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‘It's just a virus’ – viral illness in older people: prevention and management

Published online by Cambridge University Press:  03 April 2013

Ruth Payne ,
Donall Forde ,
Alicia Vedio ,
Alison Cope ,
Gary Pratt  and
Anne Tunbridge
Ruth Payne
Affiliation:
The Jenner Institute, University of Oxford, Oxford, UK
Donall Forde
Affiliation:
Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals, Sheffield, UK
Alicia Vedio
Affiliation:
Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals, Sheffield, UK
Alison Cope
Affiliation:
Department of Virology, Sheffield Teaching Hospitals, Sheffield, UK
Gary Pratt
Affiliation:
Department of Stroke and Geriatric Medicine, Sheffield Teaching Hospitals, Sheffield, UK
Anne Tunbridge*
Affiliation:
Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals, Sheffield, UK
*
Address for correspondence: Dr Anne Tunbridge, Department of Infectious Diseases and Tropical Medicine, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF. Email: [email protected]
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Summary

Many viral infections that cause minor illness in younger adults can lead to significant mortality and morbidity in older people, particularly as co-morbidities tend to accumulate with increased age. Respiratory and gastrointestinal viruses are ubiquitous and frequently cause outbreaks, with major impact on those in care homes or residential accommodation. Advances in medicine have opened the way for increased impact of the herpes viruses (varicella zoster virus, herpes simplex virus, Epstein–Barr virus and cytomegalovirus), as immune systems are manipulated. People are also leading more active lives in older age; human immunodeficiency virus (HIV) will be increasingly prevalent, as those living with HIV grow older in good health. In addition, new diagnoses of HIV, viral hepatitis and travel-related infections will present to those working in health care of older people. This review article of viral infections aims to highlight relevant pathology, with specific reference to management in older people.

Keywords

influenzarespiratory virusviral hepatitisVaricella zoster virusHerpes simplexNorovirusHIV/AIDSEpstein–Barr viruscytomegalovirusolder people
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 23 , Issue 2 , May 2013 , pp. 131 - 141
Copyright
Copyright © Cambridge University Press 2013

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References

1WHO. Seasonal Influenza; Facts and Figures. Available at: www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/influenza/facts-and-figures/seasonal-influenza (accessed 1 December 2012).Google Scholar
2The Green Book of Immunisations. Department of Health; 2012. Available at: www.wp.dh.gov.uk/immunisation/files/2012/07/Green-Book-Chapter-19-v4_71.pdfGoogle Scholar
3Hancock, K, Veguilla, V, Lu, X, Zhong, W, Butler, EN, Sun, Het al.Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. New Engl J Med 2009; 361: 1945–52.CrossRefGoogle Scholar
4Armstrong, BG, Mangtani, P, Fletcher, A, Kovats, S, McMichael, A, Pattenden, Set al.Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people. BMJ 2004; 329: 660.CrossRefGoogle ScholarPubMed
5Pebody, RG, McLean, E, Zhao, H, Cleary, P, Bracebridge, S, Foster, Ket al. Pandemic Influenza A (H1N1) 2009 and mortality in the United Kingdom: risk factors for death, April 2009 to March 2010. Euro Surveill 2010; 15: pii=19571. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19571CrossRefGoogle Scholar
6Health Protection Services. Managing Outbreaks of Acute Respiratory Illness in Care Homes: Information and Advice for Health Protection Units. Health Protection Agency; October 2012. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136714703Google Scholar
7Nichol, KL, Nordin, JD, Nelson, DB, Mullooly, JP, Hak, E. Effectiveness of influenza vaccine in the community-dwelling elderly. New Engl J Med 2007; 357: 1373–81.CrossRefGoogle ScholarPubMed
8Falsey, AR, Hennessey, PA, Formica, MA, Cox, C, Walsh, EE. Respiratory syncytial virus infection in elderly and high-risk adults. New Engl J Med 2005; 352: 1749–59.CrossRefGoogle ScholarPubMed
9McColl, MD, Corser, RB, Bremner, J, Chopra, R. Respiratory syncytial virus infection in adult BMT recipients: effective therapy with short duration nebulised ribavirin. Bone Marrow Transpl 1998; 21: 423–25.CrossRefGoogle ScholarPubMed
10Health Protection Agency. Severe acute respiratory syndrome. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SevereAcuteRespiratorySyndrome/GeneralInformation/sarsBackgroundinformationonSARS/ (accessed 7 December 2012).Google Scholar
11Falsey, AR, Walsh, EE. Viral pneumonia in older adults. Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America. 2006; 42: 518–24.CrossRefGoogle ScholarPubMed
12Lee, LE, Cebelinski, EA, Fuller, C, Keene, WE, Smith, K, Vinje, Jet al.Sapovirus outbreaks in long-term care facilities, Oregon and Minnesota, USA, 2002–2009. Emerg Infect Dis 2012; 18: 873–76.CrossRefGoogle ScholarPubMed
13Mattner, F, Sohr, D, Heim, A, Gastmeier, P, Vennema, H, Koopmans, M. Risk groups for clinical complications of norovirus infections: an outbreak investigation. Clin Microbiol Infection 2006; 12: 69–74.CrossRefGoogle ScholarPubMed
14van Asten, L, van den Wijngaard, C, van Pelt, W, van de Kassteele, J, Meijer, A, van der Hoek, Wet al.Mortality attributable to 9 common infections: significant effect of influenza A, respiratory syncytial virus, influenza B, norovirus, and parainfluenza in elderly persons. J Infectious Dis 2012; 206: 628–39.CrossRefGoogle ScholarPubMed
15Goller, JL, Dimitriadis, A, Tan, A, Kelly, H, Marshall, JA. Long-term features of norovirus gastroenteritis in the elderly. J Hosp Infection 2004; 58: 286–91.CrossRefGoogle ScholarPubMed
16Nagata, S, Asahara, T, Ohta, T, Yamada, T, Kondo, S, Bian, Let al.Effect of the continuous intake of probiotic-fermented milk containing Lactobacillus casei strain Shirota on fever in a mass outbreak of norovirus gastroenteritis and the faecal microflora in a health service facility for the aged. Br J Nutrition 2011; 106: 549–56.CrossRefGoogle Scholar
17Partridge, DG, Evans, CM, Raza, M, Kudesia, G, Parsons, HK. Lessons from a large norovirus outbreak: impact of viral load, patient age and ward design on duration of symptoms and shedding and likelihood of transmission. J Hosp Infection 2012; 81: 25–30.CrossRefGoogle ScholarPubMed
18Harris, JP, Lopman, BA, O'Brien, SJ. Infection control measures for norovirus: a systematic review of outbreaks in semi-enclosed settings. J Hosp Infection 2010; 74: 1–9.CrossRefGoogle ScholarPubMed
19van Hoek, AJ, Gay, N, Melegaro, A, Opstelten, W, Edmunds, WJ. Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. Vaccine 2009; 27: 1454–67.CrossRefGoogle ScholarPubMed
20Brisson, M, Edmunds, WJ. Epidemiology of Varicella-Zoster Virus in England and Wales. J Medical Virol 2003; 70 suppl 1: S9–14.CrossRefGoogle ScholarPubMed
21Gnann, JW Jr. Vaccination to prevent herpes zoster in older adults. J Pain 9 suppl 1: S31–36.CrossRefGoogle Scholar
22Lang, PO, Michel, JP. Herpes zoster vaccine: What are the potential benefits for the ageing and older adults? Eur Geriatr Med 2011; 2: 134–39.CrossRefGoogle Scholar
23Pentikis, HS, Matson, M, Atiee, G, Boehlecke, B, Hutchins, JT, Patti, JMet al.Pharmacokinetics and safety of FV-100, a novel oral anti-herpes zoster nucleoside analogue, administered in single and multiple doses to healthy young adult and elderly adult volunteers. Antimicrob Agents Chemotherapy 2011; 55: 2847–54.CrossRefGoogle ScholarPubMed
24Lang, PO, Pautex, S, Belmin, J, Michel, JP. Herpes zoster-related pain in aged individuals: How to manage it safely. Eur Geriatr Med 2010; 1: 273–78.CrossRefGoogle Scholar
25Gilden, D. Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia. J Internal Med 2011; 269: 496–506.CrossRefGoogle ScholarPubMed
26Brisson, M, Gay, NJ, Edmunds, WJ, Andrews, NJ. Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chickenpox. Vaccine 2002; 20: 2500–7.CrossRefGoogle ScholarPubMed
27van Hoek, AJ, Melegaro, A, Zagheni, E, Edmunds, WJ, Gay, N. Modelling the impact of a combined varicella and zoster vaccination programme on the epidemiology of varicella zoster virus in England. Vaccine 2011; 29: 2411–20.CrossRefGoogle ScholarPubMed
28Steiner, I, Kennedy, PG, Pachner, AR. The neurotropic herpes viruses: herpes simplex and varicella-zoster. Lancet Neurology 2007; 6: 1015–28.CrossRefGoogle ScholarPubMed
29Whitley, RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res 2006; 71: 141–48.CrossRefGoogle ScholarPubMed
30Puchhammer-Stockl, E, Aberle, SW, Heinzl, H. Association of age and gender with alphaherpesvirus infections of the central nervous system in the immunocompetent host. J Clinical Virol 2012; 53: 356–59.CrossRefGoogle ScholarPubMed
31Koskiniemi, M, Piiparinen, H, Mannonen, L, Rantalaiho, T, Vaheri, A. Herpes encephalitis is a disease of middle aged and elderly people: polymerase chain reaction for detection of herpes simplex virus in the CSF of 516 patients with encephalitis. The Study Group. J Neurol Neurosurg Psychiat 1996; 60: 174–78.CrossRefGoogle ScholarPubMed
32Riera-Mestre, A, Requena, A, Martinez-Yelamos, S, Cabellos, C, Fernandez-Viladrich, P. Herpes simplex encephalitis in older adults. J Am Geriatr Soc 2010; 58: 201–2.CrossRefGoogle ScholarPubMed
33Solomon, T, Michael, BD, Smith, PE, Sanderson, F, Davies, NW, Hart, IJet al.Management of suspected viral encephalitis in adults. Association of British Neurologists and British Infection Association National Guidelines. J Infection 2012; 64: 347–73.CrossRefGoogle Scholar
34Domingues, RB, Fink, MC, Tsanaclis, AM, de Castro, CC, Cerri, GG, Mayo, MSet al.Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci 1998; 157: 48–53.CrossRefGoogle ScholarPubMed
35Stowe, RP, Kozlova, EV, Yetman, DL, Walling, DM, Goodwin, JS, Glaser, R. Chronic herpesvirus reactivation occurs in aging. Exp Gerontol 2007; 42: 563–70.CrossRefGoogle ScholarPubMed
36Auwaerter, PG. Infectious mononucleosis in middle age. JAMA 1999; 281: 454–59.CrossRefGoogle ScholarPubMed
37Horwitz, CA, Henle, W, Henle, G, Schapiro, R, Borken, S, Bundtzen, R. Infectious mononucleosis in patients aged 40 to 72 years: report of 27 cases, including 3 without heterophil-antibody responses. Medicine 1983; 62: 256–62.CrossRefGoogle ScholarPubMed
38Castillo, JJ, Beltran, BE, Miranda, RN, Paydas, S, Winer, ES, Butera, JN. Epstein-barr virus-positive diffuse large B-cell lymphoma of the elderly: what we know so far. Oncologist 2011; 16: 87–96.CrossRefGoogle ScholarPubMed
39Staras, SA, Dollard, SC, Radford, KW, Flanders, WD, Pass, RF, Cannon, MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988–1994. Clinical Infectious Diseases 2006; 43: 1143–51.CrossRefGoogle ScholarPubMed
40Justo, D, Finn, T, Atzmony, L, Guy, N, Steinvil, A. Thrombosis associated with acute cytomegalovirus infection: a meta-analysis. Eur J Internal Med 2011; 22: 195–99.CrossRefGoogle ScholarPubMed
41Bennett, JM, Glaser, R, Malarkey, WB, Beversdorf, DQ, Peng, J, Kiecolt-Glaser, JK. Inflammation and reactivation of latent herpesviruses in older adults. Brain Behavior Immunity 2012; 26: 739–46.CrossRefGoogle ScholarPubMed
42Bhavan, KP, Kampalath, VN, Overton, ET. The aging of the HIV epidemic. Curr HIV/AIDS Rep 2008; 5: 150–58.CrossRefGoogle ScholarPubMed
43Pratt, G, Gascoyne, K, Cunningham, K, Tunbridge, A. Human immunodeficiency virus (HIV) in older people. Age Ageing 2010; 39: 289–94.CrossRefGoogle ScholarPubMed
44Asboe, D, Aitken, C, Boffito, M, Booth, C, Cane, P, Fakoya, Aet al.British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011. HIV Medicine 2012; 13: 1–44.CrossRefGoogle ScholarPubMed
45Health Protection Agency. HIV in the United Kingdom: 2011 Report. London: Health Protection Services, Colindale. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317131685847 (accessed December 2012).Google Scholar
46Effros, RB, Fletcher, CV, Gebo, K, Halter, JB, Hazzard, WR, Horne, FMet al.Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clinical Infectious Diseases 2008; 47: 542–53.CrossRefGoogle ScholarPubMed
47Sankar, A, Nevedal, A, Neufeld, S, Berry, R, Luborsky, M. What do we know about older adults and HIV? A review of social and behavioral literature. AIDS Care 2011; 23: 1187–207.CrossRefGoogle ScholarPubMed
48Zhao, H, Goetz, MB. Complications of HIV infection in an ageing population: challenges in managing older patients on long-term combination antiretroviral therapy. J Antimicrob Chemother 2011; 66: 1210–14.CrossRefGoogle Scholar
49Carrion, AF, Martin, P. Viral hepatitis in the elderly. Am J Gastroenterol 2012; 107: 691–97.CrossRefGoogle ScholarPubMed
50Smith, BD, Morgan, RL, Beckett, GA, Falck-Ytter, Y, Holtzman, D, Teo, CGet al.Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Reports 2012; 61 (RR-4): 1–32.Google ScholarPubMed
51Calvaruso, V, Craxi, A. 2011 European Association of the Study of the Liver hepatitis C virus clinical practice guidelines. Liver Int 2012; 32: 2–8.CrossRefGoogle Scholar
52Ly, KN, Xing, J, Klevens, RM, Jiles, RB, Ward, JW, Holmberg, SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Annals Internal Med 2012; 156: 271–78.CrossRefGoogle ScholarPubMed
53Duberg, A-S, Torner, A, Davidsdottir, L, Aleman, S, Blaxhult, A, Svensson, Aet al.Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study. J Viral Hepatitis 2008; 15: 538–50.CrossRefGoogle ScholarPubMed
54Zignego, AL, Ferri, C, Pileri, SA, Caini, P, Bianchi, FB. Extrahepatic manifestations of Hepatitis C Virus infection: a general overview and guidelines for a clinical approach. Digestive Liver Dis 2007; 39: 2–17.CrossRefGoogle ScholarPubMed
55Roche, B, Samuel, D. The difficulties of managing severe hepatitis B virus reactivation. Liver Int 2011; 31 suppl 1: 104–10.CrossRefGoogle ScholarPubMed
56Leder, K, Weller, PF, Wilson, ME. Travel vaccines and elderly persons: review of vaccines available in the United States. Clinical Infectious Diseases 2001; 33: 1553–66.CrossRefGoogle ScholarPubMed
57Genton, B, D'Acremont, V, Furrer, H-J, Hatz, C, Loutan, L. Hepatitis A vaccines and the elderly. Travel Med Infectious Dis 2006; 4: 303–12.CrossRefGoogle ScholarPubMed
58Travel Trends – Section 5 UK Residents Visits Abroad, 2011. Office for National Statistics.Google Scholar
59Brotherton, JM, Delpech, VC, Gilbert, GL, Hatzi, S, Paraskevopoulos, PD, McAnulty, JM. A large outbreak of influenza A and B on a cruise ship causing widespread morbidity. Epidemiol Infection 2003; 130: 263–71.CrossRefGoogle Scholar
60Staples JE, Gershman M, Fischer M, Centers for Disease Prevention. Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59 (RR-7): 1–27.Google Scholar
61Bouree, P. Immunity and immunization in elderly. Pathologie Biologie 2003; 51: 581–85.CrossRefGoogle ScholarPubMed