Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: Risk factors, symptomatology and clinical course compared to influenza A / B and the original SARS-CoV-2 strain

Andreas Ambrosch; Doris Luber; Frank Klawonn; Michael Kabesch

doi:10.1016/j.jcv.2023.105399

Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: Risk factors, symptomatology and clinical course compared to influenza A / B and the original SARS-CoV-2 strain

J Clin Virol. 2023 Apr:161:105399. doi: 10.1016/j.jcv.2023.105399. Epub 2023 Feb 14.

Authors

Andreas Ambrosch¹, Doris Luber², Frank Klawonn³, Michael Kabesch⁴

Affiliations

¹ Institute of Laboratory Medicine, Microbiology and Infection Prevention, Hospital of the Merciful Brothers, Regensburg, Germany. Electronic address: andreas.ambrosch@barmherzige-regensburg.de.
² Institute of Laboratory Medicine, Microbiology and Infection Prevention, Hospital of the Merciful Brothers, Regensburg, Germany.
³ Biostatistic Research Group, Helmholtz Center for Infection Research, Braunschweig, Germany; Institute for Information Engineering, Ostfalia University, Wolfenbüttel, Germany.
⁴ Clinic and Policlinic for Children and Youth Medicine of the University of Regensburg (KUNO) at the Clinic St. Hedwig, Merciful Brothers Regensburg, Germany; Science Development Campus Regensburg (WECARE) at the Clinic St. Hedwig, Regensburg, Germany.

Abstract

Background: The role and impact of RSV in the adult population is not well understood and comparative data of RSV infection, influenza A/B and SARS-CoV-2 in the elderly hospitalized for respiratory infections is limited.

Methods: In a retrospective, monocentric study we analyzed data of adult patients with respiratory infections tested positive by PCR for RSV, Influenza A/B and SARS-CoV-2 over a four-year period from 2017 to 2020. Symptoms on admission, laboratory results, and risk factors were assessed, and the clinical course and outcomes were studied.

Results: A total of 1541 patients hospitalized with respiratory disease and PCR positive for one of the 4 viruses were enrolled in the study. RSV was the second most prevalent virus before the COVID-19 pandemic and RSV patients represent the oldest group in this study with an average age of 75 years. Neither clinical nor laboratory characteristics differ clearly between RSV, Influenza A / B and SARS-CoV-2 infections. Up to 85% of patients had risk factors, with COPD and kidney disease found particularly frequently in RSV infections. Hospital stay was 12.66 days for RSV patients and thus significantly longer than for influenza A / B (10.88 and 8.86, respectively, p < 0.001), but shorter than for SARS-CoV-2 (17.87 days, p < 0.001). The risk for ICU admission and the rate of mechanical ventilation were also higher for RSV than for influenza A (OR 1.69 (p = 0.020) and 1.59 (p = 0.050)) and influenza B: (1.98 (p = 0.018) and 2.33 (p < 0.001)), but lower than for SARS-CoV-2 (0.65 (p < 0.001) and 0.59 (p = 0.035)). The risk of hospital mortality for RSV was increased compared with influenza A (1.55 (p = 0.050)) and influenza B (1.42 (p = 0.262)), but lower compared to SARs-CoV-2 (0.37 (p < 0.001).

Conclusion: RSV infections in elderly are frequent and more severe than those with influenza A/B. While the impact of SARS-CoV-2 most likely decreased in the elderly population due to vaccination, RSV can be expected to continue to be problematic for elderly patients, especially those with comorbidities and thus, more awareness on the disastrous impact of RSV in this age group is urgently needed.

Keywords: Elderly; Influenza A/B; RSV; SARS-CoCV-2; Severe respiratory infections.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
COVID-19* / epidemiology
Disease Progression
Humans
Influenza, Human*
Pandemics
Respiratory Syncytial Virus Infections* / diagnosis
Respiratory Syncytial Virus, Human*
Respiratory Tract Infections*
Retrospective Studies
Risk Factors
SARS-CoV-2