Prevalence and Incidence Rates in Older Adults
The prevalence of respiratory syncytial virus (RSV) in older adults is a significant public health issue, affecting both those living in the community and in care facilities. Prevalence rates can vary depending on the study population and setting. A meta-analysis in high-income countries estimated that RSV accounted for 4.66% of symptomatic respiratory infections in older adults year-round, rising to 7.80% during seasonal periods. Among outpatients with acute respiratory illness, RSV positivity has been reported between 5.2% and 14.9%.
Hospitalization rates for RSV in adults 65 and older range from 136.9 to 255.6 per 100,000 annually, increasing significantly with age. For those 85 and older, this rate can be as high as 666.2 per 100,000 person-years. This highlights a growing risk of severe outcomes with advanced age.
Burden on Healthcare Systems: Hospitalizations and Outcomes
RSV places a substantial burden on healthcare systems due to hospitalizations and severe outcomes in older adults. Key insights regarding hospitalizations for adults aged 60 and older in the US during the 2022–2023 RSV season are available from {Link: CDC https://www.cdc.gov/mmwr/volumes/72/wr/mm7240a1.htm}.
Comparison: RSV vs. Seasonal Influenza in Older Adults
RSV in older adults presents a burden comparable to or potentially greater than seasonal influenza. The table below outlines key points of comparison:
| Characteristic | RSV in Older Adults | Seasonal Influenza in Older Adults |
|---|---|---|
| Symptom Severity | Can cause severe lower respiratory tract infections, pneumonia, and exacerbate chronic conditions. | Can also lead to severe respiratory infections and complications. |
| Hospitalization Rate | Rates increase significantly with age, especially over 75. | Also increases with age and comorbidities, with a comparable overall burden. |
| ICU Admission | Significant rates of ICU admission reported in hospitalized cohorts. | Comparable rates of ICU admission reported in hospitalized cohorts. |
| In-Hospital Mortality | Variable, with recent US data showing around 4.7% among hospitalized patients aged 60+. Other data reports rates up to 8.18%. | Often similar to RSV, with comparable in-hospital mortality rates. |
| Complications | Can worsen existing conditions like COPD, CHF, and asthma. | Also known to exacerbate pre-existing heart and lung conditions. |
| Incidence Pattern | Seasonal outbreaks typically occur in the winter, often preceding influenza. | Seasonal outbreaks in winter, but typically follow RSV. |
| Testing Challenges | Diagnosis can be difficult due to symptom overlap and potentially diminished viral presence in older adults. | Diagnosis is also challenged by symptom overlap with other respiratory viruses. |
Risk Factors for Severe RSV in Older Adults
Several factors increase the risk of severe RSV in older adults:
- Advanced Age: Risk increases with age, particularly for individuals over 75.
- Chronic Medical Conditions: Pre-existing conditions like COPD, asthma, CHF, diabetes, and kidney or liver disease elevate risk.
- Weakened Immune System: Immunocompromised individuals are at much higher risk.
- Living in Long-Term Care Facilities: Residents of LTCFs are highly susceptible to outbreaks and severe outcomes.
- Neuromuscular Conditions: Conditions affecting airway clearance or respiratory muscles increase risk.
Prevention and The Future of RSV Management
Recent developments include new tools for preventing severe RSV in older adults. The CDC recommends that adults aged 60 and older, especially those with risk factors, discuss RSV vaccination with their doctor. New RSV vaccines are available and have shown high efficacy against severe disease. Increasing awareness and implementing targeted prevention strategies are vital to reduce the burden of RSV. As the global population ages, recognizing the importance of RSV in older adults and prioritizing vaccination will be crucial for public health.
Conclusion
RSV prevalence in older adults is a significant concern, with incidence and severity increasing substantially with age and underlying health conditions. It is a major cause of hospitalization and mortality in this population, comparable to seasonal influenza. With growing awareness and the availability of effective vaccines, healthcare providers and older adults can now take proactive steps to mitigate the risk of severe disease and protect vulnerable individuals. Continued surveillance and education are essential to address this underappreciated public health threat.
