The epidemiology of medically attended respiratory syncytial virus in older adults in the United States: A systematic review

PLoS One. 2017 Aug 10;12(8):e0182321. doi: 10.1371/journal.pone.0182321. eCollection 2017.


Objective: This review was undertaken to assess the historical evidence of the disease incidence and burden of laboratory-confirmed respiratory syncytial virus (RSV) in medically attended older adults.

Design: A qualitative systematic literature review was performed; no statistical synthesis of the data was planned, in anticipation of expected heterogeneity across studies in this population.

Methods: A literature search of PubMed, Embase, and the Cochrane Library was conducted for studies of medically attended RSV in older adults (≥ 50 years) published in the last 15 years. Two independent reviewers screened titles and abstracts based on predefined inclusion and exclusion criteria.

Results: From 10 studies reporting incidence proportions, RSV may be the causative agent in up to 12% of medically attended acute respiratory illness in older adults unselected for comorbidities, with variations in clinical setting and by year. In multiple studies, medically attended-RSV incidence among older adults not selected for having underlying health conditions increased with increasing age. Of prospectively followed lung transplant recipients, 16% tested positive for RSV. In hospitalized adults with chronic cardiopulmonary diseases, 8% to 13% were infected with RSV during winter seasons (8%-13%) or metapneumovirus season (8%). Hospitalizations for RSV in older adults typically lasted 3 to 6 days, with substantial proportions requiring intensive care unit admission and mechanical ventilation. Among older adults hospitalized with RSV, the mortality rate was 6% to 8%.

Conclusions: Protection of older adults against RSV could reduce respiratory-related burden, especially as age increases and the prevalence of comorbidities (especially cardiopulmonary comorbidities) grows.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Hospitalization
  • Humans
  • Incidence
  • Respiratory Syncytial Virus Infections / mortality*
  • Respiratory Syncytial Virus Infections / therapy
  • United States / epidemiology

Grant support

The funding for this research was provided by Novavax to RTI-Health Solutions (ADC, JY, JM, CCM). JS, VS and EH were employed by Novavax at the time the study was performed. JS and VS assisted with the formulation of the research questions and search strategy and JS, VS, and EH assisted with the interpretation of the review findings and the preparation of the manuscript. The decision to publish was made jointly by RTI-HS and Novavax.