RSV in Older Adults: Risks and Costs

RSV Impact
Respiratory syncytial virus (RSV) is a seasonally circulating virus that predominantly affects children, but there is a growing recognition of the effects of RSV among older adults (age ≥65 years). Annual estimates of US deaths due to RSV in older adults are approximately 14,000, with more than 177,000 inpatient admissions at a cost of more than $1 billion.

Given older adults’ high incidence of multimorbidity and susceptibility to adverse infection-related sequelae, RSV infections are particularly burdensome. In particular, infection with influenza and RSV commonly result in cardiorespiratory events that include acute myocardial infarction, stroke, and exacerbation of asthma and chronic obstructive pulmonary disease (COPD).

The impact of circulating RSV can be seen from the results of a landmark study, which estimated the relationship between lab-confirmed RSV infection and cardiopulmonary events in older adults and high-risk individuals admitted to several hospitals during 4 respiratory seasons. In their findings, RSV accounted for a substantial proportion of hospital admissions: 10.6% for pneumonia, 11.4% for COPD, 5.4% for heart failure, and 7.2% for asthma.

LTCF Setting and Risk for Respiratory Infections
Residents of long-term care facilities (LTCFs) are among the most susceptible to respiratory infections for several important reasons.

First, older adults are at high risk for influenza and RSV infection as a result of age-related physiologic changes such as reduced chest wall compliance, decreased cough strength, and impaired immune function due to cellular senescence. 

Second, the risk of infection is increased owing to the institutional nature of LTCFs—this risk is influenced by frequent resident exposure to coresidents, visitors, volunteers, and staff, all of whom may transmit viruses.

Third, frail residents with decreased functional capacity may experience the most severe forms of illness, requiring transfer to the hospital for supportive care and services that are not often provided in the LTCF setting.

Our recent study in LTCFs found approximately 10,939 cardiorespiratory events attributable to both influenza and RSV across 6 respiratory seasons. These events resulted in $91 million in expenses from inpatient admissions, approximately $15 million per season, and approximately $8,300 per prevented event. This suggests that preventing respiratory infections such as RSV in LTCFs can result in substantial healthcare cost savings.

Recognizing RSV Among Older Adults
RSV infections among older adults can have variable presentations. Most infections present with no symptoms or mild symptoms lasting up to 5 days and include: cough, headache, fatigue, runny nose, and throat ache. Fever may be present but is not always a reliable marker of infection in older adults. Older adults with cardiovascular illnesses, such as heart failure or acute coronary syndrome, and respiratory illnesses, such as asthma and COPD, are at risk of severe illness. Infection with RSV may also result in pneumonia. Greater attention should be paid to older adults at highest risk of severe illness from RSV infection.

Preventing RSV Infection
There are currently no approved vaccinations for RSV, although several are in development. In preparation for the potential availability of a vaccine, education on the benefits of such a vaccination should be targeted toward LTCF staff and residents.

Currently, however, the best approach to preventing RSV infection is to take precautions when RSV is circulating. Precautions relate to RSV’s airborne and surface contact routes of transmission. In LTCFs, mask wearing among residents, staff, and visitors is a standard preventive measure. In addition, RSV can persist on hard surfaces for several hours, making handwashing and sanitization of surfaces effective measures. Furthermore, eating and drinking utensils should not be shared. Taken together, these steps present effective ways to prevent the transmission of RSV, and potentially severe illness, among older adults.

Your Thoughts?
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