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. 2024 Apr 1;7(4):e244954.
doi: 10.1001/jamanetworkopen.2024.4954.

Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults

Diya Surie  1 , Katharine A Yuengling  1 , Jennifer DeCuir  1 , Yuwei Zhu  2 , Adam S Lauring  3   4 , Manjusha Gaglani  5   6   7 , Shekhar Ghamande  5   6   7 , Ithan D Peltan  8 , Samuel M Brown  8 , Adit A Ginde  9 , Amanda Martinez  9 , Nicholas M Mohr  10 , Kevin W Gibbs  11 , David N Hager  12 , Harith Ali  12 , Matthew E Prekker  13 , Michelle N Gong  14 , Amira Mohamed  14 , Nicholas J Johnson  15 , Vasisht Srinivasan  16 , Jay S Steingrub  17 , Aleda M Leis  18 , Akram Khan  19 , Catherine L Hough  19 , William S Bender  20 , Abhijit Duggal  21 , Emily E Bendall  4 , Jennifer G Wilson  22 , Nida Qadir  23 , Steven Y Chang  23 , Christopher Mallow  24 , Jennie H Kwon  25 , Matthew C Exline  26 , Nathan I Shapiro  27 , Cristie Columbus  28   29 , Ivana A Vaughn  30 , Mayur Ramesh  31 , Jarrod M Mosier  32 , Basmah Safdar  33 , Jonathan D Casey  34 , H Keipp Talbot  34   35 , Todd W Rice  34 , Natasha Halasa  36 , James D Chappell  36 , Carlos G Grijalva  35 , Adrienne Baughman  37 , Kelsey N Womack  38 , Sydney A Swan  2 , Cassandra A Johnson  2 , Cara T Lwin  2 , Nathaniel M Lewis  39 , Sascha Ellington  39 , Meredith L McMorrow  1 , Emily T Martin  18 , Wesley H Self  38 ; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network
Affiliations

Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults

Diya Surie et al. JAMA Netw Open. .

Abstract

Importance: On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making.

Objective: To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status.

Design, setting, and participants: In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023.

Exposures: RSV, SARS-CoV-2, or influenza infection.

Main outcomes and measures: Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death.

Results: Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001).

Conclusions and relevance: Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lauring reported receiving personal fees from Roche outside the submitted work. Dr Gaglani reported receiving grants from the Centers for Disease Control and Prevention (CDC), Abt Associates, and Westat; personal fees from the CDC; and serving as cochair for the Texas Pediatric Society, Texas Chapter of the American Academy of Pediatrics, Infectious Diseases and Immunization Committee outside the submitted work. Dr Peltan reported receiving grants from Janssen Pharmaceuticals and Regeneron outside the submitted work. Dr Brown reported having a patent for an airway device with royalties paid from ReddyPort. Dr Ginde reported receiving grants from the National Institutes of Health (NIH), Department of Defense (DOD), Faron Pharmaceuticals, AbbVie, and Biomeme and personal fees from SeaStar outside the submitted work. Dr Gibbs reported receiving grants from NIH and grants from DOD outside the submitted work. Dr Hager reported receiving grants from NIH outside the submitted work. Dr Gong reported receiving grants from NIH and personal fess from Philips outside the submitted work. Dr N. Johnson reported receiving grants from NIH and serving on an advisory board for Neuroptics outside the submitted work. Dr Khan reported receiving grants from Dompe Pharmaceuticals, 4D Medical, Eli Lilly, and United Therapeutics outside the submitted work. Dr Hough reported receiving grants from NIH outside the submitted work. Dr Duggal reported receiving grants from NIH and personal fees from ALung Technologies outside the submitted work. Dr Wilson reported receiving grants from NIH outside the submitted work. Dr Chang reported receiving personal fees from PureTech Health outside the submitted work. Dr Mallow reported receiving personal fees from Medical Legal Consulting outside the submitted work. Dr Vaughn reported receiving grants from CDC outside the submitted work. Dr Ramesh reported receiving personal fees from Moderna, Pfizer, and AstraZeneca outside the submitted work. Dr Safdar reported receiving grants from CDC, National Heart, Lung, and Blood Institute (NHLBI), and Comprehensive Research Associates outside the submitted work. Dr Casey reported receiving personal fees from Fisher & Paykel outside the submitted work. Dr Rice reported receiving grants from NIH NHLBI and personal fees from Cumberland Pharmaceuticals and Sanofi outside the submitted work. Dr Halasa reported receiving grants from Sanofi, Quidel, and Merck outside the submitted work. Dr Chappell reported receiving grants from Merck and research support from CDC, NIH, and DOD outside the submitted work. Dr Grijalva reported receiving grants from NIH, CDC, Agency for Healthcare Research and Quality (AHRQ), and Food and Drug Administration and personal fees from Merck and Syneos Health outside the submitted work. Dr Martin reported receiving grants from Merck outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Peak Respiratory Severity of Adults Hospitalized With Respiratory Syncytial Virus (RSV), COVID-19, or Influenza by Vaccination Status
Peak respiratory severity was classified by an ordinal scale as follows: (1) no oxygen therapy; (2) standard-flow oxygen therapy (<30 L/min); (3) high-flow nasal cannula (≥30 L/min) or noninvasive ventilation; (4) invasive mechanical ventilation; and (5) death.
Figure 2.
Figure 2.. Maximum Likelihood Phylogenetic Trees
A, 177 RSV-A sequences from adults aged 18 years and older hospitalized within the Investigating Respiratory Viruses in the Acutely Ill Network of 25 hospitals in 20 US States (tips color coded by State) and 68 contextual sequences from outside the United States collected between January and March 2020, available on Global Initiative on Sharing All Influenza Data. B, 32 RSV-B sequences from adults aged 18 years and older hospitalized within the Investigating Respiratory Viruses in the Acutely Ill Network of 25 hospitals in 20 US States (tips color coded by State) with 46 contextual sequences from outside the United States collected between January and March 2020, available on Global Initiative on Sharing All Influenza Data.
See this image and copyright information in PMC

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