Modeling Respiratory Syncytial Virus Adult Vaccination in the United States With a Dynamic Transmission Model

Background Respiratory syncytial virus (RSV) is shown to cause substantial morbidity, hospitalization, and mortality in infants and older adults. Population-level modeling of RSV allows to estimate the full burden of disease and the potential epidemiological impact of novel prophylactics. Methods We modeled the RSV epidemiology in the United States across all ages using a deterministic compartmental transmission model. Population-level symptomatic RSV acute respiratory tract infection (ARI) cases were projected across different natural history scenarios with and without vaccination of adults aged & GE;60 years. The impact of vaccine efficacy against ARIs, infectiousness and vaccine coverage on ARI incidence were assessed. The impact on medical attendance, hospitalization, complications, death, and other outcomes was also derived. Results Without a vaccine, we project 17.5-22.6 million symptomatic RSV ARI cases annually in adults aged & GE;18 years in the US, with 3.6-4.8 million/year occurring in adults aged & GE;60 years. Modeling indicates that up to 2.0 million symptomatic RSV-ARI cases could be prevented annually in & GE;60-year-olds with a hypothetical vaccine (70% vaccine efficacy against symptomatic ARI and 60% vaccine coverage) and that up to 0.69 million/year could be prevented in the nonvaccinated population, assuming 50% vaccine impact on infectiousness. Conclusions The model provides estimated burden of RSV in the US across all age groups, with substantial burden projected specifically in older adults. Vaccination of adults aged & GE;60 years could significantly reduce the burden of disease in this population, with additional indirect effect in adults aged <60 years due to reduced transmissibility. Modeling respiratory syncytial virus infections in the United States revealed a substantial disease burden in older adults. Modeled vaccination of & GE;60-year-olds had a positive impact on the disease burden of both vaccinated and nonvaccinated populations through direct and indirect effects.