ACUTE VIRAL-INFECTIONS OF UPPER RESPIRATORY-TRACT IN ELDERLY PEOPLE LIVING IN THE COMMUNITY - COMPARATIVE, PROSPECTIVE, POPULATION-BASED STUDY OF DISEASE BURDEN

Objective: To evaluate the disease burden of upper respiratory infecti ons in elderly people living at home. Design: Prospective surveillance of elderly people. Intervention: None. Setting: Leicestershire, Engla nd Subjects: 533 subjects 60 to 90 years of age. Main outcome measures : Pathogens, symptoms, restriction of activity, duration of illness, m edical consultations, interval between onset of illness and medical co nsultation, antibiotic use, admission to hospital, and death. Results: 231 pathogens were identified for 211 (43%) of 497 episodes for which diagnostic specimens were available: 121 (52%) were rhinoviruses, 59 (26%) were coronaviruses, 22 (9.5%) were influenza A or B, 17 (7%) wer e respiratory syncytial virus, 7 (3%) were parainfluenza viruses, and 3 (1%) were Chlamydia species; an adenovirus and Mycoplasma pneumoniae caused one infection each. Infections occurred at a rate of 1.2 episo des per person per annum (95% confidence interval 1.0 to 1.7; range 0- 10) and were clinically indistinguishable. Lower respiratory tract sym ptoms complicated 65% of upper respiratory infections and increased th e medical consultation rate 2.4-fold (chi(2) test P < 0.001). The medi an interval between onset of illness and medical consultation was 3 da ys for influenza and 5 days for other infections. Rhinoviruses caused the greatest disease burden overall followed by episodes of unknown ae tiology, coronaviruses, influenza A and B, and respiratory syncytial v irus. Conclusions: Respiratory viruses cause substantial morbidity in elderly people. Although respiratory syncytial virus and influenza cau se considerable individual morbidity, the burden of disease from rhino virus infections and infections of unknown aetiology seems greater ove rall. The interval between onset of illness and consultation together with diagnostic difficulties raises concern regarding the role of anti viral drugs in treating influenza.