The clinical and chest radiographic features of respiratory syncy- tial virus-associated severe respiratory illness in hospitalised adults in South Africa, 2022 - 2023

<b>What the study adds.</b> This study identified a distinct clinical and radiographic profile of adults hospitalised with respiratory syncytial virus (RSV)-associated severe respiratory illness in South Africa, where HIV infection, post-tuberculosis lung disease (PTLD) and polysubstance induced lung damage were the predominant comorbidities, unlike traditional cardiometabolic risk profiles seen elsewhere. It also found characteristic chest radiographic features such as lobar and diffuse ground-glass opacifications in these patients.<b>Implications of the findings.</b> The findings suggest the need to expand RSV vaccination recommendation protocols to include younger adults with HIV and PTLD. They also highlight the importance of improving antimicrobial stewardship and developing better diagnostic tools to differentiate viral from bacterial infections. These findings are crucial in our high burden of disease setting.