Strain and properties of respiratory syncytial virus-associated respiratory infections in adult patients in the winter season 2023/2024 in the conservative emergency room of the university clinic in Dresden | Virology Journal

The main results of our prospective observation study can be summarized as follows: [1] PCR-detected RSV infection was present in 2.2% of adult patients who were presented in our conservative emergency room with symptoms of an infection of the respiratory tract and with a reference to virus tests according to the treating doctor in the 2023-24 winter season [2]Adults with RSV had more comorbidities than those with influenza or Sars-Cov-2 and were older than patients with influenza, and [3] The RSV infection was independent of the oxygen requirement and a high hospital entry rate of 81%, acute heart events at 32%and 8%hospital mortality.

There were significant differences between patients with RSV infection and patients who were infected with SARS-COV-2 or influenza in terms of age, comorbidities as well as oxygen requirements, hospital entry and acute cardiovascular events during the hospital stays in our study. The Association of RSV with a higher need for oxygen requirements compared to influenza even remained significant after the involvement of age and comorbidities in the model.

A retrospective observation study from Italy from the 2022/2023 winter season also showed a older age, a higher Charlson comorbidity index and a higher heart failure rate in patients with RSV compared to influenza [8].

The association with a higher oxygen requirement of our data was also shown in a retrospective study from Rosenheim, Germany, in which 82.8% of patients with an RSV [3].

Remarkably, acute cardiovascular events occurred in a third of all patients infected by RSV. The association of acute viral RTI with cardiovascular complications is well established and contributes to the viable disease of the vaccine, especially with influenza [9]. Therefore, it seems noteworthy that acute heart complications in RSV appeared in our cohort compared to influenza and sars-cov-2 more often. Similar data was provided by a large systematic literature overview published in 2024, in which studies with RSV infections were evaluated between 1990 and 2019 compared to RSV-negative flu-like diseases, influenza and parainfluenza. The risk of cardiovascular events in the RSV group was 1.4 times higher than 1.4 times higher than 1.4 times higher. [10].

In addition, an analysis of the US health insurance data was collected over a period of 12 years with more than 175,000 cases [1].

Overall, these results confirm the relevant disease burden by RSV infections, especially in older and comorbid adults with considerable associated morbidity and mortality, which confirms the need for effective prevention strategies by vaccination in this endangered patient group.

The strength of our prospective study was the inclusion of all consecutive patients with a doctor who were classified as an indication for respiratory tests, which was avoided. The restrictions include the monocentric study setting and a lower number of cases of RSV infections in the evaluated season. Virus tests were carried out at the discretion of the emergency doctor and were not based on a given protocol, which could affect the results. In addition, our results are only based on PCR tests of nasopharyngeal or pharyngeal smears and could therefore be the RSV [1]. In addition, studies showed a possible underestimation of the virus defense by PCR tests in patients who, after the start of the symptoms of the emergency room, with a relevant delay, which could lead to an underestimation of the virus load [11].

We cannot rule out that virust tests have been carried out more often in seriously ill patients, which could affect the rate of hospitalization and oxygen needs. However, our relatively high admission rates, especially in the case of RSV and SARS-COV-2-infected patients, are probably associated with the old age and the comorbidity pollution as well as the high rates of oxygen dependency of these patient groups, but are still comparable to published data from Tennessee in 2014, which in 2014 is a hospitalization rate of 75% (24 out of 3 patients) in adult patients with an RSV RSV infection showed [12].

We have no data on imaging, additional microbiological results or agreed treatment restrictions in our analysis that could affect the results of the results.

In addition, the immunization status of the enclosed patients was not known, which could lead to a lower burden of influenza and Sars-Cov-2 in terms of RSV cases, since the study was carried out before the possibility of widespread use of RSV vaccines in Germany.

Due to our study design, in which all PCR tests for SARS-COV-2 or influenza had triggered the inclusion of the studies, only 1384 of 1764 patients were tested on influenza, which could underestimate the influenza rate; However, additional influenza tests were triggered by German epidemiology data and all trapped patients were tested on SARS-COV-2 and RSV.