Abstract
Background: The disease burden of respiratory syncytial virus (RSV) in older adults is substantial but not well quantified previously. We aimed to estimate country-specific hospitalisation burden of RSV-associated acute respiratory infection in older adults (>60 years) in Europe.
Methods: We collected published data (through a systematic review) and unpublished data (from GSK-sponsored studies and international collaborators) on RSV hospitalisation burden. We used multiple imputation for missing age bands. We applied stepwise statistical adjustment to account for case underascertainment related to the variations in case definitions, clinical specimens and RSV diagnostic tests in individual studies. We reported country-level RSV hospitalisation rates for countries with ≥1 eligible study reporting point estimate and 95% confidence interval (CI) of the rates (a random-effects meta-analysis was conducted when ≥2 studies were available). As an alternative method, we additionally included studies not reporting 95% CI and calculated the median of the rate point estimates.
Results: Seven studies were included from five countries: Denmark (1), Finland (1), Netherlands (1), Spain (1) and UK (3). Denmark and Spain had the highest and lowest adjusted RSV-associated hospitalisation rate (408/100000, 95% CI: 319-516; and 176/100000, 137-226) in >60 years, which was about 2.4 times the unadjusted estimate. The alternative method with 5 more studies added had similar estimates for the five countries; another country (Norway) was added and it had the highest adjusted hospitalisation rate (742/100000). RSV-associated hospitalisation rate increased with increasing age across all countries.
Conclusions: With RSV vaccines now approved for use in older adults, our findings help inform the need for country-level RSV prevention.