Estimated incidence rate of specific cardiovascular and respiratory hospitalizations attributable to Respiratory Syncytial Virus among adults in Germany between 2015 and 2019
Authors: Liang Caihua , Polkowska-Kramek Aleksandra , Lade Caroline , Bayer Lea Johanna , Bruyndonckx Robin , Huebbe Bennet , Ewnetu Worku Biyadgie , Peerawaranun Pimnara , Casas Maribel , Tran Thao Mai Phuong , Brestrich Gordon , von Eiff Christof , Gessner Bradford D. , Begier Elizabeth , Rohde Gernot 
Published: July 2024

Introduction

Respiratory syncytial virus (RSV) can cause severe outcomes among adults. However, RSV incidence in adults is frequently underestimated due to non-specific symptomatology, limited standard-of-care testing, and lower test sensitivity compared to infants. We conducted a retrospective observational study to estimate RSV-attributable incidence of hospitalizations among adults in Germany between 2015 and 2019.

Methods

Information on hospitalizations and the number of people at risk of hospitalization (denominator) was gathered from a Statutory Health Insurance (SHI) database. A quasi-Poisson regression model accounting for periodic and aperiodic time trends and virus activity was fitted to estimate the RSV-attributable incidence rate (IR) of four specific cardiovascular hospitalizations (arrhythmia, ischemic heart diseases, chronic heart failure exacerbations, cerebrovascular diseases) and four specific respiratory hospitalizations (influenza/pneumonia, bronchitis/bronchiolitis, chronic lower respiratory tract diseases, upper respiratory tract diseases).

Results

RSV-attributable IRs of hospitalizations were generally increasing with age. Among cardiovascular hospitalizations in adults aged ≥60 years, arrhythmia and ischemic heart diseases accounted for the highest incidence of RSV-attributable events, followed by chronic heart failure exacerbation, with annual IR ranges of 157– 260, 133–214, and 105–169 per 100,000 person-years, respectively. The most frequent RSV-attributable respiratory hospitalizations in adults aged ≥60 years were for chronic lower respiratory tract diseases and bronchitis/bronchiolitis, with annual IR ranges of 103–168 and 77–122 per 100,000 person-years, respectively.

Conclusion

RSV causes a considerable burden of respiratory and cardiovascular hospitalizations in adults in Germany, similar to other respiratory viruses (e.g., influenza and SARS-CoV-2). This highlights the need to implement effective prevention strategies, especially for older adults.

Key Summary Points

Respiratory syncytial virus (RSV) disease burden in adults is significant yet often remains unrecognized due to unspecific symptoms, lack of routine testing and lower test sensitivity compared to infants.

Using a quasi-Poisson regression time-series model, we estimated the age-stratified RSV-attributable incidence of specific cardiovascular and respiratory hospitalizations in Germany between 2015 and 2019.

Estimated cardiorespiratory RSV hospitalization rates increased with age and were significantly higher in older adults.

Arrhythmia, ischemic heart diseases, and chronic lower respiratory tract disease exacerbation were the most frequent causes of RSV-attributable cardiovascular and respiratory hospitalizations.

RSV causes a considerable burden of respiratory and cardiovascular hospitalizations among adults in Germany, and effective RSV vaccines could improve public health outcomes, especially for older adults.