Kiwis Warned To Be Vigilant As Data Shows Severe Respiratory Infection Hospitalisations Growing

Health experts are warning Kiwis to be vigilant this winter with new data showing hospital admissions in Auckland for acute respiratory diseases are up 13% on the same time last year.[1]

Data from government health research agency Institute of Environmental Science and Research (ESR) shows the number of hospitalisations from severe respiratory illness, including acute conditions such as COVID-19, influenza, and RSV last year, peaked at levels higher than at any time in almost a decade.[1]

The figures also show the number of acute respiratory admissions since the start of this year exceeds the previous year.[1]

Respiratory diseases such as influenza, COVID-19 and respiratory syncytial virus (RSV) are seasonal with case numbers expected to spike during the winter months.[2][3][4][5]

Respiratory syncytial virus (RSV) is a highly contagious respiratory virus that can affect people of any age, but older adults are at greater risk.[6][7][8][9][10][11]

Maori, Pacific peoples and those living in lower socioeconomic areas also have a greater risk of hospitalisation from the disease.[12]

RSV is associated with severe respiratory disease in people aged over 60 years, and so far this year, along with Rhinovirus it is the most common respiratory virus among those tested in hospital. COVID-19 and influenza are now the third and fourth most common respiratory viruses detected, respectively.[13][14][15][16][17][18]

Dr Lutz Beckert, Professor of Medicine at the University of Otago and a respiratory specialist with Te Whatu Ora Canterbury, says RSV is under-recognised and can be a serious illness in adults, particularly those with existing respiratory disease.[19][20]

“RSV is an airborne virus and spreads much the same way as influenza and COVID-19, through respiratory droplets via direct contact with an infected individual or, with contaminated surfaces - where it can live for up to six hours.[21][22][23]

We must not forget our COVID-19 lessons. During the pandemic we were able to maintain hygiene standards, wore masks and practised social distancing when we were sick,” he says.

Professor Beckert says experts are concerned that a combination of respiratory diseases particularly influenza combined with RSV could see an influx of hospital admissions over the coming winter months.

“Maori and Pacific peoples are more likely to be exposed to risk factors that increase the likelihood of harm from RSV. These risk factors include overcrowding and housing instability, lower paid employment opportunities and less access to timely medical treatment,” he says.

“Although healthy adults with RSV may have symptoms similar to the common cold and mostly be able to recover at home, older adults, especially those with compromised immune systems or heart or lung conditions, can be at higher risk from RSV. They may be more likely to suffer from severe consequences, such as pneumonia or even hospitalisation. Babies and very young children are also at higher risk and can become very unwell quickly.[24][25][26][27]

“The initial symptoms are not dissimilar to a common cold so it is important that patients monitor their symptoms and seek immediate medical assistance if they find themselves short of breath, wheezing, feverish or their cough worsens.[28][29][30]

“RSV is a notifiable disease in Australia and Beckert says it would be of benefit to have it added to New Zealand public health data to improve national surveillance,” he says.[31]

Professor Beckert says RSV infections typically follow a seasonal pattern, generally peaking during winter.[32]

“We need to treat RSV as seriously as we treat COVID or influenza,” he says.

Professor Graham Le Gros, immunologist and director of the Malaghan Institute of Medical Research says older adults and those with existing medical conditions need to be vigilant in protecting themselves against RSV as the weather cools.[33]

“We know that those in this cohort who have chronic medical conditions such diabetes, asthma, chronic obstructive pulmonary disease (COPD) and heart failure do have an elevated risk of hospitalisation from RSV,” he says.[34][35][36][37]

Le Gros says while the disease is often associated with young children, older adults are also particularly vulnerable.[38][39][40]

“Scientists have been working for decades on ways to prevent RSV infection through immunisation. We know that without vaccination our population is vulnerable to infectious diseases like RSV as was seen in the 2021 outbreak with multiple elderly patients and children hospitalised.[41][42][43]

“RSV reduces your ability to breathe and affects the chest and lungs with symptoms which are very similar to pneumonia in children and the elderly,” he says.[44][45]

Le Gros says any natural immunity built up from a prior infection is minimal so older patients do need protection against the disease.[46][47]

“RSV is an extremely contagious disease and in environments like aged care facilities, there is a risk of the virus infecting multiple residents at any one time which can put enormous pressure on the health care system,” he says.[48][49][50][51]

Arexvy is the world’s first respiratory syncytial virus (RSV) vaccine for older adults and has been registered for use in Canada, Australia, the US, the UK, the European Union, Japan and New Zealand. Research shows almost a quarter of US adults aged 60+ have reported receiving a RSV vaccine.[52][53][54][55]

Trial data shows Arexvy has an overall efficacy of 82.6% against RSV-Lower Respiratory Tract Disease (LRTD) however as with other vaccines, the vaccine may not protect all recipients. The vaccine is now available from New Zealand GP clinics for private purchase.[56][57][58]

[1] ESR Respiratory Illness Dashboard. Data time frame = Jan 2024 to 12 May 2024. Accessed 16 May 2024. (Calculation = see here). https://www.esr.cri.nz/digital-library/respiratory-illness-dashboard/

[2] Hatter L, Eathorne A, Hills T, Bruce P, Beasley R. Respiratory syncytial virus: paying the immunity debt with interest. Lancet Child Adolesc Health. 2021 Dec;5(12):e44-e45. doi: 10.1016/S2352-4642(21)00333-3. Epub 2021 Oct 23. PMID: 34695374; PMCID: PMC8598182.

[3] Chadha, M. S., Hirve, S., Bancej, C., Barr, I. G., Baumeister, E., Caetano, B. C., Chittaganpitch, M., Badarch, D., Ellis, J., Fasce, R., Herve, K., Jackson, S., Leung, V., Pisareva, M., Moyes, J., Naguib, A., Tivane, A., Zhang, W., Barakat, A., . . . Zambon, M. (2020). Human respiratory syncytial virus and influenza seasonality patterns—Early findings from the WHO global respiratory syncytial virus surveillance. Influenza and Other Respiratory Viruses, 14(6), 638–646. https://doi.org/10.1111/irv.12726

[4] Wiemken TL, Khan F, Puzniak L, Yang W, Simmering J, Polgreen P, Nguyen JL, Jodar L, McLaughlin JM. Seasonal trends in COVID-19 cases, hospitalizations, and mortality in the United States and Europe. Sci Rep. 2023 Mar 8;13(1):3886. doi: 10.1038/s41598-023-31057-1. PMID: 36890264; PMCID: PMC9994397.

[5] Bloom-Feshbach K;PloS one;2013;8;e54445

[6] CDC;2022;1-2;RSV in Older Adults and Adults with Chronic Medical Conditions

[7] Branche AR;Clin Infect Dis;2022;74;1004-1011

[8] Learn about RSV in older adults with chronic medical conditions. (2024, March 1). Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/high-risk/older-adults.html#:~:text=Adults%2060%20and%20older%20who,Some%20may%20even%20die.

[9] Mesa-Frias, M;J Manag Care Spec Phar;2022;1-13

[10] Farquharson, K. A., Anthony, D. D., Menzies, R., & Homaira, N. (2024). Burden of respiratory syncytial virus disease across the lifespan in Australia and New Zealand: a scoping review. Public Health, 226, 8–16. https://doi.org/10.1016/j.puhe.2023.10.031

[11] Cleveland clinic;2023;1;RSV in children and adults

[12] Prasad N, Newbern EC, Trenholme AA, Thompson MG, McArthur C, Wong CA, Jelley L, Aminisani N, Huang QS, Grant CC. The health and economic burden of respiratory syncytial virus associated hospitalizations in adults. PLoS One. 2020 Jun 11;15(6):e0234235. doi: 10.1371/journal.pone.0234235. PMID: 32525898; PMCID: PMC7289360.

[13] ESR Respiratory Illness Dashboard. Data time frame = Jan 2024 to 12 May 2024. Accessed 16 May 2024. https://www.esr.cri.nz/digital-library/respiratory-illness-dashboard/ (viruses detected tab | Cumulative proportion of positive tests by virus - Sentinel Hospital - Weekly viruses detected through hospital SARI sampling: (Calculation = see here).

[14] Farquharson, K. A., Anthony, D. D., Menzies, R., & Homaira, N. (2024). Burden of respiratory syncytial virus disease across the lifespan in Australia and New Zealand: a scoping review. Public Health, 226, 8–16. https://doi.org/10.1016/j.puhe.2023.10.031

[15] CDC RSV in Older Adults_SEPT UPDATE

[16] Tseng HF;The Journal of Infectious Diseases;2020;222;1298-1310

[17] Mesa-Frias, M;J Manag Care Spec Phar;2022;1-13

[18] Branche AR;Clin Infect Dis;2022;74;1004-1011

[19] Branche AR;Drugs & aging;2015;32;261-9

[20] Papi A;N Engl J Med;2023;388;595-608

[21] Kaler J, Hussain A, Patel K, Hernandez T, Ray S. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus. 2023 Mar 18;15(3):e36342. doi: 10.7759/cureus.36342. PMID: 37082497; PMCID: PMC10111061.

[22] Green book;Chapter no;19;2013;185-218

[23] WHO;2020;1-16;Transmission of SARS-CoV-2: implications for infection prevention precautions

[24] Advice for RSV and other winter respiratory illnesses. (n.d.). Health New Zealand - Te Whatu Ora Whanganui - Whanganui Hospital. https://www.wdhb.org.nz/media-releases/advice-for-rsv-and-other-winter-respiratory-illnesses/

[25] Saravanos G; Med J Aust.;2019 210;447-453

[26] CDC;2022;1-2;RSV in Older Adults and Adults with Chronic Medical Conditions

[27] Respiratory syncytial virus (RSV) - Immunisation Advisory Centre

[28] Kaler J, Hussain A, Patel K, Hernandez T, Ray S. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus. 2023 Mar 18;15(3):e36342. doi: 10.7759/cureus.36342. PMID: 37082497; PMCID: PMC10111061.

[29] Advice for RSV and other winter respiratory illnesses. (n.d.). Health New Zealand - Te Whatu Ora Whanganui - Whanganui Hospital. https://www.wdhb.org.nz/media-releases/advice-for-rsv-and-other-winter-respiratory-illnesses/

[30] Tseng HF;The Journal of Infectious Diseases;2020;222;1298-1310

[31] Australian Government. (n.d.). Retrieved March 11, 2024, from https://www.health.gov.au/diseases/respiratory-syncytial-virus-rsv-infection

[32] ESR;2022;2022 ACUTE RESPIRATORY ILLNESS SURVEILLANCE REPORT

[33] Respiratory syncytial virus (RSV) - Immunisation Advisory Centre. (n.d.). https://www.immune.org.nz/diseases/respiratory-syncytial-virus-rsv

[34] Branche AR et al. Clin Infect Dis 2022;74(6):1004–11.

[35] Prasad N et al. Clin Infect Dis 2021;73(1):e158–63.

[36] Kujawski SA et al. PLoS One 2022;17(3):e0264890.

[37] GSK;Press release;2024;1-6 Australia's first RSV vaccine

[38] Respiratory syncytial virus (RSV) - Immunisation Advisory Centre. (n.d.). https://www.immune.org.nz/diseases/respiratory-syncytial-virus-rsv

[39] Kaler J;Cureus;2023;15;1-17

[40] Farquharson KA;Public Health;2024;226;8-16

[41] Anderson LJ, Dormitzer PR, Nokes DJ, Rappuoli R, Roca A, Graham BS. Strategic priorities for respiratory syncytial virus (RSV) vaccine development. Vaccine. 2013 Apr 18;31 Suppl 2(Suppl 2):B209-15. doi: 10.1016/j.vaccine.2012.11.106. PMID: 23598484; PMCID: PMC3919153.

[42] ESR Influenza Annual Report. (n.d.). ESR. Retrieved May 8, 2024, from https://www.esr.cri.nz/media/yljpihze/esr-influenza-annual-report-2021.pdf

[43] South Canterbury DHB - RSV and other viruses: public health advice and hospital visitor restrictions. (n.d.). https://www.scdhb.health.nz/about-us/news-publications-media/news/rsv

[44] Respiratory syncytial virus (RSV) - Immunisation Advisory Centre. (n.d.). https://www.immune.org.nz/diseases/respiratory-syncytial-virus-rsv

[45] Kaler J;Cureus;2023;15;1-17

[46] Kaler J;Cureus;2023;15;1-17

[47] Walsh EE;J Infect Dis;2004;190:373-378

[48] Kaler J;Cureus;2023;15;1-17

[49] Branche AR;Drugs & aging;2015;32;261-9

[50] Respiratory syncytial virus (RSV) - Immunisation Advisory Centre. (n.d.). https://www.immune.org.nz/diseases/respiratory-syncytial-virus-rsv

[51] Influenza - Information for Aged Residential Care facilities | RPH. (n.d.). Retrieved May 13, 2024, from https://www.rph.org.nz/public-health-topics/illness-and-disease/influenza/influenza-information-for-aged-residential-care/2dhb-influenza-like-illness-arcs.pdf

[52] Arexvy Gazettal - Consent to the Distribution of a New Medicine;2024;1-1

[53] GSK;Press release;2024;1-6 Australia's first RSV vaccine (v1.0)

[54] Venkatesan P;The Lancet;2023;4;e577 https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00195-7/fulltext Accessed 23 April 2024

[55] Vaccination Trends—Adults. (n.d.). https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html#:~:text=The%20percent%20of%20the%20population%20reporting%20receipt%20of%20a%20flu,%25%20(22.8%2D25.1). (Last accessed 23 April 2024).

[56] GlaxoSmithKline New Zealand. AREXVY Data Sheet. GSK NZ; 2024. Available at https://www.medsafe.govt.nz/Profs/Datasheet/a/Arexvyinj.pdf (Last accessed 23 April 2024).

[57] Papi A;N Engl J Med;2023;388;595-608

[58] For adults aged 60 and older (96.95% CI, 57.89, 94.08; n=12,466)

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