Respiratory syncytial virus testing and vaccination in adults

This transcript has been edited for clarity.

Good morning. I'm Angela Blanche, an associate professor of medicine at the University of Rochester and an infectious disease specialist. Today I want to share with you some valuable information about respiratory syncytial virus infections in older adults. I think this information will be helpful as we move into the fall and RSV starts to spread in your area.

First, I want to talk about RSV infections in general, with some epidemiological data. Remember, RSV infections tend to be prevalent at least a month before you see influenza in your area. Why is this important? Because RSV testing is often tied to influenza testing.

Many people don't start testing for RSV in their offices or emergency departments until they see influenza circulating in their area. In fact, doing so could mean missing almost a third of the RSV season. Here in the Northeast, RSV typically starts circulating in early to mid-October, about a month and a half before influenza starts circulating in the Northeast. This is true across the country, even if the season starts a little later in the year.

So as soon as you start seeing patients with wheezing respiratory illness in your hospital, start thinking about RSV infection. If you're in the Northeast, start thinking about it in early October. Typically this starts with children. After about two to three weeks, you start seeing older adults in your clinic and emergency departments with RSV infection. Again, these two are related and something to consider when you're thinking about RSV infection and RSV infections, especially in adults.

Another thing that is often overlooked is that RSV is a virus that causes other influenza It's different from COVID in terms of how it's transmitted. COVID and influenza tend to be transmitted by droplets, meaning that a sick person coughs or sometimes talks into the air. Droplets from secretions or saliva contain the virus, which then spreads it to other people.

RSV is a little bit different. Droplets do play a role in transmission, but really, a lot of the transmission is through direct contact with secretions. What happens is that parents and grandparents come into contact with young children who are carriers of the virus, and that's how RSV spreads most often in the community. They come into contact with the children's nasal mucus and the virus on their hands. And so they actually get the infection that's associated with the virus and become infected themselves.

Another thing that's important about RSV is that fomite transmission plays a much bigger role than influenza or COVID. So your secretions fall on a desk or somewhere, or if you're feeding your child, they fall into a baby bottle. And that's where you get it. Because the secretions can live on those surfaces much longer than COVID or influenza, which can infect other people. And then that person touches their nose, and then they get RSV and get sick.

So when you think about RSV infection, not only do you think about things like wearing a mask, but also think about washing your hands frequently, especially if you have a lot of contact with young children.

I also want to talk a little bit about what happens when older adults get RSV. RSV is very different from COVID and influenza. You don't see a very severe acute illness where you get a high fever or body aches within a day or two of symptoms appearing. With RSV, it usually starts as a cold.

For the first 5-7 days, symptoms may not progress quickly. Sometimes only upper respiratory symptoms may be present. Patients usually visit a clinic or emergency department after about a week, when the virus moves to the lower respiratory tract. At this time, symptoms such as wheezing may appear. A productive cough may also develop.

In many cases, hypoxia occurs. Hypoxia is one of the indicators of the severity of RSV infection. RSV infection is slightly different from influenza, metapneumovirus, and COVID. This is because RSV infection is more likely to cause hypoxia than influenza.

It is insidious and progresses to lower respiratory tract disease, which is associated with high morbidity, mortality and hospitalization.

Wheezing is another feature of RSV infection. If a patient comes in and is wheezing when they were not previously wheezing, suspect RSV infection. Or, Congestive heart failure Or their Chronic obstructive pulmonary diseaseLet's think about RSV again, because these viruses tend to be more closely related to RSV than to other respiratory viruses.

The last thing I want to talk about is three vaccines that were recently approved by the Food and Drug Administration and are also recommended by the Advisory Committee on Immunization Practices (ACIP) to prevent RSV infection in adults. We're very excited about this. Reducing hospitalizations is great. Some of the real-world evidence from last year has demonstrated the ability to prevent hospitalizations in the first season of these vaccines.

But there is confusion about how these vaccines should be used. Updated recommendations from ACIP in June of this year include recommending vaccination for all adults 75 years of age and older and all residents of long-term care facilities. If a patient is in their 60s or early 70s, it is only recommended if they have high-risk symptoms. So how do we put this into practice?

In other words, if the patient is 62 years old and has mild High blood pressure If you're a very well-controlled patient, you're probably not a high-risk patient, but if you're in your 60s and have end-stage renal disease and are on hemodialysis or have congestive heart failure, you may want to get vaccinated this season to protect yourself against RSV infection.

Thank you for listening. I hope this helps. See you next time.