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This prospective multicenter study compared the disease severity among 5784 adults aged ≥60 years hospitalized with acute respiratory illnesses resulting from respiratory syncytial virus (RSV) infection, COVID-19, or influenza between February 2022 and May 2023. Compared with COVID-19 and influenza, RSV infection was associated with a higher risk of ICU admission. RSV infection was also associated with increased invasive mechanical ventilation and death compared with influenza. RSV-associated hospital admissions were notably less frequent than COVID-19–associated and influenza-associated hospitalizations.
The present study adds to a growing body of literature describing the significant healthcare impact of RSV by offering an important comparison with other common viral illnesses. Clinicians should discuss vaccination against RSV among adults aged ≥60 years.
On June 21, 2023, CDC's Advisory Committee on Immunization Practices recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥60 years, offered to individual adults using shared clinical decision-making. Informed use of these vaccines requires an understanding of RSV disease severity. To characterize RSV-associated severity, 5,784 adults aged ≥60 years hospitalized with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 U.S. states during February 1, 2022-May 31, 2023. Multivariable logistic regression was used to compare RSV disease severity with COVID-19 and influenza severity on the basis of the following outcomes: 1) standard flow (<30 L/minute) oxygen therapy, 2) high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV), 3) intensive care unit (ICU) admission, and 4) invasive mechanical ventilation (IMV) or death. Overall, 304 (5.3%) enrolled adults were hospitalized with RSV, 4,734 (81.8%) with COVID-19 and 746 (12.9%) with influenza. Patients hospitalized with RSV were more likely to receive standard flow oxygen, HFNC or NIV, and ICU admission than were those hospitalized with COVID-19 or influenza. Patients hospitalized with RSV were more likely to receive IMV or die compared with patients hospitalized with influenza (adjusted odds ratio = 2.08; 95% CI = 1.33-3.26). Among hospitalized older adults, RSV was less common, but was associated with more severe disease than COVID-19 or influenza. High disease severity in older adults hospitalized with RSV is important to consider in shared clinical decision-making regarding RSV vaccination.
Disease Severity of Respiratory Syncytial Virus Compared with COVID-19 and Influenza Among Hospitalized Adults Aged ≥60 Years - IVY Network, 20 U.S. States, February 2022-May 2023
MMWR Morb. Mortal. Wkly. Rep. 2023 Oct 06;72(40)1083-1088, D Surie, KA Yuengling, J DeCuir, Y Zhu, M Gaglani, AA Ginde, HK Talbot, JD Casey, NM Mohr, S Ghamande, KW Gibbs, DC Files, DN Hager, H Ali, ME Prekker, MN Gong, A Mohamed, NJ Johnson, JS Steingrub, ID Peltan, SM Brown, AM Leis, A Khan, CL Hough, WS Bender, A Duggal, JG Wilson, N Qadir, SY Chang, C Mallow, JH Kwon, MC Exline, AS Lauring, NI Shapiro, C Columbus, IA Vaughn, M Ramesh, B Safdar, N Halasa, JD Chappell, CG Grijalva, A Baughman, TW Rice, KN Womack, JH Han, SA Swan, I Mukherjee, NM Lewis, S Ellington, ML McMorrow, ET Martin, WH Self