key: cord-0942771-9c80m5xd authors: Boattini, Matteo; Almeida, André; Christaki, Eirini; Marques, Torcato Moreira; Tosatto, Valentina; Bianco, Gabriele; Iannaccone, Marco; Tsiolakkis, Georgios; Karagiannis, Christos; Maikanti, Panagiota; Cruz, Lourenço; Antão, Diogo; Moreira, Maria Inês; Cavallo, Rossana; Costa, Cristina title: Severity of RSV infection in Southern European elderly patients during two consecutive winter seasons (2017–2018) date: 2021-03-23 journal: J Med Virol DOI: 10.1002/jmv.26938 sha: dea655473aa1250adaf031dfcd44a57e5015a2e0 doc_id: 942771 cord_uid: 9c80m5xd In Europe, the respiratory syncytial virus (RSV) surveillance system is very heterogeneous and there is growing evidence of the importance of RSV infections resulting in hospitalization of elderly patients. The aim of this study was to assess the severity of RSV infection in the elderly living in the aged Southern European countries. We conducted a retrospective study of elderly patients ( ≥65‐year old) admitted for laboratory‐confirmed RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons (2017–2018). Uni‐multivariable analyses were carried out to evaluate the effect of clinical variables on radiologically confirmed pneumonia, use of noninvasive ventilation (NIV), and in‐hospital death (IHD). A total of 166 elderly patients were included. Pneumonia was evident in 29.5%. NIV was implemented in 16.3%, length of stay was 11.8 ± 12.2 days, and IHD occurred in 12.1%. Multivariable analyses revealed that the risk of pneumonia was higher in patients with chronic kidney disease (CKD) (odds ratio [OR]: 2.57; 95% confidence interval [CI]: 1.12–5.91); the use of NIV was higher in patients with obstructive sleep apnea or obesity hypoventilation syndrome (OSA or OHS) (OR: 5.38; 95% CI: 1.67–17.35) and CKD (OR: 2.52; 95% CI: 1.01–6.23); the risk of IHD was higher in males (OR: 3.30; 95% CI: 1.07–10.10) and in patients with solid neoplasm (OR: 9.06; 95% CI: 2.44–33.54) and OSA or OHS (OR: 8.39; 95% CI: 2.14–32.89). Knowledge of factors associated with RSV infection severity may aid clinicians to set priorities and reduce disease burden. Development of effective antiviral treatment and vaccine against RSV is highly desirable. Viral respiratory tract infections are a major public health concern, as highlighted by severe acute respiratory syndrome coronavirus 2 pandemic recently, especially when these affect patients with age-related chronic diseases. 1 Influenza and respiratory syncytial virus (RSV) are major viral pathogens causing acute respiratory tract infections associated with relevant rates of admission, mortality, and high hospital costs, especially among older adults. [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] In Europe, the RSV surveillance system is very heterogeneous due to the lack of uniform case definition and it often detects RSV infections within the existing surveillance system for influenza. [12] [13] [14] There is growing evidence of the importance of RSV infections resulting in hospitalization of elderly patients and for which no vaccines and targeted therapeutic options are available. There is also limited published evidence on factors associated with disease severity that may aid in setting priorities for elderly patients hospitalized due to RSV infection in the aged Southern European countries. The aims of this study were to describe the clinical features of elderly patients admitted for RSV infection and to identify factors associated with pneumonia, use of noninvasive ventilation (NIV), and in-hospital death (IHD). Overall, the number of hospitalized patients over the study period were in line with recent evidence, showing a higher prevalence of RSV infection in the elderly. 8, 16 Radiological evidence of pneumonia as patchy sub-segmental alveolar infiltrates or lobar consolidation was frequent, in line with recent reports revealing that it is noted in 30%-50% of cases. 3 The poor outcomes were also documented and consistent with evidence avalable so far 5,7,17 : more than 15% of cases necessitated noninvasive ventilatory support and the overall IHD rate exceeded 10%. No association between age and outcomes was found. This finding, in discordance with a previous report, 5 could highlight that the elderly are a nonhomogeneous, wide age group that usually faces different levels of morbidity, disability, and geriatric conditions that may be overlooked in the traditional disease model. 18 In addition, as clinical features were not so different among the three age groups studied, risk factors of RSV infection severity were examined overall, and some novelties were provided. 20 and viral infections must be kept in mind as differential diagnosis of fever in patients with cancer or on immunosuppressive treatment. The prognostic value of OSA or OHS for IHD is something new that deserves further research to investigate the immune response to RSV in the aging lung of patients bearing these comorbidities. Our study had some limitations. Several factors contributing to infection severity and mortality including frailty scores, presence of bacterial coinfection, presence of viral coinfection other than influenza, respiratory failure, and occurrence of systemic complications were not assessed. The body mass index was not evaluated, and the prognostic value of obesity was not assessed. Moreover, our study lacks an assessment of post-discharge disability and follow-up. In conclusion, elderly patients hospitalized for RSV infection bear high morbidity and mortality. Knowledge of factors associated with infection severity may aid clinicians to set priorities and reduce disease burden. Development of effective antiviral treatment and vaccine against RSV is highly desirable. COVID-19 in older adults Respiratory syncytial virus infection in adults Respiratory syncytial virus infection in older adults: an under-recognized problem Respiratory syncytial virus infection in elderly adults High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults Risk of mortality associated with respiratory syncytial virus and influenza infection in adults Respiratory syncytial virus and influenza virus infection in adult primary care patients: association of age with prevalence, diagnostic features, and illness course Cost of hospitalization associated with respiratory syncytial virus infection versus influenza infection in hospitalized older adults Respiratory syncytial virus infection in elderly and high-risk adults The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease-a systematic review European Influenza Surveillance Network. Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries Performance of surveillance case definitions for respiratory syncytial virus infections through the sentinel influenza surveillance system Respiratory syncytial virus in influenza-like illness cases: epidemiology and molecular analyses of four consecutive winter seasons Comparative virulence of seasonal viruses responsible for lower respiratory tract infections: a southern European multi-centre cohort study of hospital admissions Medically attended respiratory syncytial virus infections in adults aged ≥ 50 years: clinical characteristics and outcomes Clinical manifestations and outcomes of respiratory syncytial virus infection in adult hospitalized patients Geriatric conditions and disability: the health and retirement study Clinical features, severity, and incidence of RSV illness during 12 consecutive seasons in a community cohort of adults ≥ 60 Years Old Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France The authors declare that there are no conflict of interests. The data that support the findings of this study are available from the corresponding author upon reasonable request. This study was conducted in accordance with the Declaration of Helsinki. Formal ethical approval was obtained by the institutional review board of the coordinating center (Central Lisbon Hospital Center, no. 762_2019). http://orcid.org/0000-0001-6726-2716Lourenço Cruz http://orcid.org/0000-0001-8748-0446Cristina Costa http://orcid.org/0000-0002-6549-4553