Ryan E Malosh1, Emily T Martin2, Amy P Callear3, Joshua G Petrie3, Adam S Lauring4, Lois Lamerato5, Alicia M Fry6, Jill Ferdinands6, Brendan Flannery5, Arnold S Monto3. 1. University of Michigan School of Public Health, Ann Arbor, MI, United States. Electronic address: rmalosh@umich.edu. 2. University of Michigan School of Public Health, Ann Arbor, MI, United States. Electronic address: etmartin@umich.edu. 3. University of Michigan School of Public Health, Ann Arbor, MI, United States. 4. University of Michigan Medical School, Ann Arbor, MI, United States. 5. Henry Ford Health System, Detroit, MI, United States. 6. Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Abstract
BACKGROUND: The importance of Respiratory Syncytial Virus (RSV) is increasingly recognized in hospitalized adults, but mainly in those ≥ 65 years. OBJECTIVES: We sought to describe the epidemiology and clinical severity of RSV compared to influenza in hospitalized adults ≥18 years. STUDY DESIGN: Adults hospitalized with acute respiratory illnesses (ARI) of ≤10days duration were prospectively enrolled from two Michigan hospitals during two influenza seasons. Collected specimens were tested for RSV and influenza by real-time, reverse transcription polymerase chain reaction (RT-PCR). Viral load and subtype were determined for RSV-positive specimens. We evaluated factors associated with RSV and outcomes of infection using multivariable logistic regression. RSV-positive patients were separately compared to two reference groups: RSV-negative and influenza-negative, and influenza-positive patients. RESULTS: RSV was detected in 84 (7%) of 1259 hospitalized individuals (55 RSV-B, 29 RSV-A). The highest prevalence was found in 50-64year olds (40/460; 8.7%); 98% of RSV cases in this age group had at least one chronic comorbidity. RSV detection was associated with obesity (OR: 1.71 95% CI: 0.99-3.06, p=0.03). Individuals with RSV were admitted to the hospital later in their illness and had a higher median Charlson comborbidity index (3 vs 2 p<0.001) compared to those with influenza. Clinical severity of RSV-associated hospitalizations was similar to influenza-associated hospitalizations. DISCUSSION: In this study we observed the highest frequency of RSV-associated hospitalizations among adult 50-64 years old; many of whom had chronic comorbidities. Our results suggest the potential benefit of including these individuals in future RSV vaccination strategies.
BACKGROUND: The importance of Respiratory Syncytial Virus (RSV) is increasingly recognized in hospitalized adults, but mainly in those ≥ 65 years. OBJECTIVES: We sought to describe the epidemiology and clinical severity of RSV compared to influenza in hospitalized adults ≥18 years. STUDY DESIGN: Adults hospitalized with acute respiratory illnesses (ARI) of ≤10days duration were prospectively enrolled from two Michigan hospitals during two influenza seasons. Collected specimens were tested for RSV and influenza by real-time, reverse transcription polymerase chain reaction (RT-PCR). Viral load and subtype were determined for RSV-positive specimens. We evaluated factors associated with RSV and outcomes of infection using multivariable logistic regression. RSV-positive patients were separately compared to two reference groups: RSV-negative and influenza-negative, and influenza-positive patients. RESULTS:RSV was detected in 84 (7%) of 1259 hospitalized individuals (55 RSV-B, 29 RSV-A). The highest prevalence was found in 50-64year olds (40/460; 8.7%); 98% of RSV cases in this age group had at least one chronic comorbidity. RSV detection was associated with obesity (OR: 1.71 95% CI: 0.99-3.06, p=0.03). Individuals with RSV were admitted to the hospital later in their illness and had a higher median Charlson comborbidity index (3 vs 2 p<0.001) compared to those with influenza. Clinical severity of RSV-associated hospitalizations was similar to influenza-associated hospitalizations. DISCUSSION: In this study we observed the highest frequency of RSV-associated hospitalizations among adult 50-64 years old; many of whom had chronic comorbidities. Our results suggest the potential benefit of including these individuals in future RSV vaccination strategies.
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