Respiratory syncytial virus is neglected and threatens the health of the elderly

Respiratory syncytial virus is increasing in adults and the elderly, outpacing influenza in hospitalizations and posing prevention challenges

Fall brings with it a warning that goes far beyond the common flu.Respiratory syncytial virus (RSV), historically known to cause bronchiolitis in children, is now one of the greatest threats to longevity and health in adults and the elderly over 50 years of age.RSV circulates silently, responsible for 45% of hospitalizations. In the elderly, with a mortality rate of up to 30%, the virus "may not only cause death, but be life-threatening". Some loss of autonomy.

Although the population is accustomed to annual influenza vaccination, RSV shows more alarming figures in some clinical scenarios.Data from Fiocruz and InfoGripe newsletters show that RSV surpassed influenza in SARS notifications for three consecutive years.

According to Lessandra Michelin, an infectious disease expert and head of vaccines at GSK, the clinical presentation of RSV can easily be confused with other respiratory diseases.He cautions that people with chronic infections are at high risk for complications and should not wait for symptoms to appear at home.There is no cure for the virus, but control measures are in place.he shows.

- Read more: Influenza makes progress in Brazil and has already caused more than 1,600 deaths this year

- Read also: Bronchiolitis and pneumonia: how to recognize the first signs in children

The virus usually lasts five to seven days and can last up to two weeks in immunocompromised people.The doctor also emphasizes the importance of diagnosis when possible and reinforces that prevention is the main way.According to her, vaccination against influenza, Covid-19 and RSV significantly reduces the risk of hospitalization due to mainly respiratory viruses in circulation.Prevention, although available in the private network, still faces the challenge of lack of knowledge and lack of universal access to SUS.

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RSV i al al Brasil

Prevalence on Spidol (1st semester):

2023: RSV 41% |Influenza 14%

2024: 43% RSV |22% influenza

2025 m.: 45% VSR |27% flu

More severe than the flu

- 2.7 times more likely to develop pneumonia

- Twice more likely to be admitted to the ICU

- Possibility of double pregnancy or death

Risk of death in hospitalized patients due to RSV SARS

Children (under 4 years): 1% may die

Adults (50+ years): 14% may die

A "trigger" for chronic diseases

For people with diabetes, heart problems or lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, RSV acts as an inflammatory trigger.The virus attacks the fusion protein (F protein) to enter the airway cells, triggering systemic inflammation that can destabilize atherosclerotic plaques in the heart or lead to kidney failure.

Risk of hospitalization due to comorbidity

- COPD: 13.4 times higher risk

- CHF (heart failure): the risk is seven times higher

- Diabetes: the risk is 6.6 times higher.

- The probability of having asthma is 3.6 times higher.

- Obesity: 38% of people hospitalized with RSV have this condition.

The SUS barrier and access to the vaccine

Currently, the RSVP vaccine for adults (adjuvanted RSVPreF3) is provided mainly in dedicated networks. Although the Brazilian Society of Immunology (SBIm) and Geriatrics and Geriatrics (SBGG) recommend its use in adults over 60 years of age and in people between 50 and 59 years of age with comorbidities, the use of SUS is still limited.

Experts emphasize that a real impact on public health, reducing queues in intensive care units and beds, will only result from a high level of vaccination, which depends on the vaccine being included in the national vaccination program (PNI) for risk groups.

Weight of medical advice

Adherence to vaccination depends almost entirely on the role of the physician:

- Patient wants / Doctor recommends: 87% compliance

- Patient does not want / doctor recommended: 70% compliance

- The patient does not want to advise / doctor: only 8% adherence

Impact after hospital discharge

- One in three elderly patients die within a year of being hospitalized for RSV

- One in four require a new hospital within three months of discharge

Efficacy of adjuvant vaccines

Studies show 76% prevention from hospitalization and 100% protection from severe cases in the vaccinated population in Denmark.

The word of the experts

Elderly people and risks

"The virus infects and the bacteria die. RSV opens the door to severe bacterial pneumonia. In patients with COPD, they lose lung function very quickly. That old man with his grandson, after being hospitalized for RSV, may end up dependent on oxygen therapy or a wheelchair. This is what I call social death," said the Federal University researcher (Pullman University researcher).and Coordinator of the Center for the Study of Asthma and Asthma Diseases (NUPAIVA) and Coordinator of the Vaccine Committee of the Brazilian Society of Pulmonology and Physiology (SBPT), Rosemarie Morichi.

Risk of heart attack

"The risk of heart attack triples in the first week after RSV infection. The inflammation caused by the virus destabilizes the cardiovascular system. Among patients with heart failure who are hospitalized due to RSV and sepsis, the mortality rate reaches an alarming 45% at 12 months," says USPPC member of the Board of Cardiologists and Member of the Board of Cardiologists Dr.Medicine Commission. Brazilian Society of Cardiology (SBC), Museo Tavares.

Chronic disease and longevity

"Brazilian adults do not age 'clean', they carry a total of eight chronic diseases with them. After seven days in bed due to infection, elderly people lose 10 to 15% of their muscle mass. Immunization is not just about avoiding the virus, it is about maintaining the ability to walk, remember and live with dignity," said the geriatrician and general curator of the Brazilian Immunization Society. Gerontology (SBGG) and physician's assistantin Unifesp, Maisa Kairalla.

Diabetes and RSV

"Diabetes produces immunological dysfunction. RSV causes glycemic decompensation, patients who control the disease only with pills often have to take insulin during and after the infection. This is a complication that affects longevity," explained Rodrigo Mendes, endocrinologist and professor at Unigranrio University.

Source: the words of the experts presented at the meeting of an event sponsored by GSK Brasil in São Paulo, where the journalist went by invitation