Respiratory syncytial virus: a sleeping giant?

Abstract

The study by Jansen et al. 1 in the present issue of the European Respiratory Journal focuses on the impact of influenza and respiratory syncytial virus (RSV) on mortality and hospital admissions. As in many other similar publications, it emphasises the significance of RSV (and influenza) in all age groups and not just children, in whom the impact is already well recognised 1. In common with other similar studies, the evidence presented is derived by linking independent data on virus circulation (mainly from specimens sampled in children) with data on healthcare utilisation. As such, it falls short of direct linkage between cause and effect, although this has been demonstrated in experimental studies, which have included wild-type virus in addition to low temperature attenuated strains. In one of these studies, McKay et al. 2 administered wild-type virus to 20 human volunteers, and nine of them developed upper respiratory tract symptoms. In community-based observational cohort studies between 1977 and 1981, Monto and Sullivan 3 demonstrated average RSV isolation rates of 56 per 100 person-yrs in children aged 0–4 yrs, seven in those aged 5–19 yrs and somewhat less in older people. RSV demonstrated a clearer seasonality than other viruses studied. Zambon et al . 4 identified RSV in nose/throat virology specimens from community-based persons of all ages with influenza-like illness. Several studies have shown high rates of laboratory-confirmed infection in older people and especially in persons with chronic respiratory disease 5, 6. Basing their findings on serological studies, Dowell et al. 5 considered RSV to be one of the four most common pathogens identified in cases of lower respiratory tract infection in hospitalised adults, but went on to comment that none of the 57 cases of RSV infection included in the study were diagnosed during their period of hospitalisation. In an excellent …