Branche Angela R, Falsey Ann R, Saiman Lisa, Alba Luis, Peterson Derick, Wang Lu, Finelli Lyn, Walsh Edward E
Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, New York, USA.
Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
Open Forum Infect Dis. 2025 Jul 2;12(7):ofaf394. doi: 10.1093/ofid/ofaf394. eCollection 2025 Jul.
Respiratory syncytial virus (RSV) causes hospitalization in older adults and those with preexisting medical conditions. Three RSV vaccines are now licensed for all adults but not recommended for persons age <60 years with risk factors for RSV hospitalization. We therefore assessed the relationship of preexisting medical conditions to age-specific RSV hospitalization incidence and severe outcomes.
Adults age ≥18 years hospitalized over 3 winters (2017-2020) with polymerase chain reaction-confirmed RSV were enrolled in Rochester and New York City, NY. Population-based incidence was estimated by race and ethnicity for 4 age groups: 18-44, 45-64, 65-74, and ≥75 years. A general linear model assessed variables associated with 2 outcomes: (1) composite of intensive care unit admission and/or in-hospital mortality and (2) all-cause 6-month mortality.
Adults of all ages with congestive heart failure (CHF), coronary artery disease, chronic obstructive pulmonary disease (COPD), and diabetes were more likely to be hospitalized with RSV (incidence rate ratio, 13.66, 8.24, 5.85, and 5.35, respectively), and asthma, obesity, and immunosuppression were more prevalent among younger adults age ≤65 years. Mean annual RSV hospitalization incidence was 2.5-fold higher for Black adults age 18-44 years and 8-fold higher for those age 45-64 years compared with other races. Hispanic adults had a 2-3-fold higher incidence of hospitalization in each age stratum compared with non-Hispanics. COPD conferred a 1.9-fold higher risk of intensive care unit admission or in-hospital mortality (97.5% CI, 1.27-2.68), and both COPD and CHF increased risk of 6-month all-cause mortality. Age ≥65 years was not associated with either outcome.
Future RSV vaccine recommendations should consider the impact of preexisting conditions and racial and ethnic differences in age-related RSV hospitalization.
呼吸道合胞病毒（RSV）可导致老年人及患有基础疾病者住院。目前有三种RSV疫苗已获批准用于所有成年人，但不建议给年龄<60岁且有RSV住院风险因素的人群接种。因此，我们评估了基础疾病与特定年龄的RSV住院发病率及严重后果之间的关系。
在纽约州罗切斯特市和纽约市，纳入了3个冬季（2017 - 2020年）因聚合酶链反应确诊为RSV而住院的≥18岁成年人。按种族和族裔对4个年龄组（18 - 44岁、45 - 64岁、65 - 74岁和≥75岁）的基于人群的发病率进行了估计。采用一般线性模型评估与2种结局相关的变量：（1）重症监护病房入住和/或院内死亡的综合情况；（2）全因6个月死亡率。
患有充血性心力衰竭（CHF）、冠状动脉疾病、慢性阻塞性肺疾病（COPD）和糖尿病的各年龄段成年人更易因RSV住院（发病率比分别为13.66、8.24、5.85和5.35），而哮喘、肥胖和免疫抑制在年龄≤65岁的年轻人中更为普遍。18 - 44岁的黑人成年人平均每年RSV住院发病率比其他种族高2.5倍，45 - 64岁的黑人成年人则高8倍。与非西班牙裔成年人相比，西班牙裔成年人在每个年龄层的住院发病率高2 - 3倍。COPD使重症监护病房入住或院内死亡风险增加1.9倍（97.5%可信区间，1.27 - 2.68），COPD和CHF均增加了6个月全因死亡率的风险。年龄≥65岁与这两种结局均无关。
未来RSV疫苗的推荐应考虑基础疾病的影响以及年龄相关RSV住院方面的种族和族裔差异。
