Is RSV contagious? Get the facts about this virus.

More Than A Fifth Of Older Adults With RSV Have Acute Cardiac Events, Data Reveal

A study yesterday in JAMA Internal Medicine demonstrates that 22% of hospitalized adults aged 50 years or older with respiratory syncytial virus (RSV) infection experienced an acute cardiac event—most frequently acute heart failure (16%). Moreover, 1 in 12 of infected patients (8.5%) had no documented underlying cardiovascular disease.

RSV is associated with annual totals of up to 160,000 US hospitalizations, 10,000 deaths, and $4 billion in direct healthcare costs among adults age 65 years or older.

"Despite evidence of considerable RSV-associated morbidity, mortality, and health care expenditure, the potential severity of RSV infection in adults has historically been underappreciated by public health professionals and clinicians," the authors write. RSV is rarely tested for in the clinical settings, and symptoms usually mirror other respiratory diseases, they add. 

Despite evidence of considerable RSV-associated morbidity, mortality, and health care expenditure, the potential severity of RSV infection in adults has historically been underappreciated.

The study consisted of outcomes among 6,248 adults aged 50 years and older hospitalized for RSV during 2014 to 2018, and then in 2022 and 2023, in 12 US states. Almost 60% of the adults were women, and 65.9% were White. 

Upon hospital admission, 93.1% of those included in the study had a fever, and 80.6% had a cough.

Heart failure most common event 

A total of 56.4% of patients had underlying cardiovascular disease, including 31.9% with heart failure, 30.2% with coronary artery disease, and 25.2% with atrial fibrillation. After cardiovascular disease, diabetes (35%) and chronic obstructive pulmonary disease (34.8%) were the most common underlying conditions. 

According to the authors, the weighted estimated prevalence of experiencing an acute cardiac event among adults aged 50 years or older hospitalized with laboratory-confirmed RSV infection was 22.4% (95% confidence interval [CI], 21.0% to 23.7%.) Among those events, acute heart failure was the most common, with a prevalence of 15.8% (95% CI, 14.6% to 17.0%) in all RSV-infected patients.

Patients with underlying cardiovascular disease had a greater weighted risk of experiencing an acute cardiac event of any category compared to those without underlying cardiovascular disease (33.0% vs 8.5%). A history of heart failure, age 85 years or older, and atrial fibrillation were also associated with a higher risk of having an acute cardiac event. 

Experiencing an acute cardiac event during hospitalization was also associated with more severe RSV outcomes, including intensive care unit admission, invasive mechanical ventilation, and in-hospital death.

"Acute cardiac events occurred frequently among adults with a history of underlying cardiovascular disease, particularly chronic heart failure," the authors concluded. "However, acute cardiac events also occurred in 1 in 12 adults who had no previous documentation of cardiovascular disease, suggesting that severe RSV infection may precipitate or reveal previously undiagnosed cardiovascular disease."

RSV vaccine uptake low

Awareness of RSV's costly impact in the United States is growing, however, and in 2023, the first vaccine for adults ages 65 and older was approved for use in older Americans. 

In an editor's note published on the study, Tracy Wang, MD, MHS, a JAMA Internal Medicine associate editor, warns that RSV vaccine uptake among older Americans has been very low, much lower than flu vaccination. 

"Prior RSV-related efforts have focused on infants and young children, with many clinicians and patients still unaware of RSV burden of disease and prognosis in older adults," Wang writes. Moreover, RSV vaccines are inconsistently covered by insurance carriers.  

"This coverage difference means that many clinic offices need to refer patients to pharmacies for vaccination, and out-of-pocket costs may be necessary for vaccination," she adds. "Vaccine fatigue and access barriers among currently eligible persons need to be addressed to enhance uptake by those who stand to benefit."

 

New Tool Helps Identify Babies At High-risk For RSV

A new tool to identify infants most at risk for severe respiratory syncytial virus (RSV) illness could aid pediatricians in prioritizing children under 1 to receive a preventive medication before RSV season (October-April), according to Vanderbilt University Medical Center (VUMC) research published in Open Forum Infectious Diseases and to be presented at the American Thoracic Society 2024 International Conference.

Study authors considered factors including birth month, birth weight and whether an infant has siblings to determine who is most at risk of severe RSV illness and could benefit from the medication nirsevimab, commonly used as a preventive in newborns.

"We developed a tool to identify babies at highest risk for a severe infection due to RSV," said the study's presenter Ferdinand Cacho, MD,pediatric pulmonology fellow in the Center for Asthma Research at VUMC.

"RSV is a common respiratory infection that can cause fever, cough, runny nose, and difficulty breathing. In some babies, the infection can be so severe they need to be admitted to the hospital and be in the intensive care unit," he said.

The Centers for Disease Control & Prevention recommends early immunization with nirsevimab for all infants, but a shortage in October 2023 made it necessary to prioritize for high-risk infants who weren't eligible for immunization with a different agent known as palivizumab.

Nirsevimab is long-acting drug and only requires one dose while palivizumab is short-acting, requires monthly injections during RSV season, and is restricted to use in a subset of high-risk infants. Both medications are monoclonal antibodies used to prevent RSV lower respiratory tract infection in newborns and young children.

"Timely identification of infants at highest risk of RSV-related morbidity is key to prevention," said lead author Brittney Snyder, PhD, research assistant professor in the Division of Allergy, Pulmonary and Critical Care Medicine at VUMC.

"Our personalized risk prediction tool may have applications in allocating expensive and/or limited immunoprophylaxis (immunization with nirsevimab or palivizumab) to achieve the greatest benefit and in promoting RSV prevention among families with high-risk infants," she said.

Snyder and colleagues researched de-identified patient records of nearly 430,000 children insured by the Tennessee Medicaid Program, including infants who did not receive RSV immunoprophylaxis in the first year of life.

Among 429,365 infants in the study, 713 had severe RSV LRTI requiring ICU admission. The tool (equation) had good predictive accuracy and internal validation that indicated a good fit, the authors reported.

"Our tool was validated in a population of approximately 430,000 babies insured by the Tennessee Medicaid program, so our next step is to validate this tool in other populations, such as a U.S.-wide study and in international populations," Cacho said. "This tool can help providers, health care institutions, and policymakers prioritize a limited resource so that the most vulnerable babies receive it."

Study Finds RSV Treatment Beyfortus Prevents 5,800 Hospitalisations In France

Roughly 5,800 hospitalisations from bronchiolitis were avoided in France thanks to the new preventive medicine nirsevimab, Public Health France said on Friday.

The health agency cited two studies that showed that the antibody, which is marketed under the name Beyfortus, was effective at preventing severe cases of the illness in newborns caused by respiratory syncytial virus (RSV).

The common respiratory virus causes cold-like symptoms but can be dangerous for newborns and older adults. It is the leading cause of paediatric hospitalisation in Europe.

Cases of the virus surged following the COVID-19 pandemic, with a triple epidemic of RSV, COVID-19, and flu co-circulating in many countries.

Beyfortus, a preventive monoclonal antibody approved in Europe in late 2022, was provided to newborns in France starting in September 2023 as part of a preventive campaign.

But the government faced heavy criticism as demand for the antibody was much higher than expected.

The medicine is given as a single injection at birth. The active substance, nirsevimab, is a type of protein that attaches to a specific RSV protein to neutralise the virus.

In France, bronchiolitis is estimated to affect nearly 30 per cent of newborns under two years old every year, with two to three per cent of newborns under one being hospitalised for it.

Health authorities monitored RSV cases in hospitals, including instances of severe illness following preventive treatment.

Public Health France said that one study the agency carried out in collaboration with the Paris-based Pasteur Institute found that Beyfortus was between 75.9 and 80.6 per cent effective in preventing severe RSV requiring hospitalisation for newborns.

This was similar to the results of phase III clinical trials.

"We were able to evaluate in a very short time the positive effects in real life of nirsevimab (Beyfortus) on the health of infants, with the treatment's effectiveness estimated between 76% and 81%," said Isabelle Parent du Chatelet, head of the respiratory infections and vaccination unit at Public Health France.

She added that these results were sent to inform future policy decisions regarding the prevention of RSV.

A second study determined, using a mathematical model, that between September 2023 and February 2024, nirsevimab prevented 5,800 hospitalisations, including 4,200 for newborns up to two months old.

This represented a 23 per cent reduction in hospitalisation for babies who arrived in an emergency department for RSV compared to a scenario where the antibody was not administered.

"The two studies use different approaches. One analyses real-time data in paediatric intensive care units while the other models surveillance data in the population," Simon Cauchemez, head of mathematic modelling of infectious diseases at the Pasteur Institute, said in a statement.

"But they result in similar calculations of nirsevimab's effectiveness," he added.

View comments

---