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Publications

Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Epublish 83 citations

PubMed: 39535791 DOI: 10.1001/jamanetworkopen.2024.44756

Burden of Respiratory Syncytial Virus-Associated Hospitalizations in US Adults, October 2016 to September 2023.

JAMA Netw Open 7(11):e2444756

Authors: Fiona P Havers, Michael Whitaker, Michael Melgar, Huong Pham, Shua J Chai, Elizabeth Austin, James Meek, Kyle P Openo, Patricia A Ryan, Chloe Brown, Kathryn Como-Sabetti, Daniel M Sosin, Grant Barney, Brenda L Tesini, Melissa Sutton, H Keipp Talbot, Ryan Chatelain, Pam Daily Kirley, Isaac Armistead, Kimberly Yousey-Hindes, Maya L Monroe, Val Tellez Nunez, Ruth Lynfield, Chelsea L Esquibel, Kerianne Engesser, Kevin Popham, Arilene Novak, William Schaffner, Tiffanie M Markus, Ashley Swain, Monica E Patton, Lindsay Kim

Affiliations

  • National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • US Public Health Service Commissioned Corps, Rockville, Maryland.
  • California Emerging Infections Program, Oakland.
  • Colorado Department of Public Health and Environment, Denver.
  • Connecticut Emerging Infections Program, Yale School of Public Health, New Haven.
  • Emory University School of Medicine, Atlanta, Georgia.
  • Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta.
  • Atlanta Veterans Affairs Medical Center, Decatur, Georgia.
  • Maryland Department of Health, Baltimore.
  • Michigan Department of Health and Human Services, Lansing.
  • Minnesota Department of Health, St Paul.
  • New Mexico Department of Health, Santa Fe.
  • New York State Department of Health, Albany.
  • University of Rochester School of Medicine and Dentistry, Rochester, New York.
  • Public Health Division, Oregon Health Authority, Portland.
  • Vanderbilt University Medical Center, Nashville, Tennessee.
  • Salt Lake County Health Department, Salt Lake City, Utah.
  • University of New Mexico Health Sciences Center, Albuquerque.

Abstract

Importance

Respiratory syncytial virus (RSV) infection can cause severe illness in adults. However, there is considerable uncertainty in the burden of RSV-associated hospitalizations among adults prior to RSV vaccine introduction.

Objective

To describe the demographic characteristics of adults hospitalized with laboratory-confirmed RSV and to estimate annual rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.

Design, Setting, and Participants

This cross-sectional study used data from the RSV Hospitalization Surveillance Network (RSV-NET), a population-based surveillance platform that captures RSV-associated hospitalizations in 58 counties in 12 states, covering approximately 8% of the US population. The study period spanned 7 surveillance seasons from 2016-2017 through 2022-2023. Included cases from RSV-NET were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area and with a positive RSV test result.

Exposure

Laboratory-confirmed RSV-associated hospitalization, defined as a positive RSV test result within 14 days before or during hospitalization.

Main Outcomes and Measures

Hospitalization rates per 100 000 adult population, stratified by age group. After adjusting for test sensitivity and undertesting for RSV in adults hospitalized with acute respiratory illnesses, rates were extrapolated to the US population to estimate annual numbers of RSV-associated hospitalizations. Clinical outcome data were used to estimate RSV-associated ICU admissions and in-hospital deaths.

Results

From the 2016 to 2017 through the 2022 to 2023 RSV seasons, there were 16 575 RSV-associated hospitalizations in adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]). Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when the COVID-19 pandemic affected RSV circulation, hospitalization rates ranged from 48.9 (95% CI, 33.4-91.5) per 100 000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100 000 adults in 2017 to 2018. Rates were lowest among adults aged 18 to 49 years (8.6 [95% CI, 5.7-16.8] per 100 000 adults in 2016-2017 to 13.1 [95% CI, 11.0-16.1] per 100 000 adults in 2022-2023) and highest among adults 75 years or older (244.7 [95% CI, 207.9-297.3] per 100 000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per 100 000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84 000-230 000) in 2016 to 2017 to 193 000 (95% CI, 140 000-311 000) in 2017 to 2018. Annual ICU admission estimates ranged from 24 400 (95% CI, 16 700-44 800) to 34 900 (95% CI, 25 500-55 600) for the same seasons. Estimated annual in-hospital deaths ranged from 4680 (95% CI, 3570-6820) in 2018 to 2019 to 8620 (95% CI, 6220-14 090) in 2017 to 2018. Adults 75 years or older accounted for 45.6% (range, 43.1%-48.8%) of all RSV-associated hospitalizations, 38.6% (range, 36.7%-41.0%) of all ICU admissions, and 58.7% (range, 51.9%-67.1%) of all in-hospital deaths.

Conclusions and Relevance

In this cross-sectional study of adults hospitalized with RSV before the 2023 introduction of RSV vaccines, RSV was associated with substantial burden of hospitalizations, ICU admissions, and in-hospital deaths in adults, with the highest rates occurring in adults 75 years or older. Increasing RSV vaccination of older adults has the potential to reduce associated hospitalizations and severe clinical outcomes.

MeSH

Respiratory Syncytial Viruses, Cross-Sectional Studies, Hospitalization, Vaccines, Aged, Clinical Medicine, Viruses, Satellite Viruses, Intensive Care Units, Respiratory Syncytial Virus Vaccines

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