This page summarizes a report in CDC's MMWR by CDC and the state and local partners of RSV-NET, on hospitalizations from July 2022 to June 2023. It reflects the RSV vaccine recommendations of June 2023; check CDC for current guidance.
Respiratory syncytial virus (RSV) causes substantial illness and death in older adults: about 60,000–160,000 hospitalizations and 6,000–10,000 deaths a year among adults 65 and older. In May 2023 the Food and Drug Administration approved two RSV vaccines to prevent RSV lower respiratory tract disease in adults 60 and older. In June 2023 CDC recommended RSV vaccination for adults 60 and older through shared clinical decision-making, a recommendation with no default, where patient and clinician weigh who is likely to benefit, prioritizing those at highest risk of severe disease.
The data
RSV-NET tracks RSV hospitalizations in about 300 hospitals in 58 counties of 12 states (California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Tennessee and Utah), covering about 9% of the U.S. population. It counts residents hospitalized with a positive RSV test during their stay or in the 14 days before.
Because the 2022–23 season started earlier than pre-pandemic seasons, demographic data cover July 1, 2022–June 30, 2023. Trained staff reviewed a random sample of medical charts for October 2022–April 2023, weighted to represent all hospitalized patients.
Who was hospitalized
All 3,218 hospitalized adults aged 60 and older:
- Age. Median 75. Those 75 and older made up 54.0% of hospitalizations but only 29.0% of the area's population aged 60 and older. People 80 and older accounted for 37.5%; people 60–64 for 13.5%.
- Race and ethnicity. 67.2% White, 15.4% Black, 7.1% Asian or Pacific Islander, 6.9% Hispanic, 0.4% American Indian or Alaska Native, 3.2% other or unknown.
- Younger patients in some groups. The median age of White patients (77) was significantly higher than that of Black (70), Hispanic (74) and American Indian or Alaska Native (72) patients, and lower than that of Asian or Pacific Islander patients (79). Black patients were 28.2% of those aged 60–64 but 8.2% of those 80 and older.
The 1,634 patients whose charts were reviewed:
| Measure | Result |
|---|---|
| Aged 75 or older | 54.1% |
| Living in a long-term care facility | 17.2% (26.9% of those 80 and older) |
| At least one underlying condition | 95.5% |
| Obesity / COPD / congestive heart failure / diabetes | 37.8% / 33.7% / 33.2% / 32.6% |
| Immunocompromising condition | 18.6% |
| Median hospital stay | 4.1 days |
| At least one severe outcome | 18.5% (95% CI 15.9%–21.2%) |
| ICU admission / mechanical ventilation / died in hospital | 17.0% / 4.8% / 4.7% |
| Do-not-resuscitate or do-not-intubate orders | 20% (35% of those 80 and older) |
Coinfections were rare. Among the 95% tested for SARS-CoV-2, 2.4% were positive; among the 97.1% tested for influenza, 2.2% were. Severe outcomes were no more common with a second virus, showing that RSV alone caused substantial illness.
Conditions tied to severe outcomes. Compared with patients without severe outcomes, those with them more often had COPD (40.0% vs 32.0%), other chronic lung disease (9.1% vs 4.4%) and congestive heart failure (41.2% vs 31.4%).
The oldest bore the most. Adults 75–79 and 80 and older were 12.4% and 16.2% of the area's population, but accounted for:
| Age | Hospitalizations | ICU admissions | In-hospital deaths |
|---|---|---|---|
| 75–79 | 16.0% | 21.2% | 25.6% |
| 80 and older | 38.1% | 25.5% | 42.1% |
What it means
- Older age, especially 75 and older, long-term care residence, and underlying conditions such as COPD and congestive heart failure are risk factors worth weighing in shared decisions about RSV vaccination. Earlier research found RSV hospitalization rates 3.5–13.4 times higher in older adults with COPD and 5.9–7.6 times higher in those with heart failure; long-term care residents are vulnerable to outbreaks in their facilities.
- American Indian or Alaska Native, Black and Hispanic patients were hospitalized at younger ages than White patients, likely reflecting different age distributions and life expectancy, and possibly disparities in underlying conditions, access to care and socioeconomic status. The authors call for special attention to equitable access to vaccines for these groups.
Limitations
- Some RSV hospitalizations may have been missed because of limited testing.
- Severely ill patients may have been tested more often, which could overstate the share of severe outcomes.
- RSV-NET covers 9% of the population and may not represent the whole country.
Sources
- Havers FP, Whitaker M, Melgar M, et al. "Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus — RSV-NET, 12 States, July 2022–June 2023." MMWR 72(40). https://www.cdc.gov/mmwr/volumes/72/wr/mm7240a1.htm
- The report's figures are not reproduced, because the report was prepared jointly with state health departments and universities.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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