Clinical and human burden of respiratory syncytial virus in older adults: a narrative review with emphasis on Italian data

Respiratory syncytial virus (RSV) is a well-known driver of bronchiolitis and hospital admissions in infants. It is also a major threat for adults aged ≥ 60 years, causing acute respiratory infection with substantial morbidity and mortality. Only recently RSV surveillance programs have been implemented in Europe. In Italy, InfluNet, which has monitored influenza-like illness since 2000, began systematic RSV surveillance in the 2022–2023 season, now integrated within the national RespiVirNet framework. Interest in the burden of RSV infection in older patients has increased rapidly, particularly with new preventive tools. This narrative review summarizes recent evidence on the epidemiology and clinical features of RSV in older people, focusing on Italian data. The burden associated with hospitalization, functional and cognitive sequelae is emphasized, and comparisons with influenza are made. Evidence shows that RSV plays a significant role in winter hospital admissions among older adults, often leading to complications and lingering functional deficits beyond discharge. Those with preexisting conditions are especially at risk, and recent findings point to potential associations with cognitive deterioration. Numerous studies reveal that the severity of RSV-related hospitalisations matches that seen with influenza. Although more robust and harmonized data are needed, current evidence supports implementing targeted prevention strategies to lessen the impact of RSV in older adults. An integrated approach—combining rapid and sensitive diagnostics, routine surveillance, and access to preventive measures such as immunisation, particularly for frail individuals—holds promise for reducing the burden of RSV infection and alleviating pressures on national health services.