RSV Poses Sixfold Higher Hospitalization and Death Risk for Long-Term Care Residents

Older adults living in long-term care facilities face a dramatically higher risk of severe illness and death from respiratory syncytial virus (RSV) than their community-dwelling peers, according to new data published in The Journal of the Post-Acute and Long-Term Care Medical Association.

“This study aimed to quantify the burden of RSV infection, hospitalizations, and in-hospital death among older LTCF residents compared with community-dwelling (CD) older adults in Monroe County, NY,” wrote Kevin Popham, MPH, Center for Community Health and Prevention, University of Rochester Medical Center in Rochester, NY, and coauthors.

In a 2-season retrospective analysis of residents aged 65 years and older, researchers found that RSV-associated hospitalizations were 6.6 to 7.2 times higher among skilled nursing facility (SNF) and assisted living facility (ALF) residents compared with community-dwelling (CD) older adults. Similarly, in-hospital mortality rates were 16.6 to 18.5 times greater among LTCF residents.

Using data from the CDC’s RSV-NET surveillance platform, investigators identified 1660 laboratory-confirmed RSV infections from October 2022 through April 2024. Of these, 270 cases occurred in SNFs, 68 in ALFs, and 1322 among community dwellers. Infection rates were strikingly elevated in LTCFs at 4151.9 per 100 000 for SNF residents and 1635.0 per 100 000 for ALF residents, compared with 503.7 per 100 000 in the community. Hospitalization rates followed the same pattern: 784.3 per 100 000 in SNFs, 865.6 per 100 000 in ALFs, and only 119.7 per 100 000 among CD adults. Mortality was also disproportionately higher, with 13.7% of hospitalized SNF residents and 13.9% of ALF residents dying in the hospital versus 5.4% of hospitalized community dwellers.

RSV clusters were reported in 90% of county SNFs, with facility attack rates ranging from 0.3% to 28.5% and peaks of up to 21% in a single week. Most infections occurred among the oldest residents aged 85 years and above, who represented more than half of SNF cases.

“Preventing RSV spread in this vulnerable population requires a multifaceted approach that includes prompt diagnosis, effective infection control measures, and vaccination,” concluded the study authors.

Reference

Popham K, St George K, Felsen C, Dumyati G, Tesini BL. Disproportionate impact of respiratory syncytial virus (RSV) among older adults in long-term care settings. J Am Med Dir Assoc. 2025;26(9):105760. doi:10.1016/j.jamda.2025.105760