Quarleri J, Delpino MV. Respiratory syncytial virus in cirrhosis: Time to separate data from dogma? World J Hepatol 2026; 18(5): 118665 [DOI: 10.4254/wjh.v18.i5.118665]
Corresponding Author of This Article
Jorge Quarleri, PhD, Principal Investigator, Senior Researcher, Tenured Professor, Instituto de Investigaciones Biomédicas en Retrovirus y Sida, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Paraguay 2155, Buenos Aires C1121ABG, Argentina. quarleri@fmed.uba.ar
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Virology
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Quarleri J, Delpino MV. Respiratory syncytial virus in cirrhosis: Time to separate data from dogma? World J Hepatol 2026; 18(5): 118665 [DOI: 10.4254/wjh.v18.i5.118665]
World J Hepatol. May 27, 2026; 18(5): 118665 Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.118665
Respiratory syncytial virus in cirrhosis: Time to separate data from dogma?
Jorge Quarleri, María Victoria Delpino
Jorge Quarleri, María Victoria Delpino, Instituto de Investigaciones Biomédicas en Retrovirus y Sida, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires C1121ABG, Argentina
Author contributions: Quarleri J and Delpino MV contributed to this paper; Quarleri J designed the overall concept and outline of the manuscript; Delpino MV contributed to the discussion and design of the manuscript; Quarleri J and Delpino MV contributed to the writing and editing of the manuscript, and review of the literature.
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Corresponding author: Jorge Quarleri, PhD, Principal Investigator, Senior Researcher, Tenured Professor, Instituto de Investigaciones Biomédicas en Retrovirus y Sida, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Paraguay 2155, Buenos Aires C1121ABG, Argentina. quarleri@fmed.uba.ar
Received: January 8, 2026 Revised: January 16, 2026 Accepted: February 6, 2026 Published online: May 27, 2026 Processing time: 138 Days and 15.3 Hours
Abstract
Respiratory syncytial virus (RSV) vaccination recommendations now include adults with chronic liver disease, but there is still limited direct evidence of increased RSV risk and benefit in cirrhosis. In a single Australian center, the rate of RSV-related hospitalization among cirrhotic patients was low (0.3% of 744 cases over 8 years)—lower than that for chronic obstructive pulmonary disease, chronic kidney disease, or heart failure, but similar to diabetes—and cirrhosis did not independently predict mortality among RSV-positive inpatients. These surprising findings challenge the use of RSV vaccine trial data, where liver disease was under-represented, and population models were limited by low event counts, questioning whether cirrhosis should be treated as a high-risk condition alongside better-documented cardiopulmonary comorbidities. Clinicians should have vaccination discussions on a case-by-case basis, considering age and comorbidities. Multicenter studies are urgently needed to define RSV burden, vaccine effectiveness, and decompensation risk in cirrhosis to justify policy decisions. This review argues for separating empirical data from pathophysiological assumptions in an era of expanding adult RSV prevention.
Core Tip: Although cirrhosis is frequently categorized as a high-risk condition for respiratory syncytial virus (RSV) infection in adults, direct evidence supporting this classification remains limited. Recent real-world data indicate that RSV-related hospitalizations among patients with cirrhosis are uncommon and not independently associated with increased mortality, in contrast to the well-established risk observed in cardiopulmonary and renal diseases. Consequently, current RSV vaccination recommendations for individuals with cirrhosis rely largely on extrapolation rather than robust cirrhosis-specific evidence. Until stronger data become available, RSV vaccination in cirrhosis should be individualized, considering age and co-morbidities, while prioritizing multicenter studies to better define true risk and clinical benefit.
