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

TLDR: Rhinoviruses caused the greatest disease burden overall followed by episodes of unknown aetiology, coronaviruses, influenza A and B, and respiratory syncytial virus and patients with influenza will be difficult to target for antiviral treatment without a near patient diagnostic test.

Abstract: 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