Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France

P. Loubet (1) , N. Lenzi (2) , M. Valette (3) , V. Foulongne (4) , A. Krivine (5) , N. Houhou (6) , G. Lagathu (7) , S. Rogez (8) , S. Alain (8) , X. Duval (1, 6) , F. Galtier (9, 2) , D. Postil (10) , P. Tattevin (11) , Philippe Vanhems (12, 13) , F. Carrat (14, 15) , Bruno Lina (16) , O. Launay (17, 2)

1 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
2 F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC)
3 CNR des virus influenza - Laboratoire de Virologie [GH Nord HCL, Lyon]
4 Pathogénèse et contrôle des infections chroniques (PCCI)
5 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
6 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
7 Laboratoire de Virologie [Rennes] = Virology [Rennes]
8 Service de Bactériologie, Virologie, Hygiène [CHU Limoges]
9 INSERA CIC
10 CIC Montpellier
11 CIC1435 - Centre d'Investigation Clinique de Limoges
12 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
13 LPE-Fondation Mérieux - Laboratoire des pathogènes émergents -- Emerging Pathogens Laboratory
14 Service d'Hygiène, Epidémiologie et Prévention [Hôpital Edouard Herriot - HCL]
15 CHU Saint-Antoine [AP-HP]
16 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
17 Virpath - Virpath-Grippe, de l'émergence au contrôle -- Virpath-Influenza, from emergence to control

OBJECTIVES: The aim of this study was to analyse characteristics and outcome of respiratory syncytial virus (RSV) infection in adults hospitalized with influenza-like illness (ILI). METHODS: Patients hospitalized with ILI were included in this prospective, multicentre study carried out in six French hospitals during three consecutive influenza seasons (2012-2015). RSV and other respiratory viruses were detected by multiplex PCR in nasopharyngeal swabs. Risk factors for RSV infection were identified by backward stepwise logistic regression analysis. RESULTS: A total of 1452 patients hospitalized with ILI were included, of whom 59% (861/1452) were >65 years and 83% (1211/1452) had underlying chronic illnesses. RSV was detected in 4% (59/1452), and influenza virus in 39% (566/1452). Risk factors for RSV infection were cancer (adjusted OR 2.1, 95% CI 1.1-4.1, p 0.04), and immunosuppressive treatment (adjusted OR 2.0, 95% CI 1.1-3.8, p 0.03). Patients with RSV had a median length of stay of 9 days (6-25), and 57% of them (30/53) had complications, including pneumonia (23/53, 44%) and respiratory failure (15/53, 28%). Fifteen per cent (8/53) were admitted to an intensive care unit, and the in-hospital mortality rate was 8% (4/53). Pneumonia was more likely to occur in patients with RSV than in patients with RSV-negative ILI (44% (23/53) versus 26% (362/1393), p 0.006) or with influenza virus infection (44% versus 28% (157/560), p 0.02). CONCLUSION: RSV is an infrequent cause of ILI during periods of influenza virus circulation but can cause severe complications in hospitalized adults. Risk factors for RSV detection in adults hospitalized with ILI include cancer and immunosuppressive treatment. Specific immunization and antiviral therapy might benefit patients at risk.

Keywords: Adults; Pneumonia; Respiratory syncytial virus; Influenza-like illness; Influenza; Elderly

Domains: Infectious diseases; Pulmonology and respiratory tract; Santé publique et épidémiologie

P. Loubet, N. Lenzi, M. Valette, V. Foulongne, A. Krivine, et al.. Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France. Clinical Microbiology and Infection, 2017, 23 (4), pp.253-259. ⟨10.1016/j.cmi.2016.11.014⟩. ⟨hal-01518888⟩