Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24

Rebecca Symes; Suzanne H Keddie; Jemma Walker; Tricia McKeever; Shazaad Ahmad; David Arnold; Cariad M Evans; Emanuela Pelosi; Najib M Rahman; Elizabeth Sapey; Maria Zambon; Conall Watson; Jamie Lopez Bernal; Wei Shen Lim; The HARISS network collaborators; et al

doi:10.1016/j.jinf.2025.106570

Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24

Rebecca Symes^*, Suzanne H Keddie, Jemma Walker, Tricia McKeever, Shazaad Ahmad, David Arnold, Cariad M Evans, Emanuela Pelosi, Najib M Rahman, Elizabeth Sapey, Maria Zambon, Conall Watson, Jamie Lopez Bernal, Wei Shen Lim, The HARISS network collaborators, et al

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

2 Citations (Scopus)

Abstract

Objectives:
We aimed to describe the incidence, presentation and clinical outcomes of RSV-associated acute respiratory infection (ARI) in older adults using a new national Hospital-based ARI Sentinel Surveillance (HARISS) system in England, prior to RSV vaccine introduction.

Methods:
Adults aged ≥65 years from seven hospitals admitted for ≥24 hours with symptomatic ARI were included. We estimated the hospitalisation rate of RSV-associated ARI compared to influenza-associated ARI and assessed clinical outcomes using Poisson regression and mortality using Cox regression.

Results:
This study included 2743 adults. During winter 2023/4 the hospitalisation rate for RSV-associated ARI was 58.3 per 100,000, compared to 114.6 per 100,000 for influenza-associated ARI. Hospitalisations increased with age. Exacerbation of chronic illness (lung disease, heart disease, frailty) was a common admission reason in RSV-associated ARI, with a combined incidence of 33.1 per 100,000. Most adults with RSV-associated ARI had at least one comorbidity (81%); a high proportion with immunosuppression (26%). Symptoms and clinical outcomes including mortality were similar between RSV- and influenza-associated ARI; 30-day mortality 10.6% vs 8.7% (adjusted hazard ratio 0.85, 95% confidence interval 0.6–1.2).

Conclusions:
In England, RSV infection is a common cause of hospitalisation in older adults. Symptoms and clinical outcomes, including mortality, are comparable to influenza.

Original language	English
Article number	106570
Number of pages	9
Journal	Journal of Infection
Volume	91
Issue number	3
Early online date	6 Aug 2025
DOIs	https://doi.org/10.1016/j.jinf.2025.106570
Publication status	Published - 1 Sept 2025

Bibliographical note

Publisher Copyright:
Crown Copyright © 2025 Published by Elsevier Ltd on behalf of The British Infection Association.OGL 3.0

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Symes, R., Keddie, S. H., Walker, J., McKeever, T., Ahmad, S., Arnold, D., Evans, C. M., Pelosi, E., Rahman, N. M., Sapey, E., Zambon, M., Watson, C., Bernal, J. L., Lim, W. S., The HARISS network collaborators, & al , E. (2025). Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24. Journal of Infection, 91(3), Article 106570. https://doi.org/10.1016/j.jinf.2025.106570

@article{fe349711780b406e940c5c574d22ab4c,

title = "Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24",

abstract = "Objectives:We aimed to describe the incidence, presentation and clinical outcomes of RSV-associated acute respiratory infection (ARI) in older adults using a new national Hospital-based ARI Sentinel Surveillance (HARISS) system in England, prior to RSV vaccine introduction.Methods:Adults aged ≥65 years from seven hospitals admitted for ≥24 hours with symptomatic ARI were included. We estimated the hospitalisation rate of RSV-associated ARI compared to influenza-associated ARI and assessed clinical outcomes using Poisson regression and mortality using Cox regression.Results:This study included 2743 adults. During winter 2023/4 the hospitalisation rate for RSV-associated ARI was 58.3 per 100,000, compared to 114.6 per 100,000 for influenza-associated ARI. Hospitalisations increased with age. Exacerbation of chronic illness (lung disease, heart disease, frailty) was a common admission reason in RSV-associated ARI, with a combined incidence of 33.1 per 100,000. Most adults with RSV-associated ARI had at least one comorbidity (81\%); a high proportion with immunosuppression (26\%). Symptoms and clinical outcomes including mortality were similar between RSV- and influenza-associated ARI; 30-day mortality 10.6\% vs 8.7\% (adjusted hazard ratio 0.85, 95\% confidence interval 0.6–1.2).Conclusions:In England, RSV infection is a common cause of hospitalisation in older adults. Symptoms and clinical outcomes, including mortality, are comparable to influenza.",

author = "Rebecca Symes and Keddie, \{Suzanne H\} and Jemma Walker and Tricia McKeever and Shazaad Ahmad and David Arnold and Evans, \{Cariad M\} and Emanuela Pelosi and Rahman, \{Najib M\} and Elizabeth Sapey and Maria Zambon and Conall Watson and Bernal, \{Jamie Lopez\} and Lim, \{Wei Shen\} and \{The HARISS network collaborators\} and et al",

note = "Publisher Copyright: Crown Copyright {\textcopyright} 2025 Published by Elsevier Ltd on behalf of The British Infection Association.OGL 3.0 ",

year = "2025",

month = sep,

day = "1",

doi = "10.1016/j.jinf.2025.106570",

language = "English",

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Symes, R, Keddie, SH, Walker, J, McKeever, T, Ahmad, S, Arnold, D, Evans, CM, Pelosi, E, Rahman, NM, Sapey, E, Zambon, M, Watson, C, Bernal, JL, Lim, WS, The HARISS network collaborators & al , E 2025, 'Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24', Journal of Infection, vol. 91, no. 3, 106570. https://doi.org/10.1016/j.jinf.2025.106570

TY - JOUR

T1 - Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24

AU - Symes, Rebecca

AU - Keddie, Suzanne H

AU - Walker, Jemma

AU - McKeever, Tricia

AU - Ahmad, Shazaad

AU - Arnold, David

AU - Evans, Cariad M

AU - Pelosi, Emanuela

AU - Rahman, Najib M

AU - Sapey, Elizabeth

AU - Zambon, Maria

AU - Watson, Conall

AU - Bernal, Jamie Lopez

AU - Lim, Wei Shen

AU - The HARISS network collaborators

AU - al , et

PY - 2025/9/1

Y1 - 2025/9/1

N2 - Objectives:We aimed to describe the incidence, presentation and clinical outcomes of RSV-associated acute respiratory infection (ARI) in older adults using a new national Hospital-based ARI Sentinel Surveillance (HARISS) system in England, prior to RSV vaccine introduction.Methods:Adults aged ≥65 years from seven hospitals admitted for ≥24 hours with symptomatic ARI were included. We estimated the hospitalisation rate of RSV-associated ARI compared to influenza-associated ARI and assessed clinical outcomes using Poisson regression and mortality using Cox regression.Results:This study included 2743 adults. During winter 2023/4 the hospitalisation rate for RSV-associated ARI was 58.3 per 100,000, compared to 114.6 per 100,000 for influenza-associated ARI. Hospitalisations increased with age. Exacerbation of chronic illness (lung disease, heart disease, frailty) was a common admission reason in RSV-associated ARI, with a combined incidence of 33.1 per 100,000. Most adults with RSV-associated ARI had at least one comorbidity (81%); a high proportion with immunosuppression (26%). Symptoms and clinical outcomes including mortality were similar between RSV- and influenza-associated ARI; 30-day mortality 10.6% vs 8.7% (adjusted hazard ratio 0.85, 95% confidence interval 0.6–1.2).Conclusions:In England, RSV infection is a common cause of hospitalisation in older adults. Symptoms and clinical outcomes, including mortality, are comparable to influenza.

AB - Objectives:We aimed to describe the incidence, presentation and clinical outcomes of RSV-associated acute respiratory infection (ARI) in older adults using a new national Hospital-based ARI Sentinel Surveillance (HARISS) system in England, prior to RSV vaccine introduction.Methods:Adults aged ≥65 years from seven hospitals admitted for ≥24 hours with symptomatic ARI were included. We estimated the hospitalisation rate of RSV-associated ARI compared to influenza-associated ARI and assessed clinical outcomes using Poisson regression and mortality using Cox regression.Results:This study included 2743 adults. During winter 2023/4 the hospitalisation rate for RSV-associated ARI was 58.3 per 100,000, compared to 114.6 per 100,000 for influenza-associated ARI. Hospitalisations increased with age. Exacerbation of chronic illness (lung disease, heart disease, frailty) was a common admission reason in RSV-associated ARI, with a combined incidence of 33.1 per 100,000. Most adults with RSV-associated ARI had at least one comorbidity (81%); a high proportion with immunosuppression (26%). Symptoms and clinical outcomes including mortality were similar between RSV- and influenza-associated ARI; 30-day mortality 10.6% vs 8.7% (adjusted hazard ratio 0.85, 95% confidence interval 0.6–1.2).Conclusions:In England, RSV infection is a common cause of hospitalisation in older adults. Symptoms and clinical outcomes, including mortality, are comparable to influenza.

U2 - 10.1016/j.jinf.2025.106570

DO - 10.1016/j.jinf.2025.106570

M3 - Article (Academic Journal)

C2 - 40780588

SN - 0163-4453

VL - 91

JO - Journal of Infection

JF - Journal of Infection

IS - 3

M1 - 106570

ER -

Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023/24

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