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Respecting RSV in Adults

Amesh A. Adalja, MD, FACP, FACEP, FIDSA | July 24, 2019

When it comes to the importance of respiratory virus infections in adults, influenza has an outsized influence, given its burden of illness, its ability to cause pandemics, and the availability of easy-to-administer antiviral therapy. However, among respiratory-borne viruses – arguably the most likely pandemic threat – there are other under-appreciated viruses that have significant annual impacts and whose under-recognition is a pandemic threat.

Of these viruses, respiratory syncytial virus (RSV) is one that is well known as a cause of pediatric infection but is not an entity most physicians who treat adults test for or consider significant. A new study, published in Clinical Infectious Diseases, contrasts the mortality burden of RSV with influenza in hospitalized adults, providing important information that could change the view of clinicians regarding RSV in adults.

More Complications, ICU Use, and Long-Term Mortality with RSV

This retrospective cohort study was conducted at Kaiser Permanente Southern California and included adults aged 60 years or older who were hospitalized with RSV, influenza A, or influenza B (by PCR or viral culture). The study was conducted during the 5 winter seasons between 2011 and 2015.

Patients hospitalized with RSV tended to be, on average, 1 year older and were more likely to be female. RSV patients were more likely to be diabetic and to have COPD, asthma, and a malignancy. Not surprisingly, more patients with RSV were vaccinated against influenza than were influenza patients, and influenza patients were more likely to receive an antiviral.

Length of stay, ICU admission, pneumonia, tachypnea, hypoxia, and requirements for home health post-discharge were more frequent among RSV patients. Long-term mortality within 1 year of admission was higher among RSV patients, while short-term mortality did not differ.

Neglected Respiratory Viruses

This study is an important contribution that concretizes the burden of RSV as an adult disease. The resources and attention devoted to adult RSV are considerably less than for influenza, yet individual patient burdens are comparable – or arguably greater with RSV. To date, there is no RSV vaccine and only 1 approved RSV antiviral, ribavirin, which has a pregnancy category X designation and is administered via inhalation, which can be cumbersome. Many hospitalized adults with compatible symptoms are not tested for RSV (and consequently are not placed in droplet isolation precautions). Reconceptualizing RSV – as well as other neglected respiratory viruses – will go a long way toward improving pandemic preparedness and routine clinical care.


Ackerson B, Tseng HF, Sy LS, et al. Severe morbidity and mortality associated with respiratory syncytial virus versus influenza infection in hospitalized older adults. Clin Infect Dis 2019;69:197-203.