Respiratory syncytial virus (RSV) has not been widely studied in the outpatient, adult setting, as symptoms have been similar to other respiratory infections and the biggest burden of disease were seen in severely ill, hospitalized patients. But the recent introduction of RSV vaccines has begged for a new understanding of RSV’s burden among older, community-dwelling adults.
Two studies published earlier this month in Clinical Infectious Diseases assess the prevalence and burden of RSV among older adults (60 years and older) in six European nations (Finland, Germany, Italy, Poland, Spain and the United Kingdom) across three consecutive RSV seasons (October 2021 through April 2024).
The studies were both conducted by an international team of researchers called the RSV-019 study group.
Shortness of breath, productive cough common
The first study, which measured the prevalence of the virus, showed that community-confirmed RSV acute respiratory infection (ARI) ranged from 2.9% to 7.1% among 2,573 participants who were enrolled (139 with confirmed RSV-ARI).
The 2.9% came in the 2021-22 season, when RSV activity was still suppressed from COVID-19 pandemic restrictions. The highest prevalence, 7.1%, came the following year, when RSV infections skyrocketed in Europe and North America. During season 3, 2023 to 2024, the prevalence decreased to 4.2%
RSV was not linked to an increase in complications among those with mild to severe infections, It was, however, more often associated with dyspnea (shortness of breath; 59.6% vs 41.0%) and sputum production (72.8% vs 61.6%) than was ARI caused by other viruses, and had a distinct symptomology. The most frequently reported upper respiratory, lower respiratory, and systemic symptoms were nasal congestion/runny nose, cough, and fatigue, at similar levels as non-RSV ARI.
“Clinically diagnosing RSV infection in adults, without laboratory confirmation is difficult, as shown by our observation that only sputum production and dyspnea showed a difference >10% between participants with cRSV-ARI and participants with non-cRSV-ARI,” the authors said.
Of note, RSV patients reported lingering symptoms, including productive cough, for a median of 21 days.
Antibiotics often prescribed
That duration likely affected the findings of the second study, which demonstrated diminished health-related quality of life in RSV patients.
Using the same data from the first study, this analysis found that RSV patients with a median duration of two to 19 days of symptoms would see their physician a mean of 1.33 times, rising to 1.83 times in those 80 and older. The authors also found that 64.7% of them were prescribed antibiotics for a mean duration of 16.3 days. Often a second course of antibiotics was introduced, the authors said.
These reports suggest that RSV vaccines can prevent moderate illnesses and may provide significant benefits to our patients such reduced days of lost productivity or quality of life.
In a commentary on both studies, Angela Branche, MD, wrote, “These reports suggest that RSV vaccines can prevent moderate illnesses and may provide significant benefits to our patients such reduced days of lost productivity or quality of life, but also critically important healthcare utilization impacts such as decreased antibiotic prescription and the downstream effects of antibiotic overuse.”
