Recognizing Challenges and Enhancing Outcomes in Older Adults During RSV Season

Respiratory syncytial virus (RSV) has long been recognized as a significant pathogen affecting infants and young children. However, the toll it takes on older adult population — especially those with underlying health conditions —are becoming increasingly evident at home in the United States and globally in places like Brazil.

RSV is characterized as a highly contagious virus with a seasonal pattern of infection. The clinical manifestations of RSV often are mild upper respiratory symptoms in healthy younger adults but can be severe in older adults, leading to significant morbidity and mortality.

Understanding RSV and its impact on older adults is crucial for improving health outcomes and quality of life. The recent surge in cases during the colder months has highlighted the urgency of addressing this overlooked virus and its effects on aging populations.Recognizing the challenges older adults face and increasing their knowledge of effective prevention and treatment strategies can mitigate the risks associated with the virus.

Lessandra Michelin, M.D., M.Sc., Ph.D.

The conclusions of a multidisciplinary panel of healthcare experts examining the challenges of addressing RSV in older people was published in the journal Human Vaccines & Immunotherapeutics in August 2024. Corresponding author Lessandra Michelin, M.D., M.Sc., Ph.D., is a professor of infectious diseases in the Division of Clinical Medicine at University of Caxias do Sul in northeastern Brazil and vaccine medical lead RSV at GSK Brazil.

According to Michelin and her colleagues, RSV in older adults has been notably underrecognized, particularly in Brazil. The underrecognition stems from a clinical focus on more familiar pathogens such as influenza and, of course. COVID-19. In Brazil, this misperception becomes critical as surveillance data indicates a rising trend of RSV cases among those aged 60 and over.

The panel highlighted that the increase in cases of RSV-related severe acute respiratory illness (RSV-SARI) among older adults in Brazil warrants urgent attention. The panel noted that the fatality rates for older adults with RSV exceed 30%, and routine testing is alarmingly low. Educational initiatives directed at healthcare professionals and the general public are vital in raising awareness about RSV, especially in light of newly available protective vaccines.

The panel's methodology involved a comprehensive review of current literature and data collection from Brazil’s SIVEP-Gripe database, which chronicles RSV and other respiratory illnesses. The panel focused on the epidemiology of RSV, its clinical presentation and feedback from professionals across various specialties that underscored the need for improved diagnostic practices and better public awareness.

Data from the SIVEP-Gripe database indicate a concerning rise in RSV-SARI cases among older adults, particularly after the COVID-19 pandemic. The statistics revealed a substantial number of cases and a high proportion of ICU admissions among older individuals. Notably, between 2020 and 2022, the reported fatality rates for older adults with RSV were disproportionately higher than those seen in younger populations, emphasizing the critical need for targeted intervention in this age group.

The panel also discussed that individuals with preexisting comorbidities experience worse outcomes when infected with RSV. While specific studies vary in the assessment of risk associated with particular conditions, the consensus was clear; patients with comorbidities face higher mortality rates and complications from RSV infection. This observation underscores the need for vigilant monitoring and early intervention in affected populations.

The insights from the multidisciplinary panel illuminate a significant gap in the recognition and diagnosis of RSV infections in older adults in Brazil. With rising incidence rates and high associated fatalities, incorporating routine RSV testing into clinical practice for older patients presenting with respiratory symptoms is critical. Furthermore, the development of effective vaccines presents a unique opportunity to mitigate the burden of RSV among older people.

The panel concluded by making several recommendations, including enhancing diagnostic testing, launching educational campaigns, improving country-wide surveillance systems, continuing advocacy for vaccine uptake in eligible populations and encouraging further research into the epidemiology of RSV in older populations.