Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness

J Infect Dis. 2014 Jun 15;209(12):1873-81. doi: 10.1093/infdis/jit839. Epub 2014 Jan 29.


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.

Keywords: elderly; epidemiology; influenza; polymerase chain reaction; prevalence; respiratory infection; respiratory syncytial virus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Clinical Trials, Phase III as Topic
  • Female
  • Hospitalization
  • Humans
  • Influenza Vaccines / therapeutic use
  • Influenza, Human / epidemiology*
  • Logistic Models
  • Male
  • Prevalence
  • Randomized Controlled Trials as Topic
  • Respiratory Syncytial Virus Infections / epidemiology
  • Respiratory Syncytial Viruses / isolation & purification*
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / virology
  • Reverse Transcriptase Polymerase Chain Reaction
  • Risk Factors
  • Surveys and Questionnaires


  • Influenza Vaccines