This systematic literature review (2000–2024) summarized the burden of RSV infection in immunocompromised adults in high-income countries, covering incidence, hospitalization, ICU admission, mechanical ventilation, and mortality across solid organ transplant (SOT), hematopoietic stem cell transplant (HSCT), and other immunocompromising conditions.
Across 36 included studies, RSV infection led to high rates of hospitalization (37.5–87.5% in lung transplant; 37.7–68.0% in any SOT; 30.3–83.9% in HSCT recipients), ICU admission (11.7% lung; 3.9–17.9% any SOT; 4.8–29.8% HSCT), and mechanical ventilation (0.0–10.4% lung; 3.9–14.3% any SOT; 2.7–29.8% HSCT). Degree of immunosuppression—driven by anti-rejection regimens, corticosteroid dosing, and adjunctive agents—was identified as a key risk modifier.
Most studies were observational and retrospective; only 4 of 36 were conducted outside Europe or the USA, limiting generalizability. RSV diagnostic methods varied across studies, potentially affecting incidence estimates. No pooled meta-analysis was performed, so ranges reflect study heterogeneity rather than precise effect sizes.
Clinicians caring for lung or stem cell transplant recipients should recognize RSV as a major cause of severe respiratory illness requiring hospitalization and ICU care. Vaccination and preventive strategies should be prioritized in this group, and immunosuppression level should be weighed as a key risk factor when assessing RSV severity.
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