Respiratory Syncytial Virus (RSV) related adult-at-risk population for hospitalisation in the era of new vaccines

<bold>BACKGROUND:</bold> RSV in adults may result in hospitalisation and is increasingly recognised in elderly and high-risk groups, but UK guidelines only recommend vaccine to ages 75 to 79 years or during pregnancy (week 28 onwards). Focused on secondary care, this work (1) identifies the adult at-risk population from RSV, and (2) reviews vaccine uptake. <bold>METHODS:</bold> Retrospective review of respiratory viral infections among adults (age >16 years) in our hospital Trust during the 3 winter months ending January 2025. <bold>RESULTS:</bold> 710 respiratory viral infections accounted for 693 (17 co-infection) presentations; 477 (67%) were influenza A, 24 (3%) influenza B, 89 (13%) SARS-CoV-2-RNA, and 120 (17%) RSV. Of 120 (62% females) with RSV (10 co-infection, 7 with flu A), mean (SD, range) age was 72.2 (17.4, 19-99) years; 56 (47%) had attended A&E and 21 (18%) via same day emergency services. 64 (53%) were aged >75 years but none of the 10 in the target age group had been vaccinated. 86% had at least one co-morbidity from hypertension (42%), CKD3-5 (31%), diabetes (20%), ischaemic heart/failure (26%), COPD (19%), asthma (18%), or were immunocompromised (12%). 67 (56%) required oxygen and 30 (25%) had pneumonia on radiology. Length of stay was skewed to mean 9.5 (14.5, 0-120) days (median 5) with 25 (21%) discharged on day 0/1. 5 (4%) were in ICU and 9% died during admission. <bold>CONCLUSIONS:</bold> Data confirm (1) 17% identified respiratory viral infections are RSV (8% co-infections especially influenza A) with radiological pneumonia in 25% and early mortality in 9%, (2) wide age range with >50% older than age 75 years, (3) majority (86%) with co-morbidity and (4) none in the target age had been vaccinated.