Background: Although the burden of influenza is well characterized, the burden of community-onset non-influenza respiratory viruses has not been systematically assessed. Understanding the severity and seasonality of non-influenza viruses, including human coronaviruses, will provide a better understanding of the overall disease burden from respiratory viruses that could better inform resource utilization for hospitals and highlight the value of preventative strategies, including vaccines. Methods: From October 2017 to September 2019, a retrospective study was performed in a pre-defined catchment area to estimate the population-based incidence of community-onset respiratory viruses associated with hospitalization. Included patients were >18 years old, resided in New York City, were hospitalized for >24 hours, and had a respiratory virus detected within 3 calendar-days of admission. Disease burden was measured by hospital length of stay (LOS), intensive care unit (ICU) admissions, and in-hospital mortality and compared among those with laboratory-confirmed influenza versus those with laboratory-confirmed non-influenza viruses (human coronaviruses, parainfluenza viruses, respiratory syncytial virus, human metapneumovirus, and adenovirus). Results: During the study period, 4,232 eligible patients were identified of whom 50.9% were >65 years of age. For each virus, the population-based incidence was highest for those >80 years of age. When compared to those with influenza viruses detected, those with non-influenza respiratory viruses detected (combined) had higher population-based incidence, significantly more ICU admissions, and higher in-house mortality. Conclusions: The burden of non-influenza respiratory viruses for hospitalized adults is substantial. Prevention and treatment strategies are needed for non-influenza respiratory viruses, particularly for older adults.

Background: A systematic assessment of severe clinical outcomes associated with respiratory syncytial virus (RSV) infections in adults is lacking. Methods: Within a prospective surveillance study, we performed a nested retrospective study during two respiratory viral seasons, October 2017-April 2018 and October 2018-April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes. We explored the impact of RSV-associated hospitalizations on changes in the living situations of surviving patients from admission to discharge. Results: Overall, 403 patients were studied (median age 69 years); 29.5% were > 80 years. Common comorbidities included cardiac (47.6%) and pulmonary (45.9%) conditions and diabetes (41.4%). Severe outcomes occurred in 19.1% of patients including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had 4.43 times higher likelihood of severe RSV infection compared to those living in the community with or without assistance from family or home health aides. After discharge, 56 (15.1%) patients required an increased level of support including 36 (9.7%) with new admissions to residential living facilities. Conclusions: RSV infection was associated with severe illness in adults. Living in a facility was a risk factor for severe outcomes and likely a surrogate for frailty at admission rather than an independent risk factor. The need for an increased level of support after discharge will add RSV-related healthcare costs to those already incurred from hospitalization.