RSV incidence and prevalence

Adam C. Welch, PhD, MBA, FAPhA: hello welcome here American Journal of Managed Care® Peer Exchange It was titled “Exploring the Potential Impact of RSV Vaccines”. My name is Dr. Adam Welch. I am a pharmacist and he is an independent vaccine consultant for ETSU Health in Johnson City, Tennessee. Joining us for this virtual discussion today is Dr. Lauren Mascola, Physician and Immunization and Vaccine Policy Consultant for the Los Angeles County Public Health Department of California. Dr. Wanda Filer, Physician and Chief Medical Officer of VaxCare in Orlando, Florida. Dr. Marty Feltner is a pharmacist and pharmacy manager at the Nebraska Senior Rx Care Pharmacy in Lincoln. and Dr. Abby Lynn Singleton, senior pharmacist at Himark, Pittsburgh, Pennsylvania.

Today I will talk about some RSV topics. [respiratory syncytial virus]This includes the impact of RSV infection in adults, infectious disease control, and addressing potential barriers to market introduction of RSV vaccines. let’s start. Let’s start with Dr. Mascola. What is RS virus and how does it affect older people?

Lauren Mascola, MD, MPH: As for RSV, all people of all ages are at risk of the disease, including healthy people and those with underlying medical conditions, but the highest prevalence is in people under 2 years of age and people over 65 years of age. . The data show that RSV has an effect. Elderly populations in both community and nursing homes are similar to non-pandemic influenza, resulting in the same hospitalizations, intensive care unit visits, and mortality rates. Of all respiratory infections, the prevalence of her RSV infection in adults is estimated at about 5% per year, but can be up to 7.8% depending on the season.

According to the US Centers for Disease Control and Prevention, the disease represents a significant source of morbidity, with approximately 60,000 to 160,000 adults hospitalized with it each year. And as the population ages, the geriatric population is expected to grow by about 39% between 2020 and 2050, meaning the impact of the disease will be even greater. From 6,000 to 10,000 people die each year in this elderly population.

Adam C. Welch, PhD, MBA, FAPhA: RSV is often considered a childhood problem. But you are now saying that there is a significant risk of hospitalization for the elderly. You mentioned that RSV causes up to 160,000 adult hospitalizations and 6,000 to 10,000 deaths each year, and it’s just as important for this population.

Lauren Mascola, MD, MPH: And it increases with age. Looking at those under 65, the fatality rate is about 4%. After age 75, the fatality rate rises to about 6%. In severely frail adults, the rate can reach 10%.

Adam C. Welch, PhD, MBA, FAPhA: Wow, that’s very important. Dr. Filer, how does RSV spread? What are the symptoms to look for?

Wanda Filer, MD, MBA, FAAFP: Many adults may not be familiar with RSV, but we do not test for RSV. But that’s who comes to my family doctor’s office. They will come in with a sore throat, they will come in feeling tired. They come with a bad head and a stuffy nose. RSV is known to cause profuse runny noses. The other is cough, which is cough from upper respiratory tract disease and may be transmitted by respiratory droplets, aerosolized droplets from sick people, or picked up on surfaces. It can stay alive for several hours on the surface. A person may remain contagious for 3 to 8 days, or up to 4 weeks if immunity is compromised. So they can spread it to the community.

You may not be aware that you are exposing yourself to this situation. You come to the office and think you have a head cold. However, in about 25% of patients presenting with a “just a cold,” the cold progresses to the lower respiratory system and can eventually lead to bronchitis, or tracheobronchitis. As Dr. Mascola said, some of these patients will develop pneumonia and require hospitalization. I think that’s why many of us are so excited about the idea of ​​an RSV vaccine, a way to prevent the disease and keep people out of work and all the suffering that comes with this disease.

Adam C. Welch, PhD, MBA, FAPhA: Some of the symptoms you describe are very similar to other respiratory diseases we are familiar with: COVID-19 and the flu. So how do we distinguish between COVID-19 and RSV?

Wanda Filer, MD, MBA, FAAFP: It’s not always easy.we often use this word flu-like illness. This could look a lot like the flu, COVID-19, or RSV. In recent years, more rapid tests have become available. It is not so prevalent in the foreign world. Many emergency departments are now testing. We obviously didn’t test for COVID-19 until the pandemic hit. We are doing more testing for influenza. But frankly, I think one of the reasons we are unaware of RSV in adults is that we didn’t test because there was nothing to do. We plan to treat it symptomatically, but there were no antivirals available. Not yet. Therefore, provide supportive care. We are doing further tests in the emergency department. Frankly, the burden of the disease we just heard from Dr. Mascola is probably much greater. There are probably many more RSVs that we are not aware of. So testing can help us better address this issue.

Lauren Mascola, MD, MPH: Wanda, isn’t it possible that there are asymptomatic people who have RSV and are spreading the disease?

Wanda Filer, MD, MBA, FAAFP: absolutely. As mentioned earlier, in some cases, especially those with weakened immune systems, the infection can last for weeks and spread the disease silently. they have no idea. Many people have mild infections but feel perfectly fine. Meanwhile they are spreading it to the community. The incidence of this disease in adults often peaks in winter. Come to think of it, it’s cold and flu season. And this person is one of those criminals.

Marty J. Feltner, Ph.D.: I think you made the right point about the underreporting. At this time, we do not really know the prevalence of her RSV in our community and long-term care settings. The virus is clinically very similar to influenza and COVID-19. So we really need to start testing all three, especially in long-term care facilities.

Lauren Mascola, MD, MPH: Also, from a public health perspective, most states currently do not treat RSV as a reportable disease. Again, because there was nothing you could do to prevent it. No reason to count it. Most state and local health departments do not count or track RSV cases, so they have no idea what is happening in their communities.

Marty J. Feltner, Ph.D.: It’s a voluntary declaration. Perhaps 12 or 14 states have reported him with RSV.

Adam C. Welch, PhD, MBA, FAPhA: Dr. Filer, you mentioned the seasonality and peak times of RSV. Due to COVID-19 and the pandemic, people have not been able to interact with each other as usual during his past year. So over the past few years, has he seen any change in his RSV?

Wanda Filer, MD, MBA, FAAFP: Maybe it’s because I’m a bit of a public health nerd too, but I find it really interesting. People were wearing masks when they were at home, but what we saw was an outbreak of RSV in June. It was happening all summer long. It was a very heavy burden. We’ve all heard about the pediatric ICU. [intensive care units] It’s buried, but it was also seen in the adult space. And in adult ICUs, whether it was COVID-19 or respiratory syncytial virus, they sometimes coexisted. And in the case of the flu, it had multiple burdens and was occurring all year round. Now that life is theoretically getting a little more normal, there is a suspicion that we will return to a more normal pattern. So probably again he will have RSV between he in October and he in March.

Adam C. Welch, PhD, MBA, FAPhA: Respiratory syncytial virus is expected to peak around the same time as the peak of influenza, potentially causing an extra burden of upper respiratory tract symptoms that people will need to deal with, and health care providers needing to be adequate in this process. must be dealt with.

Marty J. Feltner, Ph.D.: From a pharmacy’s perspective, flu season may mean doing all three doses of the vaccine, but this will also present a significant challenge for the pharmacy and healthcare community.

Lauren Mascola, MD, MPH: I think for the first time we are considering an adult platform for a vaccine coming in the fall. I never thought there was an established routine for adults to be vaccinated normally, but now we consider at least three vaccines each fall. We are considering four vaccines that adults may need to receive each fall season, including a pneumococcal vaccine, an influenza vaccine, a COVID-19 booster, and possibly RSV. increase.

Adam C. Welch, PhD, MBA, FAPhA: It gives us as a provider more information and more prevention options.

I edited the transcript for clarity.