RSV More Severe Than Influenza in Hospitalized Older Adults

Respiratory syncytial virus (RSV) infections in adults tend to be more severe than influenza but less severe than SARS-CoV-2, according to study results published in the Journal of Clinical Virology.

The retrospective study compared inpatient experiences with four viruses — RSV, influenza A, influenza B, and SARS-CoV- 2 — between 2017 and 2020 at a hospital in Germany. The analysis included more than 1500 adults hospitalized with respiratory infections and a positive result on a polymerase chain reaction (PCR) test for one of the viruses.

Patients hospitalized with RSV infections tended to be older, with an average age of 75 years, than those hospitalized with other viruses, according to the study. While most of the hospitalized adults with respiratory infections had risk factors, chronic obstructive pulmonary disease and kidney disease were most common among those with RSV.

Inpatient stays averaged 17.87 days for patients with SARS-CoV-2, 12.66 days for patients with RSV, 10.88 days for patients with influenza A, and 8.86 days for patients with influenza B. 

Similarly, the rates of intensive care unit admission, mechanical ventilation, and hospital mortality were highest with SARS-CoV-2, followed by RSV, influenza A, and influenza B. For patients hospitalized with RSV, odds ratios of ICU admission were 0.65 compared with SARS-CoV-2, 1.69 compared with influenza A, and 1.98 compared with influenza B. Odds ratios for mechanical ventilation in patients with RSV were 0.59 compared with SARS-CoV-2, 1.59 compared with influenza A, and 2.33 compared with influenza B. Finally, odds ratios for hospital mortality in patients with RSV were 0.37 compared with SARS-CoV-2, 1.55 compared with influenza A, and 1.42 compared with influenza B.

“Our data show that RSV is a highly prevalent and severe infection in the elderly,” researchers wrote. “Second only to the original strain of SARS-CoV-2, it leads to significantly more complications, a more severe course with more admissions to ICU, a longer stay in the hospital, and even more fatalities than influenza A/B.”

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Reference: 
Andreas A, Doris L, Frank K, Michael K. Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: risk factors, symptomatology and clinical course compared to influenza A/B and the original SARS-CoV-2 strain. J Clin Virol. 2023;161:105399. doi:10.1016/j.jcv.2023.105399