The Negative Impact of RSV in Adults: A Look at Quality of Life

Key Takeaways

• RSV infection can result in considerable disease burden in the aging population globally.
• Recent data suggest that RSV infection can profoundly impair overall health and quality of life (eg, physical functioning, mental well-being) of relatively healthy older adults in the community setting.

Respiratory syncytial virus (RSV) often is overlooked as a respiratory virus that mainly affects children—but it causes considerable disease burden in the aging population worldwide.

In a review by Ting and colleagues assessing the global burden of RSV, the estimated incidence rate of RSV-associated acute respiratory infection in adults 65 years of age or older was found to be 6.7 per 1000 persons per year in industrialized countries. The global number of hospital admissions and in-hospital deaths for RSV-associated acute respiratory infection in older adults was estimated at 336,000 and 14,000, respectively.

RSV not only reduces the life expectancy of those affected, but also can jeopardize quality of life. Until recently, little data were available on quantifying the impact on quality of life of older adults with RSV.

RESCEU: RSV Burden in Older Adults

Study Design
The RESCEU older adult study was conducted to investigate the disease burden of RSV infection in relatively healthy community-dwelling adults aged 60 years or older in the pre‒COVID-19 era.

This study actively followed 1040 older adults in Belgium, the United Kingdom, and the Netherlands during 2 consecutive RSV seasons (1 October to 1 May in 2017/18 and 2018/19). During the RSV season, participants were contacted weekly, and if they had any acute respiratory infection symptoms for at least 1 day, they underwent a point-of-care polymerase chain reaction test at home within 72 hours, with RSV infections confirmed within 24 hours.

Measuring Quality of Life
Patients recorded their weekly quality of life using the EQ-5D-5L questionnaire from symptom onset over 4 weeks or until symptom free. The questionnaire included 5 health-related quality of life dimensions (ie, mobility, self-care, usual activities, pain/discomfort, anxiety/depression), with each dimension being divided into 5 levels (eg, no problems, slight problems, moderate problems, severe problems, extreme problems). These data were converted into health utility values where 0 was equivalent to dead and 1 was the value of full health. A question on overall self-rated health was also included, ranging in value from 0 (worst imaginable health) to 100 (best imaginable health).

Results
At the beginning of the infection period, all patients reported at least slight problems in the 5 health-related quality of life dimensions. Before being infected, 32.4%, 2.9%, 8.8%, 41.2%, and 11.8% of patients reported problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, respectively. The percentages increased to 41.2%, 29.4%, 52.9%, 76.5%, and 35.3% during the first week of RSV infection, suggesting that RSV can impose a negative impact on physical functioning, cause pain and discomfort, and increase the level of anxiety and depression.

As for overall quality of life, the average utility value decreased markedly from preseason to Week 1 (from 0.896 to 0.801) and then increased weekly. It was during Week 3 that the average utility value returned to its preseason level. Similarly, the average self-rated health value decreased from 81.6 to 64.2 from baseline to Week 1, then bounced back in Week 3.

Interpretation
Although recruited patients were relatively healthy community-dwelling older adults outside the hospital setting, a substantial negative impact of RSV on physical functioning and mental well-being was observed. Larger studies are needed to further evaluate the impact of quality of life of RSV infections in adults, including location-specific data and other patient populations (eg, adults with other risk factors for severe disease).

A View Ahead
RSV infection continues to be a major concern in the aging population and is projected to increase in burden, as more than 30% of the EU population is expected to be 65 years of age or older by 2100.

Based on a joint statement from the European Centre for Disease Prevention and Control and WHO earlier this fall, additional pressure on the healthcare system is expected with the high levels of circulating RSV in the community, alongside the circulation of COVID-19 and influenza.

Because we are in respiratory virus season, these data are extremely important to prompt more attention to adults at high risk of being infected with RSV. Luckily, preventive strategies are forthcoming, with several vaccine candidates in clinical trials, but more efforts are needed to help reduce the burden of RSV on patients and the healthcare system. 

Your Thoughts?
In what ways does RSV infection affect quality of life in your patients? Join the discussion by leaving a comment.