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Increased testing and higher clinical suspicion may improve estimates of RSV’s burden in young adults aged less than 50.
The burden of RSV-related illness among adults is likely underestimated, even as this population faces serious health risks stemming from the disease, according to findings from a study presented at the American Thoracic Society International Conference 2024.
“Over the past few years, there has been more recognition of the burden of disease of RSV in older adults. We now know that older adults infected with RSV are at significant risk for hospitalization and serious disease,” Yolanda Penders, PhD, explains. “However, the burden in younger adults, up to 50 years of age, is less well explored. As a first step towards establishing the burden of disease in this age group, as well as identifying the main data gaps.”
Finding the Data
Dr. Penders and colleagues searched the EMBASE and PubMed databases for studies elucidating the burden of RSV in young adults aged up to 50. Studies that met inclusion criteria were performed in high-income countries, published in English, and available since Jan. 1, 2000. The main outcomes included rates of RSV-related hospitalization, rates of complications attributable to RSV, and mortality.
“We focused our inclusion criteria on correctly identifying RSV cases,
distinguishing between ICD-10 coded cases,” Dr. Penders notes. “RSV is very prone to underestimation of cases due to a lack of testing in the adult population, modeling studies, and prospective studies,” Penders said. “For data on complications and outcomes associated with RSV hospitalizations, we only took into consideration studies where RSV was confirmed via RT-PCR, as other methods are known to be less sensitive in adults.”
A total of 13 papers met inclusion criteria for the systematic literature review. The researchers found that prospective and modeling studies reported a higher RSV disease burden than those estimated using ICD-10 coding. The reported hospitalization rates for adults with RSV ranged from 7.7 to 21.1 per 100,000 population in prospective studies, whereas ICD-10 estimates put the burden at 0.1 to 0.4 per 100,000.
Dr. Penders said she and her colleagues expected the estimates from prospective studies “to provide the most complete picture of the burden of disease.”
The Value of Investigating RSV Risk
With this burden of disease comes several risks. Adults hospitalized with RSV face a risk for requiring treatment in an intensive care unit, with up to 22% of these patients entering ICUs. Furthermore, as many as 10% of adults who are hospitalized with RSV disease die from the illness, Penders and colleagues reported. Patients hospitalized for RSV in the 17 to 49 years of age group reportedly stayed in the hospital for an average of 5.6 to 19.2 days.
Despite the risks, this area remains under-explored, Dr. Penders explained.
“Testing for RSV is not often considered in clinical practice in adults, as there is no RSV-specific treatment for them,” she said. “However, this has the effect of systematically underestimating the burden of disease of RSV: we have no reason for testing it, so we don’t test it, so we don’t know it’s there. This is why we see the lower burden of disease when looking at ICD-10 coded cases. This review shows that the true burden may be 10 to 30-fold higher than medical records show.”
KEY TAKEAWAYS
- RSV is underestimated among adults aged younger than 50, despite the fact that this population faces serious RSV-related risks
- RSV testing is not often considered in young adults due to the lack of RSV-specific treatment for this group
- Study results indicate that the true RSV burden in this age group may be 10 to 30-fold higher than medical records indicate
