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. 2024 Nov 4;7(11):e2444756.
doi: 10.1001/jamanetworkopen.2024.44756.

Burden of Respiratory Syncytial Virus-Associated Hospitalizations in US Adults, October 2016 to September 2023

Fiona P Havers  1   2 , Michael Whitaker  1 , Michael Melgar  1 , Huong Pham  1 , Shua J Chai  1   2   3 , Elizabeth Austin  4 , James Meek  5 , Kyle P Openo  6   7   8 , Patricia A Ryan  9 , Chloe Brown  10 , Kathryn Como-Sabetti  11 , Daniel M Sosin  12 , Grant Barney  13 , Brenda L Tesini  14 , Melissa Sutton  15 , H Keipp Talbot  16 , Ryan Chatelain  17 , Pam Daily Kirley  3 , Isaac Armistead  4 , Kimberly Yousey-Hindes  5 , Maya L Monroe  9 , Val Tellez Nunez  10 , Ruth Lynfield  11 , Chelsea L Esquibel  18 , Kerianne Engesser  13 , Kevin Popham  14 , Arilene Novak  15 , William Schaffner  16 , Tiffanie M Markus  16 , Ashley Swain  17 , Monica E Patton  1   2 , Lindsay Kim  1   2
Affiliations

Burden of Respiratory Syncytial Virus-Associated Hospitalizations in US Adults, October 2016 to September 2023

Fiona P Havers et al. JAMA Netw Open. .

Abstract

Importance: Respiratory syncytial virus (RSV) infection can cause severe illness in adults. However, there is considerable uncertainty in the burden of RSV-associated hospitalizations among adults prior to RSV vaccine introduction.

Objective: To describe the demographic characteristics of adults hospitalized with laboratory-confirmed RSV and to estimate annual rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.

Design, setting, and participants: This cross-sectional study used data from the RSV Hospitalization Surveillance Network (RSV-NET), a population-based surveillance platform that captures RSV-associated hospitalizations in 58 counties in 12 states, covering approximately 8% of the US population. The study period spanned 7 surveillance seasons from 2016-2017 through 2022-2023. Included cases from RSV-NET were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area and with a positive RSV test result.

Exposure: Laboratory-confirmed RSV-associated hospitalization, defined as a positive RSV test result within 14 days before or during hospitalization.

Main outcomes and measures: Hospitalization rates per 100 000 adult population, stratified by age group. After adjusting for test sensitivity and undertesting for RSV in adults hospitalized with acute respiratory illnesses, rates were extrapolated to the US population to estimate annual numbers of RSV-associated hospitalizations. Clinical outcome data were used to estimate RSV-associated ICU admissions and in-hospital deaths.

Results: From the 2016 to 2017 through the 2022 to 2023 RSV seasons, there were 16 575 RSV-associated hospitalizations in adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]). Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when the COVID-19 pandemic affected RSV circulation, hospitalization rates ranged from 48.9 (95% CI, 33.4-91.5) per 100 000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100 000 adults in 2017 to 2018. Rates were lowest among adults aged 18 to 49 years (8.6 [95% CI, 5.7-16.8] per 100 000 adults in 2016-2017 to 13.1 [95% CI, 11.0-16.1] per 100 000 adults in 2022-2023) and highest among adults 75 years or older (244.7 [95% CI, 207.9-297.3] per 100 000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per 100 000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84 000-230 000) in 2016 to 2017 to 193 000 (95% CI, 140 000-311 000) in 2017 to 2018. Annual ICU admission estimates ranged from 24 400 (95% CI, 16 700-44 800) to 34 900 (95% CI, 25 500-55 600) for the same seasons. Estimated annual in-hospital deaths ranged from 4680 (95% CI, 3570-6820) in 2018 to 2019 to 8620 (95% CI, 6220-14 090) in 2017 to 2018. Adults 75 years or older accounted for 45.6% (range, 43.1%-48.8%) of all RSV-associated hospitalizations, 38.6% (range, 36.7%-41.0%) of all ICU admissions, and 58.7% (range, 51.9%-67.1%) of all in-hospital deaths.

Conclusions and relevance: In this cross-sectional study of adults hospitalized with RSV before the 2023 introduction of RSV vaccines, RSV was associated with substantial burden of hospitalizations, ICU admissions, and in-hospital deaths in adults, with the highest rates occurring in adults 75 years or older. Increasing RSV vaccination of older adults has the potential to reduce associated hospitalizations and severe clinical outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Meek reported receiving grants from the Centers for Disease Control and Prevention (CDC) Emerging Infections Program cooperative agreement during the conduct of the study. Ms Ryan reported receiving grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study. Ms Brown reported receiving grants from the Michigan Department of Health and Human Services during the conduct of the study. Dr Sosin reported receiving grants from the CDC during the conduct of the study. Dr Sutton reported receiving grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study. Dr Talbot reported receiving grants from the CDC during the conduct of the study. Ms Daily Kirley reported receiving grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study. Dr Armistead reported receiving grants to the Colorado Department of Public Health and Environment from the CDC Emerging Infections Program cooperative agreement during the conduct of the study. Ms Yousey-Hindes reported receiving grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study. Ms Monroe reported receiving grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study. Ms Tellez Nunez reported receiving federal grants from the Council of State and Territorial Epidemiologists (CSTE) during the conduct of the study. Dr Lynfield reported receiving grants to the Minnesota Department of Health from the CDC Emerging Infections Program cooperative agreement during the conduct of the study and serving as an associate editor for the American Academy of Pediatrics Red Book and receiving a fee donated to the Minnesota Department of Health outside the submitted work. Dr Markus reported receiving grants from the CDC during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Weekly Adjusted Respiratory Syncytial Virus (RSV)–Associated Hospitalizations per 100 000 Adult Population for the 2016 to 2017 Through 2022 to 2023 Seasons
Season is defined as October to April for 2016 to 2017 through 2019 to 2020 and as October to September for 2020 to 2021 through 2022 to 2023.
Figure 2.
Figure 2.. Proportion of Adults With Respiratory Syncytial Virus–Associated Intensive Care Unit (ICU) Stay and In-Hospital Death by Age Group for the 2016 to 2017 Through 2022 to 2023 Seasons
Season is defined as October to April for 2016 to 2017 through 2019 to 2020 and as October to September for 2020 to 2021 through 2022 to 2023.
Figure 3.
Figure 3.. Adjusted Respiratory Syncytial Virus (RSV)–Associated Hospitalizations per 100 000 Adult Population by Age and Season for the 2016 to 2017 Through 2022 to 2023 Seasons
Hospitalization rates were adjusted for underdetection of RSV infection due to testing practices and diagnostic test sensitivity. Season is defined as October to April for 2016 to 2017 through 2019 to 2020 and as October to September for 2020 to 2021 through 2022 to 2023. Error bars represent 95% CIs.
See this image and copyright information in PMC

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