746. Characteristics of Respiratory Syncytial Virus (RSV) Infection among Hospitalized Adults — United States, 2014–2017
Session: Poster Abstract Session: Respiratory Infections: Viral
Thursday, October 4, 2018
Room: S Poster Hall
Background: Respiratory syncytial virus (RSV) vaccines are in clinical development for older adults. We described RSV infections among adults requiring hospitalization and risk factors for severe outcomes using a population-based platform, the Influenza Hospitalization Surveillance Network (FluSurv-NET).

Methods: Surveillance occurred October 1–April 30 (2014–2017) at sites located in 7 states (California, Georgia, Michigan, Minnesota, New York, Oregon, and Tennessee) covering an annual catchment population of up to 13 million adults ≥18 years. Laboratory-confirmed RSV cases were identified using hospital and state public health laboratories, hospital infection preventionists, and/or reportable condition databases. Medical charts were reviewed for demographic and clinical data. International Classification of Diseases (ICD) discharge codes were abstracted. Odds ratios (OR) and 95% confidence intervals (CI) were determined to assess risk factors for ICU hospitalization and deaths.

Results: 2,326 hospitalized RSV cases were identified. Over half were ≥65 years (62%, n=1438/2326), female (59%, n=1362/2326), white (70%, n=1301/1855), and had ≥3 underlying medical conditions (52%, n=1204/2326). 20% (n=398/2000) were hospitalized in the ICU (median length of stay, 3 days; interquartile range, 1–6 days), and 5% (n=96/2001) died in the hospital. Congestive heart failure (CHF; OR: 1.4, 95% CI: 1.1–1.8) and chronic obstructive pulmonary disease (COPD; OR: 1.3, 95% CI: 1.1–1.7) were associated with ICU admission, while age ≥80 years (OR: 4.1, 95% CI: 1.8–12.1) and CHF (OR: 2.4, 95% CI: 1.6–3.6) were associated with in-hospital deaths. RSV-specific ICD codes were listed in the first 9 positions in only 44% (879/1987) of cases.

Conclusion: To our knowledge, this is the largest U.S. case series of RSV-infected hospitalized adults. Most cases were ≥65 years and had multiple underlying medical conditions. Older age, CHF, and COPD were associated with the most severe outcomes. Few cases had RSV-specific ICD codes, suggesting that administrative data underestimate adult RSV-related hospitalizations. Continued surveillance is needed to understand the epidemiology of RSV among adults as vaccine products move toward licensure.

Lindsay Kim, MD, MPH1, Bryanna Cikesh, MPH1, Pam Daily Kirley, MPH2, Evan J. Anderson, MD3,4, Seth Eckel, MPH5, Kathryn Como-Sabetti, MPH6, Elizabeth M. Dufort, MD7, Christina B. Felsen, MPH8, Courtney Crawford, MPH9, H. Keipp Talbot, MD, MPH10, Gayle E. Langley, MD, MPH11 and Susan I. Gerber, MD1, (1)Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (2)California Emerging Infections Program, Oakland, CA, (3)Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Atlanta, GA, (4)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (5)Communicable Disease Division, Michigan Department of Health and Human Services, Lansing, MI, (6)Minnesota Department of Health, Saint Paul, MN, (7)Division of Epidemiology, New York State Department of Health, Albany, NY, (8)NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, (9)Acute and Communicable Disease Prevention Section, Oregon Health Authority, Portland, OR, (10)Vanderbilt University Medical Center, Nashville, TN, (11)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

L. Kim, None

B. Cikesh, None

P. D. Kirley, None

E. J. Anderson, NovaVax: Grant Investigator , Research grant . Pfizer: Grant Investigator , Research grant . AbbVie: Consultant , Consulting fee . MedImmune: Investigator , Research support . PaxVax: Investigator , Research support . Micron: Investigator , Research support .

S. Eckel, None

K. Como-Sabetti, None

E. M. Dufort, None

C. B. Felsen, None

C. Crawford, None

H. K. Talbot, Sanofi Pasteur: Investigator , Research grant . Gilead: Investigator , Research grant . MedImmune: Investigator , Research grant . Vaxinnate: Safety Board , none . Seqirus: Safety Board , none .

G. E. Langley, None

S. I. Gerber, None

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