Walia N, Lu I, Hannah N, Sood S. Evaluating cirrhosis and respiratory syncytial virus infection: Should we vaccinate? World J Hepatol 2026; 18(3): 114519 [DOI: 10.4254/wjh.v18.i3.114519]
Corresponding Author of This Article
Nicholas Hannah, BBiomedSc, MD, FRACP, Department of Gastroenterology and Hepatology, The Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Melbourne 3050, Victoria, Australia. nicholas.hannah2@mh.org.au
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Gastroenterology & Hepatology
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Retrospective Study
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Mar 27, 2026 (publication date) through Mar 26, 2026
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World Journal of Hepatology
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1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Walia N, Lu I, Hannah N, Sood S. Evaluating cirrhosis and respiratory syncytial virus infection: Should we vaccinate? World J Hepatol 2026; 18(3): 114519 [DOI: 10.4254/wjh.v18.i3.114519]
World J Hepatol. Mar 27, 2026; 18(3): 114519 Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.114519
Evaluating cirrhosis and respiratory syncytial virus infection: Should we vaccinate?
Nirbaanjot Walia, Irene Lu, Nicholas Hannah, Siddharth Sood
Nirbaanjot Walia, Irene Lu, Nicholas Hannah, Siddharth Sood, Department of Gastroenterology and Hepatology, Northern Health, Melbourne 3076, Victoria, Australia
Nicholas Hannah, Department of Gastroenterology and Hepatology, The Royal Melbourne Hospital, Melbourne Health, Melbourne 3050, Victoria, Australia
Nicholas Hannah, Siddharth Sood, Department of Medicine, University of Melbourne, Melbourne 3010, Victoria, Australia
Author contributions: Walia N and Sood S were responsible for study conceptualization, design and data collection; Walia N was responsible for data analysis; Walia N, Lu I, Hannah N, and Sood S were involved in data interpretation. All others contributed to manuscript preparation, review and have approved the final manuscript.
Institutional review board statement: The study received approval from the Northern Health Research Development and Governance Unit (approval No. 63.2024).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Additional data may be made available on request to the corresponding author.
Corresponding author: Nicholas Hannah, BBiomedSc, MD, FRACP, Department of Gastroenterology and Hepatology, The Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Melbourne 3050, Victoria, Australia. nicholas.hannah2@mh.org.au
Received: September 22, 2025 Revised: October 22, 2025 Accepted: January 4, 2026 Published online: March 27, 2026 Processing time: 185 Days and 17.2 Hours
Abstract
BACKGROUND
Respiratory syncytial virus (RSV) is a common respiratory infection with significant morbidity and mortality amongst patients with certain comorbidities. A vaccination for RSV has recently been developed and is being considered in patients with cirrhosis given its association with an immunocompromised state. There is a paucity of research, however, evaluating the risks of RSV in cirrhosis.
AIM
To assess the burden of RSV in cirrhosis and compare it to other conditions included in vaccination recommendations.
METHODS
We performed a retrospective, single-center study at an Australian tertiary hospital from 2017 to 2024. Patients hospitalised with RSV and either cirrhosis, ischaemic heart disease, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, obesity and diabetes were identified using International Statistical Classification of Diseases codes. Prevalence of RSV alongside co-morbidities was documented, and predictors of in-hospital mortality among RSV-positive patients were assessed using multivariable logistic regression.
RESULTS
Among 163 patients hospitalised with RSV, two had cirrhosis (1.2%). In contrast, a higher proportion had other comorbidities. Of 744 individual patients with cirrhosis known to our service over the 8-year study period, 0.3% were hospitalised with RSV. This was higher than obesity (0.0%), ischaemic heart disease (0.1%) and diabetes (0.2%), but lower than congestive heart failure (0.5%), chronic obstructive pulmonary disease (0.7%) and chronic kidney disease (0.7%). Of 50 RSV-positive patients died during their admission, including one patient with cirrhosis. Independent risk factors for inpatient mortality included age (odds ratio: 1.05, 95% confidence interval: 1.02-1.09, P < 0.001) and diabetes (odds ratio: 2.19, 95% confidence interval: 1.01-4.84, P = 0.049), but not cirrhosis.
CONCLUSION
The burden of RSV amongst patients with cirrhosis appears to be low, but may be higher than other at-risk conditions. Further population-level data is required to inform RSV vaccination strategies.
Core Tip: Respiratory syncytial virus (RSV) is an increasingly recognised cause of hospitalisation in adults, but its impact in patients with cirrhosis remains poorly defined. In this hospital-based study, RSV-related admissions among patients with cirrhosis were relatively infrequent and were not associated with the degree of healthcare utilisation or mortality observed in several other chronic disease groups. These findings suggest that the burden of RSV in cirrhosis requires further evaluation, and further research is required on the relationship between RSV and cirrhosis to help inform vaccination strategies.
