Hanage William P, Schaffner William
Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
Infect Dis Ther. 2025 Jan;14(Suppl 1):5-37. doi: 10.1007/s40121-024-01080-4. Epub 2024 Dec 30.
Influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are acute respiratory infections (ARIs) that can cause substantial morbidity and mortality among at-risk individuals, including older adults. In this narrative review, we summarize themes identified in the literature regarding the epidemiology, seasonality, immunity after infection, clinical presentation, and transmission for these ARIs, along with the impact of the COVID-19 pandemic on seasonal patterns of influenza and RSV infections, with consideration of data specific to older adults when available. As the older adult population increases globally, it is of paramount importance to fully characterize the true disease burden of ARIs in order to develop appropriate mitigation strategies to minimize their impact in vulnerable populations. Challenges associated with characterizing the burden of these diseases include the shared symptomology and clinical presentation of influenza virus, RSV, and SARS-CoV-2, which complicate accurate diagnosis and highlight the need for improved testing and surveillance practices. To this end, multiple regional, national, and global virologic and disease surveillance systems have been established to provide accurate knowledge of viral epidemiology, support appropriate preparedness and response to potential outbreaks, and help inform prevention strategies to reduce disease severity and transmission. Beyond the burden of acute illness, long-term health consequences can also result from influenza virus, RSV, and SARS-CoV-2 infection. These include cardiovascular and pulmonary complications, worsening of existing chronic conditions, increased frailty, and reduced life expectancy. ARIs among older adults can also place a substantial financial burden on society and healthcare systems. Collectively, the existing data indicate that influenza virus, RSV, and SARS-CoV-2 infections in older adults present a substantial global health challenge, underscoring the need for interventions to improve health outcomes and reduce the disease burden of respiratory illnesses.Graphical abstract and video abstract available for this article.
流感病毒、呼吸道合胞病毒（RSV）和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）都是急性呼吸道感染（ARIs），可在包括老年人在内的高危人群中导致大量发病和死亡。在这篇叙述性综述中，我们总结了文献中关于这些ARIs的流行病学、季节性、感染后的免疫力、临床表现和传播等方面确定的主题，以及COVID-19大流行对流感和RSV感染季节性模式的影响，并在有可用数据时考虑老年人的具体数据。随着全球老年人口的增加，全面描述ARIs的真实疾病负担对于制定适当的缓解策略以尽量减少其对脆弱人群的影响至关重要。描述这些疾病负担所面临的挑战包括流感病毒、RSV和SARS-CoV-2的共同症状和临床表现，这使得准确诊断变得复杂，并突出了改进检测和监测方法的必要性。为此，已经建立了多个区域、国家和全球病毒学及疾病监测系统，以提供关于病毒流行病学的准确知识，支持对潜在疫情的适当准备和应对，并帮助为预防策略提供信息以降低疾病严重程度和传播。除了急性疾病的负担外，流感病毒、RSV和SARS-CoV-2感染还可能导致长期健康后果。这些包括心血管和肺部并发症、现有慢性病的恶化、虚弱加剧和预期寿命缩短。老年人中的ARIs也会给社会和医疗系统带来巨大的经济负担。总体而言，现有数据表明，老年人中的流感病毒、RSV和SARS-CoV-2感染对全球健康构成了重大挑战，凸显了采取干预措施以改善健康结果和减轻呼吸道疾病疾病负担的必要性。本文提供图形摘要和视频摘要。
