Costello J, Colosia A, Bertzos K, McQuarrie K. Systematic literature review of the signs and symptoms of respiratory syncytial virus in high-risk adults and immunocompromised populations. Poster presented at the International Society for Influenza and other Respiratory Virus Diseases (ISIRV) 2022 Conference; September 26, 2022. Belfast, United Kingdom.

BACKGROUND: Adults aged ≥65 years, those with chronic lung or heart disease, and those with weakened immune systems are at risk for severe respiratory syncytial virus (RSV) illness, such as symptoms consistent with lower respiratory tract (LRT) infection, pneumonia, respiratory failure, and death. No treatments are approved specifically to treat RSV in adults, and the symptom burden in these at-risk adult populations is not well documented. A systematic literature review (SLR) was conducted to document RSV signs and symptoms (RSV S&S) in adults at high risk for disease progression due to age or comorbidities and in immunocompromised adolescents and adults.

METHODS: Two researchers independently reviewed published articles from 2011 to 2021 obtained from electronic database searches (MEDLINE, MEDLINE In-Process, Embase, PsycINFO, and Cochrane Library), conference abstracts from the past 3 years, and bibliographies of relevant SLRs to identify patient-reported RSV S&S in high-risk adults and immunocompromised patients. Other outcomes of interest included RSV S&S duration and length of stay (LOS) for hospitalized patients.

RESULTS: Limited evidence was identified assessing RSV S&S reported by adult patients at high risk for RSV-related disease progression (6 studies) or immunocompromised patients (1 study). No studies reported separate data for immunocompromised adolescents. Across the 7 studies, high-risk and immunocompromised adults reported a variety of upper respiratory tract (URT), LRT, systemic, and behavioral symptoms. The most frequent commonly occurring (>40% of patients) RSV S&S were cough (7 studies), sputum, dyspnea, and fever/feverishness (5 studies each). There were no clear symptom trends by treatment setting, although a higher proportion of URT symptoms were seen in community versus hospital settings. LRT symptoms were common in both settings. Duration of RSV S&S (2 studies) ranged from 17-19 days and did not vary substantially by region. Mean hospital LOS (5 studies) varied from 3.5-11 days in the Americas; the median varied from 6 (Americas) to 15 days (China).

CONCLUSION: Based on the limited evidence published, the most frequent commonly reported RSV S&S across settings in high-risk and immunocompromised adults are primarily LRT symptoms, which may be relevant when considering assessment and treatment targets. RSV S&S in high-risk and immunocompromised adults can last weeks (17-19 days in this SLR). For hospitalized adults, LOS varied across countries, which may be due to different healthcare systems and discharge protocols. Further research is needed to assess RSV S&S in adult and adolescent populations, particularly immunocompromised patients and specifically adolescents.

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