Background Respiratory syncytial virus (RSV) is an increasinglyrecognized cause of illness in adults. Data on the epidemiologyand clinical effects in community-dwelling elderly persons andhigh-risk adults can help in assessing the need for vaccinedevelopment.
Methods During four consecutive winters, we evaluated all respiratoryillnesses in prospective cohorts of healthy elderly patients(65 years of age) and high-risk adults (those with chronic heartor lung disease) and in patients hospitalized with acute cardiopulmonaryconditions. RSV infection and influenza A were diagnosed onthe basis of culture, reverse-transcriptase polymerase chainreaction, and serologic studies.
Results A total of 608 healthy elderly patients and 540 high-riskadults were enrolled in prospective surveillance, and 1388 hospitalizedpatients were enrolled. A total of 2514 illnesses were evaluated.RSV infection was identified in 102 patients in the prospectivecohorts and 142 hospitalized patients, and influenza A was diagnosedin 44 patients in the prospective cohorts and 154 hospitalizedpatients. RSV infection developed annually in 3 to 7 percentof healthy elderly patients and in 4 to 10 percent of high-riskadults. Among healthy elderly patients, RSV infection generatedfewer office visits than influenza; however, the use of healthcare services by high-risk adults was similar in the two groups.In the hospitalized cohort, RSV infection and influenza A resultedin similar lengths of stay, rates of use of intensive care (15percent and 12 percent, respectively), and mortality (8 percentand 7 percent, respectively). On the basis of the diagnosticcodes of the International Classification of Diseases, 9th Revision,Clinical Modification at discharge, RSV infection accountedfor 10.6 percent of hospitalizations for pneumonia, 11.4 percentfor chronic obstructive pulmonary disease, 5.4 percent for congestiveheart failure, and 7.2 percent for asthma.
Conclusions RSV infection is an important illness in elderlyand high-risk adults, with a disease burden similar to thatof nonpandemic influenza A in a population in which the prevalenceof vaccination for influenza is high. An effective RSV vaccinemay offer benefits for these adults.
Source Information
From the Department of Medicine, Rochester General Hospital (A.R.F., P.A.H., M.A.F., E.E.W.) and the Department of Medicine, University of Rochester School of Medicine and Dentistry (A.R.F., E.E.W.) — both in Rochester, N.Y.; and the Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md. (C.C.).
Address reprint requests to Dr. Falsey at the Infectious Diseases Unit, Rochester General Hospital, 1425 Portland Ave., Rochester, NY 14621, or at ann.falsey{at}viahealth.org.
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