Anyone can be infected by respiratory syncytial virus (RSV)1

Learn which patients are at risk of severe RSV disease and uncover the importance of protecting against RSV.1

Anyone can be infected by respiratory syncytial virus (RSV) Anyone can be infected by respiratory syncytial virus (RSV)
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why

Uncover RSV

A VIRAL RESPIRATORY THREAT

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RSV CAN BE EASILY MISTAKEN FOR INFLUENZA1

THE SYMPTOMS OF RSV AND INFLUENZA ARE STRIKINGLY SIMILAR, SO DISTINGUISHING THEM BASED ON CLINICAL PRESENTATION ALONE IS VERY DIFFICULT.1

LIKE INFLUENZA, RSV IS AN RNA VIRUS THAT IS2:

HIGHLY CONTAGIOUS

HIGHLY CONTAGIOUS3-5

HIGHLY CONTAGIOUS3-5

  • RSV is spread through close contact with infected individuals or contact with infected surfaces3
  • RSV can be spread through infected surfaces for extended periods of time, with examples including skin (30 minutes), fabric (2 hours), gloves (5 hours) and furniture (7 hours)5

SEASONAL

SEASONAL6-8

SEASONAL6-8

  • RSV incidence tends to overlap with influenza season, typically occurring between late fall and early spring in the US6,7
  • RSV can be unpredictable: peak seasons can vary up to a month based on location and time.8

COMMON CAUSE OF ACUTE RESPIRATORY INFECTIONS(ARI)

COMMON CAUSE OF ACUTE RESPIRATORY INFECTIONS(ARI)1,3,5

COMMON CAUSE OF ACUTE RESPIRATORY INFECTIONS(ARI)1,3,5

  • Although most patients experience mild symptoms that can be resolved on their own, RSV-associated ARI can cause severe respiratory complications in certain cases.1,3,5
  • When spread to the lower respiratory tract, RSV-associated ARI could lead to bronchiolitis and pneumonia1,3,5

Most people get RSV before 2 years old, and are at risk of another infection for the rest of their lives.9,10

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For some people, RSV can be just as serious as influenza.11-15

In infants12,13*

infants

In infants12,13*

RSV has exhibited higher death rates than influenza in infants12

In a study from Washington State, the incidence of RSV in infants seen at outpatient clinics was 7x higher than that of influenza13

In some adults with certain risk factors14

In some adults with certain risk factors

In some adults with certain risk factors14

Among adults who are immunocompromised or have an underlying condition like COPD or congestive heart failure, RSV has been associated with medical resource utilization similar to that of influenza14

In adults 60 years and older15†

In adults 60 years and older

In adults 60 years and older15†

Older adults hospitalized for RSV had longer hospital stays (≥7 days) and worse 1-year survival rates compared with patients with influenza15

* Infants defined as children aged 0-4 years12,13
†Based on a study of RSV patients aged 60 years and above15

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who

Uncover RSV

People of all ages, both healthy and with certain chronic conditions, are at risk of RSV.16

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People of all ages

Anyone could get infected by RSV17

Many may display no symptoms or mild symptoms only, but could still spread RSV to others.18

School-age children could unknowingly pass the virus to family members18,19
Usually, healthy adults might get RSV at the workplace without knowing it, and might transmit the virus to their infant children or elderly relatives15,18
Healthcare workers might unknowingly spread RSV to patients and colleagues16

Those with flu symptoms can avoid spreading RSV through the following ways20:

When coughing or sneezing, cover your mouth and nose with tissue or clothing sleeves instead of your hands20
Wash your hands for more than 20 seconds with soap and water frequently20
Avoid close contact with others (e.g. kissing, shaking hands, sharing utensils) 20
Clean frequently touched surfaces like door handles& mobile devices20

However, some populations remain at risk of severe disease outcomes: 21,22

Preterm babies aged 6 months and below22

Preterm babies aged 6 months and below

Children with chronic conditions, aged 2 years and below22

Children with chronic conditions, aged 2 years and below

Older adults aged 65 and above21

Older adults aged 65 and above

Those with an immunodeficiency21,22

Those with an immunodeficiency

Patients with certain chronic illnesses

Such as chronic heart or lung disease21,22

Patients with certain chronic illnesses

what

UNCOVER RSV

An underestimated cause of respiratory tract infection1,5

RSV TYPICALLY BEGINS WITH COMMON SYMPTOMS OF UPPER RESPIRATORY TRACT INFECTION (URTI) BUT CAN PROGRESS TO LOWER RESPIRATORY TRACT INFECTION (LRTI)3,5

Click the circles to find out more

Nasal Congestion3,5
Runny Nose5
Cough3,5
Wheezing 1,3
Bronchiolitis5,6
Pneumonia3,22
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Graphics for demonstration purposes only

SYMPTOMS OF RSV CAN RANGE FROM MILD COLD-LIKE SYMPTOMS TO SEVERE RESPIRATORY DISTRESS.6,14,24,25

INFANTS & YOUNG CHILDREN6,25,26

IN INFANTS, CLINICAL PRESENTATION MAY INCLUDE

IN INFANTS, CLINICAL PRESENTATION MAY INCLUDE6,25,26:

  • Bronchiolitis6
  • Pneumonia25
  • Croup25
  • Apnea26
  • Upper respiratory tract infection25

ADULTS WITH CERTAIN CHRONIC CONDITIONS27,28

IN SOME ADULTS WITH CERTAIN CHRONIC CONDITIONS, RSV MAY PROGRESS TO SEVERE COMPLICATIONS THAT RESULT IN

IN SOME ADULTS WITH CERTAIN CHRONIC CONDITIONS, RSV MAY PROGRESS TO SEVERE COMPLICATIONS THAT RESULT IN27,28:

  • Respiratory failure28
  • Prolonged hospitalization28
  • High mortality28

*While the study design was for adults 18 years and older, the mean age at time of diagnosis was 75.1 years in the RSV group and 74.7 years in the influenza group.

OLDER ADULTS3,5

IN OLDER ADULTS, CLINICAL PRESENTATION MAY INCLUDE

IN OLDER ADULTS, CLINICAL PRESENTATION MAY INCLUDE3,5,21:

  • Upper respiratory tract infection3,5
  • Exacerbation of asthma, chronic obstructive pulmonary disease, and chronic heart failure14
  • Pneumonia21

how

Uncover RSV

RSV IS A VIRUS THAT EXPOSES SOME TO POTENTIALLY SERIOUS OUTCOMES1,3,5,14

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especially in infants especially in infants

RSV is a highly contagious virus, especially in infants5

Infants younger than 6 months are at increased risk of RSV infection as their antibody responses are blunted and have easily inflamed and congested respiratory tracts.3,5

In the United States, RSV in infants has caused3:

Approximately 40%-90%

Of bronchiolitis-related hospitalizations3

Up to 50%

Of pneumonia-related hospitalizations3

The seasonal incidence of medically attended RSV in infants (aged between 6-11 months) was two times of older children (aged between 24-59 months).29§

§
According to a 2016 community cohort study describing the seasonal incidence of medical attendance instances of both out-patient and in-patient RSV and influenza cases, with a study population of 2384 children aged between 6 -59 months. This study focused on children living in the Marshfield Epidemiologic Study Area (MESA), a dynamic, population-based cohort of approximately 54 000 residents living in 14 zip codes surrounding Marshfield, Wisconsin. Nearly all MESA residents receive their medical care from Marshfield Clinic, an integrated, multispecialty healthcare system serving the MESA population.29
(Note: Hong Kong has no similar epidemiological study)

In medically-attended paediatric patients (aged above 1 and below 18), RSV infections were more common in younger children13||:

184.4 persons
/1000 persons

Aged 1

110.9 persons
/1000 persons

Aged 2-4

31.4 persons
/1000 persons

Aged 5-9

10.3 persons
/1000 persons

Aged 10-17

||
According to a 2021 study in Washington, USA conducted across 5 influenza seasons, on medical attendance due to Acute Respiratory Infection among adults and children aged 1 year and above.(2011/2012-2015/2016)13

What is the impact of RSV on infants in Hong Kong?

On average, 314 infants per year per 10000 infants (aged 0-4 years)
Were hospitalized due to RSV30
Approximately 37% of infants (aged 0-4 years) hospitalised due to respiratory disease
Were infected with RSV30
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Some adults are at higher risk of RSV-associated diseases and even mortality Some adults are at higher risk of RSV-associated diseases and even mortality

Some adults are at higher risk of RSV-associated diseases and even mortality14

Conditions such as chronic heart disease, COPD and asthma are risk factors for severe RSV.14

IN A STUDY OF ADULT PATIENTS WITH CORE RISK FACTORS FOR SEVERE RSV OR INFLUENZA INFECTION14:

A GREATER PROPORTION OF PATIENTS WITH RSV AND CORE RISK FACTORS REQUIRED HOSPITAL STAYS >3 DAYS COMPARED TO PATIENTS WITH INFLUENZA AND CORE RISK FACTORS14

RSV PATIENTS EXPERIENCED MORE COMPLICATIONS DURING HOSPITALIZATION, INCLUDING LOWER RESPIRATORY COMPLICATIONS, CARDIOVASCULAR COMPLICATIONS, AND BACTERIAL SUPERINFECTIONS, COMPARED TO PATIENTS WITH INFLUENZA14

#
CORE RISK FACTORS INCLUDE ANY ONE OR A COMBINATION OF THE FOLLOWING: AGE ≥65 YEARS OLD, CHRONIC HEART DISEASE, COPD, ASTHMA14
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Older adults are at higher risk of developing severe outcomes from RSV Older adults are at higher risk of developing severe outcomes from RSV

Older adults are at higher risk of developing severe outcomes from RSV 1,32

Gradual deterioration of the immune system due to aging, or immunosenescence is one of the reasons why older adults are more susceptible to RSV infections. Even active older adults will experience varying degrees of immunosenescence.1

In a study of adult RSV patients (with and without preexisting conditions), older adults had worse prognoses compared to adults aged between 18-49.32:

3 times more of hospitalization

When comparing older patients aged ≥65 with adult patients aged 18-49.31

Longer duration of hospitalization

When comparing older patients aged ≥65 and adult patients aged 18-49.32

Up to two times of A&E and out-patient clinic visits

When comparing older patients aged ≥65 and adult patients aged 18-49.32

In older adults (aged ≥60) with RSV7:

The risk of hospitalization, emergency room visits, or pneumonia is twice as high for people with or without comorbidities.7

Despite the burden of RSV, RSV is mainly tackled by supportive care like drinking more fluids, and there is no widely accessible specific prevention option32

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UNCOVER RSV

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References: 1. Talbot HK, Belongia EA, Walsh EE, Schaffner W. Respiratory syncytial virus in older adults: a hidden annual epidemic. Infect Dis Clin Pract. 2016;24(6):295-302. 2. Drysdale SB, Barr RS, Rollier CS, Green CA, Pollard AJ, Sande CJ. Priorities for developing respiratory syncytial virus vaccines in different target populations. Sci Transl Med. 2020;12(535):eaax2466. 3. Walsh EE, Hall CB. Respiratory Syncytial Virus (RSV). In Bennett JE, et al, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 2015:1948-1960. 4. Bhat R, Farrag MA, Almajhdi FN. Double-edged role of natural killer cells during RSV infection. Int Rev Immunol. 2020;39(5):233-244. 5. Carvajal JJ, Avellaneda AM, Salazar-Ardiles C, Maya JE, Kalergis AM, Lay MK. Host components contributing to respiratory syncytial virus pathogenesis. Front Immunol. 2019;10:2152. 6. Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1):62-72. 7. Belongia EA, King JP, Kieke BA, et al. Clinical features, severity, and incidence of RSV illness during 12 consecutive seasons in a community cohort of adults ≥60 years old. Open Forum Infect Dis. 2018;5(12):ofy316. 8. Rose EB, Wheatley A, Langley G, Gerber S, Haynes A. Respiratory syncytial virus seasonality – United States, 2014-2017. MMWR Morb Mortal Wkly Rep. 2018;67(2):71-76. 9. Bueno SM, González PA, Cautivo KM, et al. Protective T cell immunity against respiratory syncytial virus is efficiently induced by recombinant BCG. Proc Natl Acad Sci. 2008;105(52):20822-20827. 10. Centers for Disease Control and Prevention (CDC). RSV in infants and young children. In: Respiratory Syncytial Virus Infection (RSV) [website]. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Accessed May 2024. Available at https://www.cdc.gov/rsv/high-risk/infants-young-children.html 11. Zhou H, Thompson WW, Viboud CG, et al. Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008. Clin Infect Dis. 2012;54(10):1427-1436. 12. Hansen CL, Chaves SS, Demont C, Viboud C. Mortality associated with influenza and respiratory syncytial virus in the US, 1999-2018. JAMA Netw Open. 2022;5(2):e220527. 13. Jackson ML, Scott E, Kupers J, Nalla AK, Roychoudury P, Chu HY. Epidemiology of respiratory syncytial virus across five influenza seasons among adults and children one year of age and older – Washington State, 2011/2012-2015/2016. J Infect Dis. 2021;223(1):147-156. 14. Hartnett J, Donga P, Ispas G, et al. Risk factors and medical resource utilization in US adults hospitalized with influenza or respiratory syncytial virus in the Hospitalized Acute Respiratory Tract Infection study. Influenza Other Respir Viruses. 2022;16(5):906-915. 15. Ackerson B, Tseng HF, Sy LS, et al. Severe morbidity and mortality associated with respiratory syncytial virus versus influenza infection in hospitalized older adults. Clin Infect Dis. 2019;69(2):197-203. 16. Hall CB. Nosocomial respiratory syncytial virus infections: the “Cold War” has not ended. Clin Infect Dis. 2000;31(2):590-596. 17. Centers for Disease Control and Prevention (CDC). For healthcare providers. In: Respiratory Syncytial Virus (RSV) [website]. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Accessed May 2024. Available at https://www.cdc.gov/rsv/clinical/index.html 18. Centers for Disease Control and Prevention (CDC). RSV transmission. In: Respiratory Syncytial Virus Infection (RSV) [website]. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Accessed May 2024. Available at https://www.cdc.gov/rsv/about/transmission.html 19. Goldstein E, Nguyen HH, Liu P, et al. On the relative role of different age groups during epidemics associated with respiratory syncytial virus. J Infect Dis. 2018;217(2):238-244. 20. Centers for Disease Control and Prevention (CDC). RSV prevention. In: Respiratory Syncytial Virus Infection (RSV) [website]. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Accessed May 2024. Available at https://www.cdc.gov/rsv/about/prevention.html 21. Centers for Disease Control and Prevention (CDC). Older adults are at high risk for severe RSV infection. In: Respiratory Syncytial Virus Infection (RSV) [website]. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Accessed May 2024. Available at https://www.cdc.gov/rsv/factsheet-older-adults.pdf. 22. Centers for Disease Control and Prevention (CDC). RSV in infants and young children. Accessed May 2024. https://www.cdc.gov/rsv/downloads/RSV-in-Infants-and-Young-Children.pdf 23. Stephens LM, Varga SM. Considerations for a respiratory syncytial virus vaccine targeting an elderly population. Vaccines (Basel). 2021;9(6):624. 24. Centers for Disease Control and Prevention (CDC). Symptoms and care. In: Respiratory Syncytial Virus Infection (RSV) [website]. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Accessed May 2024. Available at https://www.cdc.gov/rsv/about/symptoms.html 25. Hall CB. Respiratory syncytial virus and parainfluenza virus. N Engl J Med. 2001;344(25):1917-1928. 26. Eiland LS. Respiratory syncytial virus: diagnosis, treatment and prevention. J Pediatr Pharmacol Ther. 2009;14(2):75-85. 27. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352(17):1749-1759. 28. Lee N, Lui GCY, Wong KT, et al. High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis. 2013;57:1069-1077. 29. Simpson MD, Kieke BA Jr, Sundaram ME, et al. Incidence of medically attended respiratory syncytial virus and influenza illnesses in children 6-59 months old during four seasons. Open Forum Infect Dis. 2016;3(2)ofw081. 30. Chan PKS, Tam WWS, Lee TC, et al. Hospitalization Incidence, Mortality, and Seasonality of Common Respiratory Viruses Over a Period of 15 Years in a Developed Subtropical City. Medicine (Baltimore). 2015;94(46):e2024. doi:10.1097/MD.0000000000002024 31. Amand C, Tong S, Kieffer A, Kyaw MH. Healthcare resource use and economic burden attributable to respiratory syncytial virus in the United States: a claims database analysis. BMC Health Serv Res. 2018;18(1):294. 32. Gatt D, Martin I, AlFouzan R, Moraes TJ. Prevention and Treatment Strategies for Respiratory Syncytial Virus (RSV). Pathogens. 2023;12(2):154. Published 2023 Jan 17. doi:10.3390/pathogens12020154.