RSV infection poses a substantial severe disease burden for immunocompromised adults in high-income countries.
RSV infection has long been recognized as a major driver of severe respiratory illness in children, but a new systematic review highlights its serious impact in adults with compromised immunity. The review examined evidence published from 2000–2024 and found that immunocompromised adults, particularly transplant recipients, often experienced hospitalization, intensive care unit admission, mechanical ventilation, and death after laboratory-confirmed respiratory syncytial virus infection.
The analysis included 36 English-language studies from high-income countries. Most were conducted in Europe or the USA, and the evidence base was heavily concentrated in solid organ transplant recipients and hematopoietic stem cell transplant recipients. Eleven studies evaluated solid organ transplant recipients, including eight focused on lung transplant recipients, while 17 studies assessed hematopoietic stem cell transplant recipients.
Hospitalization and ICU Care Were Common
Across the included studies, substantial proportions of RSV-infected immunocompromised adults required hospital care. Hospitalization occurred in 37.5–87.5% of lung transplant recipients, 37.7–68.0% of any solid organ transplant recipients, and 30.3–83.9% of hematopoietic stem cell transplant recipients.
Severe complications were also frequent. Intensive care unit admission was reported in 11.7% of lung transplant recipients, 3.9–17.9% of any solid organ transplant recipients, and 4.8–29.8% of hematopoietic stem cell transplant recipients. Mechanical ventilation was required in 0.0–10.4%, 3.9–14.3%, and 2.7–29.8% of these groups, respectively.
Mortality findings varied by population and follow-up window. Within 1 month of RSV infection, all-cause mortality reached 25.8% in some hematopoietic stem cell transplant cohorts, while RSV-related mortality reached 22.6% in one study.
Immunosuppression May Shape RSV Risk
The review suggests that the degree of immunosuppression may be an important determinant of RSV infection risk and outcomes. In lung and stem cell transplant recipients, anti-rejection regimens, corticosteroid dosing, adjunctive immunosuppressive agents, and time from transplant appeared clinically relevant.
The authors noted that RSV vaccination and other preventive strategies should be prioritized for immunocompromised adults. However, they also emphasized persistent evidence gaps, including limited stratification by age, comorbidities, immune status, medication use, and time since transplant. More multicenter studies with standardized case definitions are needed to guide clinical practice and immunization policy.
Reference
Saeedi P et al. Burden of respiratory syncytial virus infection in immunocompromised adults: A systematic review of the evidence from high-income countries. Infect Dis Ther. 2026;doi:10.1007/s40121-026-01379-4.
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