Comparative Severity of RSV and Other RVIs Versus Influenza in Hospitalized Cancer Patients

Overview

In a retrospective cohort of 1823 hospitalized cancer patients with respiratory viral infections (RVIs), respiratory syncytial virus (RSV) and other non-vaccine-preventable RVIs demonstrated higher severity compared to seasonal influenza. RSV infection was associated with increased odds of ICU/high-dependency admission and mortality within one month.

Background

Respiratory viral infections are a major cause of morbidity and mortality in immunocompromised cancer patients. While vaccines exist for influenza and RSV, other RVIs such as human metapneumovirus (HMPV) and human parainfluenza virus (HPIV) currently lack preventive options. Multiplex PCR testing enables simultaneous detection of multiple RVIs, allowing for comparative severity analyses. Understanding the burden of different RVIs in this population is critical for guiding vaccine and therapeutic development.

Data Highlights

Key Findings

• Among 1823 hospitalized cancer patients with RVIs, 29.4% experienced severe infection defined by oxygen use, ICU/HD admission, or death within one month.
• RSV infections had nearly double the odds of severe outcomes compared to influenza (aOR 1.94).
• RSV was associated with significantly increased odds of ICU/high-dependency admission (aOR 2.41) and mortality at one month (aOR 2.42) compared to influenza.
• Other non-vaccine-preventable RVIs such as HMPV and adenovirus also showed higher severity than influenza (aORs 1.77 and 2.19, respectively).
• Older age, presence of comorbidities, coinfections, and nosocomial transmission were independently associated with increased severity of RVIs.
• Multiplex PCR testing enabled comprehensive detection and comparison of multiple RVIs in this immunocompromised population.

Clinical Implications

Clinicians should recognize that RSV and other non-influenza RVIs can cause more severe disease than seasonal influenza in hospitalized cancer patients. This underscores the importance of infection prevention measures, especially to reduce nosocomial transmission. Additionally, there is a critical need to develop and implement vaccines and therapeutics targeting RSV and other non-vaccine-preventable RVIs to reduce morbidity and mortality in this vulnerable population.

Conclusion

RSV and other non-vaccine-preventable respiratory viruses cause more severe outcomes than influenza in hospitalized cancer patients, highlighting the urgent need for expanded preventive and therapeutic strategies. Infection control remains paramount to mitigate the substantial morbidity and mortality associated with these infections.

References

1. Authors/Source/2024 -- Comparative Analysis of Respiratory Syncytial Virus and Other Respiratory Infections Against Seasonal Influenza in Hospitalized Cancer Patients