The disease burden of respiratory syncytial virus in older adults

Abstract

Purpose of review To highlight the respiratory syncytial virus (RSV) disease burden and the current developments and challenges in RSV prevention for older adults ≥60 years through analysis of RSV epidemiology and the effectiveness of emerging vaccines. Recent findings In industrialized countries, RSV incidence rates and hospitalization rates among older adults are estimated to be 600.7 cases per 100 000 person-years and 157 hospitalizations per 100 000 person-years, respectively. Yet, accurately determining RSV morbidity and mortality in older adults is challenging, thus resulting in substantially under-estimating the disease burden. The in-hospital fatality rates vary substantially with age and geographies, and can be as high as 9.1% in developing countries. Two promising RSV vaccines for the elderly have been approved, demonstrating efficacies of up to 94.1%, signifying considerable advancement in RSV prevention. However, concerns over potential side effects remain. Summary RSV is associated with a significant burden in older adults. While the landscape of RSV prevention in older adults is promising with the licensure of vaccines from two companies, current trial data underscore the need for additional studies. Addressing the real-world effectiveness of these vaccines, understanding potential rare side effects, and ensuring broad inclusivity in future trials are crucial steps to maximize their potential benefits.

Vaccines for the Elderly and Vaccination Programs in Europe and the United States

“…The impact of RSV in the elderly can be similar to that of seasonal influenza, with the most severe consequences in nursing homes, where annual attack rates reach 5–10%, with significant rates of pneumonia (10–20%) and death (2–5%) [ 133 ]. The in-hospital fatality rates related to RSV infections can be as high as 9.1% in developing countries [ 134 ]. Published estimates of RSV incidence and prevalence in older adults vary widely and are most likely underestimated [ 135 ].…”

“…It is estimated that between 60,000 and 160,000 older adults in the US are hospitalized and 6000–10,000 die due to RSV infection each year [ 137 ]. Yet, accurately determining RSV morbidity and mortality in older adults is challenging, thus resulting in a substantial under-estimation of the disease burden [ 134 ]. Given the significant burden of RSV-related disease in the elderly, there is an urgent need to develop an effective vaccination strategy, which is why WHO has prioritized the development of an RSV vaccine, emphasizing the importance of vaccination in the adult age [ 138 , 139 ].…”

COVID-19, Influenza, and RSV in Children and Adults: A Clinical Comparative Study of 12,000 Cases

“…RSV is a common respiratory virus in infants, often presenting mild cold-like symptoms in adults but potentially causing severe bronchiolitis in children, increasing hospitalization and mortality rates in younger age groups [ 3 , 11 , 12 ]. Since the 1970s, research has intensified around RSV infections in the elderly, indicating higher risks and potential severe cardiac and pulmonary complications [ 13 , 14 , 15 ]. With the global increase in life expectancy, RSV demands further research due to its significant impact on vulnerable populations.…”

“…Investigations into the severity of infections caused by COVID-19, FLU, and RSV have predominantly concentrated on pediatric and adult populations independently, often scrutinizing the effects of either individual viruses or their combined impact [ 2 , 4 , 6 , 7 , 8 , 10 , 11 , 13 , 16 , 17 , 18 , 19 ]. Notwithstanding, comparative analyses delineating the clinical manifestations of these pathogens among individuals younger than 18 versus those of adults remain markedly limited.…”

RSV Infection in Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis

“…When dealing with the global burden of RSV and with RSV-associated direct and indirect costs, it is important to stress that RSV also affects older individuals [ 33 , 34 , 35 , 36 ]. In the European Union alone, it causes around 160,000 hospitalizations annually in adults aged ≥ 18 years, with 92% of cases involving adults aged ≥ 65 years [ 37 ], for a corresponding hospitalization rate of around 157 per 100,000 [ 38 ]; however, these figures are reasonably underestimate because of the low rate of testing in adults elderly. Even though COVID-19 pandemic was associated with a substantial decrease in global rates for RSV-associated hospitalization (−79.7% in high income countries, −13.8% in upper-middle-income countries), post-pandemic seasons were associated with a sustained rebound of incidence estimates, with increased healthcare-associated costs [ 37 , 39 , 40 ].…”