immunosenescence and chronic conditions are both contributing factors for elevated risk.

Trial registration: PROSPERO (CRD42022315239).

Keywords: respiratory syncytial virus; risk factors; severe.

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Conflict of interest statement

Potential conflicts of interest. D. C., S. K., B. D. G., and E. B. are employees of Pfizer & Co and may own Pfizer stock. Pfizer & Co is developing an adult vaccine for prevention of RSV infection. A. N., W. N., M. L., A. M., and J. M. are employees of RTI Health Solutions, which received funding from Pfizer & Co for this work, including manuscript development.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) diagram for studies. Of the 90 included studies, 89 were extracted, and 26 reported risk factors for hospitalization, mortality, lower respiratory tract infection or pneumonia, and severe outcomes.
Figure 2.
Figure 2.
Risk of severe RSV outcomes by cardiac conditions. IRRs were included only for a subset of the adult age groups presented in the study; all other outcomes included adults aged ≥18 years, and all age groups in the study are included in the tables. Error bars indicate 95% CIs. CAD, coronary artery disease; CHF, congestive heart failure; IRR, incidence rate ratio; LRTI, lower respiratory tract infection; NYC, New York City; OR, odds ratio; RR, relative risk; RSV, respiratory syncytial virus.
Figure 3.
Figure 3.
Risk of severe RSV outcomes by respiratory conditions. IRRs were included only for a subset of the adult age groups presented in the study; all other outcomes included adults aged ≥18 years, and all age groups in the study are included in the tables. Error bars indicate 95% CIs. aThis number is reported as a β coefficient obtained from logistic regression in Table 2 of the article, but it appears to be an OR based on the counts reported in Table 1 of the article. COPD, chronic obstructive pulmonary disease; IRR, incidence rate ratio; LRTI, lower respiratory tract infection; NYC, New York City; OR, odds ratio; RR, relative risk; RSV, respiratory syncytial virus.
Figure 4.
Figure 4.
Risk of severe RSV outcomes by nonimmunocompromised conditions. IRRs were included only for a subset of the adult age groups presented in the study; all other outcomes included adults aged ≥18 years, and all age groups in the study are included in the tables. Error bars indicate 95% CIs. CKD, chronic kidney disease; IRR, incidence rate ratio; LRTI, lower respiratory tract infection; NYC, New York City; OR, odds ratio; RR, relative risk; RSV, respiratory syncytial virus; TIA, transient ischemic attack.
Figure 5.
Figure 5.
Risk of severe RSV outcomes by immunocompromised conditions. IRRs were included only for a subset of the adult age groups presented in the study; all other outcomes included adults aged ≥18 years, and all age groups in the study are included in the tables. Error bars indicate 95% CIs. ESRD, end-stage renal disease; HCT, hematopoietic cell transplant; HR, hazard ratio; IRR, incidence rate ratio; LRTI, lower respiratory tract infection; OR, odds ratio; RR, relative risk; RSV, respiratory syncytial virus; SCT, stem cell transplant; SOT, solid organ transplant.
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