Study Design, Sites, and Participants
From October 2017 to April 2018 (Year 1) and from October 2018 to April 2019 (Year 2), we performed prospective surveillance among hospitalized adults 18 years of age and older who had laboratory-confirmed RSV infection. Surveillance occurred at three academically affiliated hospitals from the same multi-campus institution. The hospitals were located in Northern Manhattan and included a ~750-bed tertiary care hospital for adult patients, a ~200-bed community hospital for adult patients, and a ~250-bed children’s hospital. The Columbia University Irving Medical Center Institutional Review Board approved this study with a waiver of documentation of consent.
As per the standard of care in these hospitals, patients with acute respiratory infections (ARI) and anticipated hospitalization are tested for viral respiratory pathogens to inform infection prevention and control and influenza treatment. These tests are most often performed in the emergency department (ED). Nasopharyngeal swabs are processed in the clinical microbiology laboratories affiliated with these hospitals using a multiplex reverse transcription polymerase chain reaction (PCR) assay (FilmArray Respiratory Panel, BioFire Diagnostics, Inc., Salt Lake City, UT) which includes RSV on the panel. Potential patients were identified during the prospective surveillance study by monitoring admissions from the ED (Monday through Friday) and by reviewing the Department of Infection Prevention and Control’s internal database of epidemiologically significant pathogens in hospitalized patients. Since surveillance did not occur during weekends or holidays, at the end of each surveillance period, the electronic medical records (EMR) of all hospitalized adults were queried to identify any additional patients with positive RSV tests who may have been missed by active surveillance.
Eligible patients for the current study were 18 years and older, had laboratory-confirmed RSV infection, two or more symptoms consistent with ARI (fever, cough, shortness of breath, sore throat, headache, malaise, myalgia, sputum production, wheezing, hoarseness, and/or pleuritic chest pain) documented in the EMR, were hospitalized for at least 24 hours, and lived in New York City as per their residential zip code.