New Respiratory Viruses and the Elderly

Jartti, Laura; Langen, Henriikka; Söderlund-Venermo, Maria; Vuorinen, Tytti; Ruuskanen, Olli; Jartti, Tuomas

Influenza viruses typically cause mid-winter epidemics. The typical respiratory symptoms (cough, fever and sore throat), however, are poorly associated (43%) with confirmed influenza illnesses in older adults [34, 35] . Hypoxia and chest radiographs consistent with the acute respiratory distress syndrome are characteristic of patients requiring intensive care [34] . If death occurs, it follows approximately more than one week after the onset of symptoms and mortality correlates with high virus titers. The cause of death is usually progressive cardiopulmonary failure. The influenza-related morbidity in the elderly is closely related to the prevalence of influenza virus infections among children (reservoir) [36] . The diagnosis is mainly based on antigen detection and PCR of respiratory specimen, but culture and serology are also available. Treatment options are neuraminidase inhibitors (oseltamivir and zanamivir) or adamantane derivatives (amantadine and rimantadine) [37] . Systemic corticosteroids are not effective and may, in fact, increase the risk of hospital-acquired pneumonia and superinfections [38] . Strain-specific influenza vaccination is usually available after 6 to 12 months after emergence of pandemic and has usually high immunogenicity among elderly subjects [39] .