Respiratory syncytial virus vs. Influenza virus infection: mortality and morbidity comparison over 7 epidemic seasons in an elderly population

C Recto; S Fourati; M Khellaf; J-M Pawlotsky; N De Prost; H Diakonoff; C Donadio; L Pouga; C de Tymowski; C Kassasseya

doi:10.1093/infdis/jiae171

Respiratory syncytial virus vs. Influenza virus infection: mortality and morbidity comparison over 7 epidemic seasons in an elderly population

J Infect Dis. 2024 Apr 4:jiae171. doi: 10.1093/infdis/jiae171. Online ahead of print.

Authors

C Recto¹, S Fourati², M Khellaf³, J-M Pawlotsky², N De Prost^{4

5}, H Diakonoff⁶, C Donadio⁷, L Pouga², C de Tymowski⁸, C Kassasseya³

Affiliations

¹ AP-HP, Henri Mondor University Hospital, Department of Internal Medicine and Geriatrics, F-94010 Creteil's Paris-Est University, Creteil, France.
² Virology Department, Henri Mondor University Hospital, Paris-Est University and INSERM U955. Creteil's Paris-Est University, Creteil, France.
³ Emergency Department, APHP, Henri Mondor University Hospital, Paris EST Creteil University, Creteil, France.
⁴ Service de Medecine Intensive Reanimation, Hopitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hopitaux de Paris (AP-HP), 94010, Creteil, France.
⁵ Groupe de Recherche Clinique CARMAS, Creteil's Paris-Est University, Creteil, France.
⁶ Institution Nationale des Invalides, Paris, France. Institut Droit et Santé, Inserm UMR_S 1145, Université Paris Cité, France.
⁷ University Hospital Pitié-Salpêtrière- Charles Foix, Geriatric's Department, AP-HP, Sorbonne University, Paris, France.
⁸ Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, AP-HP, Hôpital Bichat, F-75018 Paris, France.

PMID: 38574192
DOI: 10.1093/infdis/jiae171

Abstract

Background: Respiratory syncytial virus (RSV) infection is gaining interest due to the recent development of vaccines, but it is still misdiagnosed in the elderly. The primary objective was to compare all-cause mortality at day 30. Secondary objectives were to compare clinical presentation, and rates of consolidative pneumonia, hospitalization, and intensive care unit (ICU) admission.

Methods: Single-centre retrospective study conducted in a French university hospital during 7 epidemic seasons. All patients aged ≥75 years were included.

Results: 558 patients were included: 125 with RSV and 433 with Influenza. Median age was 84.8 years. RSV patients had more respiratory symptoms (wheezing, dyspnea), whereas Influenza patients had more general symptoms (fever, asthenia, myalgia). Consolidative pneumonia (28.8% vs. 17.2%; p = 0.004), hospitalization rates (83.2% vs. 70%; p = 0.003), ICU admissions (7.2% vs. 3.0%; p = 0.034) and length of stay (9 days [2-16] vs. 5 days [0-12]; p = 0.002), were higher in the RSV group. Mortality rates at day 30 were comparable (RSV 9.6%, Influenza 9.7%; p = 0.973).

Conclusions: This study included the largest cohort of RSV-infected patients aged over 75, documented in-depth thus far. RSV shares a comparable mortality rate with Influenza but is associated with higher rates of consolidative pneumonia, hospitalization, ICU admissions, and extended hospital stays.

Keywords: Influenza virus; Respiratory syncytial virus; elderly; lower tract respiratory infection (LTRI); mortality; pneumonia.

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