Abstract
BackgroundGrowing evidence suggests respiratory syncytial virus (RSV) is an important cause of respiratory disease in adults. However, the adult burden remains largely uncharacterized as most RSV studies focus on children, and population-based studies with laboratory-confirmation of infection are difficult to implement. Indirect modelling methods, long used for influenza, can further our understanding of RSV burden by circumventing some limitations of traditional surveillance studies that rely on direct linkage of individual-level exposure and outcome data.MethodsMultiple linear time-series regression was used to estimate RSV burden in the United Kingdom (UK) between 1995 and 2009 among the total population and adults in terms of general practice (GP) episodes (counted as first consultation ≥28 days following any previous consultation for same diagnosis/diagnostic group), hospitalisations, and deaths for respiratory disease, using data from Public Health England weekly influenza/RSV surveillance, Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics. The main outcome considered all ICD-listed respiratory diseases and, for GP episodes, related symptoms. Estimates were adjusted for non-specific seasonal drivers of disease using secular cyclical terms and stratified by age and risk group (according to chronic conditions indicating severe influenza risk as per UK recommendations for influenza vaccination). Trial registration NCT01706302. Registered 11 October 2012.ResultsAmong adults aged 18+ years an estimated 487,247 GP episodes, 17,799 hospitalisations, and 8,482 deaths were attributable to RSV per average season. Of these, 175,070 GP episodes (36 %), 14,039 hospitalisations (79 %) and 7,915 deaths (93 %) were in persons aged 65+ years. High- versus low-risk elderly were two-fold more likely to have a RSV-related GP episode or death and four-fold more likely be hospitalised for RSV. In most seasons since 2001, more GP episodes, hospitalisations and deaths were attributable to RSV in adults than to influenza.ConclusionRSV is associated with a substantial disease burden in adults comparable to influenza, with most of the hospitalisation and mortality burden in the elderly. Treatment options and measures to prevent RSV could have a major impact on the burden of RSV respiratory disease in adults, especially the elderly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1218-z) contains supplementary material, which is available to authorized users.
Highlights
Growing evidence suggests respiratory syncytial virus (RSV) is an important cause of respiratory disease in adults
In addition to cardiorespiratory disease and other subcategories of respiratory disease, we examined the RSV-attributable burden associated with the selected antibiotic prescriptions (GP episodes only)
Model fit With few exceptions RSV infection is reported in the United Kingdom (UK) solely in winter months and our study was confined to the winter period between September and mid-May
Summary
Growing evidence suggests respiratory syncytial virus (RSV) is an important cause of respiratory disease in adults. In a study in the United States (US), symptomatic RSV infection was detected annually in 3-7 % of 608 healthy community-living persons aged 65+ years followed for four years, and 813 % of 1388 patients hospitalised for acute respiratory infections during the same period [5]. In another prospective study conducted in 14 countries, RSV was detected among 7.4 % of 556 episodes of moderate-to-severe influenza-like-illness in elderly adults [8]. Other research suggests that age-related defects in cell-mediated immunity to RSV may lead to increased susceptibility and severe disease in older individuals [9, 10]
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