Over Half of RSV-Related Deaths in Hospitalized Adults Occur After Discharge

Approximately 1 in 10 adults hospitalized with respiratory syncytial virus (RSV) died during hospitalization or within 60 days of discharge, and more than half of those deaths occurred after the patient had left the hospital, according to CDC surveillance data presented at IDWeek 2026 in Washington, DC.¹ A companion oral presentation focused on the first 30 days after discharge found that many post-discharge deaths occurred among adults who were not discharged to hospice and that RSV was rarely recorded on their death certificates.²

Limited information has been available on mortality associated with RSV hospitalization, particularly deaths that occur after discharge, according to the investigators.¹

RSV-NET Data Span 8 Seasons

Both analyses drew on the RSV Hospitalization Surveillance Network (RSV-NET), part of the CDC's Respiratory Virus Hospitalization Surveillance Network (RESP-NET). RSV-NET conducts active, population-based surveillance of laboratory-confirmed RSV hospitalizations across 170 counties in 14 states, covering more than 300 acute care hospitals and approximately 11% of the US population.¹

The investigators identified 18,301 adults aged 18 years and older who were hospitalized with laboratory-confirmed RSV during 8 seasons between 2014 and 2024; the 2019-2020 and 2020-2021 seasons were excluded because of pandemic-related disruptions. Deaths were identified through medical record review and matches with death certificate data.¹

Over Half of Deaths Occurred Post-Discharge

In the 60-day analysis, 1851 adults (10.1%) died: 4.4% in the hospital and 5.7% within 60 days of discharge. Most adults who died were aged 65 years or older (81.2%), female (53.8%), and non-Hispanic White (69.9%), and 93.4% had at least 1 underlying medical condition. During hospitalization, 45.1% required intensive care unit (ICU) admission and 25.5% received invasive mechanical ventilation.¹

Among adults who died after discharge, 30.8% had been discharged to hospice, and 78.3% died within 30 days of leaving the hospital. Compared with in-hospital deaths, a greater proportion of post-discharge deaths occurred among adults aged 65 years or older (84.4% vs 77.1%), whereas a smaller share had at least 1 underlying medical condition (90.4% vs 97.0%), required ICU admission (28.4% vs 66.5%), or received invasive mechanical ventilation (9.2% vs 46.3%; P < .0001 for all).¹

Unexpected Deaths After Non-Hospice Discharge

In the oral presentation, Michael Melgar, MD, a medical epidemiologist at the CDC, presented the 30-day analysis on behalf of Rebecca C. Woodruff, PhD, MPH, an epidemiologist at the CDC. Overall, 1565 adults (8.6%) died within this window, including 812 (4.4%) in the hospital and 753 (4.2%) within 30 days of discharge. Of all hospitalized adults, 286 (1.6%) died after discharge to hospice, while 467 (2.6%) died after discharge to another setting. The overall proportion of adults who died ranged from 7.4% in the 2018-2019 season to 9.7% in the 2015-2016 season.^1,3

Melgar described the non-hospice group as the most concerning, noting that these patients were likely discharged home or to a higher level of care and were "probably not expected to die within a month" of their RSV hospitalization.²

RSV Rarely Recorded on Death Certificates

Only 10.1% of adults who died during hospitalization or within 30 days of discharge had RSV listed as a cause of death on the death certificate.² This included 15.0% of in-hospital deaths, 6.7% of post-discharge hospice deaths, and 3.9% of post-discharge non-hospice deaths. The investigators concluded that this limits the usefulness of death certificate–based surveillance for RSV. By comparison, Melgar noted that prior CDC analyses found influenza listed on approximately 37% of death certificates and COVID-19 on approximately 72%.³

Implications for Prevention and Transitions of Care

According to Melgar, the results support prioritizing RSV vaccination among eligible adults, as well as stronger discharge planning and early follow-up after hospitalization.⁴ The investigators did not examine RSV vaccination status among patients hospitalized during the 2023-2024 season, when adult RSV vaccines first became available.²

The CDC currently recommends a single dose of any FDA-licensed RSV vaccine for all adults aged 75 years and older and for adults aged 50 to 74 years who are at increased risk of severe RSV; adults who have already received a dose should not receive another at this time.⁴ For pharmacists involved in immunization and transitions of care, the data highlight that mortality risk extends beyond the hospital stay, including among adults who never required intensive care.¹

Limitations

The investigators noted potential under-detection of hospitalizations due to clinician-driven testing and potentially incomplete death ascertainment. Deaths were not necessarily attributable to RSV infection, and the results may not generalize to the overall US population.¹

REFERENCES

1. Woodruff RC, Milucky J, O'Halloran A, et al. 30-day mortality among adults hospitalized with laboratory-confirmed respiratory syncytial virus infection. Presented at: IDWeek 2026; October 23, 2026; Washington, DC.

2. Rudd T. RSV hospitalization may be taking a surprising mortality toll, CDC finds. MedPage Today. Published October 24, 2026. Accessed October 29, 2026. https://www.medpagetoday.com/meetingcoverage/idweek/123563

3. Grossi G. IDWeek studies tie RSV, flu, and COVID-19 to harm after acute illness. AJMC. Published October 23, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/idweek-studies-tie-rsv-flu-and-covid-19-to-harm-after-acute-illness

4. Clinical guidance for RSV immunizations and vaccines. CDC. August 18, 2025. Accessed October 29, 2026. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/index.html