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      Estimation of the Number of Respiratory Syncytial Virus–Associated Hospitalizations in Adults in the European Union

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          Abstract

          Background

          Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in adults that can result in hospitalizations. Estimating RSV-associated hospitalization is critical for planning RSV-related healthcare across Europe.

          Methods

          We gathered RSV-associated hospitalization estimates from the RSV Consortium in Europe (RESCEU) for adults in Denmark, England, Finland, Norway, Netherlands, and Scotland from 2006 to 2017. We extrapolated these estimates to 28 European Union (EU) countries using nearest-neighbor matching, multiple imputations, and 2 sets of 10 indicators.

          Results

          On average, 158 229 (95% confidence interval [CI], 140 865–175 592) RSV-associated hospitalizations occur annually among adults in the EU (≥18 years); 92% of these hospitalizations occur in adults ≥65 years. Among 75–84 years, the annual average is estimated at 74 519 (95% CI, 69 923–79 115) at a rate of 2.24 (95% CI, 2.10–2.38) per 1000. Among ≥85 years, the annual average is estimated at 37 904 (95% CI, 32 444–43 363) at a rate of 2.99 (95% CI, 2.56–3.42).

          Conclusions

          Our estimates of RSV-associated hospitalizations in adults are the first analysis integrating available data to provide the disease burden across the EU. Importantly, for a condition considered in the past to be primarily a disease of young children, the average annual hospitalization estimate in adults was lower but of a similar magnitude to the estimate in young children (0–4 years): 158 229 (95% CI, 140 865–175 592) versus 245 244 (95% CI, 224 688–265 799).

          Abstract

          Respiratory syncytial virus causes a high annual number of hospital admissions in adults across the European Union (roughly 160 000 per year). About 92% of these admissions occur in adults aged ≥65 years.

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          Most cited references43

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Global Disease Burden Estimates of Respiratory Syncytial Virus–Associated Acute Respiratory Infection in Older Adults in 2015: A Systematic Review and Meta-Analysis

            Respiratory syncytial virus-associated acute respiratory infection (RSV-ARI) constitutes a substantial disease burden in older adults aged ≥65 years. We aimed to identify all studies worldwide investigating the disease burden of RSV-ARI in this population. We estimated the community incidence, hospitalization rate, and in-hospital case-fatality ratio (hCFR) of RSV-ARI in older adults, stratified by industrialized and developing regions, using data from a systematic review of studies published between January 1996 and April 2018 and 8 unpublished population-based studies. We applied these rate estimates to population estimates for 2015 to calculate the global and regional burdens in older adults with RSV-ARI in the community and in hospitals for that year. We estimated the number of in-hospital deaths due to RSV-ARI by combining hCFR data with hospital admission estimates from hospital-based studies. In 2015, there were about 1.5 million episodes (95% confidence interval [CI], .3 million-6.9 million) of RSV-ARI in older adults in industrialized countries (data for developing countries were missing), and of these, approximately 14.5% (214 000 episodes; 95% CI, 100 000-459 000) were admitted to hospitals. The global number of hospital admissions for RSV-ARI in older adults was estimated at 336 000 hospitalizations (uncertainty range [UR], 186 000-614 000). We further estimated about 14 000 in-hospital deaths (UR, 5000-50 000) related to RSV-ARI globally. The hospital admission rate and hCFR were higher for those aged ≥65 years than for those aged 50-64 years. The disease burden of RSV-ARI among older adults is substantial, with limited data from developing countries. Appropriate prevention and management strategies are needed to reduce this burden.
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              Respiratory Syncytial Virus and Other Respiratory Viral Infections in Older Adults With Moderate to Severe Influenza-like Illness

              Background.  Few studies have prospectively assessed viral etiologies of acute respiratory infections in community-based elderly individuals. We assessed viral respiratory pathogens in individuals ≥65 years with influenza-like illness (ILI). Methods.  Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal/throat swabs from 556 episodes of moderate-to-severe ILI, defined as ILI with pneumonia, hospitalization, or maximum daily influenza symptom severity score (ISS) >2. Cases were selected from a randomized trial of an adjuvanted vs nonadjuvanted influenza vaccine conducted in elderly adults from 15 countries. Results.  Respiratory syncytial virus (RSV) was detected in 7.4% (41/556) moderate-to-severe ILI episodes in elderly adults. Most (39/41) were single infections. There was a significant association between country and RSV detection (P = .004). RSV prevalence was 7.1% (2/28) in ILI with pneumonia, 12.5% (8/64) in ILI with hospitalization, and 6.7% (32/480) in ILI with maximum ISS > 2. Any virus was detected in 320/556 (57.6%) ILI episodes: influenza A (104/556, 18.7%), rhinovirus/enterovirus (82/556, 14.7%), coronavirus and human metapneumovirus (each 32/556, 5.6%). Conclusions.  This first global study providing data on RSV disease in ≥65 year-olds confirms that RSV is an important respiratory pathogen in the elderly. Preventative measures such as vaccination could decrease severe respiratory illnesses and complications in the elderly.
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                Author and article information

                Contributors
                Journal
                J Infect Dis
                J Infect Dis
                jid
                The Journal of Infectious Diseases
                Oxford University Press
                0022-1899
                1537-6613
                01 December 2023
                29 May 2023
                29 May 2023
                : 228
                : 11
                : 1539-1548
                Affiliations
                Centre for Global Health, Usher Institute, University of Edinburgh , United Kingdom
                Netherlands Institute for Health Services Research , Utrecht, The Netherlands
                Netherlands Institute for Health Services Research , Utrecht, The Netherlands
                Postgraduate Medical School in Public Health, University of Florence , Italy
                Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
                Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen , Denmark
                Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
                Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen , Denmark
                Department of Infection Control and Vaccines, Norwegian Institute of Public Health , Oslo
                Centre for Infectious Disease Control, National Institute for Public Health and the Environment , Bilthoven
                Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , The Netherlands
                School of Public Health, Nanjing Medical University , China
                Department of Health Security, Finnish Institute for Health and Welfare , Helsinki
                Sanofi Vaccines , Lyon, France
                Centre for Global Health, Usher Institute, University of Edinburgh , United Kingdom
                Netherlands Institute for Health Services Research , Utrecht, The Netherlands
                Author notes

                The RESCEU investigators are listed in the Acknowledgments.

                Correspondence: Richard Osei-Yeboah, PhD, Centre for Global Health, Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK ( richard.osei-yeboah@ 123456ed.ac.uk ); John Paget, PhD, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, The Netherlands ( j.paget@ 123456nivel.nl ).

                Potential conflicts of interest. R. O.-Y. reports support from the Innovative Medicines Initiative (IMI)–funded PROMISE consortium. T. K. F. reports support from the IMI-funded PROMISE consortium and consulting fees from Pfizer as chairperson for European Congress of Clinical Microbiology and Infectious Diseases conference symposium on RSV infections among adults. M. B. is an employee of Sanofi Vaccines and may hold stock in the company. H. C. reports grants, personal fees, and nonfinancial support from the World Health Organization, grants and personal fees from Sanofi Pasteur, and grants from the Bill & Melinda Gates Foundation; all payments were made via the University of Edinburgh. H. C. is a shareholder in the Journal of Global Health Ltd. J. P. declares unrestricted grants from Sanofi to the Netherlands Institute for Health Services Research (Nivel) for research on RSV, influenza, and severe acute respiratory syndrome coronavirus 2. Nivel received a research grant from the University of Edinburgh for the submitted work. All other authors report no potential conflicts.

                All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

                Author information
                https://orcid.org/0000-0003-4622-3691
                https://orcid.org/0000-0002-2742-0297
                https://orcid.org/0000-0002-0841-2400
                https://orcid.org/0000-0002-6169-6262
                Article
                jiad189
                10.1093/infdis/jiad189
                10681866
                37246742
                cf6d9da5-3e7f-4d59-96a0-9ac44603927a
                © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 17 February 2023
                : 23 May 2023
                : 25 May 2023
                : 06 July 2023
                Page count
                Pages: 10
                Categories
                Major Article
                Viruses
                AcademicSubjects/MED00290

                Infectious disease & Microbiology
                respiratory syncytial virus,european union,adults,burden,hospitalization

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