Alexander Domnich, Francesco Lapi, Andrea Orsi, Piero Luigi Lai, Alessio Signori, Luca Pestarino, Pier Claudio Brasesco, Marta Vicentini, Anna Puggina, Alen Marijam, Maria João Fonseca, Elisa Turriani, Carlo-Simone Trombetta, Giada Garzillo, Federica Stefanelli, Valentina Ricucci, Bianca Bruzzone, Donatella Panatto, Giancarlo Icardi
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This study aims to compare RSV rates captured by ARI versus ILI case definitions and to describe the clinical and economic trajectories of RSV in older adults.</p><p><strong>Methods: </strong>The study was conducted in Italy during the 2023/2024 and 2024/2025 seasons. Thirty-eight general practitioners were randomized 1:1 to enroll individuals ≥ 50 years presenting for care and meeting the European criteria for ARI or ILI, respectively. Alternative definitions were also explored. All subjects were tested for respiratory pathogens. RSV-positive individuals were followed for up to one month.</p><p><strong>Results: </strong>Of 1431 patients (ARI: 741; ILI: 690) included, 5.2% tested positive for RSV. Odds of RSV in the ARI group (5.8%) was 26% higher than in the ILI group (4.6%) [odds ratio (OR) 1.26; 95% CI 0.60-2.65]. Exclusion of GPs with unexpectedly low enrollment rates increased the OR to 1.67 (95% CI 0.80-3.42). Conversely, adults in the ILI group showed higher rates of influenza A (OR 0.83; 95% CI 0.47-1.44) and SARS-CoV-2 (OR 0.57; 95% CI 0.34-0.95). A proposed alternative case definition, denoted as ARI with wheezing and/or productive cough and/or rhonchi and/or dyspnea was sensitive at 92.0% and specific at 30.8%. Among 75 RSV-positive outpatients, the case-complication, case-hospitalization and case-fatality rates were 30.7%, 2.7%, and 1.3%, respectively. The mean costs per RSV case were € 168.71 from the payer perspective and up to € 899.51 from the societal perspective.</p><p><strong>Conclusions: </strong>Compared to a highly sensitive ARI definition, ILI-based surveillance likely underestimates the incidence of RSV. Further qualifiers can enhance specificity of the ARI case definition. 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引用次数: 0
摘要
在欧洲，呼吸道合胞病毒（RSV）的监测最近已被纳入现有的基于流感样疾病（ILI）或急性呼吸道感染（ARI）病例定义的流感监测平台。本研究旨在比较ARI和ILI病例定义捕获的RSV发病率，并描述老年人RSV的临床和经济轨迹。方法：研究于2023/2024和2024/2025季节在意大利进行。38名全科医生以1:1的比例随机分组，分别纳入≥50岁就诊并符合ARI或ILI欧洲标准的个体。还探讨了其他定义。所有受试者都进行了呼吸道病原体检测。对rsv阳性个体进行了长达一个月的随访。结果：1431例患者(ARI: 741例；包括ILI: 690)， 5.2%的人检测出呼吸道合胞病毒阳性。呼吸道感染组RSV发生率（5.8%）比ILI组（4.6%）高26%[比值比（OR） 1.26；95% ci 0.60-2.65]。排除入组率意外低的全科医生使OR增加到1.67 （95% CI 0.80-3.42）。相反，ILI组的成年人患甲型流感的几率更高(OR 0.83；95% CI 0.47-1.44)和SARS-CoV-2 (OR 0.57；95% ci 0.34-0.95)。提出的另一种病例定义，即伴有喘息和/或生产性咳嗽和/或口臭和/或呼吸困难的ARI，其敏感性为92.0%，特异性为30.8%。75例rsv阳性门诊患者的并发症、住院率和病死率分别为30.7%、2.7%和1.3%。从支付方角度来看，每个RSV病例的平均成本为168.71欧元，从社会角度来看，平均成本高达899.51欧元。结论：与高度敏感的ARI定义相比，基于il的监测可能低估了RSV的发病率。进一步的限定符可以增强ARI病例定义的特异性。该研究证实了呼吸道合胞病毒对老年人的重大负担。
A Cluster Randomized Study to Explore Case Definitions, Clinical Course and Consequences of RSV in Community-Dwelling Adults Aged ≥ 50 Years.
Introduction: In Europe, surveillance of respiratory syncytial virus (RSV) has been recently incorporated into existing influenza monitoring platforms that are based on influenza-like illness (ILI) or acute respiratory infection (ARI) case definitions. This study aims to compare RSV rates captured by ARI versus ILI case definitions and to describe the clinical and economic trajectories of RSV in older adults.
Methods: The study was conducted in Italy during the 2023/2024 and 2024/2025 seasons. Thirty-eight general practitioners were randomized 1:1 to enroll individuals ≥ 50 years presenting for care and meeting the European criteria for ARI or ILI, respectively. Alternative definitions were also explored. All subjects were tested for respiratory pathogens. RSV-positive individuals were followed for up to one month.
Results: Of 1431 patients (ARI: 741; ILI: 690) included, 5.2% tested positive for RSV. Odds of RSV in the ARI group (5.8%) was 26% higher than in the ILI group (4.6%) [odds ratio (OR) 1.26; 95% CI 0.60-2.65]. Exclusion of GPs with unexpectedly low enrollment rates increased the OR to 1.67 (95% CI 0.80-3.42). Conversely, adults in the ILI group showed higher rates of influenza A (OR 0.83; 95% CI 0.47-1.44) and SARS-CoV-2 (OR 0.57; 95% CI 0.34-0.95). A proposed alternative case definition, denoted as ARI with wheezing and/or productive cough and/or rhonchi and/or dyspnea was sensitive at 92.0% and specific at 30.8%. Among 75 RSV-positive outpatients, the case-complication, case-hospitalization and case-fatality rates were 30.7%, 2.7%, and 1.3%, respectively. The mean costs per RSV case were € 168.71 from the payer perspective and up to € 899.51 from the societal perspective.
Conclusions: Compared to a highly sensitive ARI definition, ILI-based surveillance likely underestimates the incidence of RSV. Further qualifiers can enhance specificity of the ARI case definition. The study confirms a significant burden of RSV in older adults.
期刊介绍：
Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.
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