title: Viral shedding and immune responses to respiratory syncytial virus infection in older adults.
abstract: BACKGROUND
  Comprehensive analyses of host, viral, and immune factors associated with severe respiratory syncytial virus (RSV) infection in adults have not been performed.
  
  
  METHODS
  Adults with RSV infection identified in both outpatient and inpatient settings were evaluated. Upper and lower respiratory tract virus load, duration of virus shedding, select mucosal chemokine and cytokine levels, humoral and mucosal immunoglobulin responses, and systemic T-cell responses were measured.
  
  
  RESULTS
  A total of 111 RSV-infected adults (61 outpatients and 50 hospitalized patients) were evaluated. Hospitalized subjects shed virus in nasal secretions at higher titers and for longer durations than less ill outpatients, had greater mucosal interleukin 6 (IL-6) levels throughout infection, and had higher macrophage inflammatory protein 1α (MIP-1α) levels early in infection. Persons >64 years old and those with more severe disease had a higher frequency of activated T cells in the blood than younger, less ill subjects at infection. Multivariate analysis found that the presence of underlying medical conditions, female sex, increased mucosal IL-6 level, and longer duration of virus shedding were associated with severe disease. Older age and increased nasal MIP-1α levels were of borderline statistical significance.
  
  
  CONCLUSIONS
  Multiple factors, but not older age, are independently associated with severe RSV infection in adults. The presence of underlying medical conditions had the greatest influence on disease severity.
authors: Department of Medicine, University of Rochester School of Medicine and Dentistry, New York, USA. edward.walsh@rochestergeneral.org
authors: Edward E
authors: EE
authors: Walsh
authors: Derick R
authors: DR
authors: Peterson
authors: Aja E
authors: AE
authors: Kalkanoglu
authors: Frances Eun-Hyung
authors: FE
authors: Lee
authors: Ann R
authors: AR
authors: Falsey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000032:analysis / Q000097:blood; D005260:Female; D006801:Humans; D018928:Immunity, Mucosal; D008297:Male; D008875:Middle Aged; D018357:Respiratory Syncytial Virus Infections / Q000276:immunology* / Q000821:virology*; D018113:Respiratory Syncytial Virus, Human / Q000276:immunology* / Q000302:isolation & purification*; D012137:Respiratory System / Q000821:virology; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral
references: Curr Opin Immunol. 2009 Aug;21(4):418-24
references: 19570667
references: J Infect Dis. 2012 Jul 1;206(1):56-62
references: 22529314
references: J Med Virol. 2006 Nov;78(11):1493-7
references: 16998887
references: Pediatr Infect Dis J. 1999 Feb;18(2):115-22
references: 10048682
references: Clin Microbiol Rev. 2005 Jul;18(3):541-55
references: 16020689
references: J Infect Dis. 2005 Jun 1;191(11):1861-8
references: 15871119
references: J Virol. 2010 Jan;84(2):1148-57
references: 19864390
references: Clin Infect Dis. 2001 Sep 15;33(6):792-6
references: 11512084
references: J Infect Dis. 2009 Oct 15;200(8):1242-6
references: 19758094
references: Immun Ageing. 2010 Oct 20;7:14
references: 20961416
references: J Infect Dis. 2010 Dec 1;202(11):1659-66
references: 20979459
references: Clin Infect Dis. 1995 Aug;21(2):376-9
references: 8562747
references: J Med Virol. 2005 Feb;75(2):282-9
references: 15602730
references: J Med Virol. 2004 Jun;73(2):295-9
references: 15122807
references: N Engl J Med. 2001 Jun 21;344(25):1917-28
references: 11419430
references: Clin Infect Dis. 2012 Apr;54(7):905-12
references: 22238168
references: J Immunol. 2007 Dec 15;179(12):8410-7
references: 18056387
references: J Med Virol. 2010 Jul;82(7):1266-71
references: 20513094
references: N Engl J Med. 1979 Mar 8;300(10):530-4
references: 763253
references: J Infect Dis. 2005 Apr 15;191(8):1225-32
references: 15776367
references: J Infect Dis. 2004 Jan 15;189(2):233-8
references: 14722887
references: J Infect Dis. 2005 May 15;191(10):1710-8
references: 15838799
references: J Virol. 2010 Mar;84(5):2374-83
references: 20015982
references: J Infect Dis. 1999 May;179(5):1268-73
references: 10191235
references: N Engl J Med. 2005 Apr 28;352(17):1749-59
references: 15858184
references: J Clin Microbiol. 2012 Jan;50(1):21-4
references: 22090400
references: Antiviral Res. 2004 Sep;63(3):191-6
references: 15451187
references: J Pediatr. 1981 May;98(5):708-15
references: 7229749
references: J Infect Dis. 2004 Jul 15;190(2):373-8
references: 15216475
references: J Virol. 2008 Mar;82(5):2040-55
references: 17928346
references: Immunity. 2008 May;28(5):710-22
references: 18468462
references: J Virol Methods. 2010 Jan;163(1):144-6
references: 19733195
references: Mech Ageing Dev. 2005 Nov;126(11):1223-9
references: 16098562
references: N Engl J Med. 2009 Feb 5;360(6):588-98
references: 19196675
references: JAMA. 2003 Jan 8;289(2):179-86
references: 12517228
references: J Infect Dis. 2002 Mar 1;185(5):682-5
references: 11865426