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RSV risk in older adult male RSV risk in older adult female

It’s contagious, it’s dangerous,
and it's just as prevalent as the flu.

It’s not the flu.
It’s RSV.

For older adult patients in your practice, the consequences of annual respiratory syncytial virus (RSV) infection are serious, underrecognized, and require effective prevention.1

RSV is an important respiratory virus that has similar clinical manifestations to influenza, but has been shown to be a distinct cause for serious lower respiratory tract infections such as pneumonia.2,3

Prevention of RSV disease with reduction of global disease burden requires an effective vaccine.

June 2016 - The Advisory Committee on
Immunization Practices (ACIP) identifies Older Adults
as a "population at risk of severe disease" from RSV.4

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About RSV

RSV is a virus that causes infections in the respiratory tract. Transmission occurs in predictable, annual epidemics, beginning in the fall and continuing through early spring. Each year in the US, RSV in older adults causes an estimated 2.5 million infections, approximately 900,000 medical interventions (including hospitalizations, outpatient visits, and ER visits) and 16,000 deaths.1,3,4

With an impact as serious as influenza, RSV severely affects older adults aged 65 and over, and puts their loved ones and caregivers at risk of infection. With no vaccines currently available, RSV poses a significant and real threat to the community.1-3,5

  • RSV in
    Older Adults
  • Why Older Adults?
  • Common Symptoms
  • RSV vs FLU
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RSV in older adults

RSV is responsible for serious lower respiratory tract infections that can lead to pneumonia, hospitalizations, and even death in older adults.3

Because RSV infection has signs and symptoms that are similar to other viruses, such as influenza, RSV in older adults is often misdiagnosed. Therefore, increased awareness of this prevalent, recurrent, and potentially deadly threat is needed.1,3,6

Why Older Adults?

Older adults may be more vulnerable to RSV due to the diminished antibody and cellular immune responses that occur with aging. These age-associated immune declines put older adults at greater risk.3,5

In patients with respiratory and/or underlying cardiopulmonary diseases, such as congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), these conditions may be exacerbated by RSV infection. In some severe cases, RSV infection can result in hospitalization or even death.3

Understanding the signs and symptoms

RSV symptoms generally appear 3 to 5 days after exposure to the virus. These symptoms include nasal congestion, cough, wheezing, dyspnea, and possibly fever.3

Because the signs and symptoms of RSV are similar to those associated with influenza, and because diagnostic testing is not routinely performed, it is often difficult to confirm RSV infection in older adults. Importantly, studies have shown that this has led to the misuse of antibiotics to treat RSV infections.3,7,8

Distinguishing RSV from the FLU

RSV infection in older adults can present a variety of clinical manifestations ranging from asymptomatic infection to respiratory failure and death. In most cases, after an incubation period of 3 to 5 days, persons with RSV infections begin to develop coryza-type symptoms that are commonly seen with other viral pathogens.3

Although there is a significant amount of overlap, the presence of symptoms such as dyspnea and wheezing are commonly associated with RSV, whereas a fever tends to occur more frequently with influenza infections, as shown in the table below.

RSV vs FLU SYMPTOMS

Clinical manifestations of RSV infection compared with symptomatic influenza A disease3

Symptoms RSV (%) Influenza (%)
Cough 85–95 89
Dyspnea 51–93 32
Wheezing 33–90 30
Rhinorrhea 22–78 64
Sore Throat 16–64 64
Myalgias 10–64 70
Fever 48–56 72

Risk and incidence of RSV

Rates of documented RSV infections, associated hospitalizations, and related deaths highlight the need for greater awareness.

Burden of Disease

RSV infection is a significant cause of morbidity and mortality in older adults and emerges as a recurrent and annual epidemic. Recent studies suggest that RSV infection in older adults occurs with incidence and mortality rates similar to seasonal influenza.1,3

RSV Hospitalizations

In a landmark, prospective, US-based study of 1471 patients who were hospitalized with respiratory illnesses and evaluated over 4 consecutive winters, a fairly constant rate of RSV infection (8%–13%) was observed. Additionally, in 2 of the 4 winters, RSV infection rates were higher than influenza infection rates, which were more variable (1%–20%). This study also revealed similar mortality rates for the 2 viruses at 7% and 8%, respectively.3

  • Burden of Disease
  • RSV Hospitalizations
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Novavax estimated US burden of disease for RSV, influenza, and pneumococcal pneumonia in adults 65+ is comparable4

RSV Influenza Pneumococcus
Number of Infections 2,540,000 2,883,052 1,286,556
Hospitalizations 207,000 262,095 339,853
Deaths 16,000 14,607 22,449
Novavax estimated US burden of disease for RSV, influenza, and pneumococcal pneumonia in adults 65+ is comparable Novavax estimated US burden of disease for RSV, influenza, and pneumococcal pneumonia in adults 65+ is comparable

The number of hospitalizations due to RSV are comparable to those due to flu and are more consistent from year to year3

The number of hospitalizations due to RSV are comparable to those due to flu and are more consistent from year to year

ANNUAL PREDICTABILITY OF RSV

Over several seasons of observation, reports of influenza-like illnesses (ILI) show significant variation, while RSV infection rates remain predictable from year-to-year.9,10

Seasonal Impact of ILI in the US

In a retrospective analysis of 6 different influenza seasons that included data measuring the percentage of ILI on a week-to-week basis within the total population, the results demonstrated a wide range of variability of incidences of outpatient visits for ILI in the years observed.9

Seasonal Impact of RSV in the US

In a nationwide study examining 6 consecutive influenza seasons that included data representing the percentage of RSV-positive tests reported on a week-to-week basis, the results showed a consistent pattern of seasonal infections across all 6 years.10

Seasonal Impact of RSV in the UK

In a study using a multiple linear time-series regression model, the burden of RSV was estimated over 14 seasons (from 1995 to 2009) among the total population and adults in terms of general practice (GP) episodes, hospitalizations, and deaths from respiratory disease.5

Study results demonstrated that in most seasons after 2001, more GP episodes, hospitalizations, and deaths were attributable to RSV in older adults than to influenza.5

  • SEASONAL
    IMPACT IN THE US
  • SEASONAL
    IMPACT IN THE UK
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Percentage of Visits for ILI* for 2015-2016 and Selected Previous Seasons9

Percentage of Visits for Influenza-like illness for 2015-2016 and Selected Previous Seasons

*ILI is defined as fever—temperature of 100°F [37.8°C] or greater—accompanied by a cough and/or sore throat.


Percentage of RSV-Positive Tests for 2015-2016 and Past 5 Seasons10

Percentage of RSV-Positive Tests for 2015-2016 and Past 5 Seasons

In a UK-based study spanning 14 consecutive seasons, RSV was shown to be a predictable, annual epidemic in older adults5

In a UK-based study spanning 14 consecutive seasons, RSV was shown to be a predictable, annual epidemic

GP = general practice

Know the Facts

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RSV occurs in older adults annually, beginning in the fall and continuing through early spring3

In the US, RSV has an estimated incidence of 2.5 million infections per year in older adults4

In the US, RSV is responsible for an estimated 900,000 medical interventions per year in older adults4

In the US, RSV results in an estimated 16,000 deaths per year in older adults4

In the US, RSV is responsible for an estimated 207,000 hospitalizations per year in older adults4

What Can Be Done?

DEVELOPMENTS IN RSV TREATMENT AND PREVENTION

In the absence of a preventive option, healthcare providers (HCPs) are left with current treatments of limited practicality and efficacy; therefore, symptoms are managed with supportive care. However, the ongoing development of preventative vaccines will ultimately help address the unmet medical need to effectively prevent RSV disease in older adults.1,3

Learn more about ongoing trials of RSV vaccines at ClinicalTrials.gov.

MONITOR THE IMPACT OF RSV IN YOUR PRACTICE

Due to the lack of awareness of the annual morbidity and mortality caused by RSV in older adults and the lack of a specific treatment option, HCPs infrequently consider confirming a diagnosis of RSV. It is important to be informed about RSV in order to properly assess the disease burden of RSV in your practice.2,3

  • Educate yourself and your peers on the real burden of RSV in older adults
  • Consider testing for RSV to establish the burden of disease in your practice
  • Develop practice protocols in anticipation of vaccinations against RSV

References

  • 1. Simões EAF, DeVincenzo JP, Boeckh M, et al. Challenges and opportunities in developing respiratory syncytial virus therapeutics. J Infect Dis. 2015;211(suppl 1):S1-S20.
  • 2. Light MJ. Variability of respiratory syncytial virus seasonality and mortality. In: Ghanei M, ed. Respiratory Diseases. Rijeka, Croatia: InTech Europe; 2012:195-216.
  • 3. Branche AR, Falsey AR. Respiratory syncytial virus infection in older adults: an under-recognized problem. Drugs Aging. 2015;32:261-269.
  • 4. Data on file. Gaithersburg, MD: Novavax, Inc; 2016.
  • 5. Fleming DM, Taylor RJ, Lustig RL, et al. Modelling estimates of the burden of respiratory syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infect Dis. 2015;15:443-455.
  • 6. Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, Talbot HK. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206:56-62.
  • 7. Brendish NJ, Schiff HF, Clark TW. Point-of-care testing for respiratory viruses in adults: the current landscape and future potential. J Infect. 2015;71:501-510.
  • 8. Falsey AR. Respiratory syncytial virus: a global pathogen in an aging world. Clin Infect Dis. 2013;57(8):1078-1080.
  • 9. Centers for Disease Control and Prevention. FluView: a weekly influenza surveillance report prepared by the influenza division. 2015-2016 influenza season, week 15 ending April 16, 2016. https://stacks.cdc.gov/view/cdc/39016. Prepared April 22, 2016. Accessed April 22, 2016.
  • 10. IMS Health, AstraZeneca. RSVAlert®: Stay on top of RSV activity in your area. https://rsvalert.com/. Accessed April 22, 2016.
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