Respiratory syncytial virus‐associated deaths in the United States according to death certificate data, 2005 to 2016

BACKGROUND AND AIMS: In the United States, respiratory infections due to respiratory syncytial virus (RSV) cause an estimated 57 000 hospitalizations annually among children aged <5 years and 177 000 hospitalizations among adults aged ≥65 years. RSV‐associated deaths are less well described. It will be important to establish a baseline of RSV‐coded deaths prior to the introduction of vaccines, immunoprophylaxis products, and anti‐viral therapies currently in development. METHODS: US death certificate data for all ages from 2005 through 2016 were compiled through the National Center for Health Statistics. Deaths with International Classification of Diseases codes of J12.1 (RSV‐pneumonia), J20.5 (RSV‐bronchitis), or J21.0 (RSV‐bronchiolitis) assigned as either the underlying cause of death or a contributing cause of death were considered “RSV‐associated” for this analysis. RESULTS: Among 30.5 million deaths, 1001 (.003%) were assigned an RSV‐associated cause of death as follows: 697 (69.6%) RSV‐pneumonia, 277 (27.7%) RSV‐bronchiolitis, 17 (1.7%) RSV‐bronchitis, and 10 (1.0%) with multiple RSV‐associated causes. Most deaths were among children <5 (47.8%) and adults ≥50 (40.4%) years of age. Almost half (46.8%) had an RSV‐associated cause as the primary underlying cause of death. The average annual number of RSV‐associated deaths did not significantly change among those aged <5 and 5 to 49 years. However, RSV‐pneumonia deaths among adults aged ≥50 years increased from 17.6 in 2005 to 2012 to 57.3 in 2013 to 2016 (P value <.0001). CONCLUSIONS: From 2005 to 2016, the number of recorded RSV‐associated deaths increased, primarily due to greater RSV‐associated pneumonia deaths among older adults since 2013. The reasons for this increase are not clear but likely reflect increased testing for RSV among adults. The number of RSV‐associated deaths according to death certificates compared with estimates derived from active, laboratory‐confirmed surveillance and models using hospital administrative data suggests that counts from death certificates are a large underestimation, particularly among adults.