Influenza and respiratory syncytial virus infections in the oldest-old continent

Abstract

SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni-and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02-3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67-11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09-8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06-13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14-5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.

The burden of seasonal influenza in Italy: A systematic review of influenza‐related complications, hospitalizations, and mortality

“…Four articles (25%) evaluated the number of deaths due to influenza in the study population 22,23,25,29 . Death occurred in 4.1% of patients with laboratory‐confirmed influenza, 29 but in a higher percentage of patients with severe influenza or ARDS, namely 24.1% and 46% of cases 22,29 .…”

“…Death occurred in 4.1% of patients with laboratory‐confirmed influenza, 29 but in a higher percentage of patients with severe influenza or ARDS, namely 24.1% and 46% of cases 22,29 . Death occurred in 13.9% of hospitalized oldest‐old patients with laboratory‐confirmed influenza and/or respiratory syncytial virus infection 25 . The risk of death was decreased by 33%–39% by vaccination 23 …”

“…Twenty‐four articles were then screened by full text, and eight studies were excluded with the following reasons: did not meet the inclusion criteria ( n = 2), not related to the topic ( n = 4), reviews (=2). Eventually, 16 articles 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 published from 2001 to 2020 were included in the qualitative synthesis. Details about the study selection process are shown in the flowchart (Figure 1 ).…”

Longitudinal proteomic profiling of dialysis patients with COVID-19 reveals markers of severity and predictors of death

“…ESKD is well recognised as an immunosuppressed state [14][15][16], with defects in both innate and adaptive immunity [17][18][19][20]. Accordingly, ESKD confers increased vulnerability to viral infections including influenza and respiratory syncytial virus [21][22][23][24]. In addition, ESKD results in a chronic low-grade inflammatory state [25].…”

Respiratory Syncytial Virus: New Challenges for Molecular Epidemiology Surveillance and Vaccination Strategy in Patients with ILI/SARI

“…In Italy, an influenza surveillance system covering the whole country (InfluNet) has been operating over the last two decades [18]. Nevertheless, hRSV surveillance has not yet been fully implemented and the knowledge about spread and impact of this pathogen is mainly limited to data from individual research studies, primarily focused on children with influenza-like illness [19][20][21] or other specific settings [22].…”