Adults with weakened immune systems, particularly transplant recipients, face significant risks of severe illness and death from respiratory syncytial virus (RSV).
RT’s Three Key Takeaways:
- High Hospitalization Rates: Immunocompromised adults, especially lung and stem cell transplant recipients, frequently require hospital care following a laboratory-confirmed respiratory syncytial virus infection.
- Severe Clinical Outcomes: Significant proportions of this patient population require intensive care unit admission and mechanical ventilation, with some cohorts experiencing mortality rates exceeding 25%.
- Preventive Priority: The study authors suggested that healthcare providers should prioritize respiratory syncytial virus vaccination and other preventive strategies for patients with high degrees of immunosuppression.
Respiratory syncytial virus (RSV) infection represents a significant severe disease burden for immunocompromised adults in high-income countries, according to a systematic review published in Infectious Diseases and Therapy.
The analysis examined 36 English-language studies published between 2000 and 2024, primarily from the US and Europe. Researchers focused on solid organ transplant recipients and hematopoietic stem cell transplant recipients to determine the impact of the virus on these vulnerable populations.
Data showed that 37.5% to 87.5% of lung transplant recipients and 30.3% to 83.9% of hematopoietic stem cell transplant recipients required hospitalization after infection. Among all solid organ transplant recipients, hospital care was necessary for 37.7% to 68.0% of patients.
Severe clinical complications were also frequent among these groups. Intensive care unit (ICU) admission occurred in up to 29.8% of hematopoietic stem cell transplant recipients and 11.7% of lung transplant recipients. Mechanical ventilation requirements reached 29.8% in stem cell cohorts and 10.4% in lung transplant groups.
Mortality findings varied by the specific population and the follow-up window. Within one month of RSV infection, all-cause mortality reached 25.8% in some hematopoietic stem cell transplant cohorts, while RSV-related mortality reached 22.6% in one study.
The review indicated that the degree of immunosuppression serves as a primary determinant for RSV infection risk and outcomes. In lung and stem cell transplant recipients, factors such as anti-rejection regimens, corticosteroid dosing, adjunctive immunosuppressive agents, and the time elapsed since the transplant appeared clinically relevant to patient prognosis.
The authors noted that RSV vaccination and other preventive strategies should be prioritized for immunocompromised adults. However, they also identified persistent evidence gaps, including a lack of data stratified by age, comorbidities, immune status, medication use, and time since transplant.
More multicenter studies with standardized case definitions are needed to guide clinical practice and immunization policy, the authors said.
Reference
Saeedi P et al. Burden of respiratory syncytial virus infection in immunocompromised adults: A systematic review of the evidence from high-income countries. Infect Dis Ther. 2026;doi:10.1007/s40121-026-01379-4.
This article was originally published by AMJ and was made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
