From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults
Abstract
:1. Introduction
2. Research Questions
- (a)
- Is RSV a forgotten pathogen among older adults? Is there a shift in trend in the importance that is being given to it?
- (b)
- Does RSV disease among older adults present a considerable burden?
- (c)
- What new and developing strategies are there to reduce the need for medical care in older adults? Are these relevant?
3. Materials and Methods
4. RSV Microbiological and Epidemiological Overview
5. Literature Overview Output
6. Can We Consider RSV a Forgotten Pathogen in Older Adults?
6.1. Literature Focus of RSV Infection in Older Adults
6.2. Factors Supporting RSV Being a Forgotten Pathogen in Older Adults
6.2.1. Clinical Picture and Disease Management
6.2.2. Diagnostic Challenges
6.2.3. Recent Developments on Surveillance and Case Definition
7. Estimating RSV Disease Burden in Older Adults
7.1. Limitations in Estimating RSV Disease Burden in Older Adults
7.2. Burden of Coinfections
8. Pipeline of Vaccines and New Therapeutics
9. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Study | Period | Country | Patients (n) | Age ± SD or (Range) or [IQR], Years | Critically Ill Patients % (n) | Pneumonia % (n) | Coinfection % (n) | Mortality Rate % (n) |
---|---|---|---|---|---|---|---|---|
[2] | 1999–2003 | USA | 46 | Not reported | Not reported | 2 (1) | Not reported | 0 |
56 | Not reported | Not reported | 7 (4) | 4 (2) | ||||
132 | 76 ± 13 | 15 (20) | 31 (41) | 8 (10) | ||||
[78] | 2007–2008 | USA | 26 | 65 ± 14 | 0 | Not reported | Not reported | 0 |
32 | 71 ± 13 | 34 (11) | 19 (6) | |||||
[90] | 2005–2008 | USA | 33 | 69.8 ± 14.9 | 18 (6) | 15 (5) | Not reported | 6 (2) |
17 | 72.0 ± 14.8 | 29 (5) | 24 (4) | 0 | ||||
[79] | 2006–2009 | USA | 31 | 68 [56–78] | 9.7 (3) | Not reported | Not reported | 6.5 (2) |
[50] | 2007–2012 | Guatemala | 65 | ≥50 | 9 (6) | 59 (23) | Not reported | 13 (8) |
[11] | 2009–2011 | Hong Kong, China | 607 | 75.1 ± 16.4 | Not reported | 42.3 | 12.5 | 9.1 |
[77] | 2009–2010 | USA | 32 | 60.8 [44.8–68.9] | 16.7 (4) | Not reported | Not reported | 4.2 (1) |
[51] | 2012–2013 | Canada | 86 | 74 (19–102) | 15 (13) | 40 (34) | 13 (11) | 6 (5) |
[4] | 2008–2009 | 15 countries | 41 | Not reported | Not reported | 4.9 (2) | 4.9 (2) | Not reported |
[72] | 2009–2012 | USA | 41 | 53.8 ± 11.8 | 14.6 (6) | Not reported | Not reported | 4.9 (2) |
28 | 55 ± 15.1 | 17.9 (5) | 10.7 (3) | |||||
106 | 62.1 ± 19.8 | 24.5 (26) | 6.6 (7) | |||||
[69] | 2013 | Hong Kong, China | 123 | 78 ± 15 | 12.2 (15) | 67.5 (83) | Not reported | 8.9 (11) |
[81] | 2012–2013 | USA | 75 | >65 | Not reported | 34.7 | Not reported | 4 |
39 | Not reported | 38.5 | 10.3 | |||||
[60] | 2012–2015 | France | 53 | 74 (61–84) | 15 (8) | 44 (23) | Not reported | 8 (4) |
[54] | 2004–2016 | USA | 243 | ≥60 | 0 | 9.5 (23) | Not reported | 0 |
[21] | 2015–2016 | Spain | 95 | 57.7 | Not reported | 33.6 (32) | Not reported | 14.7 (14) |
[73] | 2000–2013 | USA | 181 | 59 (18–87) | 13 (24) | Not reported | 8 (14) | 7 (13) |
[70] | 2005–2014 | Switzerland | 107 | 60.5 [48–70.6] | 29.3 (17) | 36.9 (62) | 23.4 (25) | 19 (11) |
68 | 50.8 [37.3–59.4] | |||||||
[55] | 2009–2015 | USA | 489 | 60 ± 17 | 27 (132) | 38.8 (190) | 8.2 (40) | 3.9 (19) |
[59] | 2005–2018 | The Netherlands | 192 | 60.7 [50.8–69.2] | 16 (30) | Not reported | 42.2 (81) | 8 (16) |
[56] | 2014–2015 | Thailand | 69 | 72 [58–81] | 36.2 (25) | 79.7 (55) | 8.7 (6) | 15.9 (11) |
[91] | 2013–2016 | France | 27 | 70 [56–82] | 66.7 (18) | 100 (27) | 100 (27) | 25.9 (7) |
62 | 76 [59–85] | 21 (13) | 100 (62) | 0 | 17.7 (11) | |||
[57] | 2012–2015 | Republic of Korea | 132 | ≥65 | 25 (33) | 56.8 (75) | Not reported | 10.6 (14) |
[12] | 2011–2015 | USA | 664 | 78 (60–103) | 18 | 66 | Not reported | 5.6 |
[92] | 2017–2019 | China | 113 | 64.2 ± 16.3 | 22.1 (25) | Not reported | Not reported | 11.5 (13) |
[93] | 2014–2019 | France | 616 | 70.4 ± 19.4 | Not reported | Not reported | 0 | 4.9 (30) |
85 | 66.6 ± 18.6 | 100 (85) | 12.9 (11) | |||||
[68] | 2016–2018 | Alaska, USA | 8 | 68 [52–77] | Not reported | 75(6) | 0 | 0 |
[76] | 2013–2015 | USA | 192 | ≥65 | 13 (25) | Not reported | 20.3 (39) | 5.9 (11) |
[67] | 2019–2019 | Austria | 103 | 57 [40–73] | 6.8 (7) | 17.5 (18) | Not reported | 2.9 (3) |
[37] | 2012–2015 | New Zealand | 281 | (18–80) | 2.8 (8) | Not reported | Not reported | 1.4 (4) |
[35] | 2017–2019 | Belgium, UK, The Netherlands | 59 | 75 (70–79) | 0 | Not reported | Not reported | 0 |
[62] | 2017–2019 | Italy, Portugal, Cyprus | 166 | 80.9 ± 8.7 | Not reported | 29.6 (49) | Not reported | 12.1 (20) |
[63] | 2017–2019 | Switzerland | 79 | 78 [65–84] | 19 (15) | 40.5 (32) | Not reported | 10.1 (8) |
[71] | 2015–2017 | USA | 1713 | ≥65 (60%) | 20 (344) | Not reported | Not reported | 5 (86) |
[75] | 2016–2018 | China | 71 | 77 [67–83] | 4.2 (3) | 46.5 (33) | 21.1 (15) | 7 (5) |
[65] | 2017–2018 | Finland | 152 | 73 [65–86] | 3.9 (6) | 37.5 (57) | Not reported | 8.6 (13) |
[61] | 2011–2018 | France, Belgium | 309 | 67.2 ± 15 | 100 (309) | Not reported | 27.2 (84) | 23.9 (74) |
[74] | 2017–2019 | USA | 403 | 69.0 [57.2–82.1] | 16.4 (66) | Not reported | Not reported | 7.7 (31) |
[64] | 2015–2019 | France | 1168 | 75 [63–85] | 24.6 (288) | Not reported | 18.2 (213) | 6.6 (77) |
[58] | 2016–2019 | USA | 622 | ≥65 | 12.4 | Not reported | Not reported | 1.5 (9) |
Study | Acute Lower Respiratory Infection | Hospitalization | Requirement for Ventilatory Support or ICU Admission | Short-Term Mortality |
---|---|---|---|---|
[26] | - Chronic pulmonary disease; | |||
- Functional disability; | ||||
- Low serum neutralizing antibody titre; | ||||
[38] | - Underlying medical conditions; | |||
- Female sex; | ||||
- Increased mucosal IL-6 level; | ||||
- Longer duration of virus shedding; | ||||
[11] | - Chronic lung disease; - Pneumonia; - Elevated urea and ALT; | - Advanced age; | ||
- Pneumonia; | ||||
- Requirement for ventilation; | ||||
- Bacterial superinfection; | ||||
- Elevated urea and WBC count; | ||||
[80] | - Congestive heart failure; | |||
- Exposure to children; | ||||
[50] | - Cardiovascular disease; | |||
[51] | - Need for ICU and mechanical ventilation; | |||
[69] | - Older age; | |||
- Major comorbidities; | ||||
- Bacterial superinfection; | ||||
- Requirement for ventilation; | ||||
[72] | - Age > 60 years (vs. age ≤ 60) | |||
[94] | - Lower respiratory infection, chronic respiratory disease, bacterial coinfection, and fever; | |||
[60] | - Cancer - Immunosuppressive treatment; | |||
[54] | - Age ≥ 75 years (vs. 60–64 years); - COPD or congestive heart failure; | |||
[73] | - Neutropenia and lymphocytopenia and not receiving ribavirin-based therapy during RSV upper respiratory tract infection; | - Neutropenia and lymphocytopenia at RSV diagnosis; | ||
[70] | - Solid tumours or leukaemia, chronic immunosuppression (vs. HSCT recipients); | |||
[59] | - Lower respiratory tract infection, chronic pulmonary disease, temperature, confusion, and elevated urea; | |||
[8] | - Older age; | |||
- COPD; | ||||
- Congestive heart failure; | ||||
- Chronic kidney disease; | ||||
- Previous pneumonia; | ||||
- Haematological malignancies; | ||||
- Stroke; | ||||
- Baseline healthcare resource use; | ||||
[12] | - ≥ two hospitalizations in the prior six months; | |||
- Tachypnoea; | ||||
- Altered consciousness; | ||||
- Lymphoma; | ||||
- During hospitalization: | ||||
- Acute renal failure; | ||||
- Atrial fibrillation; | ||||
- Neurovascular complication; | ||||
[76] | - Neurologic disease; - Respiratory disease; - Congestive heart failure; | |||
[62] | - OSA/OHS; - Chronic kidney disease; | - Male gender; - Solid neoplasm; - OSA/OHS; | ||
[67] | - Age > 65 years; | - Respiratory disease; - Complications; - Pneumonia; - Superinfection; | - Age > 65 years; | |
- Smoking; | ||||
- Cardiac disease; | ||||
- Diabetes mellitus; | ||||
- Pneumonia; | ||||
[37] | - Age 65–80 and diabetes mellitus; - Age ≥ 50 years and chronic heart failure or COPD; | |||
[71] | - Higher census tract-level poverty and crowding; | |||
[75] | - IL-6 concentration; | |||
[5] | - COPD; | |||
- Coronary artery disease; | ||||
- Congestive heart failure; | ||||
[64] | - Chronic heart or respiratory failure; - Coinfection; | - Age ≥ 85 years; | ||
- Neutropenia; | ||||
- Acute respiratory failure; | ||||
- Need for ventilation support; | ||||
- Withdrawing of life-sustaining therapies; | ||||
[95] | - COPD or asthma; | |||
- Ischemic heart disease; | ||||
- Stroke; | ||||
- Diabetes; | ||||
- Chronic kidney disease; |
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Boattini, M.; Almeida, A.; Comini, S.; Bianco, G.; Cavallo, R.; Costa, C. From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults. Viruses 2024, 16, 531. https://doi.org/10.3390/v16040531
Boattini M, Almeida A, Comini S, Bianco G, Cavallo R, Costa C. From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults. Viruses. 2024; 16(4):531. https://doi.org/10.3390/v16040531
Chicago/Turabian StyleBoattini, Matteo, André Almeida, Sara Comini, Gabriele Bianco, Rossana Cavallo, and Cristina Costa. 2024. "From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults" Viruses 16, no. 4: 531. https://doi.org/10.3390/v16040531
APA StyleBoattini, M., Almeida, A., Comini, S., Bianco, G., Cavallo, R., & Costa, C. (2024). From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults. Viruses, 16(4), 531. https://doi.org/10.3390/v16040531