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Review
. 2017 Aug 10;12(8):e0182321.
doi: 10.1371/journal.pone.0182321. eCollection 2017.

The epidemiology of medically attended respiratory syncytial virus in older adults in the United States: A systematic review

Ann D Colosia  1 , Jin Yang  1 , Eric Hillson  2 , Josephine Mauskopf  1 , Catherine Copley-Merriman  1 , Vivek Shinde  2 , Jeffrey Stoddard  2
Affiliations
Review

The epidemiology of medically attended respiratory syncytial virus in older adults in the United States: A systematic review

Ann D Colosia et al. PLoS One. .

Abstract

Objective: This review was undertaken to assess the historical evidence of the disease incidence and burden of laboratory-confirmed respiratory syncytial virus (RSV) in medically attended older adults.

Design: A qualitative systematic literature review was performed; no statistical synthesis of the data was planned, in anticipation of expected heterogeneity across studies in this population.

Methods: A literature search of PubMed, Embase, and the Cochrane Library was conducted for studies of medically attended RSV in older adults (≥ 50 years) published in the last 15 years. Two independent reviewers screened titles and abstracts based on predefined inclusion and exclusion criteria.

Results: From 10 studies reporting incidence proportions, RSV may be the causative agent in up to 12% of medically attended acute respiratory illness in older adults unselected for comorbidities, with variations in clinical setting and by year. In multiple studies, medically attended-RSV incidence among older adults not selected for having underlying health conditions increased with increasing age. Of prospectively followed lung transplant recipients, 16% tested positive for RSV. In hospitalized adults with chronic cardiopulmonary diseases, 8% to 13% were infected with RSV during winter seasons (8%-13%) or metapneumovirus season (8%). Hospitalizations for RSV in older adults typically lasted 3 to 6 days, with substantial proportions requiring intensive care unit admission and mechanical ventilation. Among older adults hospitalized with RSV, the mortality rate was 6% to 8%.

Conclusions: Protection of older adults against RSV could reduce respiratory-related burden, especially as age increases and the prevalence of comorbidities (especially cardiopulmonary comorbidities) grows.

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Conflict of interest statement

Competing Interests: VS is and EH and JS were full-time employees of Novavax, Inc., a company engaged in latestage development of RSV vaccines. ADC, JY, CCM, and JM are employees of RTI International, a nonprofit consulting company that received funding from Novavax for this project. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA diagram.
PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Fig 2
Fig 2. Incidence rates for medically attended RSV for age-specific populations by type of RSV medical encounter.
CAP = community-acquired pneumonia; ED = emergency department; HCP = health care provider; RSV = respiratory syncytial virus. a In Fowlkes et al. [17], surveillance was conducted in 57 HCP practices in 12 sites, including nine states (Florida, Iowa, Minnesota, New Jersey, North Dakota, Oregon, Utah, Virginia, and Wisconsin) and three jurisdictions (Los Angeles County, New York City, and Philadelphia).
Fig 3
Fig 3. Mortality due to RSV in older adults from special populations, by population and clinical setting.
ARI = acute respiratory illness; ED = emergency department; LTC = long-term care; RSV = respiratory syncytial virus. Note: The case fatality ratio in the bottom right panel of the figure shows the proportion of RSV-positive older adults who died. a Two deaths and one patient discharged to hospice. b Sample size not reported.
See this image and copyright information in PMC

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MeSH terms

Grants and funding

The funding for this research was provided by Novavax to RTI-Health Solutions (ADC, JY, JM, CCM). JS, VS and EH were employed by Novavax at the time the study was performed. JS and VS assisted with the formulation of the research questions and search strategy and JS, VS, and EH assisted with the interpretation of the review findings and the preparation of the manuscript. The decision to publish was made jointly by RTI-HS and Novavax.