Respiratory syncytial virus (RSV), an RNA virus spread by droplet infection that affects all ages, is increasingly recognised as an important pathogen in adults, especially among older people living with comorbidities. Distinguishing RSV from other acute viral infections on clinical grounds alone, with sufficient precision to be clinically useful, is not possible. The reference standard diagnosis is by PCR: point-of-care tests perform less well with lower viral loads. Testing samples from a single respiratory tract site could result in underdetection. RSV is identified in 6–11% of outpatient respiratory tract infection (RTI) consultations in older adults (≥60 years, or ≥65 years, depending on the study) and accounts for 4–11% of adults (≥18 years) hospitalised with RTI, with 6–15% of those hospitalised admitted to intensive care, and 1–12% of all adults hospitalised with RSV respiratory tract infection dying. Community-based studies estimate the yearly incidence of RSV infection at around 3–7% in adults aged 60 years and older in high-income countries. Although RSV accounts for a similar disease burden as influenza in adults, those hospitalised with severe RSV disease are typically older (most ≥60 years) and have more comorbidities, more respiratory symptoms, and are frequently without fever. Long-term sequelae are common and include deterioration of underlying disease (typically heart failure and COPD). There are few evidence-based RSV-specific treatments currently available, with supportive care being the main modality. Two protein subunit vaccines for protection from severe RSV in adults aged 60 years and older were licensed in 2023, and a third—an mRNA-based vaccine—recently gained market approval in the USA. The phase 3 studies in these three vaccines showed good protection against severe disease. Data on real-world vaccine effectiveness in older adults, including subgroups at high risk for RSV-associated hospitalisation, are needed to establish the best use of these newly approved RSV vaccines. New diagnostics and therapeutics are being developed, which will also need rigorous evaluation within their target populations to ensure they are used only for those in whom there is evidence of improved outcomes. There is an urgent need to reconceptualise this illness from one that is serious in children, but far less important than influenza in older people, to thinking of RSV as also a major risk to health for older people that needs targeted prevention and treatment.

中文翻译：

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成人呼吸道合胞病毒感染的叙述性综述


呼吸道合胞病毒 （RSV） 是一种通过飞沫感染传播的 RNA 病毒，影响所有年龄段，越来越被认为是成人的重要病原体，尤其是在患有合并症的老年人中。仅凭临床依据区分 RSV 与其他急性病毒感染，不可能具有足够的精确度以具有临床价值。参考标准诊断是通过 PCR：即时检测在病毒载量较低时效果较差。检测来自单个呼吸道部位的样本可能会导致检测不足。在老年人（≥60 岁或 ≥65 岁，取决于研究）的门诊呼吸道感染 （RTI） 咨询中，有 6-11% 的 RSV 被发现，占因 RTI 住院的成年人（≥18 岁）的 4-11%，其中 6-15% 的住院患者入住重症监护室，1-12% 的因 RSV 呼吸道感染住院的成年人死亡。基于社区的研究估计，在高收入国家，60 岁及以上成年人的 RSV 感染年发病率约为 3-7%。尽管 RSV 在成人中的疾病负担与流感相似，但因严重 RSV 疾病住院的患者通常年龄较大（大多数≥ 60 岁），合并症更多，呼吸道症状更多，并且通常没有发热。长期后遗症很常见，包括基础疾病（通常是心力衰竭和 COPD）的恶化。目前可用的循证 RSV 特异性治疗方法很少，支持性护理是主要方式。两种用于保护 60 岁及以上成人免受严重 RSV 感染的蛋白亚单位疫苗于 2023 年获得批准，第三种疫苗（一种基于 mRNA 的疫苗）最近在美国获得市场批准。 这三种疫苗的 3 期研究表明对重症具有良好的保护作用。需要关于疫苗在老年人（包括 RSV 相关住院高风险亚组）中的实际有效性数据，以确定这些新批准的 RSV 疫苗的最佳用途。新的诊断和治疗方法正在开发中，这也需要在目标人群中进行严格评估，以确保它们仅用于有证据表明结果得到改善的人。迫切需要将这种疾病从儿童严重但远不如老年人流感重要的疾病重新定义为将 RSV 视为老年人健康的主要风险，需要有针对性的预防和治疗。