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RSV causes disproportionate morbidity and mortality in vulnerable populations. A study in Seattle, Washington, found that residents of homeless shelters are more likely to suffer from severe RSV infections and to have co-infections with other respiratory viruses.

Respiratory syncytial virus (RSV) is among the leading causes of severe respiratory infection among people of various ages. However, children and older adults are particularly at risk. The aging population in homeless shelters is at increased risk of developing severe RSV infections due to health disparities and poor access to healthcare. This vulnerable group remains largely neglected by researchers. Additionally, these individuals are less likely to receive adequate medical care and thus continue to harbor the infection. Studies also show that this particular population group is aging and thus entering the high-risk group.

Viral Co-Infections Are Common in RSV Patients in Homeless Shelters

This study included residents and staff of homeless shelters in King County, Washington. Those with new or worsening symptoms of acute respiratory infection were included in the study. The study was published in the journal Influenza and Other Respiratory Viruses.

The study included 15,364 encounters at which participants completed screening questionnaires and specimens were collected and tested. Of these, 35 were positive for RSV. Cough and rhinorrhea were the most common symptoms, along with myalgia, headaches, sore throat, fatigue, and fever. RT-PCR was used to identify respiratory viruses. 

The study found that 54% of adult participants reported current tobacco use. A high rate of respiratory viral co-infections (26%) was also noted in patients who tested positive for RSV. The most commonly detected co-infections were adenovirus, influenza, metapneumovirus, rhinovirus, and seasonal coronavirus. This shows why health inequalities may lead to more severe infections in vulnerable populations.

The Bottom line

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It is well known that vulnerable population groups, like those living in congested homeless shelters, are at greater risk of respiratory viral infections. However, the study also shows that there could be multiple reasons for more severe RSV in such patients. This population is more likely to use tobacco and have co-infections with other viral agents. Moreover, those providing care to these patients also risk contracting such infections. The study had multiple limitations: it did not conduct a comparison with data for the stably housed population or collect follow-up data, and it lacked longitudinal data. 


McCulloch, D. J., Rogers, J., Wang, Y., Chow, E. J., Link, A. C., Wolf, C. R., Uyeki, T. M., Rolfes, M. A., Mosites, E., Sereewit, J., Duchin, J. S., Sugg, N., Greninger, A. L., Boeckh, M., Englund, J. A., Shendure, J., Hughes, J. P., Starita, L. M., Roychoudhury, P., & Chu, H. Y. (2023). Respiratory syncytial virus and other respiratory virus infections in residents of homeless shelters – King County, Washington, 2019–2021. Influenza and Other Respiratory Viruses, 17(6). https://doi.org/10.1111/irv.13166