Abstract Background Data on chronic conditions associated with increased respiratory syncytial virus (RSV)-associated hospitalization rates among adults aged ≥ 50 years have guided RSV vaccination recommendations. Similar data are needed for younger adults. Methods We compared RSV hospitalization rates among community-dwelling adults aged 18-49 years with and without nine chronic medical conditions in a 38-county catchment area across seven states. Numerators included adults with and without each chronic condition who were hospitalized with laboratory-confirmed RSV infection identified through the RSV Hospitalization Surveillance Network (RSV-NET) during two RSV surveillance seasons during 2016-2018. Denominators were catchment area population estimates of adults with and without self-reported history of each chronic condition from the Behavioral Risk Factor Surveillance System and the US Census. Poisson regression using Monte Carlo simulation generated unadjusted rates and adjusted rate ratios (aRR) and 95% Monte Carlo uncertainty intervals (UI), adjusted for sex and race or ethnicity group. Results Among community-dwelling adults aged 18-49 years, RSV hospitalization rates ranged from 11.7 hospitalizations per 100,000 (UI: 5.9, 23.6) for adults with non-severe obesity (body mass index BMI 30-39 kg/m2) to 113.1 hospitalizations per 100,000 (UI: 47.3, 274.3) for adults with chronic kidney disease (Figure 1). Those with each of the nine chronic conditions had higher RSV hospitalization rates compared to those without the respective conditions: chronic kidney disease (aRR=13.9, UI: 9.2, 21.2), diabetes (aRR=6.1, UI: 4.1, 9.1), severe obesity (BMI ≥ 40 kg/m2; aRR=5.3, UI: 3.4, 8.3), chronic obstructive pulmonary disease (aRR=4.0, UI: 2.4, 6.5), asthma (aRR=3.9, UI: 3.0, 5.1), coronary artery disease (aRR=3.6, UI: 2.1, 6.0), stroke (aRR=3.6, CI: 2.3, 5.9), current smoking (aRR=2.1, UI: 1.6, 2.7), and non-severe obesity (aRR=1.6, UI: 1.1, 2.4) (Figure 2). RSV hospitalization rates were higher among adults aged 18-49 years with 1 (aRR=2.2, UI: 1.7, 2.9) or ≥2 chronic conditions (aRR=8.3, UI: 6.4-10.9) vs. none. Conclusion Chronic conditions were associated with higher rates of RSV hospitalization among younger adults, which can guide national vaccination recommendations. Disclosures Lucy S. Witt, MD, MPH, Merck & Co: Grant/Research Support William Schaffner, MD, Abbott Dignostics: Honoraria
Woodruff et al. (Thu,) studied this question.