RSV in Adults- Colors 1

Respiratory Syncytial Virus (RSV) in Adults

Understanding RSV

Protecting Older Adults

Assess with Certainty. Treat with Confidence.

Stop the Spread

Vaccine

In comparison to medication alone

Resources & References

Risk Factors

> 100 Scientific Articles Published

©2023 American College of Chest Physicians. No part of this publication may be reproduced/used in any manner without permission from the publisher.

Understanding RSV

The Zephyr Endobronchial Valve was granted a “breakthrough medical status”20 by the FDA and is indicated for bronchoscopic treatment of patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation (CV). The Zephyr Valve is an implantable device used to occlude all airways feeding the hyperinflated lobe of a lung that is most diseased with emphysema. Trapped air escapes through the Zephyr Valves until the lobe volume is reduced. The remaining lobes are then able to expand more fully and work more efficiently, reducing pressure on the diaphragm and improving overall lung function. 30 to 60-minute procedure Typically, 3 to 5 valves placed to completely occlude the lobe Can be removed or replaced if needed 3-night stay in the hospital

Understanding RSV

Epidemiology

Relationship to other viruses

Mechanism of Infection Pathways How the Body Fights RSV

Transmission and Immunology

Stop the Spread

Avoid close contact with others

Stay home when sick

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such as kissing, shaking hands, and sharing cups and eating utensils

Dropet

PPE

Cover your coughs and sneezes with a tissue or your shirt sleeve, not your hands

Gown, gloves and masks when working with RSV positive patient.

Wash hands

Contact

Wash your hands often with soap and water for at least 20 seconds.

Clean frequently touched surfaces such as doorknobs and mobile devices

Risk Factors

Comorbidities:

Age

(Flare up) cardiopulmonary disease, diabetes, chronic kidney disease,immunodeficiency, dementia – (ILI and Comorbidity flare up work in tandem causingstress on the patient?)

Spectrum of infection, specifically ability for RSV to cause pneumonia and criticalillness among high-risk elderly patients

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Demographics

Residency

Hospitalization rates highest in Native American/Alaska Native, Black,Hispanic/Latino groups.

Increased risk in long-term care facility residents

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Recovery

Season

Increased spread

Long term damages/challenges to pre infection

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Protecting Older Adults

Patients treated with the Zephyr Valve compared to patients on medication alone were able to:

• Return to activities that were previously limited
• Feel less shortness of breath
• Walk longer distances
• Have more energy
• Feel more confident leaving their home

Complications of the Zephyr Endobronchial Valve treatment can include but are not limited to pneumothorax, worsening of COPD symptoms, hemoptysis, pneumonia, dyspnea and, in rare cases, death.nec justo. Vestibulum sit amet est et justo semper aliquam.

Vaccine

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Take 1 month post-infection, Take with covid/flu?

The GSK and Pfizer vaccines use the prefusion form of the RSV Fglycoprotein as their main antigen. This protein is highly conserved between PSV-A and RSV-B. The vaccine trials appear to have equivalent efficacy against both subtypes Adjuvants act as immune co-stimulants along with the vaccine antigen, with a goal of increasing antibody levels and (when relevant) T-cell responses following vaccination. Some adjuvants are associated with increased systemic side effects, not fewer. Adjuvants generally do not have an effect on vaccine shelf life (although some preservatives used in vaccines do have this function). While adiuvanted vaccines may provoke a febrile response, this is not the intended effect but rather a side effect of the boosted immune stimulus.

Frequency

82.6%

94.1%

Efficacy in the prevention of severe LRTI.

Efficacy of RSV PreF3OA vaccine based on a phase 3 clinical trial

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Resources/References

Treatment Centers

Reimbursment

Physician Education

Transmission and Immunology

• Droplet transmission
• Aerosols up to 3 ft.
• Fomites: stable on hard surfaces or hands for several hours
• Hospital precautions therefore droplet AND contact
• Incubation: 2-8 days; contagious prior to clinical symptoms and up to 7 days
• Neutralizing antibodies wane over time; repeat infections common
• Anti-RSV IgG and IgA have 4x reduction in 75% of adults 1 year after infection
• T cell immunity key to viral clearance and recovery.
• Altered CD4 and CD8 T cells at higher risk.
• Immunodeficiency, allogenic stem cell transplant, lung transplant, etc.
• Older adults shed virus longer, perhaps due to altered cellular immunity.

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Relationship to Influenza

RSV infection was associated with greater odds of length of stay ≥7 days (odds ratio [OR] = 1.5) pneumonia (OR = 2.7) ICU admission (OR = 1.3) COPD exacerbation (OR = 1.7) greater mortality within 1 year of admission (OR = 1.3) More subsequent hospitalizations

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Family Pneumoviridae

Genus, Orthopneumoviridae

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Epidemiology

60,000 to 100,000

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Age at which most are infected by

Number of hospitalizations per year

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5%

6,000 to 10,000

proportion of respiratory infections estimated in older adults (~7% in high-risk adults)

Number of deaths per year

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