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. 2025 Mar;90(3):106440.
doi: 10.1016/j.jinf.2025.106440. Epub 2025 Feb 12.

Incidence of RSV-related hospitalizations for ARIs, including CAP: Data from the German prospective ThEpiCAP study

Caihua Liang  1 , Elizabeth Begier  2 , Stefan Hagel  3 , Juliane Ankert  4 , Liz Wang  5 , Claudia Schwarz  6 , Lea J Bayer  7 , Christof von Eiff  8 , Qing Liu  9 , Jo Southern  10 , Jeffrey Vietri  11 , Sonal Uppal  12 , Bradford D Gessner  13 , Christian Theilacker  14 , Mathias W Pletz  15
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Free article

Incidence of RSV-related hospitalizations for ARIs, including CAP: Data from the German prospective ThEpiCAP study

Caihua Liang et al. J Infect. 2025 Mar.
Free article

Abstract

Background: RSV is a leading cause of ARI, including CAP, in older adults. Data available often underestimate RSV-related ARI incidence. We estimated RSV-related ARI hospitalization incidence from a prospective CAP study, adjusting for undiagnosed RSV infections due to nasopharyngeal/nasal swab testing only.

Methods: Active surveillance of adult CAP hospitalizations in Germany was conducted between 2021-2023. Nasopharyngeal/nasal swabs were RSV-tested, and age-group specific proportions were applied to calculate RSV-related CAP incidence. This was divided by the CAP proportions among RSV-related ARI hospitalizations (from multispecimen study) to extrapolate RSV-related ARI rates.

Results: Among 1040 radiologically confirmed CAP cases, 3.7% tested RSV-positive via nasopharyngeal/nasal swab, corresponding to 7.8% after adjusting for underdetection. For 18-59 and ≥60 years, adjusted RSV-related CAP hospitalization rates (95% CI) were 4.9 (1.8-10.9) and 115.6 (78.8-163.6); adjusted RSV-related ARI hospitalization rates were 19.8 (6.8-50.1) and 401.6 (260.7-609.3) per 100,000, respectively. Within 30 days of an RSV-related CAP admission, 18.2% of those ≥65 years died, and 11.1% and 36.4% had cardiovascular events among those 18-64 and ≥65 years, respectively.

Conclusions: Older adults in Germany experience a high burden of RSV-related ARI hospitalizations, including CAP, underscoring RSV vaccination's potential utility for this population.

Keywords: Acute respiratory infection; Community-acquired pneumonia; Hospitalization; Respiratory syncytial virus.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Caihua Liang, Elizabeth Begier, Liz Wang, Claudia Schwarz, Lea J. Bayer, Christof von Eiff, Qing Liu, Jo Southern, Jeffrey Vietri, Sonal Uppal, Bradford D. Gessner, and Christian Theilacker are Pfizer employees and may own Pfizer stock. Stefan Hagel and Mathias Pletz are employees of Jena University Hospital, which received funding from Pfizer in connection with conducting the CAP incidence study and with the development of this manuscript. Stefan Hagel and Mathias Pletz also received speaker honoraria and research funding from Pfizer.

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