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Objectives Respiratory syncytial virus (RSV) is one of the most important causes of lower respiratory tract illnesses. In this study, we examined the number and severity of RSV infections among adult patients. The underlying diseases and background information of patients with RSV were examined and compared with the patients with influenza.Design Retrospective cohort study.Setting Patients receiving tertiary care services in Kuopio University Hospital (KUH) district in Eastern Finland.Participants 725 patients (152 with RSV infection and 573 with influenza) treated in KUH between November 2017 and May 2018.Primary and secondary outcome measures Hospitalisation and mortality.Results Compared with influenza, RSV caused a more serious disease in terms of hospitalisation (84.2% vs 66.0%, p