Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness

Ann R. Falsey*, Janet E. McElhaney, Jiri Beran, Gerrit A. Van Essen, Xavier Duval, Meral Esen, Florence Galtier, Pierre Gervais, Shinn Jang Hwang, Peter Kremsner, Odile Launay, Geert Leroux-Roels, Shelly A. McNeil, Andrzej Nowakowski, Jan Hendrik Richardus, Guillermo Ruiz-Palacios, Suzanne St Rose, Jeanne Marie Devaster, Lidia Oostvogels, Serge DurviauxSylvia Taylor*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background. Few studies have prospectively assessed viral etiologies of acute respiratory infections in community-based elderly individuals. We assessed viral respiratory pathogens in individuals ≥65 years with influenza-like illness (ILI). Methods. Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal/throat swabs from 556 episodes of moderate-to-severe ILI, defined as ILI with pneumonia, hospitalization, or maximum daily influenza symptom severity score (ISS) >2. Cases were selected from a randomized trial of an adjuvanted vs nonadjuvanted influenza vaccine conducted in elderly adults from 15 countries. Results. Respiratory syncytial virus (RSV) was detected in 7.4% (41/556) moderate-to-severe ILI episodes in elderly adults. Most (39/41) were single infections. There was a significant association between country and RSV detection (P =. 004). RSV prevalence was 7.1% (2/28) in ILI with pneumonia, 12.5% (8/64) in ILI with hospitalization, and 6.7% (32/480) in ILI with maximum ISS > 2. Any virus was detected in 320/556 (57.6%) ILI episodes: influenza A (104/556, 18.7%), rhinovirus/enterovirus (82/556, 14.7%), coronavirus and human metapneumovirus (each 32/556, 5.6%). Conclusions. This first global study providing data on RSV disease in ≥65 year-olds confirms that RSV is an important respiratory pathogen in the elderly. Preventative measures such as vaccination could decrease severe respiratory illnesses and complications in the elderly.

Original languageEnglish
Pages (from-to)1873-1881
Number of pages9
JournalJournal of Infectious Diseases
Issue number12
Publication statusPublished - 15 Jun 2014
Externally publishedYes

Bibliographical note

Funding Information:
Potential conflicts of interest. M. E., G. R.-P., F. G., P. K., O. L., G. L.-R., S. M., and J. H. R. report grants from the GlaxoSmithKline group of companies (GSK) to their respective institutes for the conduct of clinical trials. M. E. and J. M. disclose having received support from GSK for travel and accommodations to attend the meetings of the Publication Steering Committee for the Influence65 trial. J. M. reports personal fees from GSK, Sanofi, MedImmune, Merck, Abott Pharmaceuticals, Merck Frosst, Sanofi, the International Federation of Pharmaceutical Manufacturers & Associations, World Health Organization, Canadian Institutes of Health Research, as well as grants from CIHR and NIH NIAID. In addition, J. M. declares having a patent entitled ‘Methods of Determining Cell Mediated Response’ licensed to AMRIC (Advanced Medical Research Institute of Canada). G. L.-R. reports having received consultancy fees from GSK in the field of vaccine adjuvantation, influenza and other vaccines, and from Immune Targeting Systems in the field of influenza and HBV vaccine development. O. L. reports having also received grants from vaccine manufacturers other than the commercial entity that sponsored this study. S. M. discloses having received grants and personal fees from GSK during the conduct of the study, and other grants and personal fees from GSK, Pfizer Canada, Sanofi Pasteur, Novartis, Merck, outside the present work. A. N. reports having received honoraria from GSK for educational lectures and for performing clinical trials. A. F. reports grants from Sanofi Pasteur, Astrazeneca, and ADMA, Inc, as well as personal fees from Novavax, Retroscreen, Jans-sen, Hologic and ADMA, Inc, outside the submitted work. X. D. discloses having received grants from Pfizer outside the submitted work. S. S. R., J.-M. D., L. O., S. D., and S. T. are employees of GSK, and J.-M. D., L. O., and S. T. report ownership of GSK stock options. All other authors report no potential conflicts.

Funding Information:
Financial support. This work was supported by GlaxoSmithKline Biologicals SA. GlaxoSmithKline Biologicals SA was involved in all stages of the conduct and analysis of the studies included in this pooled analysis. Glaxo-SmithKline Biologicals SA also funded all costs associated with the development and the publishing of the present article. All authors participated in the design or implementation or analysis, and interpretation of the study and in the development of this article. All authors had full access to the data and gave final approval before submission. The corresponding author was responsible for submission of the publication.


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