Table 2. Severity of RSV-Associated Hospitalizations vs COVID-19– or Influenza-Associated Hospitalizations, by Vaccination Status, Among US Adults.
| In-hospital outcomes | Patients, No. (%) | RSV vs COVID-19 by vaccination status | Patients with influenza, No. (%) | RSV vs influenza by vaccination status | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RSV (n = 484) | COVID-19 | ||||||||||||||
| Unvaccinated (n = 1422) | Vaccinated (n = 5000)a | Unvaccinated | Vaccinateda | Unvaccinated (n = 699) | Vaccinated (n = 393)b | Unvaccinated | Vaccinatedb | ||||||||
| aOR (95% CI)c | P value | aOR (95% CI)c | P value | aOR (95% CI)c | P value | aOR (95% CI)c | P value | ||||||||
| Supplemental oxygen therapyd | 355 (73.4) | 857 (60.3) | 2924 (58.5) | 1.82 (1.42-2.32) | <.001 | 2.16 (1.74-2.68) | <.001 | 460 (65.8) | 249 (63.4) | 1.27 (0.97-1.68) | .09 | 1.86 (1.36-2.55) | <.001 | ||
| Advanced respiratory supporte | 146 (30.2) | 332 (23.4) | 888 (17.8) | 1.40 (1.10-1.78) | .006 | 2.03 (1.64-2.51) | <.001 | 157 (22.5) | 57 (14.5) | 1.47 (1.12-1.93) | .006 | 2.71 (1.89-3.87) | <.001 | ||
| Acute organ failuref | 152 (31.4) | 359 (25.3) | 1015 (20.3) | 1.32 (1.05-1.68) | .02 | 1.84 (1.49-2.26) | <.001 | 170 (24.3) | 61 (15.5) | 1.38 (1.05-1.81) | .02 | 2.62 (1.85-3.71) | <.001 | ||
| ICU admission | 120 (24.8) | 326 (22.9) | 847 (16.9) | 1.11 (0.86-1.43) | .43 | 1.55 (1.24-1.95) | <.001 | 152 (21.8) | 42 (10.7) | 1.14 (0.86-1.53) | .36 | 2.65 (1.78-3.95) | <.001 | ||
| Hospital-free days, median (IQR)g | 23 (18-25) | 23 (17-25) | 23 (19-25) | 1.18 (0.98-1.42)h | .08 | 0.85 (0.72-1.00)h | .05 | 24 (20-26) | 24 (22-26) | 0.79 (0.64-0.97)h | .03 | 0.53 (0.42-0.68)h | <.001 | ||
| IMV or death | 58 (12.0) | 201 (14.1) | 458 (9.2) | 0.82 (0.59-1.13) | .22 | 1.38 (1.02-1.86) | .03 | 72 (10.3) | 20 (5.1) | 1.20 (0.82-1.76) | .35 | 2.81 (1.62-4.86) | <.001 | ||
Abbreviations: aOR, adjusted odds ratio; ICU, intensive care unit; IMV, invasive mechanical ventilation; RSV, respiratory syncytial virus.
Includes patients with receipt of the original (ancestral strain) monovalent vaccines, specifically at least 2 doses of BNT1262b2, (Pfizer-BioNTech), mRNA-1273 (Moderna), or NVX-CoV2373 (Novavax), or at least 1 dose of Ad26.COV2.S (Janssen) or at least 1 dose of BNT1262b2 Bivalent vaccine and mRNA-1273.222 bivalent vaccine. Patients who received bivalent vaccination may have previously received 1 to 5 doses of the original (ancestral strain) monovalent vaccines.
Patients were classified as vaccinated against influenza if they received the current season’s influenza vaccine based on the period in which they were enrolled.
Multivariable logistic regression models were adjusted for age, sex, race and ethnicity, number of organ systems with chronic medical conditions and US Department of Health & Human Services region.
Supplemental oxygen therapy was defined as use of supplemental oxygen at any flow rate with any device for those not on chronic supplemental oxygen, or as escalation of respiratory support for patients who use chronic supplemental oxygen, at any time during hospitalization prior to day 28.
Advanced respiratory support was defined as receipt of organ support for respiratory failure (ie, acute use of HFNC, noninvasive ventilation, or IMV) at any time during the hospitalization before day 28. Patients receiving chronic home noninvasive ventilation were classified as requiring respiratory support if they received IMV in the hospital. Patients receiving chronic home IMV were ineligible for this outcome.
Acute organ failure is a composite of respiratory failure (ie, acute use of high-flow nasal cannula, noninvasive ventilation, and IMV), cardiovascular failure (ie, use of vasopressors) or renal failure (ie, acute use of kidney replacement therapy).
Hospital-free days to day 28 is a composite of in-hospital death and hospital length of stay defined as the number of days alive and out of the hospital between admission and 28 days later. Patients who died during the hospitalization are classified as having −1 hospital-free days and those who were hospitalized for more than 28 days were classified as having zero hospital-free days. For patients discharged alive before day 28, hospital-free days were calculated as 28 minus the length of stay to generate an ordinal scale.
Because hospital-free days is an ordinal outcome, multivariable proportional odds models were used to estimate the association of hospital-free days between RSV and unvaccinated or vaccinated COVID-19 or influenza. Models were adjusted for the same covariables used in multivariable logistic regression models, including age, sex, race and ethnicity, number of organ systems with chronic medical conditions and US Department of Health & Human Services region.