Vega-Piris, LorenaGalindo Carretero, SilviaMayordomo, José LuisRumayor-Zarzuelo, Mercedes BelénÁlvarez Río, VirginiaGallardo García, VirtudesGarcía Vázquez, MiriamGarcía Rodríguez, María Del CarmenBasile, LucaLópez González-Coviella, NievesBarranco Boada, Maria IsabelPérez-Martínez, OlaiaLameiras Azevedo, AnaQuiñones-Rubio, CarmenGiménez Duran, JaumeFernández Ibáñez, AnaGarcía Rivera, María VictoriaRamos Marín, VioletaCastrillejo, DanielVoloria Raymundo, Luis JavierLarrauri, AmparoMonge Corella, SusanaSARI Sentinel Surveillance Group2024-11-082024-11-082024-11J Infect. 2024 Nov;89(5):106292.0163-4453https://hdl.handle.net/20.500.12105/25460Introduction: Our aim was to estimate the risk of pneumonia, admission to intensive care unit (ICU) or death in individuals ≥65 years old admitted to hospital with RSV, compared to influenza or COVID-19. Methods: We included hospitalised patients from Severe Acute Respiratory Infection Surveillance in Spain between 2021-2024, aged ≥65 years, laboratory confirmed for RSV, influenza or SARS-CoV-2. Using a binomial regression with logarithmic link, we estimated the relative risk (RR) of pneumonia, ICU admission and in-hospital mortality, in patients with RSV compared to influenza or SARS-CoV-2, adjusting for age, sex, season and comorbidities. We stratified the estimates by vaccination status for influenza or SARS-CoV2. Results: Among patients unvaccinated for influenza or SARS-CoV-2, those with RSV had similar or lower risk of pneumonia [vs. influenza: RR= 0.91 (95% Confidence Interval: 0.72-1.16); vs. SARS-CoV-2: 0.81 (0.67-0.98)], ICU admission [vs. influenza: 0.93 (0.41-2.08); vs. SARS-CoV-2: 1.10 (0.61-1.99)] and mortality [vs. influenza: 0.64 (0.32-1.28); vs. SARS-CoV-2: 0.56 (0.30-1.04)]. Among the vaccinated, results were largely similar except for a higher risk of ICU admission with RSV [vs. influenza: 2.13(1.16-3.89); vs. SARS-CoV-2: 1.83 (1.02-3.28)] CONCLUSIONS: RSV presented similar or lower intrinsic severity than influenza or SARS-CoV2. Among vaccinated patients, RSV was associated to higher ICU-admission, suggesting the potential for preventive RSV vaccination.engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/ICU admissionInfluenzaMortalityPneumoniaSARS-CoV2Severe acute respiratory infectionSyncytial respiratory virusVaccinationAgedAged, 80 and overCOVID-19FemaleHospital MortalityHospitalizationHumansInfluenza, HumanIntensive Care UnitsMaleRespiratory Syncytial Virus InfectionsRespiratory Syncytial Virus, HumanSARS-CoV-2Severity of Illness IndexSpainAttribution-NonCommercial-NoDerivatives 4.0 International3934140289510629210.1016/j.jinf.2024.1062921532-2742The Journal of infectionopen access