Understanding the Importance of RSV Testing in At-Risk, Elderly Adults

To increase positive outcomes this, and every, respiratory season it’s important to understand the effects that respiratory syncytial virus (RSV) can have in older adults and how diagnostic testing can lead to better healthcare outcomes for these at-risk patients.

RSV causes cold-like symptoms in most patients, but adults over 65 and those with certain pre-existing respiratory or cardiovascular conditions face an increased risk of complications, like pneumonia. Each year, RSV leads to thousands of hospitalizations and deaths in at-risk patients.¹ RSV symptoms in older adults can range from mild to life-threatening, potentially leading to respiratory failure (8-13%) or even death (2-5%).²

Timely and accurate diagnosis or RSV can lead to faster treatment and increase the likelihood of better outcomes for at-risk or elderly patients.

Why is RSV a serious health concern for some adults over 65?

Adults over the age of 65, who contract RSV, can have a greater risk of developing pneumonia and bronchiolitis, as well as worsening pre-existing conditions like asthma, COPD, congestive heart failure, or a compromised immune system.³ Due to the similarities of symptoms between the common cold and RSV, it can be difficult for a patient to know which illness they’ve contracted without proper testing by their healthcare provider.

Here are some basic statistics from the U.S. National Institutes of Health’s National Library of Medicine⁴ for at-risk adults with an active RSV infection:

10% to 31% of adults hospitalized for RSV infection will require intensive care support
3% to 17% of hospitalized adults will require mechanical ventilation
Among the high-risk patients, 32% will require hospitalization and 26% will need intensive care support
Mortality rates range from 11% to 18% in hospitalized adults
RSV-related case fatalities for high-risk adults with cardiopulmonary disease is an estimated 13%

The role of RSV testing in early detection and better treatment

Part of the challenge with RSV is that it can often go undiagnosed, due to the commonalities in symptoms with the common cold. Delayed diagnosis of RSV in at-risk patients can lead to additional complications, hospitalizations, and death. An accurate estimation of the incidence rate of RSV infection in the elderly population is important to navigate the clinical and economic burden of the disease, and to identify populations which may be in greatest need for treatment or prevention of RSV. The accuracy of real-world studies in estimating RSV incidence depends on the amount of RSV testing supporting the diagnosis codes that are reported through real-world data.⁵

There are two types of tests used to diagnose RSV infections: Rapid RSV antigen tests and Molecular RSV tests. RSV antigen tests are the most common for RSV, taking a fluid sample from the nose of the patient to check for certain proteins from the RSV virus called antigens. RSV antigens trigger the immune system to attack the virus. Molecular tests are automated (instrument run) diagnostics that look for genetic material from the RSV virus in the patient sample. These tests typically find smaller amounts of the virus than antigen tests, making them ideal for older children and adults who tend to have less of the virus in their noses than infants and younger children.⁶

Future trends in RSV testing and treatment

To more proactively and effectively prevent RSV going forward, providers need to better understand how current and future trends are going to impact testing and treatment options. New tools in the prevention and treatment of RSV are moving through the development pipeline, undergoing regulatory review, and under discussion at the Advisory Committee on Immunization Practices (ACIP). As these tools are licensed and ultimately recommended, new options will be available to help reduce the burden of this serious, yet often underappreciated public health threat.⁷

One of the primary efforts of RSV prevention is tracking and measuring the virus across the population. The Centers for Disease Control and Prevention has several systems designed to focus on monitoring and describing seasonal trends, clinical risk factors, rates of illness and hospitalization, as well as demographics of patients seeking care for illness associated with RSV.⁸

The National Respiratory and Enteric Virus Surveillance System (NREVSS) is a lab-based system that monitors season and circulation patterns of RSV and other viruses.
The RSV Hospitalization Surveillance Network (RSV-NET) is a population-based surveillance for RSV-associated hospitalizations in the U.S. among children and adults.
The New Vaccine Surveillance Network (NVSN) is a multisite, active, population-based pediatric surveillance network for acute respiratory hospitalizations and outpatient visits associated with RSV and other respiratory pathogen.

The Takeaway for Providers

So how can care providers arm themselves and their patients with the tools needed to improve RSV outcomes during respiratory season? Education is key. Providers should ensure their at-risk patients are aware of and understand the implications of an undiagnosed or untreated RSV infection. Diagnosing as close to the patient as possible is also important. By having a reliable diagnostic solution at the point of care, providers can be ready to assess, test, diagnose, and treat their patients within a single office visit. Providers are more likely to have the answers they need and may be able to prescribe treatment that could lead to a better outcome for their at-risk patient with RSV.

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