Burden of respiratory syncytial virus in adults in the United Kingdom: A systematic literature review and gap analysis

Abstract

Despite the growing recognition of a potentially significant respiratory syncytial virus (RSV) disease burden in adults, relevant evidence in the United Kingdom (UK) is limited. This systematic literature review (SLR) aimed to identify the disease burden of RSV in UK adults, including certain high‐risk subgroups and existing evidence gaps. Published studies (2011 onwards) reporting epidemiological, economic and clinical burden outcomes in UK adults (≥15 years) with RSV were identified from indexed databases, including MEDLINE, Embase and the Cochrane library. High‐risk groups included elderly (≥65 years), immunocompromised, co‐morbid and co‐infected patients. Outcomes included RSV incidence/prevalence, mortality, clinical presentation and direct/indirect resource use/costs. Twenty‐eight publications on 28 unique studies were identified, mostly in general/respiratory indicator (n = 17), elderly (n = 10) and immunocompromised (n = 6) cohorts. Main outcomes reported in the general/respiratory indicator cohort were RSV infection incidence (seasonal/annual: 0.09–17.9%/6.6–15.1%), mortality (8,482 deaths/season) and direct resource use (including mean general practitioner [GP] episodes/season: 487,247). Seasonal/annual incidence was 14.6–26.5%/0.7–16% in high‐risk cohorts. Attributed to RSV in the elderly were 7,915 deaths/season and 175,070 mean GP episodes/season. Only two studies reported on co‐morbid cohorts. Clinical burden outcomes were only reported in general and immunocompromised patients, and no evidence was found in any cohort on indirect economic burden or RSV complications. Evidence captured suggests that RSV may have a substantial burden in UK adults. However, available data were limited and highly heterogenous, with further studies needed to characterise the burden of RSV in adults and to validate our findings.

Burden of Disease of Respiratory Syncytial Virus in Older Adults and Adults Considered at High Risk of Severe Infection

“…In adults 60 years of age and older, a SR of developed countries, including Canada, found that RSV caused between 4.7% and 7.8% of symptomatic respiratory infections (7). Overall, the incidence of medically attended RSV RTI increased with increasing age (8, 9). For instance, a SR and meta-analysis (MA) found that rates of medically attended RSV RTI among adults from the United States (US) increased from 934 per 100,000 in adults 18 to 49 years of age to 1,519 per 100,000 in adults 65 years of age and older (10).…”