Managed Care - November 2008 - (Page RSV13)

RSV Infection in the Adult Population JULIO A. RAMIREZ, MD, FACP Chief, Division of Infectious Diseases, University of Louisville Professor of Medicine, Department of Veterans Affairs Medical Center, Louisville, Ky. Respiratory syncytial virus (RSV) is usually regarded ure, page 14). Over the course of four winters, 2,514 resas a concern of pediatricians, whereas, in fact, RSV is a piratory tract infections occurred among these patients. significant and unrecognized cause of seasonal respiraUsing reverse transcriptase-polymerase chain reaction tory tract infections (RTIs) in adults as well. (PCR) technology, 102 RSV infections and 44 influenza RSV may be responsible for as much as 25 percent of infections were found among the ambulatory patients excess wintertime mortality usually attributed (the healthy elderly and the high-risk adults), to influenza. For all age groups, the RSVand 142 RSV and 154 influenza infections were associated mortality rate in the category of found in the hospitalized patients. None of the underlying respiratory and circulatory deaths healthy elderly or high-risk patients with in(a group that includes pneumonia and influenza infections died. Among the healthy eldfluenza deaths but excludes the accidental erly with an RSV infection, no deaths were deaths that would be captured by the comrecorded, but 4 percent of the high-risk pamonly used metric of all-cause mortality) has tients with an RSV infection died. Among the been estimated at 4.3 per 100,000 person-years. hospitalized patients, 8 percent of those with an Among persons aged 65 and older, the mortalRSV infection died, as did 7 percent of those JULIO A. ity rate rises to 26.5 per 100,000 person-years, with an influenza infection. On a nationwide RAMIREZ, MD, and 78 percent of RSV-associated underlying basis, this RSV mortality rate was estimated to FACP respiratory and circulatory deaths occur in this translate into 14,000 deaths annually. The augroup (Thompson 2003). thors also estimated that RSV would account for about One of the best studies showing the effects of RSV on 180,000 hospital admissions each year at a cost exceedmorbidity and mortality in adults in the United States aping $1 billion. peared in the New England Journal of Medicine (Falsey Clinical manifestation of RSV 2005). The study followed 680 healthy elderly patients and 540 high-risk adults1, and 1,388 patients hospitalized Clinical manifestation of RSV will vary with the paduring the winter with cardiopulmonary illnesses (Figtient’s age and immune status, and whether the infection is primary or secondary. The depth to which the virus deJulio A. Ramirez, MD, FACP, received his medical degree and inscends into the respiratory tract may be regarded as an indication of the degree to which a patient is immunoternal medicine training at the La Plata National University compromised, owing to age or illness or both. At both exSchool of Medical Science, Argentina. He completed a fellowship tremes of age, when the immune system either is undein Critical Care Medicine at the National Institute of Respiratory veloped or decreasing, RSV can gain a foothold deep in Diseases and Thoracic Surgery, University of Chile; a residency in the respiratory tract. Internal Medicine at Lincoln Medical Center, New York Medical In an RSV infection, virus particles attach to airway College; and a fellowship in Infectious Diseases at the University epithelium, which leads to destruction of the epithelial of Louisville School of Medicine, Kentucky. Ramirez is board cercells and damage to cilia, similar to the way the mucotified in internal medicine and holds subspecialty certification in ciliary mechanism is damaged by the influenza virus. In infectious diseases. His areas of research interest include clinical severe influenza pneumonia or severe RSV pneumonia, research, management of community-acquired pneumonia, and the tissue damage is a consequence of the release of cytobasic research, diagnosis, and pathogenesis of infections due to kines and chemokines. The virulence of the virus deatypical pathogens. Ramirez was a member of the U. S. Food and pends upon its ability to provoke an immune response Drug Administration advisory committee for anti-infective drugs from 2001 to 2005. He is a member of the American Thoracic Society Committee for the development of national guidelines for management of community-acquired pneumonia, and is on the National Institute of Allergy and Infectious Diseases, Division of Extramural Activities, Scientific Review Board. 1 Patients aged 21 years or older with physician-diagnosed heart failure [New York Heart Association class II or higher] or chronic pulmonary disease severe enough to restrict activities or require the use of long-term medication. SUPPLEMENT / RSV 13

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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