Lethality rate from respiratory virus in elderly people reaches 25% in ten years

Brazil Agency - Although more prevalent in young children, respiratory syncytial virus (RSV) infection can also be serious in the elderly, with a higher risk of death. From 2013 to 2023, the fatality rate in this group was nearly 26%, according to a survey conducted by researchers from the Oswaldo Cruz Foundation (Fiocruz), the Federal University of Santa Catarina, the pharmaceutical company GSK, and the healthcare information company IQVIA.

The survey data show that 71,5% of patients who died had at least one comorbidity, the most common of which were cardiovascular diseases, followed by diabetes and lung diseases. The proportion was similar to that of all hospitalized elderly patients, regardless of outcome: 64,2% already had some heart condition, 32% had diabetes, and 26,5% had some lung disease.

"This is a virus that causes an intense inflammatory process, and the cardiac patient suffers direct damage. A study with patients in England revealed that healthy patients who became infected with the virus had myocarditis, which is inflammation of the heart. With RSV, the patient who already has heart failure decompensates, the oxygen supply decreases, and they have to work much harder to pump that heart, which is already diseased. People with coronary artery disease, who are at risk of heart attack, had three times the risk after an infection," explains GSK infectious disease specialist Lessandra Michelini, one of the study's authors.

In absolute numbers, RSV infection in the elderly appears to be a minor problem, as only 3.348 hospitalizations in this age group were recorded by public or private units in the Influenza Epidemiological Surveillance Information System during this ten-year period. Lessandra explains that testing for the respiratory syncytial virus only began to be done more frequently from 2017 onwards, but even today many adults with the disease go undetected.

"Children have a higher viral load in the oropharynx, so it's easier for the swab test to diagnose the virus. Adults, on the other hand, need to be in the very early stages of infection to have a high viral load. And when they have symptoms like fever, they usually stay home for about 3 or 4 days, waiting to get better, before going to the hospital. Unless they are already very ill and need to be hospitalized. Then there's a greater chance of getting tested," adds Lessandra.

Even so, the study showed that the hospitalization rate rose from 0.3 to 2.1 from 2013 to 2023, a seven-fold increase. Furthermore, 32.6% of patients required intensive care unit admission, and nearly 70% required respiratory support.

Vaccination

RSV can be prevented with vaccination, but for now the two options authorized for use in the elderly in Brazil are only available in the private sector: Arexvy, produced by GSK, and Abrysvo, from Pfizer.

The Ministry of Health announced the incorporation of Abrysvo into the Unified Health System (SUS) starting in the second half of this year, but only for pregnant women, with the aim of protecting newborns. At the time of the announcement, the government said it was considering expanding the vaccination to specific groups of elderly people, but without giving a timeline.

A recent study conducted by GSK to evaluate the efficacy of Arexvy over three seasons of RSV circulation found that the vaccine had 82,6% coverage against infections and 94% against severe cases in the first year, and that the accumulated protection over 31 months was 62,9%. 

The data comes from monitoring around 25 elderly people vaccinated in 17 countries.