Drugs & Aging

, Volume 32, Issue 4, pp 261–269 | Cite as

Respiratory Syncytial Virus Infection in Older Adults: An Under-Recognized Problem

  • Angela R. BrancheEmail author
  • Ann R. Falsey
Current Opinion


Human respiratory syncytial virus (RSV) is an enveloped, single-stranded, negative-sense RNA virus and member of the Paramyxoviridae family of the genus Pneumovirus that was first reported as a major pathogen in pediatric populations. However, since its discovery, RSV has not infrequently been detected in adults. Reinfection occurs throughout life, with more severe disease occurring in older adults, immunocompromised patients, and those with underlying cardiopulmonary disease. Initially described as the cause of nursing home outbreaks of respiratory disease, there is a now significant body of literature describing the clinical importance of RSV in older adults in a multitude of settings including long-term care, adult daycares, and in community-dwelling adults. Moreover, recent reports from China and other countries emphasize that RSV is a global pathogen that will become increasingly important in developed nations with aging populations. Annual attack rates in the USA range from 2 to 10 % in community-dwelling older adults and 5–10 % in older adults living in congregate settings. Population-based calculations of the proportion of acute respiratory illnesses attributable to RSV estimate that 11,000 elderly persons die annually in the USA of illnesses related to RSV infection. Clinical manifestations of RSV infections are similar to that of other viral respiratory pathogens and include cough, nasal congestion, rhinorrhea, sore throat, and dyspnea. Lower respiratory tract disease is common and may result in respiratory failure (8–13 %) or death (2–5 %). Recent advances in molecular diagnostics have made it possible to rapidly identify RSV infection using nucleic acid amplification tests, although clinicians will need to suspect the diagnosis when viral activity is high. At the present time, treatment is supportive. Effective antiviral agents for the treatment and vaccines for prevention of RSV remain a significant unmet medical need in the older adult population.


Chronic Obstructive Pulmonary Disease Influenza Respiratory Syncytial Virus Respiratory Syncytial Virus Infection Palivizumab 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr. Falsey has served on advisory boards for Novavax, Hologic, Gilead, and Medimmune and has received research funding from AstraZeneca, Sanofi Pasteur, GlaxoSmith Kline, and ADMA Biologics. Dr. Branche has no financial disclosures.


  1. 1.
    Hendry RM, Fernie BF, Anderson LJ, McIntosh K. Antigenic and epidemiologic analysis of distinct strains of respiratory syncytial virus from two successive community outbreaks (1983–85). In: Mahy B, editor. Biology of negative strand viruses. Amsterdam: Elsevier; 1987. p. 397–403.Google Scholar
  2. 2.
    Hendry RM, Talis AL, Godfrey E, Anderson LJ, Fernie BF, McIntosh K. Concurrent circulation of antigenically distinct strains of respiratory syncytial virus during community outbreaks. J Infect Dis. 1986;153:291–7.PubMedGoogle Scholar
  3. 3.
    Anderson LJ, Hierholzer JC, Tsou C, et al. Antigenic characterization of respiratory syncytial virus strains with monoclonal antibodies. J Infect Dis. 1985;151:626–33.PubMedGoogle Scholar
  4. 4.
    Walsh EE, McConnochie KM, Long CE, Hall CB. Severity of respiratory syncytial virus infection is related to virus strain. J Infect Dis. 1997;175:814–20.PubMedGoogle Scholar
  5. 5.
    Okiro EA, Ngama M, Bett A, Nokes DJ. The incidence and clinical burden of respiratory syncytial virus disease identified through hospital outpatient presentations in Kenyan children. PLoS One. 2012;7:e52520.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Regnier S, Huels J. Association between respiratory syncytial virus hospitalizations in infants and respiratory sequelae: systematic review and meta-analysis. Pediatr Infect Dis J. 2013;32(8):820–6.PubMedGoogle Scholar
  7. 7.
    Stockman LJ, Curns AT, Anderson LJ, Fischer-Langley G. Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997–2006. Pediatr Infect Dis J. 2012;31:5–9.PubMedGoogle Scholar
  8. 8.
    Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–86.PubMedGoogle Scholar
  9. 9.
    Nicholson KG, Kent J, Hammersley V, Cancio E. Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden. BMJ. 1997;315:1060–4.PubMedCentralPubMedGoogle Scholar
  10. 10.
    Nicholson KG. Impact of influenza and respiratory syncytial virus on mortality in England and Wales from January 1975 to December 1990. Epidemiol Infect. 1996;116:51–63.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Zambon MC, Stockton JD, Clewley JP, Fleming DM. Contribution of influenza and respiratory syncytial virus to community cases of influenza-like illness: an observational study. Lancet. 2001;358:1410–6.PubMedGoogle Scholar
  12. 12.
    Mullooly JP, Bridges CB, Thompson WW, et al. Influenza- and RSV-associated hospitalizations among adults. Vaccine. 2007;25:846–55.PubMedGoogle Scholar
  13. 13.
    van Asten L, van den Wijngaard C, van Pelt W, et al. Mortality attributable to 9 common infections: significant effect of influenza A, respiratory syncytial virus, influenza B, norovirus, and parainfluenza in elderly persons. J Infect Dis. 2012;206:628–39.PubMedGoogle Scholar
  14. 14.
    Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352:1749–59.PubMedGoogle Scholar
  15. 15.
    Falsey AR, Treanor JJ, Betts RF, Walsh EE. Viral respiratory infections in the institutionalized elderly: clinical and epidemiologic findings. J Am Geriatr Soc. 1992;40:115–9.PubMedGoogle Scholar
  16. 16.
    Falsey AR, Walsh EE. Respiratory syncytial virus infection in adults. Clin Microbiol Rev. 2000;13:371–84.PubMedCentralPubMedGoogle Scholar
  17. 17.
    O’Shea MK, Pipkin C, Cane PA, Gray GC. Respiratory syncytial virus: an important cause of acute respiratory illness among young adults undergoing military training. Influenza Other Respir Viruses. 2007;1:193–7.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Hall CB, Long CE, Schnabel KC. Respiratory syncytial virus infections in previously healthy working adults. Clin Infect Dis. 2001;33:792–6.PubMedGoogle Scholar
  19. 19.
    Falsey AR, Formica MA, Walsh EE. Simple method for combining sputum and nasal samples for virus detection by reverse transcriptase PCR [letter]. J Clin Microbiol. 2012;50(8):2835.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Falsey AR, McElhaney JE, Beran J, et al. Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness. J Infect Dis. 2014;209:1873–81.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Volling C, Hassan K, Mazzulli T, et al. Respiratory syncytial virus infection-associated hospitalization in adults: a retrospective cohort study. BMC Infect Dis. 2014;14:665 (014-0665-2).PubMedCentralPubMedGoogle Scholar
  22. 22.
    Falsey AR, Becker KL, Swinburne AJ, et al. Bacterial complications of respiratory tract viral illness: a comprehensive evaluation. J Infect Dis. 2013;208:432–41.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Mathur U, Bentley DW, Hall CB. Concurrent respiratory syncytial virus and Influenza A infections in the institutionalized elderly and chronically ill. Ann Intern Med. 1980;93:49–52.PubMedGoogle Scholar
  24. 24.
    Caram LB, Chen J, Taggart EW, et al. Respiratory syncytial virus outbreak in a long-term care facility detected using reverse transcriptase polymerase chain reaction: an argument for real-time detection methods. J Am Geriatr Soc. 2009;57:482–5.PubMedGoogle Scholar
  25. 25.
    Ellis SE, Coffey CS, Mitchel EF Jr, Dittus RS, Griffin MR. Influenza- and respiratory syncytial virus-associated morbidity and mortality in the nursing home population. J Am Geriatr Soc. 2003;51:761–7.PubMedGoogle Scholar
  26. 26.
    Falsey AR, McCann RM, Hall WJ, et al. Acute respiratory tract infection in daycare centers for older persons. J Am Geriatr Soc. 1995;43:30–6.PubMedGoogle Scholar
  27. 27.
    Widmer K, Griffin MR, Zhu Y, Williams JV, Talbot HK. Respiratory syncytial virus- and human metapneumovirus-associated emergency department and hospital burden in adults. Influenza Other Respir Viruses. 2014;8:347–52.PubMedCentralPubMedGoogle Scholar
  28. 28.
    Naorat S, Chittaganpitch M, Thamthitiwat S, et al. Hospitalizations for acute lower respiratory tract infection due to respiratory syncytial virus in Thailand, 2008–2011. J Infect Dis. 2013;208(Suppl 3):S238–45.PubMedGoogle Scholar
  29. 29.
    McCracken JP, Prill MM, Arvelo W, et al. Respiratory syncytial virus infection in Guatemala, 2007–2012. J Infect Dis. 2013;208(Suppl 3):S197–206.PubMedGoogle Scholar
  30. 30.
    Lee N, Lui GC, Wong KT, et al. High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis. 2013;57:1069–77.PubMedGoogle Scholar
  31. 31.
    Ju X, Fang Q, Zhang J, Xu A, Liang L, Ke C. Viral etiology of influenza-like illnesses in Huizhou, China, from 2011 to 2013. Arch Virol. 2014;159:2003–10.PubMedGoogle Scholar
  32. 32.
    Dia N, Richard V, Kiori D, et al. Respiratory viruses associated with patients older than 50 years presenting with ILI in Senegal, 2009 to 2011. BMC Infect Dis. 2014;14:189.PubMedCentralPubMedGoogle Scholar
  33. 33.
    Casiano-Colon AE, Hulbert BB, Mayer TK, Walsh EE, Falsey AR. Lack of sensitivity of rapid antigen tests for the diagnosis of respiratory syncytial virus infection in adults. J Clin Virol. 2003;28:169–74.PubMedGoogle Scholar
  34. 34.
    Falsey AR, Formica MA, Walsh EE. Diagnosis of respiratory syncytial virus infection: comparison of reverse transcription-PCR to viral culture and serology in adults with respiratory illness. J Clin Microbiol. 2002;40:817–20.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Falsey AR, McCann RM, Hall WJ, Criddle MM. Evaluation of four methods for the diagnosis of respiratory syncytial virus infection in older adults. J Am Geriatr Soc. 1996;44:71–3.PubMedGoogle Scholar
  36. 36.
    Sundaram ME, Meece JK, Sifakis F, Gasser RA Jr, Belongia EA. Medically attended respiratory syncytial virus infections in adults aged ≥50 years: clinical characteristics and outcomes. Clin Infect Dis. 2014;58:342–9.PubMedGoogle Scholar
  37. 37.
    McClure DL, Kieke BA, Sundaram ME, et al. Seasonal incidence of medically attended respiratory syncytial virus infection in a community cohort of adults ≥50 years old. PLoS One. 2014;9:e102586.PubMedCentralPubMedGoogle Scholar
  38. 38.
    Falsey AR, Walsh EE, Capellan J, et al. Comparison of the safety and immunogenicity of 2 respiratory syncytial virus (rsv) vaccines–nonadjuvanted vaccine or vaccine adjuvanted with alum–given concomitantly with influenza vaccine to high-risk elderly individuals. J Infect Dis. 2008;198:1317–26.PubMedGoogle Scholar
  39. 39.
    Falsey AR, Walsh EE, Betts RF. Serologic evidence of respiratory syncytial virus infection in nursing home patients. J Infect Dis. 1990;162:568–9.PubMedGoogle Scholar
  40. 40.
    Arroyo JC, Jordan W, Milligan L. Upper respiratory tract infection and serum antibody responses in nursing home patients. Am J Infect Control. 1988;16:152–8.PubMedGoogle Scholar
  41. 41.
    Sorvillo FJ, Huie SF, Strassburg MA, Butsumyo A, Shandera WX, Fannin SL. An outbreak of respiratory syncytial virus pneumonia in a nursing home for the elderly. J Infect. 1984;9:252–6.PubMedGoogle Scholar
  42. 42.
    Gross PA, Rodstein M, LaMontagne JR, et al. Epidemiology of acute respiratory illness during an influenza outbreak in a nursing home. Arch Intern Med. 1988;148:559–61.PubMedGoogle Scholar
  43. 43.
    Mandal SK, Joglekar VM, Khan AS. An outbreak of respiratory syncytial virus infection in a continuing-care geriatric ward. Age Ageing. 1985;14:184–6.PubMedGoogle Scholar
  44. 44.
    Garvie DG, Gray J. Outbreak of respiratory syncytial virus infection in the elderly. Br Med J. 1980;281:1253–4.PubMedCentralPubMedGoogle Scholar
  45. 45.
    Agius G, Dindinaud G, Biggar RJ, et al. An epidemic of respiratory syncytial virus in elderly people: clinical and serological findings. J Med Virol. 1990;30:117–27.PubMedGoogle Scholar
  46. 46.
    Nicholson KG, Baker DJ, Farquhar A, Hurd D, Kent J, Smith SH. Acute upper respiratory tract viral illness and influenza immunization in homes for the elderly. Epidemiol Infect. 1990;105:609–18.PubMedCentralPubMedGoogle Scholar
  47. 47.
    Osterweil D, Norman D. An outbreak of an influenza-like illness in a nursing home. J Am Geriatr Soc. 1990;38:659–62.PubMedGoogle Scholar
  48. 48.
    Wald TG, Miller BA, Shult P, Drinka P, Langer L, Gravenstein S. Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons? J Am Geriatr Soc. 1995;43:170–4.PubMedGoogle Scholar
  49. 49.
    Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, Talbot HK. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206:56–62.PubMedCentralPubMedGoogle Scholar
  50. 50.
    Zhou H, Thompson WW, Viboud CG, et al. Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993–2008. Clin Infect Dis. 2012;54:1427–36.PubMedCentralPubMedGoogle Scholar
  51. 51.
    Miggins M, Hasan A, Hohmann S, et al. The potential influence of common viral infections diagnosed during hospitalization among critically ill patients in the United States. PLoS One. 2011;6:e18890.PubMedCentralPubMedGoogle Scholar
  52. 52.
    Walsh EE, Peterson DR, Falsey AR. Is clinical recognition of respiratory syncytial virus infection in hospitalized elderly and high-risk adults possible? J Infect Dis. 2007;195:1046–51.PubMedGoogle Scholar
  53. 53.
    Mehta J, Walsh EE, Mahadevia PJ, Falsey AR. Risk factors for respiratory syncytial virus illness among patients with chronic obstructive pulmonary disease. COPD. 2013;10(3):293–9.PubMedGoogle Scholar
  54. 54.
    De Serres G, Lampron N, La Forge J, et al. Importance of viral and bacterial infections in chronic obstructive pulmonary disease exacerbations. J Clin Virol. 2009;46:129–33.PubMedGoogle Scholar
  55. 55.
    Falsey AR, Formica MA, Hennessey PA, Criddle MM, Sullender WM, Walsh EE. Detection of respiratory syncytial virus in adults with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173:639–43.PubMedCentralPubMedGoogle Scholar
  56. 56.
    Walsh EE, Peterson DR, Falsey AR. Risk factors for severe respiratory syncytial virus infection in elderly persons. J Infect Dis. 2004;189:233–8.PubMedGoogle Scholar
  57. 57.
    Fransen H, Heigl Z, Wolontis S, Forsgren M, Svedmyr A. Infections with viruses in patients hospitalized with acute respiratory illness, Stockholm 1963–1967. Scand J Infect Dis. 1969;1:127–36.PubMedGoogle Scholar
  58. 58.
    Dowell SF, Anderson LJ, Gary HE Jr, et al. Respiratory syncytial virus is an important cause of community-acquired lower respiratory infection among hospitalized adults. J Infect Dis. 1996;174:456–62.PubMedGoogle Scholar
  59. 59.
    Ebbert JO, Limper AH. Respiratory syncytial virus pneumonitis in immunocompromised adults: clinical features and outcome. Respiration. 2005;72:263–9.PubMedGoogle Scholar
  60. 60.
    Anaissie EJ, Mahfouz TH, Aslan T, et al. The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management. Blood. 2004;103:1611–7.PubMedGoogle Scholar
  61. 61.
    Latchford T, Shelton BK. Respiratory syncytial virus in blood and marrow transplant recipients. Clin J Oncol Nurs. 2003;7:418–22.PubMedGoogle Scholar
  62. 62.
    Small TN, Casson A, Malak SF, et al. Respiratory syncytial virus infection following hematopoietic stem cell transplantation. Bone Marrow Transplant. 2002;29:321–7.PubMedGoogle Scholar
  63. 63.
    Ljungman P. Respiratory virus infections in stem cell transplant patients: the European experience. Biol Blood Marrow Transplant. 2001;7(Suppl):5S–7S.PubMedGoogle Scholar
  64. 64.
    Krinzman S, Basgoz N, Kradin R, et al. Respiratory syncytial virus-associated infections in adult recipients of solid organ transplants. J Heart Lung Transplant. 1998;17:202–10.PubMedGoogle Scholar
  65. 65.
    Englund JA, Sullivan CJ, Jordan MC, Dehner LP, Vercellotti GM, Balfour HH. Respiratory syncytial virus infection in immunocompromised adults. Ann Intern Med. 1988;109:203–8.PubMedGoogle Scholar
  66. 66.
    Hertz MI, Englund JA, Snover D, Bitterman PB, McGlave P. Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: a clinical approach and review of the literature. Medicine. 1989;68:269–81.PubMedGoogle Scholar
  67. 67.
    Kim YJ, Guthrie KA, Waghmare A, et al. Respiratory syncytial virus in hematopoietic cell transplant recipients: factors determining progression to lower respiratory tract disease. J Infect Dis. 2014;209:1195–204.PubMedGoogle Scholar
  68. 68.
    Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. Clin Infect Dis. 2013;56:258–66.PubMedCentralPubMedGoogle Scholar
  69. 69.
    Khanna N, Widmer AF, Decker M, et al. Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature. Clin Infect Dis. 2008;46:402–12.PubMedGoogle Scholar
  70. 70.
    Boeckh M, Englund J, Li Y, et al. Randomized controlled multicenter trial of aerosolized ribavirin for respiratory syncytial virus upper respiratory tract infection in hematopoietic cell transplant recipients. Clin Infect Dis. 2007;44:245–9.PubMedGoogle Scholar
  71. 71.
    Schiffer JT, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M. Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantation. Haematologica. 2009;94:1101–8.PubMedCentralPubMedGoogle Scholar
  72. 72.
    Camargo CA Jr, Ginde AA, Clark S, Cartwright CP, Falsey AR, Niewoehner DE. Viral pathogens in acute exacerbations of chronic obstructive pulmonary disease. Intern Emerg Med. 2008;3:355–9.PubMedGoogle Scholar
  73. 73.
    Wilkinson TM, Donaldson GC, Johnston SL, Openshaw PJ, Wedzicha JA. Respiratory syncytial virus, airway inflammation, and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173:871–6.PubMedGoogle Scholar
  74. 74.
    Walsh EE, Falsey AR, Hennessey PA. Respiratory syncytial and other virus infections in persons with chronic cardiopulmonary disease. Am J Respir Crit Care Med. 1999;160:791–5.PubMedGoogle Scholar
  75. 75.
    Dimopoulos G, Lerikou M, Tsiodras S, et al. Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease. Pulm Pharmacol Ther. 2012;25:12–8.PubMedGoogle Scholar
  76. 76.
    Kherad O, Rutschmann OT. Viral infections as a cause of chronic obstructive pulmonary disease (COPD) exacerbation. Praxis (Bern 1994). 2010;99:235–40.Google Scholar
  77. 77.
    Hutchinson AF, Ghimire AK, Thompson MA, et al. A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD. Respir Med. 2007;101:2472–81.PubMedGoogle Scholar
  78. 78.
    Proud D, Chow CW. Role of viral infections in asthma and chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol. 2006;35:513–8.PubMedGoogle Scholar
  79. 79.
    Walsh EE, Falsey AR. Humoral and mucosal immunity in protection from natural respiratory syncytial virus infection in adults. J Infect Dis. 2004;190:373–8.PubMedGoogle Scholar
  80. 80.
    Falsey AR, Cunningham CK, Barker WH, et al. Respiratory syncytial virus and influenza A infections in the hospitalized elderly. J Infect Dis. 1995;172:389–94.PubMedGoogle Scholar
  81. 81.
    Nicoli EJ, Trotter CL, Turner KM, Colijn C, Waight P, Miller E. Influenza and RSV make a modest contribution to invasive pneumococcal disease incidence in the UK. J Infect. 2013;66:512–20.PubMedCentralPubMedGoogle Scholar
  82. 82.
    Henrickson KJ, Hall CB. Diagnostic assays for respiratory syncytial virus disease. Pediatr Infect Dis J. 2007;26:S36–40.PubMedGoogle Scholar
  83. 83.
    Hall WJ, Hall CB, Speers DM. Respiratory syncytial virus infection in adults: clinical, virologic, and serial pulmonary function studies. Ann Intern Med. 1978;88:203–5.PubMedGoogle Scholar
  84. 84.
    Duncan CB, Walsh EE, Peterson DR, Lee FE, Falsey AR. Risk factors for respiratory failure associated with respiratory syncytial virus infection in adults. J Infect Dis. 2009;200:1242–6.PubMedCentralPubMedGoogle Scholar
  85. 85.
    Falsey AR, Formica MA, Treanor JJ, Walsh EE. Comparison of quantitative reverse transcription-PCR to viral culture for assessment of respiratory syncytial virus shedding. J Clin Microbiol. 2003;41:4160–5.PubMedCentralPubMedGoogle Scholar
  86. 86.
    Walsh EE, Falsey AR. Age related differences in humoral immune response to respiratory syncytial virus infection in adults. J Med Virol. 2004;73:295–9.PubMedGoogle Scholar
  87. 87.
    Branche AR, Walsh EE, Formica MA, Falsey AR. Detection of respiratory viruses in sputum from adults by use of automated multiplex PCR. J Clin Microbiol. 2014;52:3590–6.PubMedCentralPubMedGoogle Scholar
  88. 88.
    Lee FE, Walsh EE, Falsey AR. The effect of steroid use in hospitalized adults with respiratory syncytial virus-related illness. Chest. 2011;140:1155–61.PubMedCentralPubMedGoogle Scholar
  89. 89.
    Walsh EE, Peterson DR, Kalkanoglu AE, Lee FE, Falsey AR. Viral shedding and immune responses to respiratory syncytial virus infection in older adults. J Infect Dis. 2013;207:1424–32.PubMedCentralPubMedGoogle Scholar
  90. 90.
    Chemaly RF, Shah DP, Boeckh MJ. Management of respiratory viral infections in hematopoietic cell transplant recipients and patients with hematologic malignancies. Clin Infect Dis. 2014;59(Suppl 5):S344–51.PubMedGoogle Scholar
  91. 91.
    Shah JN, Chemaly RF. Management of RSV infections in adult recipients of hematopoietic stem cell transplantation. Blood. 2011;117:2755–63.PubMedGoogle Scholar
  92. 92.
    Marcelin JR, Wilson JW, Razonable RR, Mayo Clinic Hematology/Oncology and Transplant Infectious Diseases Services. Oral ribavirin therapy for respiratory syncytial virus infections in moderately to severely immunocompromised patients. Transpl Infect Dis. 2014;16:242–50.PubMedGoogle Scholar
  93. 93.
    Johnson S, Oliver C, Prince GA, et al. Development of a humanized monoclonal antibody (MEDI-493) with potent in vitro and in vivo activity against respiratory syncytial virus. J Infect Dis. 1997;176:1215–24.PubMedGoogle Scholar
  94. 94.
    Ottolini MG, Curtis SR, Mathews A, Ottolini SR, Prince GA. Palivizumab is highly effective in suppressing respiratory syncytial virus in an immunosuppressed animal model. Bone Marrow Transplant. 2002;29:117–20.PubMedGoogle Scholar
  95. 95.
    Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. The IMpact-RSV Study Group. Pediatrics 1998;102:531–7.Google Scholar
  96. 96.
    Saez-Llorens X, Moreno MT, Ramilo O, et al. Safety and pharmacokinetics of palivizumab therapy in children hospitalized with respiratory syncytial virus infection. Pediatr Infect Dis J. 2004;23:707–12.PubMedGoogle Scholar
  97. 97.
    de Fontbrune FS, Robin M, Porcher R, et al. Palivizumab treatment of respiratory syncytial virus infection after allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2007;45:1019–24.PubMedGoogle Scholar
  98. 98.
    DeVincenzo JP, Whitley RJ, Mackman RL, et al. Oral GS-5806 activity in a respiratory syncytial virus challenge study. N Engl J Med. 2014;371:711–22.PubMedGoogle Scholar
  99. 99.
    Wright PF. Progress in the prevention and treatment of RSV infection. N Engl J Med. 2014;371:776–7.PubMedGoogle Scholar
  100. 100.
    Boukhvalova MS, Prince GA, Soroush L, Harrigan DC, Vogel SN, Blanco JC. The TLR4 agonist, monophosphoryl lipid A, attenuates the cytokine storm associated with respiratory syncytial virus vaccine-enhanced disease. Vaccine. 2006;24:5027–35.PubMedGoogle Scholar
  101. 101.
    Schepens B, Ibanez LI, De Baets S, et al. Nanobodies(R) specific for respiratory syncytial virus fusion protein protect against infection by inhibition of fusion. J Infect Dis. 2011;204:1692–701.PubMedGoogle Scholar
  102. 102.
    Haynes LM. Progress and challenges in RSV prophylaxis and vaccine development. J Infect Dis. 2013;208(Suppl 3):S177–83.PubMedGoogle Scholar
  103. 103.
    Gonzalez IM, Karron RA, Eichelberger M, et al. Evaluation of the live attenuated cpts 248/404 RSV vaccine in combination with a subunit RSV vaccine (PFP-2) in healthy young and older adults. Vaccine. 2000;18:1763–72.PubMedGoogle Scholar
  104. 104.
    Falsey AR, Walsh EE. Safety and immunogenicity of a respiratory syncytial virus subunit vaccine (PFP-2) in ambulatory adults over age 60. Vaccine. 1996;14:1214–8.PubMedGoogle Scholar
  105. 105.
    Garlapati S, Garg R, Brownlie R, et al. Enhanced immune responses and protection by vaccination with respiratory syncytial virus fusion protein formulated with CpG oligodeoxynucleotide and innate defense regulator peptide in polyphosphazene microparticles. Vaccine. 2012;30:5206–14.PubMedGoogle Scholar
  106. 106.
    Gilead Sciences. GS-5806 in hematopoietic cell transplant recipients with respiratory syncytial virus (RSV) infection of the lower respiratory tract [ identifier NCT02254421]. National Institutes of Health, Accessed 24 Mar 2015.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Infectious Disease Unit, Department of MedicineUniversity of RochesterRochesterUSA
  2. 2.Department of MedicineRochester General HospitalRochesterUSA

Personalised recommendations