Severe Morbidity and Short- and Mid- to Long-term Mortality in Older Adults Hospitalized with Respiratory Syncytial Virus Infection.

BACKGROUND We describe the clinical epidemiology and outcomes among a large cohort of older adults hospitalized with respiratory syncytial virus (RSV) infection in the US. METHODS Hospitalized adults aged ≥60 years who tested positive for RSV between 01/01/2011-6/30/2015 were identified from Kaiser Permanente Southern California. Patient-level demographics, comorbidities, clinical presentation, utilization, complications, and mortality were evaluated. RESULTS There were 664 participants hospitalized with RSV (61% female, 64% aged ≥75 years). Baseline chronic diseases were prevalent (all >30%). Nearly two-thirds (66%) developed pneumonia, 80% of which were radiographically confirmed. Very severe tachypnea (≥26 breaths per minute) was common (56%). Approximately 21% required ventilator support and 18% were admitted to the intensive care unit. Mortality during hospitalization was 5.6% overall (4.6% in 60-74 year-olds and 6.1% in ≥75 year-olds). Cumulative mortality within 30 days, 3 months, 6 months, and 12 months of admission was 8.6%, 12.3%, 17.2%, and 25.8%, respectively. CONCLUSION RSV infection in hospitalized older adults often manifested as severe, life-threatening lower respiratory tract illness with high rates of pneumonia, requirement for ventilatory support, and short- and long-term mortality. Increased recognition of the substantial RSV disease burden in adults will be important in the evaluation and use of urgently needed interventions.