Respiratory syncytial virus: time for surveillance across all ages, with a focus on adults

Abstract

Human respiratory syncytial virus (RSV), a leading cause of serious respiratory illness, can affect individuals of all ages, especially children below two years of age and adults 60 years of age and above, as well as individuals with chronic comorbidities, such as chronic pulmonary or cardiovascular conditions, and immunocompromised individuals [1,2]. In adults, clinical outcomes of RSV infection vary from mild, cold-like symptoms to more serious complications, including pneumonia, exacerbations of chronic medical conditions (e.g. asthma, chronic obstructive pulmonary disease, congestive heart failure), and can lead to death [3]. The RSV-related hospitalisation burden is especially high in older adults. A meta-analysis conducted on data from high-income countries across different continents (based on literature published between 1 January 2000 and 3 November 2021) estimated that approximately 470 000 individuals 60 years of age and above were hospitalised in 2019 due to RSV, of whom approximately 33 000 died. The pooled estimate for RSV acute respiratory infection (ARI) attack rate was 1.62% (95% CI = 0.84–3.08%), corresponding to an estimated 5.2 million RSV-associated ARI cases [2]. As RSV symptoms in adults resemble those of other common respiratory viruses (e.g. influenza), clinical diagnosis of RSV may be challenging.

Circulation of the two major RSV antigenic groups (A and B) is seasonal in temperate climates, with a peak during the winter months, but has a more variable pattern in tropical climates. In addition, RSV circulation overlaps with the influenza season but usually lasts longer (16–22 vs. 6–8 weeks, respectively) [1]. Human respiratory syncytial virus circulation was impacted during the first two years of the coronavirus disease 2019 (COVID-19) pandemic, with RSV cases substantially declining after the widespread implementation of public health and social measures and re-emerging out of season when measures were gradually lifted [4].

Human respiratory syncytial virus surveillance is limited, geographically heterogeneous, and does not systematically include all age groups. While the burden of RSV is highest among very young children, adults 60 years of age and above, and individuals with underlying health conditions, other populations also contribute to RSV transmission. Therefore, improved RSV surveillance systems are needed to better understand the epidemiology of RSV and inform public health measures. To identify the current challenges in RSV surveillance in adults and the ways to expand RSV surveillance systems, an advisory board among seven experts with national and international expertise in infectious diseases and surveillance was held in August 2022. The main points discussed by the group are summarised in plain language in Figure 1.

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DOI

https://doi.org/10.7189/jogh.14.03008

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https://www.research.ed.ac.uk/en/publications/68b3efd2-5484-46cd-b4e8-9862c6a08ae6