While it is often thought of as a disease in children, respiratory syncytial virus (RSV) infections cause significant illness and death in older adults every year. Clinicians are urged to learn more about the illness and death caused by RSV in these patients and to develop protocols in anticipation of vaccinations against the virus.
Respiratory syncytial virus (RSV) infections can cause a variety of respiratory illnesses, such as bronchiolitis and pneumonia. In addition to infants and young children, symptomatic RSV infections can occur in adults. The infection usually lasts less than 5 days in healthy adults, and symptoms are often consistent with upper respiratory tract infections. These include runny nose, cough, headache, fatigue, and fever. High-risk adults, such as those with certain chronic illnesses (like congestive heart failure or COPD) or weakened immune systems, may have more severe symptoms with lower respiratory tract involvement.
Although people of any age can be infected with RSV, recent data estimate that the virus commonly impacts older patients, accounting for approximately 177,000 hospitalizations and 14,000 deaths each year among adults older than age 65. “Studies have found that RSV infection is a significant cause of illness and death in older adults,” says Lindsay Kim, MD, MPH. Modeling studies have also suggested that RSV in older adults occurs with incidence and mortality rates similar to seasonal influenza. In the United States, RSV infections generally occur during the fall, winter, and spring.
A Challenging Diagnosis
Since RSV has signs and symptoms that are similar to other viruses, it can be difficult to diagnose RSV in older adults, says Dr. Kim (Table). “As we learn more about the scope of RSV burden in the adult population, it has become clear that greater awareness is needed of this prevalent, recurrent, and potentially deadly infection,” she says. Older adults are more likely to have more severe illness due to RSV, leading to complications like hospitalization or even death.
RSV can be as serious as influenza and severely affects older adults, putting them and their caregivers at risk for the infection. “Several different types of laboratory tests are available to diagnose RSV infection, but these are not routinely performed in adults,” says Dr. Kim. She urges clinicians to become educated on the burden of RSV in older adults and consider RSV as a diagnosis for older adults with consistent symptoms, especially during RSV season.
RSV can survive on hard surfaces such as tables and crib rails for many hours. RSV typically lives on soft surfaces such as tissues and hands for shorter amounts of time. Adults who are infected with RSV are usually contagious for 3 to 8 days. The virus can be spread when infected people cough or sneeze into the air, creating virus-containing droplets that can linger briefly in the air. Others can get infected if the droplet particles contact their nose, mouth, or eye. The infection can also result from direct and indirect contact with nasal or oral secretions from infected people. Transmission of RSV usually occurs when people touch an infectious secretion and then rub their eyes or nose.
Prevention & Treatment
“Researchers are working to develop RSV vaccines,” says Dr. Kim. “When these vaccines come to market, they will become valuable tools for physicians to reduce the burden of RSV in adults.” A growing number of RSV vaccine candidates are using a variety of technologies and target diverse populations, including pediatric and elderly populations. While most are at a preclinical stage, several candidates are in clinical development.
In the absence of a preventive option, healthcare providers currently treat patients with symptom management. “Symptoms need to be managed with supportive care,” Dr. Kim says, “but the ongoing development of preventive vaccines will ultimately help address the unmet medical need to effectively prevent RSV in older adults.”
In the meantime, clinicians can take steps to help prevent the spread of RSV. Specifically, older adults with cold-like symptoms should be instructed to do the following:
- Cover coughs and sneezes.
- Wash hands frequently with soap and water for at least 20 seconds.
- Avoid sharing their eating utensils with others.
- Refrain from kissing others.
- Clean potentially contaminated surfaces.
Parents should also pay special attention to protecting infants and young children, who are at high risk for developing severe disease if they are infected with RSV. These high-risk children include premature infants, children younger than 2 years with chronic lung or heart conditions, and children with weakened immune systems.
“Ultimately, we need to increase awareness about the illness and death that RSV causes every year in older adults and the lack of a specific treatment option,” says Dr. Kim. Healthcare providers should consider RSV as a diagnosis for older adults. By becoming informed about RSV, clinicians can improve their assessment of RSV and develop practice protocols in anticipation of vaccinations against RSV.
Readings & Resources (click to view)
CDC. Respiratory syncytial virus (RSV) infection. For Healthcare Professionals. Available at: https://www.cdc.gov/rsv/clinical/index.html.
McClure DL, Kieke BA, Sundaram ME, et al. Seasonal incidence of medically attended respiratory syncytial virus infection in a community cohort of adults ≥50 years old. See comment in PubMed Commons belowPLoS One. 2014;9:e102586. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25025344.
Higgins D, Trujillo C, Keech C. Advances in RSV vaccine research and development – a global agenda. Vaccine. 2016;34:2870-2875. Available at: http://www.sciencedirect.com/science/article/pii/S0264410X16301682.
Falsey AR, Hennessey RN, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. New Engl J Med. 2005;352:1749-1759.
Falsey AR, Walsh EE. Respiratory syncytial virus infection in adults. Clin Microbiol Rev. 2000;13:371-384.
Mayo Clinic. Diseases and Conditions. Respiratory syncytial virus (RSV). Available at: http://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/basics/symptoms/con-20022497.
Simões EAF, DeVincenzo JP, Boeckh M, et al. Challenges and opportunities in developing respiratory syncytial virus therapeutics. J Infect Dis. 2015;211(suppl 1):S1-S20.
Branche AR, Falsey AR. Respiratory syncytial virus infection in older adults: an under-recognized problem. Drugs Aging. 2015;32:261-269.
Fleming DM, Taylor RJ, Lustig RL, et al. Modelling estimates of the burden of respiratory syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infect Dis. 2015;15:443-455.
Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, Talbot HK. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206:56-62.
Brendish NJ, Schiff HF, Clark TW. Point-of-care testing for respiratory viruses in adults: the current landscape and future potential. J Infect. 2015;71:501-510.
Falsey AR. Respiratory syncytial virus: a global pathogen in an aging world. Clin Infect Dis. 2013;57:1078-1080.