One in 20 Adults with RSV Is Hospitalized, Study Says

Among adults with outpatient respiratory syncytial virus (RSV) infections across six RSV seasons, roughly 1 in 20 people were hospitalized within 28 days, according to a large cohort study using data from three health record databases.

Joshua T. Swan, PharmD, MPH, found that in a cohort of more than 67,000 outpatients with RSV infection, hospitalization rates were 4.5% to 6.2% across three databases and 6.5% to 8% in a high-risk subgroup. He reported that it was .5. From Pfizer and colleagues in New York City JAMA Network Open.

High-risk characteristics included age 65 and older, asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). The prevalence of comorbidities among patients in the three databases was 20% to 30.5% for COPD, 14.6% to 24.4% for CHF, 14.6% to 24.4% for asthma, and 14% to 14% for those 65 years and older. It was 54.5.

Swan and his team noted that RSV infection rates are underestimated, in part because of underutilization of virus tests. Although there are three available vaccines against RSV, the number of approved treatments for it is small.

“Therapeutic and preventive measures to reduce hospitalizations following RSV infection would provide major benefits to patients in the U.S. healthcare system,” they wrote.

swan said MedPage Today “The absolute risk of one in 20 patients being hospitalized observed in our study represents a significant and meaningful risk for vulnerable adults.”

Much of the public’s attention has historically focused on the risk of hospitalization for young children with RSV, he added.

The authors noted that previous studies have suggested that 82% to 90% of hospitalizations observed within 28 to 30 days of RSV diagnosis in adults are associated with acute respiratory infection.

Cameron Wolfe, MBBS, from Duke University Medical Center in Durham, North Carolina, said: MedPage Today The study’s results “confirm what we’ve been concerned about for some time, which is that it’s similar to the flu and more recently Covid-19. We’re seeing a lot of older adults and those at risk ultimately needing to be hospitalized after RSV.”

“An additional strength is that this (study) did not attempt to separate those diagnosed with RSV pneumonia alone,” he added. “We’ve known for a while that some heart attacks are triggered by the stress of a bad viral infection, some strokes are triggered by dehydration and falls, etc.”

Wolfe noted that there are no antiviral drugs proven to be effective against RSV. “Testing is important for RSV not only because it helps you give a name to the disease you have and proves that you don’t need antivirals for COVID or flu, for example, or antibiotics for bacteria.”

For this study, Swan and colleagues analyzed closed claims data for RSV outpatient encounters from electronic health records in three de-identified databases (Optum’s Integrated Claims-Clinical dataset, TriNetX Linked, and Veradigm Network EHR) from October 2016 to September 2022. It covers six seasons of RSV. Open claims were not included and all patients had commercial or government insurance.

Researchers identified 67,239 RSV infections diagnosed in adult outpatients: 2,771 from Optum, 7,442 from TriNetX, and 57,026 from Veradigm. Most infections occurred among women (62-67%).

Outpatient diagnostic sites included clinics and emergency rooms.

The percentage of patients hospitalized varied by database. The rate of hospitalized RSV patients was 6.2% for Optum, 6% for TriNetX, and 4.5% for Veradigm. In the high-risk subgroup, these rates were 7.6%, 8.5% and 6.5%, respectively.

Swan and his team noted that RSV infections identified in their database through a positive laboratory test result or diagnosis code underrepresent the actual number of RSV events during the period. “Therefore, the study findings are only applicable to RSV infections identified in the outpatient setting and cannot be used to estimate the true burden of RSV infections in the larger population,” they wrote.