Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Netw Open. 2024 Apr 1;7(4):e244954. doi: 10.1001/jamanetworkopen.2024.4954.
On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making.
To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023.
RSV, SARS-CoV-2, or influenza infection.
Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death.
Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001).
Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.
2023 年 6 月 21 日，疾病控制与预防中心建议使用共同临床决策为 60 岁及以上的成年人接种首支呼吸道合胞病毒（RSV）疫苗。了解成年人 RSV 疾病的严重程度有助于指导这一临床决策。
描述因 RSV 住院的成年人的疾病严重程度，并比较其与 COVID-19 和流感疾病的严重程度，同时比较疫苗接种状况的影响。
设计、地点和参与者：在这项队列研究中，从 2022 年 2 月 1 日至 2023 年 5 月 31 日，从美国 25 个州的 25 家医院前瞻性纳入因急性呼吸道疾病和实验室确诊的 RSV、SARS-CoV-2 或流感感染而住院的 18 岁及以上成年人。在每位患者住院期间，使用标准化表格收集临床数据。分析数据的时间为 2023 年 8 月至 10 月。
RSV、SARS-CoV-2 或流感感染。
使用多变量逻辑回归，根据 COVID-19 和流感疫苗接种情况，比较 RSV 疾病与 COVID-19 和流感严重程度，用于一系列临床结局，包括侵入性机械通气（IMV）和院内死亡的复合结局。
在纳入的 7998 名成年人（中位数[IQR]年龄为 67[54-78]岁；4047[50.6%]为女性）中，484 人（6.1%）因 RSV 住院，6422 人（80.3%）因 COVID-19 住院，1092 人（13.7%）因流感住院。在 RSV 患者中，58 人（12.0%）经历了 IMV 或死亡，与未接种 COVID-19 疫苗的 1422 名患者中的 201 人（14.1%）和接种 COVID-19 疫苗的 5000 名患者中的 458 人（9.2%）相比，与未接种流感疫苗的 699 名患者中的 72 人（10.3%）和接种流感疫苗的 393 名患者中的 20 人（5.1%）相比。在调整分析中，与未接种 COVID-19 疫苗的住院患者相比，RSV 住院患者的 IMV 或院内死亡的几率并无显著差异（调整后的比值比[OR]，0.82；95%CI，0.59-1.13；P=0.22），与未接种流感疫苗的住院患者相比（调整后的 OR，1.20；95%CI，0.82-1.76；P=0.35）也无显著差异；然而，与接种 COVID-19 疫苗的住院患者相比，RSV 住院患者发生 IMV 或死亡的几率显著更高（调整后的 OR，1.38；95%CI，1.02-1.86；P=0.03），与接种流感疫苗的住院患者相比（调整后的 OR，2.81；95%CI，1.62-4.86；P<0.001）也是如此。
在这项美国队列研究中，在首支 RSV 疫苗建议发布前的 16 个月内，因 RSV 住院的成年人发病率低于 COVID-19 或流感，但未接种疫苗的患者中 RSV 疾病的严重程度与 COVID-19 或流感相似，而接种疫苗的患者中 RSV 疾病的严重程度则重于 COVID-19 或流感，IMV 或死亡是最严重的结局。
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