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. 2025 Oct;19(10):e70174.
doi: 10.1111/irv.70174.

Clinical and Socioeconomic Burden of RSV Infections Among Older Adults in Primary Care: An International Prospective Cohort Study

Sarah F Hak  1 , Joanne G Wildenbeest  1 , Sara Bracaloni  2 , Michela Scarpaci  2 , Tommaso Cosci  2 , Enrica Esposito  2 , Maria Chironna  2 , Donatella Panatto  2 , Giancarlo Icardi  2 , Melissa Torrisi  2 , Leonardo Bonaldo  2 , Eugenio Mammolenti  2 , Emma Te Bogt  3 , Jacqueline Vlaskamp-Smit  1 , Louis J Bont  1 , Caterina Rizzo  2 , Roderick P Venekamp  3
Affiliations

Clinical and Socioeconomic Burden of RSV Infections Among Older Adults in Primary Care: An International Prospective Cohort Study

Sarah F Hak et al. Influenza Other Respir Viruses. 2025 Oct.

Abstract

Introduction: Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of acute respiratory infections (ARI) in older adults. However, primary care data on RSV infections are scarce.

Methods: We conducted a prospective cohort study over two winter seasons (2022-2023 and 2023-2024) in Italy and the Netherlands (NCT06318936). Older adults (≥ 60 years) presenting to primary care with ARI were tested for RSV and influenza. Clinical and socioeconomic burden was assessed through questionnaires on Days 1, 14, and 30. In secondary analyses, we compared between RSV- and influenza-positive patients and estimated RSV-ARI incidence in Dutch primary care.

Results: Of 703 older adults tested, 93 (13.2%) were RSV-positive and 100 (14.2%) influenza-positive. In RSV patients (mean age: 76 years [SD: 8], 63% ≥ 1 comorbidity), mean illness duration was 17 days (SD: 10). Repeat primary care visits occurred in 38% (33/87), emergency department referral in 5% (4/88), and hospitalization in 2% (2/88) of RSV patients. The mean costs per RSV episode were €78.1 (95%CI: 74.4-81.8) and €279.7 (95%CI: 245.5-318.2) from a healthcare system and societal perspective, respectively. The annual RSV-ARI incidence rate was 10.3 episodes per 1000 person-years. RSV patients were significantly older, and had less often fever, muscle pain, and fatigue than influenza patients, but clinical and socioeconomic burdens were comparable.

Conclusions: This prospective study is the first sufficiently large to demonstrate that the primary care burden of RSV infections among older adults is substantial and comparable with influenza. These findings are highly relevant for informing public health decisions on novel RSV vaccines.

Keywords: RSV; burden; costs; incidence; older adults; outpatient; primary care; respiratory syncytial virus.

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Conflict of interest statement

EB, EE, EM, GI, JV, LB, MC, MS, MT, RPV, SB, SH, TC, and DP report no potential conflict of interest. CR declares that she received fees for participation in advisory boards from AstraZeneca, Seqirus, MSD, Sanofi, and GSK and for CME lectures from Seqirus, Sanofi, AstraZeneca, MSD, and GSK. JW has been an investigator for clinical trials sponsored by pharmaceutical companies including AstraZeneca, Merck, Pfizer, Sanofi, and Janssen. All funds have been paid to UMCU. JW participated in the advisory board of Janssen and Sanofi with fees paid to UMCU. LJB has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. UMCU has received major funding (> €100,000 per industrial partner) for investigator‐initiated studies from AbbVie, MedImmune, AstraZeneca, Sanofi, Janssen, Pfizer, MSD, and MeMed Diagnostics. UMCU has received major funding for the RSV GOLD study from the Bill & Melinda Gates Foundation. UMCU has received major funding as part of the public–private partnership IMI‐funded RESCEU and PROMISE projects with partners GSK, Novavax, Janssen, AstraZeneca, Pfizer, and Sanofi. UMCU has received major funding from Julius Clinical for participating in clinical studies sponsored by MedImmune and Pfizer. UMCU received minor funding (€1000–25,000 per industrial partner) for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, GSK, Novavax, Pfizer, Moderna, AstraZeneca, MSD, Sanofi, Genzyme, and Janssen. LJB is the founding chairman of the ReSViNET Foundation. CR participated in the Advisory Board and Expert scientific discussion for Seqirus, MSD, GSK, Sanofi, and AstraZeneca.

Figures

FIGURE 1
FIGURE 1
Flowchart. 1Two participants tested positive for both influenza and RSV.
FIGURE 2
FIGURE 2
Symptoms of RSV‐positive patients at Days 1, 14, and 30 after the initial primary care visit.
FIGURE 3
FIGURE 3
Proportion of RSV‐positive patients reporting any health‐related quality of life problems in each EQ‐5D‐5L domain, at Days, 14, and 30 after the initial primary care visit.
See this image and copyright information in PMC

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