RSV Disease in the Elderly
Condition: Respiratory Infections, Acute; Respiratory Syncytial Virus
MeSH terms: Respiratory Tract Infections
Study type: Observational

Summary: 
      Respiratory syncytial virus (RSV) causes sickness and deaths in older people every winter.
      This study will investigate how aging affects the body's immune response (body's response to
      disease) to RSV. About 2000 people, age 21 and older, who reside in the upstate NY area, will
      be recruited. Two groups of subjects will be studied. The 1st group of volunteers will be
      recruited prior to the start of RSV season in year 1 of the study. These volunteers will
      include healthy people and people with various medical conditions. The 2nd group of
      volunteers will be patients admitted to Rochester General Hospital for acute respiratory
      illness. Procedures will include drawing blood from a vein in the arm (2 tablespoons),
      collecting nasal swabs, and collecting sputum. Volunteers may participate in study related
      procedures for up to 3 years.
    

Detailed description: 
      Respiratory infections account for significant excess morbidity and mortality among older
      people each winter. Influenza A virus and Respiratory Syncytial Virus (RSV) have emerged as
      two of the most important viruses for this age group. The resultant morbidity and mortality
      among these populations is substantial. Natural RSV infection in adults of various ages with
      mild, moderate, and severe RSV disease will be evaluated in order to accomplish the following
      primary objectives: to assess the effect of aging on the immune response to natural RSV
      infection; to assess the effect of aging on the clearance of RSV infection; to assess the
      effect of aging on the innate immune response to natural RSV infection; to assess the
      possibility of virus spread to the lower airways and; to assess the role of the RSV-specific
      immune response in the pathogenesis of severe disease. Study participants will include
      approximately 2000 persons, male and female, greater than or equal to age 21, including
      healthy persons, persons with common medical conditions (i.e., hypertension, diabetes,
      thyroid conditions, arthritis, coronary artery disease, skin cancer, etc), persons with
      underlying chronic pulmonary or cardiac conditions, and persons with signs and symptoms of
      acute respiratory tract illness who reside in the Upstate, New York area. A prospective
      cohort of ~800 persons will be recruited prior to the onset of RSV season in year one and
      followed for respiratory illnesses during each RSV season for three years or until the
      subject has a documented RSV illness. This group will contain persons of various ages and a
      spectrum of medical conditions. This population will be used to evaluate age-related
      differences in the immune response to RSV and viral shedding patterns.These volunteers are
      expected to provide primarily cases of mild to moderately severe RSV disease. A second group
      of subjects with signs and symptoms of acute respiratory tract illness will be recruited from
      the Lifetime After hours Urgent Care Center, Rochester General Hospital emergency room and
      inpatient medical service. Those identified with RSV infection will provide cases of moderate
      to severe RSV disease. At the end of RSV season, a control group will be selected. This group
      will be comprised from subjects chosen from the prospective cohort who did not have an RSV
      infection during that winter season. Controls will be matched by age and underlying
      conditions for each of the RSV infected subjects. The following outcome measures will be
      assessed: RSV severity: severe disease=hospitalized cases, mild-moderate
      disease=non-hospitalized cases; virus load: quantity and duration of RSV shedding as
      determined by quantitative RT-PCR; T cell responses; antibody: acute serum IgG to RSV F and G
      proteins by EIA and and neutralization titer to RSV A2 or B1 virus depending upon the
      infecting strain; local innate immune response: maximum IL-6 or IL-8 or MIP-1 alpha levels in
      nasal secretions; systemic innate immune response: maximum number of NK cells in the
      peripheral blood; and systemic inflammation: maximum serum IL-6 or C reactive protein value.
    

Time perspective: Prospective
Keywords: Respiratory Syncytial Virus Infections, RSV, elderly