Burden of Respiratory Syncytial Virus (RSV) Infection Among Adults in Nursing and Care Homes: A Systematic Review.

Abstract

Background: Older adults in nursing and care homes (NCHs) are vulnerable to severe respiratory syncytial virus (RSV) in fection, hospitalization, and death. This study aimed to gather data on RSV disease among older adults in NCHs and identify reported risk factors for RSV hospitalization and case fatality. Methods: The study protocol was registered in PROSPERO (CRD42022371908). We searched MEDLINE, EMBASE, and Global Health databases to identify articles published between 2000 and 2023. Observational and experimental studies conducted among older adults in NCHs requiring assistive care and reporting RSV illness were included and relevant data were extracted. Results: Of 18,690 studies screened, 32 were selected for full-text review, and 20 were included. Overall, the number of NCH residents ranged from 42 to 1459 with a mean age between 67.6 and 85 years. Attack rates ranged from 6.7% to 47.6% and annual incidence ranged from 0.5% to 14%. Case fatality rates ranged from 7.7% to 23.1%. We found similar annual incidence rates of RSV-positive acute respiratory infection (ARI) of 4582 (95% CI: 3259–6264) and 4785 (95% CI: 2258–10,141) per 100,000 reported in two studies. Annual incidence rate of RSV-positive lower respiratory tract infection was 3040 (95% CI: 1986–4454) cases per 100,000 adults. Annual RSV-ARI hospital admission rates were between 600 (95% CI: 190–10,000) and 1104 (95% CI: 350–1930) per 100,000 person-years. Among all RSV disease cases, commonly reported chronic medical conditions included chronic ob structive pulmonary disease (COPD), heart failure, ischemic heart disease, coronary artery disease, hypertension, diabetes, kid ney dysfunction, cerebrovascular accident, malignancies, dementia, and those with a Charlson comorbidity score>6.5.