Background Respiratory syncytial virus (RSV) is an increasingly recognized cause of illness in adults. Data on the epidemiology and clinical effects in community-dwelling elderly persons and high-risk adults can help in assessing the need for vaccine development. Methods During four consecutive winters, we evaluated all respiratory illnesses in prospective cohorts of healthy elderly patients (> or =65 years of age) and high-risk adults (those with chronic heart or lung disease) and in patients hospitalized with acute cardiopulmonary conditions. RSV infection and influenza A were diagnosed on the basis of culture, reverse-transcriptase polymerase chain reaction, and serologic studies. Results A total of 608 healthy elderly patients and 540 high-risk adults were enrolled in prospective surveillance, and 1388 hospitalized patients were enrolled. A total of 2514 illnesses were evaluated. RSV infection was identified in 102 patients in the prospective cohorts and 142 hospitalized patients, and influenza A was diagnosed in 44 patients in the prospective cohorts and 154 hospitalized patients. RSV infection developed annually in 3 to 7 percent of healthy elderly patients and in 4 to 10 percent of high-risk adults. Among healthy elderly patients, RSV infection generated fewer office visits than influenza; however, the use of health care services by high-risk adults was similar in the two groups. In the hospitalized cohort, RSV infection and influenza A resulted in similar lengths of stay, rates of use of intensive care (15 percent and 12 percent, respectively), and mortality (8 percent and 7 percent, respectively). On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, Clinical Modification at discharge, RSV infection accounted for 10.6 percent of hospitalizations for pneumonia, 11.4 percent for chronic obstructive pulmonary disease, 5.4 percent for congestive heart failure, and 7.2 percent for asthma. Conclusions RSV infection is an important illness in elderly and high-risk adults, with a disease burden similar to that of nonpandemic influenza A in a population in which the prevalence of vaccination for influenza is high. An effective RSV vaccine may offer benefits for these adults.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa043951

Respiratory syncytial virus infection in elderly and high-risk adults.

Respiratory syncytial virus (RSV), originally recovered from a colony of chimpanzees with coryza and designated chimpanzee coryza agent,1,2 and human parainfluenza virus types 1, 2, 3, and 4 have been known primarily as respiratory pathogens in young children. They are now recognized as important pathogens in adults as well. Adults infected with these viruses tend to have more variable and less distinctive clinical findings than children, and the viral cause of the infection is often unsuspected. The consistency of the annual outbreaks of these agents and the frequency of reinfection suggest that they impose a considerable, but ill-defined, disease . . .

Respiratory Syncytial Virus and Parainfluenza Virus

The effects of respiratory viral infection on the time course of chronic obstructive pulmonary disease (COPD) exacerbation were examined by monitoring changes in systemic inflammatory markers in stable COPD and at exacerbation. Eighty-three patients with COPD (mean [SD] age, 66.6 [7.1] yr, FEV(1), 1.06 [0.61] L) recorded daily peak expiratory flow rate and any increases in respiratory symptoms. Nasal samples and blood were taken for respiratory virus detection by culture, polymerase chain reaction, and serology, and plasma fibrinogen and serum interleukin-6 (IL-6) were determined at stable baseline and exacerbation. Sixty-four percent of exacerbations were associated with a cold occurring up to 18 d before exacerbation. Seventy-seven viruses (39 [58.2%] rhinoviruses) were detected in 66 (39.2%) of 168 COPD exacerbations in 53 (64%) patients. Viral exacerbations were associated with frequent exacerbators, colds with increased dyspnea, a higher total symptom count at presentation, a longer median symptom recovery period of 13 d, and a tendency toward higher plasma fibrinogen and serum IL-6 levels. Non-respiratory syncytial virus (RSV) respiratory viruses were detected in 11 (16%), and RSV in 16 (23.5%), of 68 stable COPD patients, with RSV detection associated with higher inflammatory marker levels. Respiratory virus infections are associated with more severe and frequent exacerbations, and may cause chronic infection in COPD. Prevention and early treatment of viral infections may lead to a decreased exacerbation frequency and morbidity associated with COPD.

https://www.atsjournals.org/doi/pdf/10.1164/ajrccm.164.9.2105011

Respiratory Viruses, Symptoms, and Inflammatory Markers in Acute Exacerbations and Stable Chronic Obstructive Pulmonary Disease

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)12162-9.pdf

The common cold

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(99)05190-9.pdf

Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial

Objective: To evaluate the disease burden of upper respiratory infections in elderly people living at home. Design: Prospective surveillance of elderly people. Intervention: None. Setting: Leicestershire, England Subjects: 533 subjects 60 to 90 years of age. Main outcome measures: Pathogens, symptoms, restriction of activity, duration of illness, medical consultations, interval between onset of illness and medical consultation, antibiotic use, admission to hospital, and death. Results: 231 pathogens were identified for 211 (43%) of 497 episodes for which diagnostic specimens were available: 121 (52%) were rhinoviruses, 59 (26%) were coronaviruses, 22 (9.5%) were influenza A or B, 17 (7%) were respiratory syncytial virus, 7 (3%) were parainfluenza viruses, and 3 (1%) were Chlamydia species; an adenovirus and Mycoplasma pneumoniae caused one infection each. Infections occurred at a rate of 1.2 episodes per person per annum (95% confidence interval 1.0 to 1.7; range 0-10) and were clinically indistinguishable. Lower respiratory tract symptoms complicated 65% of upper respiratory infections and increased the medical consultation rate 2.4-fold (χ 2 test P Conclusions: Respiratory viruses cause substantial morbidity in elderly people. Although respiratory syncytial virus and influenza cause considerable individual morbidity, the burden of disease from rhinovirus infections and infections of unknown aetiology seems greater overall. The interval between onset of illness and consultation together with diagnostic difficulties raises concern regarding the role of antiviral drugs in treating influenza. Key messages There are few data on the morbidity associated with respiratory viruses other than influenza in elderly people Respiratory virus infections in elderly people are clinically indistinguishable, and patients with influenza will be difficult to target for antiviral treatment without a near patient diagnostic test Overall, two thirds of elderly people with colds and four fifths of those with influenza and respiratory syncytial virus can be expected to develop lower respiratory illness Although influenza and respiratory syncytial virus cause substantial morbidity in elderly people, the disease burden from rhinovirus infections and colds of unknown aetiology is greater overall Most elderly patients seek medical attention beyond 48 hours when the benefits of antiviral treatment of influenza remain unproved

Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden

Objective: To assess the role of rhinoviruses in elderly people living in the community. Design: Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, and specimens were collected for diagnostic serology and human rhinovirus polymerase chain reaction. Setting: Leicestershire, England. Subjects: 533 subjects aged 60 to 90. Main outcome measures: Symptoms, restriction of activity, medical consultations, and antibiotic use during 96 rhinovirus infections. Adjusted odds ratios for lower respiratory syndromes with respect to smoking and health status. Results: A viral cause was established in 211 (43%) of 497 respiratory illnesses; rhinoviruses were identified in 121 (24%) and as single pathogens in 107. The median duration of the first or only rhinovirus infection in the 96 people with 107 rhinovirus infections was 16 days; 18 of the 96 patients were confined to bed and 25 were unable to cope with routine household activities. Overall, 60 patients with rhinovirus infections had lower respiratory tract syndromes; 41 patients consulted their doctor, 31 of them (76%) receiving antibiotics. One patient died. Logistic regression analysis showed that chronic medical conditions increased the estimated probability of lower respiratory rhinovirus illness by 40% (95% confidence interval 17% to 68%) and smoking by 47% (14% to 90%). There were almost six times as many symptomatic rhinovirus infections as influenza A and B infections. Conclusions: Rhinoviruses are an important cause of debility and lower respiratory illness among elderly people in the community. Chronic ill health and smoking increase the likelihood of lower respiratory complications from such infections. The overall burden of rhinovirus infections in elderly people may approach that of influenza. Key messages Rhinoviruses are responsible for more colds in elderly people living in the community than are other respiratory pathogens combined Almost two thirds of elderly people with rhino- virus infections can be expected to develop lower respiratory illness More than 40% of rhinovirus infections in elderly people are seen by medical practitioners, and three quarters of those consulting are prescribed antibiotics Risk factors for lower respiratory rhinovirus illness include chronic medical conditions and cur- rent smoking; past smoking is not an independent risk factor and stopping smoking is the only factor identified thus far that could reduce the severity of rhinovirus illness in elderly people

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Esperanza Cancio

Papers

Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden

Risk factors for lower respiratory complications of rhinovirus infections in elderly people living in the community: prospective cohort study