Abstract
Acute respiratory infections (ARI) constitutes a substantial disease burden in adults and the elderly. We aimed to identify all case-control studies investigating the potential role of respiratory viruses in the etiology of ARI in older adults aged 65 years old or more. We conducted a systematic literature review (across 7 databases) of case-control studies published from 1996 to 2017, which investigated the viral profile of older adults with and without ARI. We then computed a pooled odds ratio (OR) with 95% CI and virus–specific attributable fraction among the exposed (AFE) of 8 common viruses – respiratory syncytial virus (RSV), influenza virus (Flu), parainfluenza virus (PIV), human metapneumovirus (HMPV), adenovirus (AdV), rhinovirus (RV), bocavirus (BoV), and coronavirus (CoV). From the 16 studies included, there was strong evidence for association indicating possible causal attribution for RSV (OR 8.5 (3.9-18.5); AFE 88%), Flu (OR 8.3 (4.4-15.9); AFE 88%), PIV (OR not available (NA); AFE ~100%), HMPV (OR 9.8 (2.3-41.0); AFE 90%), AdV (OR NA; AFE ~100%), RV (OR 7.1 (3.7-13.6); AFE 86%) and CoV (OR 2.8 (2.0-4.1); AFE 65%) in older adults presenting with ARI compared to those without respiratory symptoms (asymptomatic) or healthy older adults. However, there was no significant difference in the detection of BoV in cases and controls. This review supports RSV, Flu, PIV, HMPV, AdV, RV and CoV as important causes of ARI in older adults, and provides quantitative estimates of the absolute proportion of virus–associated ARI cases to which a viral cause can be attributed.
Highlights
From the 16 studies included, there was strong evidence of possible causal attribution for respiratory syncytial virus (RSV) (OR, 8.5 [95% confidence intervals (CIs), 3.9–18.5]; AFE, 88%), Flu (OR, 8.3 [95% CI, 4.4–15.9]; AFE, 88%), parainfluenza virus (PIV) (OR, not available; AFE, approximately 100%), human metapneumovirus (HMPV) (OR, 9.8 [95% CI, 2.3–41.0]; AFE, 90%), AdV (OR, not available; AFE, approximately 100%), RV (OR, 7.1 [95% CI, 3.7–13.6]; AFE, 86%) and CoV (OR, 2.8 [95% CI, 2.0–4.1]; AFE, 65%) in older adults presenting with Acute respiratory tract infections (ARI), compared with those without respiratory symptoms or healthy older adults
Forty-three studies were excluded for a variety of reasons: no data specific to older adults ≥65 years old were available (n = 1), the case or control definitions were not fulfilled (n = 4), no applicable data for cases and controls were reported (n = 36), or serum was used as the clinical specimen (n = 2)
We demonstrated strong evidence in support of a potential causal attribution when a virus is identified in older adults presenting with ARI or pneumonia for RSV (OR, 8.5 [95% CI, 3.9–18.5]; AFE, 88%), Flu (OR, 8.3 [95% CI, 4.4–15.9]; AFE, 88%), PIV (OR, not available [NA]; AFE, approximately 100%), human metapneumovirus (hMPV) (OR, 9.8 [95% CI, 2.3–41.0]; AFE, 90%), AdV (OR, NA; AFE, approximately 100%), RV (OR, 7.1 [95% CI, 3.7–13.6]; AFE, 86%), and CoV (OR, 2.8 [95% CI, 2.0–4.1]; AFE, 65%)
Summary
Acute respiratory tract infections (ARI) constitute a substantial disease burden in adults and elderly individuals. We aimed to identify all case-control studies investigating the potential role of respiratory viruses in the etiology of ARI in older adults aged ≥65 years. We conducted a systematic literature review (across 7 databases) of case-control studies published from 1996 to 2017 that investigated the viral profile of older adults with and those without ARI. This review supports RSV, Flu, PIV, HMPV, AdV, RV, and CoV as important causes of ARI in older adults and provides quantitative estimates of the absolute proportion of virus-associated ARI cases to which a viral cause can be attributed. Acute respiratory tract infections (ARI), including pneumonia, constitute a substantial disease burden in adults and elderly individuals. The substantial contribution of viruses to ARI hospitalizations among adults is being increasingly recognized [2, 3]
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