Introduction: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illness (ARI) in older adults and those with comorbidities. Understanding disease burden could guide prevention efforts.
Methods: We performed active surveillance for RSV among adults aged ≥50 years hospitalized with ARI and adults of any age hospitalized with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) exacerbations from Georgia Health District 3 at two Atlanta hospitals during two respiratory seasons (2018-2019 & 2019-2020). All participants were tested for RSV using the BioFire Respiratory Panel (nasopharyngeal and oropharyngeal swabs); subsets also had serology and standard-of-care results. Annual population-based incidences of RSV-related hospitalizations were estimated by age strata and study group, adjusting for differences in sampling, diagnostic testing, and test sensitivity. Denominators for ARI incidence estimates were from the US Census. CHF and COPD denominators were limited to individuals with underlying CHF or COPD, respectively, as defined by NHANES data.
Results: Of 3,090 eligible patients, 1558 were included; 757 (48.6%) had ARI, 490 (31.4%) CHF exacerbation, and 311 (20.0%) COPD exacerbation. Overall, 92 (5.9%) participants tested positive for RSV. Based on data from two seasons, annual population-based incidences among adults aged ≥50 years were 74 per 100,000 (95%CI: 73, 77) for laboratory-confirmed RSV-related ARI hospitalizations alone, and 58% higher when including all laboratory-confirmed RSV-related hospitalizations (ARI and CHF/COPD exacerbations): 117 per 100,000 (95%CI: 114, 123).
Conclusions: RSV was associated with a substantial burden of hospitalizations among adults aged ≥50 years, particularly when CHF and COPD exacerbations were included.
Keywords: CHF; COPD; Incidence; RSV; elderly; older adults.
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America.