Respiratory Syncytial Virus and Other Respiratory Viral Infections in Older Adults With Moderate to Severe Influenza-like Illness

Abstract

Background. Few studies have prospectively assessed viral etiologies of acute respiratory infections in community-based elderly individuals. We assessed viral respiratory pathogens in individuals ≥65 years with influenza-like illness (ILI).Methods. Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal/throat swabs from 556 episodes of moderate-to-severe ILI, defined as ILI with pneumonia, hospitalization, or maximum daily influenza symptom severity score (ISS) >2. Cases were selected from a randomized trial of an adjuvanted vs nonadjuvanted influenza vaccine conducted in elderly adults from 15 countries.Results. Respiratory syncytial virus (RSV) was detected in 7.4% (41/556) moderate-to-severe ILI episodes in elderly adults. Most (39/41) were single infections. There was a significant association between country and RSV detection (P = .004). RSV prevalence was 7.1% (2/28) in ILI with pneumonia, 12.5% (8/64) in ILI with hospitalization, and 6.7% (32/480) in ILI with maximum ISS > 2. Any virus was detected in 320/556 (57.6%) ILI episodes: influenza A (104/556, 18.7%), rhinovirus/enterovirus (82/556, 14.7%), coronavirus and human metapneumovirus (each 32/556, 5.6%).Conclusions. This first global study providing data on RSV disease in ≥65 year-olds confirms that RSV is an important respiratory pathogen in the elderly. Preventative measures such as vaccination could decrease severe respiratory illnesses and complications in the elderly.

Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091

“…Severe illness and death among laboratory-confirmed RSV-infected adults has been reported (29,30), even though the clinical association between pathogen detection and disease remains difficult to interpret in the absence of comparison groups (i.e., RSV prevalence among adults without respiratory illness). Studies conducted in Kenya and South Africa that compared the RSV prevalence among patients hospitalized with severe acute respiratory illness (SARI) to control groups found that RSV infection was associated with hospitalization among children <5 years of age, but no association was found among persons >5 years of age (31,32).…”

Infection Control Implications of Protracted Lengths of Stay With Noninfluenza Viral Influenza-Like Illnesses in Hospitalized Adults During the 2015 Influenza A (H3N2) Epidemic

“…Since hMPV, RSV, and HPIV-3 have been implicated in serious nosocomial outbreaks in adults, we placed patients with hMPV, RSV, or HPIV-3 on standard, contact, and droplet precautions for cough duration and used single rooms when available. [8][9][10] Early in the influenza epidemic here, influenza and ILI patients were given single rooms. Influenza patients had single room priority and cohorting was performed whenever possible.…”

“…Because some viral ILIs (eg, hMPV, RSV, HPIV-3) have potential for nosocomial spread and serious hospital outbreaks, we thought it prudent to put these ILI patients in single rooms. 9,10 Since the viral etiology of ILIs was known by PCR, it was thought that cohorting would decrease the bed burden, but cohorting was of limited value because ILIs of the same type were not in hospital at the same time. Single room availability was further limited by the prolonged LOS of some ILI viruses-for example, RSV (8.1 days) and R/E (8 days).…”

Infections Requiring Hospitalization in Patients on Hemodialysis

“…The ILI data compiled by the Centers for Disease Control and Prevention (CDC) on the basis of a sample of 2900 outpatient health care providers in all states, representing .30 million patient visits each year, show wide variation in the timing and strength of each (presumed) influenza season. ILI, defined as "fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat without a known cause other than influenza," is a commonly encountered clinical entity (11)(12)(13)(14). Although the CDC data provide weekly estimates of the percentage of all outpatient visits caused by ILI at a national level, some studies (11)(12)(13)(14) suggest that considerably ,50%, perhaps as low as 20%, of such clinical syndromes may be caused by true influenza.…”

“…ILI, defined as "fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat without a known cause other than influenza," is a commonly encountered clinical entity (11)(12)(13)(14). Although the CDC data provide weekly estimates of the percentage of all outpatient visits caused by ILI at a national level, some studies (11)(12)(13)(14) suggest that considerably ,50%, perhaps as low as 20%, of such clinical syndromes may be caused by true influenza. ILI, therefore, probably reflects a set of clinical symptoms that can be caused by a large number of viruses infecting the upper and lower respiratory tracts, including rhinovirus, adenovirus, respiratory syncytial virus, parainfluenza virus, and human metapneumovirus.…”