Hospitalisation Burden Estimates of Respiratory Syncytial Virus with Adjustment for Case Underascertainment in Adults Aged 18 to 65 Years in High-income Countries: a Systematic Review, Meta-analysis, and Modelling Study

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ID: 315818
2026
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Abstract
Abstract Background Respiratory syncytial virus (RSV) disease burden among adults younger than 65 years is not well documented. We aimed to estimate the hospitalisation burden of RSV in adults aged 18–64 years in high-income countries. Methods We conducted a systematic review (PROSEPRO: CRD42022377741) to identify studies reporting estimates of RSV hospitalisation burden in the study population. For each individual study included, we followed a two-step statistical approach to adjust for RSV case under-ascertainment related to the use of clinical specimen and diagnostic test. Random-effects meta-analysis was conducted to estimate RSV hospitalisation and mortality burden. We further compared estimates above between 18–64 years in this study to ≥65 years in our previous study using the same methodology. Results Based on 8 studies, the adjusted annual RSV-associated hospitalisation rate was 48/100,000 (95% CI: 31–77) in adults aged 18–64 years. According to 12 studies, more than three quarters of RSV-associated hospitalised adults had at least one comorbidity; adults aged 50–64 years with asthma, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, or diabetes, and adults aged 18–49 years with congestive heart failure or diabetes had comparable RSV hospitalisation rates to those aged ≥65 years without these comorbidities. 6.1% (5.2–7.1) of RSV-associated hospitalised cases aged 18–64 years died in hospital (3 studies). Conclusion Adults aged 18–64 years with certain comorbidities have substantial RSV hospitalisation burden comparable to those aged ≥65 years without these comorbidities, and could be the additional target populations for RSV vaccination programmes.
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Authors You Li, Sébastien Kenmoe, Elizabeth Begier, Pia Wahi-Singh, Bhanu Wahi-Singh, A Branche, Edward E Walsh, Caihua Liang, Reiko Sato, Bradford D Gessner, Harish Nair
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag341
URL
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