In a retrospective cohort study published in The Journal of Infectious Diseases, researchers sought to ascertain the incidence of RSV hospitalizations among older adults living in long-term care facilities (LTCFs) compared with community-dwelling (CD) individuals.

The authors wrote, “Older age and comorbid conditions increase risk for severe respiratory syncytial virus (RSV). Skilled nursing facilities (SNFs) and assisted living (AL) facilities represent an intersection of risk factors.”

In this study cohort over 3 years, researchers gathered and reviewed hospitalization records to identify and compare the population-based incidence of RSV-associated hospitalization for CD, SNF, and AL adults aged ≥65 years, with median ages of 76, 83, and 86 years, respectively. Dementia and congestive heart failure (CHF) were more prevalent among SNF and AL residents.

The results revealed that the annual incidence of RSV hospitalization was 117 per 100,000 for community-dwelling adults, 440 per 100,000 for skilled nursing facility SNF residents, and 740 per 100,000 for assisted living AL residents.

The researchers noted that these findings indicated “a need for unequivocal RSV vaccine recommendations in SNF and AL residents.”

Additionally, researchers observed that the average age of participants was higher among LTCF residents, with SNF and AL residents having more prevalent conditions, such as dementia and CHF.

The authors estimated that rates of RSV-associated hospitalizations are three to nine times higher for adults aged 65 years and older living in AL facilities and three to four times higher for residents in SNFs compared to CD adults of the same age group. Additionally, these rates are estimated to be two to five times higher for AL residents and two to three times higher for SNF residents when compared with the oldest and presumably highest-risk group of community-dwelling adults aged 85 years and older.

The authors wrote, “Most prior studies assessing the burden of RSV disease in LTCFs have described attack rates from seasonal outbreaks or relied on retrospective data from national claims database. These reports likely underestimated the incidence of cardiorespiratory hospitalization attributable to RSV since RSV testing has not historically been routine clinical practice, and coding of RSV as the primary diagnosis for hospitalization remains inconsistent.”

The authors also noted that to the best of their knowledge, their data represent the only prospective study comparing population-based estimations of the incidence of RSV-associated hospitalization for CD, AL, and SNF adults in patients aged ≥65 years, clearly indicating an augmented risk for severe clinical outcomes in the latter two patient populations.

“Further study is needed to assess whether our findings will be replicated in other geographic locations, but these data suggest a need for strong vaccine recommendations to prevent RSV disease in this vulnerable population,” the authors concluded.

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