Severity of RSV infection in Southern European elderly patients during two consecutive winter seasons (2017–2018)

Abstract

In Europe, the respiratory syncytial virus (RSV) surveillance system is very heterogeneous and there is growing evidence of the importance of RSV infections resulting in hospitalization of elderly patients. The aim of this study was to assess the severity of RSV infection in the elderly living in the aged Southern European countries. We conducted a retrospective study of elderly patients ( ≥65‐year old) admitted for laboratory‐confirmed RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons (2017–2018). Uni‐multivariable analyses were carried out to evaluate the effect of clinical variables on radiologically confirmed pneumonia, use of noninvasive ventilation (NIV), and in‐hospital death (IHD). A total of 166 elderly patients were included. Pneumonia was evident in 29.5%. NIV was implemented in 16.3%, length of stay was 11.8 ± 12.2 days, and IHD occurred in 12.1%. Multivariable analyses revealed that the risk of pneumonia was higher in patients with chronic kidney disease (CKD) (odds ratio [OR]: 2.57; 95% confidence interval [CI]: 1.12–5.91); the use of NIV was higher in patients with obstructive sleep apnea or obesity hypoventilation syndrome (OSA or OHS) (OR: 5.38; 95% CI: 1.67–17.35) and CKD (OR: 2.52; 95% CI: 1.01–6.23); the risk of IHD was higher in males (OR: 3.30; 95% CI: 1.07–10.10) and in patients with solid neoplasm (OR: 9.06; 95% CI: 2.44–33.54) and OSA or OHS (OR: 8.39; 95% CI: 2.14–32.89). Knowledge of factors associated with RSV infection severity may aid clinicians to set priorities and reduce disease burden. Development of effective antiviral treatment and vaccine against RSV is highly desirable.

Estimation of the number of RSV-associated hospitalisations in adults in the European Union

“…Our estimates, based on the available data, suggest a high burden of RSV in terms of hospital admissions in adult populations. Several studies have previously reported the burden and severity of clinical outcomes of RSV among adults in different settings [7,9,10,[27][28][29][30]. For instance, in previous studies, the prevalence of RSV has been reported to be two times higher in patients aged over 75 years compared to those aged below 60 years [31].…”

Clinical and Socioeconomic Burden of Respiratory Syncytial Virus in Iceland

“…Finally, it is becoming increasingly clear that RSV is not only a pediatric disease but also the cause of severe respiratory infections in the elderly, often leading to intensive care admission and even death. 39,40 Although the data are reliable for the Icelandic population, caused by the small size and strong healthcare infrastructure for children the results may not be representative for other countries.…”

Review of respiratory syncytial virus infection among older adults and transplant recipients

“…OSA and OHS also conferred a mortality risk as did solid malignancies. 10 Over the same time frame, Boattini et al also studied hospitalized adults >85 years of age with community-acquired or nosocomial RSV and reported that COPD or asthma were associated with findings of pneumonia in the study population; COPD or asthma, RSV, and influenza B resulted in greater use of NIV. Another stark finding of this study is the reported mortality risk due to CKD.…”