The invisible burden of RSV on older adults
As we continue to move beyond the COVID-19 pandemic, we’ve seen many aspects of life returning to normal. The removal of social distancing measures and national and local lockdowns have allowed us to see friends and family once again without fear. However, this has led to increased transmission of other respiratory diseases and, as we’re already seeing, there are now some very real concerns about a lesser-known virus – respiratory syncytial virus, or RSV.1
RSV is one of the most common respiratory viruses, causing coughs and colds during the winter months.2 Symptoms including congested or runny nose, coughing, fever, and sore throat mean that RSV can easily be mistaken for other respiratory viruses which are also prevalent during the same season, such as COVID-19 or flu.3 Because of this, there are concerns that cases of RSV are severely underestimated.2
Although RSV can affect both adults and infants, the majority of general awareness and understanding is on paediatric cases, despite evidence showing a significant impact on those aged 65+ years: current data estimates that 79% of all adult hospital admissions caused by RSV are in adults aged 65+ years,4 and that 17% of people aged 60+ years hospitalised with RSV need readmission within one month of discharge.5
While the older adult incidence of RSV may not be as well-known, it can lead to severe disease and fatal complications, especially among people with underlying health conditions who are at high-risk of potential exacerbation of underlying co-morbidities.6 RSV can exacerbate the symptoms of asthma and chronic obstructive pulmonary disease (COPD).7 Furthermore, RSV is estimated to cause approximately 8,000 deaths among older adults every year in the UK alone.4
When trying to capture the true burden of RSV, there are several considerations that are lacking which go some way to explain the issue: 1) testing, 2) awareness among both the public and HCPs, and 3) accurate incidence data in age 65+ populations.
Due to the similar nature of RSV’s symptoms compared to other respiratory diseases, the only way to definitively diagnose the virus is through clinical testing.2 However, due to a lack of treatment options among older adults2 and a preference for staying at home with milder symptoms, testing and diagnosis has proven to be a significant barrier to establishing true burden.5
This lack of testing amplifies the misdiagnosis of RSV, as its symptoms are so similar to other, more common respiratory viruses like flu. A lack of recognition can also be seen in older adults themselves, who can’t differentiate between the symptoms of RSV and other viral respiratory infections, and so are unlikely to push for RSV tests or diagnoses. Combined, these factors result in a hugely underestimated incidence rate in populations aged 65 or older.4
The early data from this year’s RSV season is already showing a marked increase in RSV hospitalisations among children and older adults.1 Together with spikes of other seasonal viruses like flu and another wave of COVID-19 expected, this has led to the term “tripledemic” being coined.8 The concern is, of course, the additional pressure on an already strained NHS: severe RSV infection accounts for an estimated 14,000 hospitalisations every year in adults aged 65+ in the UK.4
However, this is just one of the important societal implications of RSV that are often forgotten or overlooked. Others include:
- Economic burden: Recovery from an RSV infection can take up to two weeks.3 Despite the UK state pension being eligible from age 65, there are still nearly 1.5 million people in employment who are aged 65+, a number which is rising regularly.9 Absence from work due to illness has an often-overlooked impact on the economy, especially with the current cost-of-living crisis causing an increase in essential expenditure.10
- Care homes: Due to the transmission method of RSV – through contact with droplets from infected people when they cough and sneeze11 – and the additional risk to older adults, super spreader events in care homes are particularly dangerous.12 This is then made worse with cross-generational transmission from visiting children who may unknowingly bring RSV to their older relatives.13
- Family units: Older adults can often help with childcare during regular working hours, allowing for working parents to be uninterrupted during their day.14 If these older family members are ill, with RSV or otherwise, this assistance is no longer available, which places increased pressure on what the family unit can manage and may lead to an increase in days off due to dependence.
When considered together, these wider-reaching issues emphasise the importance of raising awareness of RSV and its severity, not just among HCPs and at high-risk populations, but also family members. They are the ones that have the power to pass on the information and influence their older relatives, which could not only keep them healthier for longer, but also one day save their lives.
At Janssen, we not only recognise these complexities that make RSV such a challenging virus to monitor and research, but are also deeply committed to doing all that we can to support older adults in keeping healthy as they age. We hope that, in time, we will go some way to equipping older adults with the information they need to discuss RSV with their HCPs and, ultimately, to take control of their own health.
Despite the renewed public focus on RSV seen in the news recently, there is still a great deal of work to be done to uncover realities of RSV in the UK, especially among older populations. Raising awareness of the severity and impact amongst HCPs and the disease itself among the public is key to ensuring correct and timely diagnosis and the provision and use of adequate testing. By drawing attention to the broader impact among varied populations, we want to see more done to reveal the hidden burden that is RSV.
This article has been commissioned by, and developed by, Janssen-Cilag Ltd.
About the author
Malcolm Macartney is a Medical Adviser for Infectious Diseases and Vaccines at Janssen UK, holding the position since June 2020. Malcolm has dedicated his career to virology and has extensive experience working as a clinical and R&D scientist, researching therapies for viruses, including HIV, HBV, HCV and influenza. Prior to joining Janssen, Malcolm worked as a Biomedical Scientist for the Royal Free NHS Trust, investigating the research and diagnosis of resistance to current and future antiviral therapies.
- UK Health Security Agency. Weekly national Influenza and COVID-19 surveillance report. Week 47 report (up to week 46 data). Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1120325/Weekly_Flu_and_COVID-19_report_w47.pdf. Last accessed: December 2022.
- Gov.uk. Respiratory syncytial virus (RSV): symptoms, transmission, prevention, treatment. Available at: https://www.gov.uk/government/publications/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment. Last accessed: December 2022.
- Mayo Clinic. Respiratory Syncytial Virus. Available at: https://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098. Last accessed: December 2022
- Fleming, D. M., et al. Modelling estimates of the burden of Respiratory Syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infectious Diseases. 2015;15(1):1-12.
- Tseng H, et al. Severe Morbidity and Short- and Mid- to Long-term Mortality in Older Adults Hospitalized with Respiratory Syncytial Virus Infection, The Journal of Infectious Diseases. 2020;222(8): 1298–1310.
- Cleveland Clinic. Respiratory Syncytial Virus in Children and Adults. Available at: https://my.clevelandclinic.org/health/diseases/8282-respiratory-syncytial-virus-in-children-and-adults. Last accessed: December 2022.
- Nam HH, Ison MG. Respiratory syntactical virus infection in adults. British Medical Journal. 2019;366:l5021
- UK Parliament. NHS: Respiratory Syncytial Virus Infections. Available at: https://hansard.parliament.uk/Lords/2022-06-09/debates/D2577A93-7319-476F-866D-747ED553A529/NHSRespiratorySyncytialVirusInfections. Last accessed December 2022
- Office for National Statistics. People aged 65 years and over in employment, UK: January to March 2022 to April to June 2022. Available at: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/articles/peopleaged65yearsandoverinemploymentuk/januarytomarch2022toapriltojune2022. Last accessed: December 2022.
- Gov.uk. Work, Health and Disability Green Paper Data Pack. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/644090/work-health-and-disability-green-paper-data-pack.pdf. Last accessed: December 2022.
- CDC. RSV Transmission. https://www.cdc.gov/rsv/about/transmission.html. Accessed: December 2022.
- Childs, A., et al. The burden of respiratory infections among older adults in long-term care: a systematic review. BMC Geriatrics. 2019; 19(1): 1-10
- Korsten, k., et al. Contact With Young Children Increases the Risk of Respiratory Infection in Older Adults in Europe—the RESCEU Study. Journal of Infectious Diseases. 2022; 226(1):79-86.
- Buchanan, A.& Rotkirch, A. Twenty-first century grandparents: global perspectives on changing roles and consequences. Contemporary Social Science. 2018; 13(2):131-144.