World Health Organization Influenza-Like Illness Underestimates the Burden of Respiratory Syncytial Virus Infection in Community-Dwelling Older Adults
RESCEU Investigators
(2022) The Journal of infectious diseases, volume 226, issue Supplement_1, pp. S71 - S78
(Article)
Abstract
BACKGROUND: Respiratory syncytial virus (RSV) surveillance is heavily dependent on the influenza-like illness (ILI) case definition from the World Health Organization (WHO). Because ILI includes fever in its syndromic case definition, its ability to accurately identify acute respiratory tract infections (ARTI) caused by RSV in older adults is uncertain. METHODS:
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The accuracy of the WHO ILI and a modified ILI (requiring only self-reported fever) case definitions in identifying patients with PCR-confirmed RSV-ARTI was evaluated in community-dwelling older adults (≥60 years) from the prospective European RESCEU cohort study. RESULTS: Among 1040 participants, 750 ARTI episodes were analyzed including 36 confirmed RSV-ARTI. Due to a general lack of fever, sensitivity for RSV-ARTI was 33% for modified ILI and 11% for ILI. The area under the curve for both ILI definitions was 0.52 indicating poor discrimination for RSV. RSV-ARTI could not be distinguished from all other ARTI based on clinical symptoms. CONCLUSIONS: The use of ILI underestimated the occurrence of RSV-ARTI in community-dwelling older adults up to 9-fold (11% sensitivity). Because worldwide RSV surveillance depends largely on ILI, there is an urgent need for a better approach to measure the occurrence of RSV disease and the impact of future RSV vaccine introduction. Clinical Trials Registration. NCT03621930.
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Keywords: Aged, Cohort Studies, Fever, Humans, ILI, Independent Living, Infant, Influenza, Human/diagnosis, Prospective Studies, RESCEU, RSV, Respiratory Syncytial Virus Infections/diagnosis, Respiratory Syncytial Virus, Human, Respiratory Tract Infections, Virus Diseases, World Health Organization, case definition, older adults, respiratory syncytial virus, Journal Article, Clinical Trial, Research Support, Non-U.S. Gov't
ISSN: 0022-1899
Publisher: Oxford University Press
Note: Funding Information: We gratefully acknowledge the support of volunteers who participated in this study. We thank all the general practitioners for their cooperation in the recruitment of participants from their offices. We thank the staff who was responsible for local patient recruitment and follow-up in Antwerp (Tita De Winter, Caroline Verschueren, Tine Maes, Ingrid Develter, Lizzy Winnepenninckx, and Lisbeth Minnen), Oxford (Behnaz Ravanfar, Heather Rutter, Julie Allen, Karen Madronal, Irene Noel, Bernadette Mundy, Belinda I'Anson, Samantha Squires, and Pippa Whitbread with the support with of the NIHR Clinical Research Network: Thames Valley and South Midlands research nurse team), and Utrecht (Brigitte Buiteman, Loes Nibbelke, Lieke Kam, Marin Bont, and Victor Kroon); staff of the Laboratory of Medical Microbiology of the University of Antwerp (Stalin Solomon Raj) and Oxford (Elisabeth Clutterbuck, Joseph McGinley, and Gu-Lung Lin) for sample processing and storage; epidemiologists Katrien Oude Rengerink and Marie Billard for their contributions in the statistical analysis; Cepheid for unconditionally providing us with the point-of-care test used in this study; Myra Widjojoatmodjo (Janssen, Leiden) for her contribution to overall setup of the project at the project initiation and Linong Zhang and Charlotte Vernhes (Sanofi Pasteur R&D Cambridge, MA) for their leadership on the RESCEU WP5 SP activities; and Hélène Bisceglia, Sandrine Montano, and Thibault Perret (Sanofi Pasteur R&D Marcy l'Etoile, France) for the hands-on work in the laboratories in France. Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
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