McLaughlin John M, Khan Farid, Begier Elizabeth, Swerdlow David L, Jodar Luis, Falsey Ann R
Pfizer Vaccines, Collegeville, Pennsylvania, USA.
Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, New York, USA.
Open Forum Infect Dis. 2022 Jun 17;9(7):ofac300. doi: 10.1093/ofid/ofac300. eCollection 2022 Jul.
Adult respiratory syncytial virus (RSV) vaccines are in the late stages of development. A comprehensive synthesis of adult RSV burden is needed to inform public health decision-making.
We performed a systematic review and meta-analysis of studies describing the incidence of medically attended RSV (MA-RSV) among US adults. We also identified studies reporting nasopharyngeal (NP) or nasal swab reverse transcription polymerase chain reaction (RT-PCR) results with paired serology (4-fold-rise) or sputum (RT-PCR) to calculate RSV detection ratios quantifying improved diagnostic yield after adding a second specimen type (ie, serology or sputum).
We identified 14 studies with 15 unique MA-RSV incidence estimates, all based on NP or nasal swab RT-PCR testing alone. Pooled annual RSV-associated incidence per 100 000 adults ≥65 years of age was 178 (95% CI, 152‒204; n = 8 estimates) hospitalizations (4 prospective studies: 189; 4 model-based studies: 157), 133 (95% CI, 0‒319; n = 2) emergency department (ED) admissions, and 1519 (95% CI, 1109‒1929; n = 3) outpatient visits. Based on 6 studies, RSV detection was ∼1.5 times higher when adding paired serology or sputum. After adjustment for this increased yield, annual RSV-associated rates per 100 000 adults age ≥65 years were 267 hospitalizations (uncertainty interval [UI], 228‒306; prospective: 282; model-based: 236), 200 ED admissions (UI, 0‒478), and 2278 outpatient visits (UI, 1663‒2893). Persons <65 years with chronic medical conditions were 1.2-28 times more likely to be hospitalized for RSV depending on risk condition.
The true burden of RSV has been underestimated and is significant among older adults and individuals with chronic medical conditions. A highly effective adult RSV vaccine would have substantial public health impact.
成人呼吸道合胞病毒（RSV）疫苗正处于研发后期。需要对成人RSV负担进行全面综合分析，以为公共卫生决策提供依据。
我们对描述美国成年人中就医的RSV（MA-RSV）发病率的研究进行了系统评价和荟萃分析。我们还确定了报告鼻咽（NP）或鼻拭子逆转录聚合酶链反应（RT-PCR）结果并结合配对血清学（4倍升高）或痰液（RT-PCR）的研究，以计算RSV检测率，量化添加第二种标本类型（即血清学或痰液）后诊断率的提高。
我们确定了14项研究，有15个独特的MA-RSV发病率估计值，均仅基于NP或鼻拭子RT-PCR检测。每10万名≥65岁成年人中，RSV相关的年住院发病率汇总为178（95%CI，152‒204；n = 8个估计值）（4项前瞻性研究：189；4项基于模型的研究：157），急诊（ED）就诊人数为133（95%CI，0‒319；n = 2），门诊就诊人数为1519（95%CI，1109‒1929；n = 3）。根据6项研究，添加配对血清学或痰液时，RSV检测率高出约1.5倍。在对这一提高的检出率进行调整后，每10万名≥65岁成年人中，RSV相关的年发病率为267例住院（不确定区间[UI]，228‒306；前瞻性研究：282；基于模型的研究：236），200例ED就诊（UI，0‒478），2278例门诊就诊（UI，1663‒2893）。根据风险状况，<65岁患有慢性疾病的人因RSV住院的可能性是正常人的1.2至28倍。
RSV的实际负担被低估，在老年人和患有慢性疾病的个体中负担较重。一种高效的成人RSV疫苗将对公共卫生产生重大影响。
