101
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Vittucci AC, Zangari P, Ciarlitto C, Di Camillo C, Grandin A, Cotugno N, Marchili MR, Villani A. Active prophylaxis for respiratory syncytial virus: current knowledge and future perspectives. Minerva Pediatr 2018; 70:566-578. [PMID: 30334621 DOI: 10.23736/s0026-4946.18.05305-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common respiratory pathogen in infants and young children but represents also an important cause of morbidity in adults, particularly in the elderly and immunocompromised persons. Despite its global impact on human health, no effective treatment is available except for supportive care and no safe vaccine has been licensed yet. Vaccine development has been hindered by several factors including vaccine enhanced disease associated with formalin-inactivated RSV vaccine, ethical concerns and lack of consensus concerning the most appropriate target antigen. In this review, we analyze history of RSV vaccine and current approaches for preventing RSV including live-attenuated, vector-based, subunit, nucleic acid-based, particle-based vaccines and we debate about concerns on target population, correlates of protection and obstacles that are slowing the progress toward a successful RSV vaccination strategy.
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Affiliation(s)
- Anna C Vittucci
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy -
| | - Paola Zangari
- Congenital and Perinatal Infections Research Unit, Division of Immune and Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | | | - Chiara Di Camillo
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Annalisa Grandin
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Nicola Cotugno
- Congenital and Perinatal Infections Research Unit, Division of Immune and Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Maria R Marchili
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Alberto Villani
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
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102
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Abstract
Respiratory syncytial virus (RSV) infection in infants is a major cause of morbidity and mortality worldwide. Despite intense research efforts, safe and effective vaccines have remained elusive. Risk factors for the development of severe disease are well known, and those infants at highest risk are identified to receive RSV prophylaxis in the form of anti-RSV monoclonal antibody. Still, many other infant groups remain at risk and could benefit from an effective RSV prevention program. An explosion of clinic research activity is bringing unprecedented progress. Several of the most promising approaches currently being evaluated in clinical trials are reviewed. [Pediatr Ann. 2018;47(9):e371-e376.].
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103
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Song JY, Lim JH, Lim S, Yong Z, Seo HS. Progress toward a group B streptococcal vaccine. Hum Vaccin Immunother 2018; 14:2669-2681. [PMID: 29995578 PMCID: PMC6314413 DOI: 10.1080/21645515.2018.1493326] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/18/2018] [Accepted: 06/19/2018] [Indexed: 01/31/2023] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) is a leading cause of severe invasive disease in neonate, elderly, and immunocompromised patients worldwide. Despite recent advances in the diagnosis and intrapartum antibiotic prophylaxis (IAP) of GBS infections, it remains one of the most common causes of neonatal morbidity and mortality, causing serious infections. Furthermore, recent studies reported an increasing number of GBS infections in pregnant women and elderly. Although IAP is effective, it has several limitations, including increasing antimicrobial resistance and late GBS infection after negative antenatal screening. Maternal immunization is the most promising and effective countermeasure against GBS infection in neonates. However, no vaccine is available to date, but two types of vaccines, protein subunit and capsular polysaccharide conjugate vaccines, were investigated in clinical trials. Here, we provide an overview of the GBS vaccine development status and recent advances in the development of immunoassays to evaluate the GBS vaccine clinical efficacy.
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Affiliation(s)
- Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyang Lim
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sangyong Lim
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon, Republic of Korea
| | - Zhi Yong
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon, Republic of Korea
| | - Ho Seong Seo
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon, Republic of Korea
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104
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Scheltema NM, Kavelaars XM, Thorburn K, Hennus MP, van Woensel JB, van der Ent CK, Borghans JAM, Bont LJ, Drylewicz J. Potential impact of maternal vaccination on life-threatening respiratory syncytial virus infection during infancy. Vaccine 2018; 36:4693-4700. [PMID: 29941327 DOI: 10.1016/j.vaccine.2018.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection is an important cause of infant mortality. Here, we estimated the potential impact of maternal vaccination against RSV on life-threatening RSV infection in infants. METHODS We developed a mathematical model for maternal vaccine-induced antibody dynamics and used characteristics of a maternal RSV vaccine currently in phase 3 of clinical development. The model was applied to data from two cohorts of children younger than 12 months with RSV-related paediatric intensive care unit (PICU) admission in the United Kingdom (n = 370) and the Netherlands (n = 167), and a cohort of 211 children younger than 12 months with RSV-related in-hospital death from 20 countries worldwide. RESULTS Our model predicted that, depending on vaccine efficiency, maternal vaccination at 30 weeks' gestational age could have prevented 62-75% of RSV-related PICU admissions in the United Kingdom and 76-87% in the Netherlands. For the global mortality cohort, the model predicted that maternal vaccination could have prevented 29-48% of RSV-related in-hospital deaths. Preterm children and children with comorbidities were predicted to benefit less than (healthy) term children. CONCLUSIONS Maternal vaccination against RSV may substantially decrease life-threatening RSV infections in infants.
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Affiliation(s)
- Nienke M Scheltema
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Xynthia M Kavelaars
- Department of Methods and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Kentigern Thorburn
- Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Marije P Hennus
- Department of Paediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Job B van Woensel
- Department of Paediatric Intensive Care, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Cornelis K van der Ent
- Department of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands
| | - José A M Borghans
- Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands.
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105
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Abstract
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections and causes up to 200,000 infant deaths a year worldwide. The average rate of hospitalization for severe RSV infection is 5 per 1000 children, and the rate is three-times higher in those with congenital heart disease (CHD). Palivizumab, a monoclonal antibody, reduces hospitalization rates and intensive care admissions. It is used prophylactically and is administered as monthly doses during the RSV season. Hemodynamically unstable CHD is the most susceptible CHD to a severe episode of RSV infection. This review explores current evidence surrounding therapies, patterns of infection and identifies groups which may still be vulnerable to severe RSV infection.
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Affiliation(s)
- Manjiri Joshi
- Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Robert M Tulloh
- Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
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106
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Human respiratory syncytial virus: pathogenesis, immune responses, and current vaccine approaches. Eur J Clin Microbiol Infect Dis 2018; 37:1817-1827. [PMID: 29876771 DOI: 10.1007/s10096-018-3289-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/22/2018] [Indexed: 10/14/2022]
Abstract
Respiratory syncytial virus continues to pose a serious threat to the pediatric populations worldwide. With a genomic makeup of 15,200 nucleotides, the virus encodes for 11 proteins serving as envelope spikes, inner envelope proteins, and non-structural and ribonucleocapsid complexes. The fusion (F) and attachment (G) surface glycoproteins are the key targets for neutralizing antibodies. The highly variable G with altered glycosylations and the conformational alternations of F create challenges for vaccine development. The metastable F protein is responsible for RSV-host cell fusion and thus infectivity. Novel antigenic sites were identified on this form following its stabilization and solving its crystal structure. Importantly, site ø displays neutralizing activity exceeding those of post-F-specific and shared antigenic sites, such as site II which is the target for Palivizumab therapeutic antibody. Induction of high neutralizing antibody responses by pre-F immunization in animal models promoted it as a major vaccine candidate. Since RSV infection is more serious at age extremities and in individuals with undermining health conditions, vaccines are being developed to target these populations. Infants below three months of age have a suppressive immune system, making vaccines' immunogenicity weak. Therefore, a suggested strategy to protect newborns from RSV infection would be through passive immunity of maternal antibodies. Hence, pregnant women at their third trimester have been selected as an ideal target for vaccination with RSV pre-F vaccine. This review summarizes the different modes of RSV pathogenesis and host's immune response to the infection, and illustrates on the latest updates of vaccine development and vaccination approaches.
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107
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Vojtek I, Dieussaert I, Doherty TM, Franck V, Hanssens L, Miller J, Bekkat-Berkani R, Kandeil W, Prado-Cohrs D, Vyse A. Maternal immunization: where are we now and how to move forward? Ann Med 2018; 50:193-208. [PMID: 29308916 DOI: 10.1080/07853890.2017.1421320] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pregnancy and the postpartum period are associated with elevated risks to both mother and infant from infectious disease. Vaccination of pregnant women, also called maternal immunization, has the potential to protect pregnant women, foetuses and infants from several vaccine-preventable diseases. Maternal immunoglobulin G antibodies are actively transferred through the placenta to provide passive immunity to new-borns during the first months of life, until the time for infant vaccinations or until the period of greatest susceptibility has passed. Currently, inactivated influenza, tetanus, and pertussis vaccines are recommended during pregnancy in many countries, but other vaccines may also be administered to pregnant women when risk factors are present. Several new vaccines with a specific indication for use during pregnancy are under development (e.g. respiratory syncytial virus and group B streptococcus vaccines). Years of experience suggest that maternal immunization against influenza, tetanus or pertussis has an acceptable safety profile, is well tolerated, effective and confers significant benefits to pregnant women and their infants. This review describes the principles of maternal immunization and provides an update of the recent evidence regarding the use and timing of maternal immunization. Finally, the barriers preventing wider vaccination coverage and the current limitations in addressing these are also described ( Supplementary Material ). Key messages Maternal immunization gives pregnant women greater protection against infectious diseases; induces high levels of maternal antibodies that can be transferred to the foetus; and helps protect new-borns during their first months of life, until they are old enough to be vaccinated. Pregnant women and new-borns are more vulnerable to infectious diseases than the overall population; nevertheless, vaccination rates are often low in pregnant women. This review provides an update of the recent evidence regarding the use and timing of maternal immunization and describes the barriers preventing wider vaccination uptake and the current limitations in addressing these.
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Affiliation(s)
- Ivo Vojtek
- a R&D Department , GSK , Wavre , Belgium
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108
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Chatzis O, Darbre S, Pasquier J, Meylan P, Manuel O, Aubert JD, Beck-Popovic M, Masouridi-Levrat S, Ansari M, Kaiser L, Posfay-Barbe KM, Asner SA. Burden of severe RSV disease among immunocompromised children and adults: a 10 year retrospective study. BMC Infect Dis 2018; 18:111. [PMID: 29510663 PMCID: PMC5838875 DOI: 10.1186/s12879-018-3002-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) recipients, with less known about other immunocompromised patients. Methods Ten-year retrospective cohort study of immunocompromised patients presenting with RSV disease documented at University Hospitals of Lausanne and Geneva. Severe RSV-related outcomes referred to RSV documented respiratory conditions requiring hospital admission, presenting as lower respiratory tract infection (LRTI) or pneumonia. We used multivariable logistic regression to assess clinical and laboratory correlates of severe RSV disease. Results From 239 RSV-positive immunocompromised in and out-patients 175 were adults and 64 children of whom 111 (47.8%) presented with LRTI, which resulted in a 38% (89/239) admission rate to hospital. While immunocompromised children were more likely to be admitted to hospital compared to adults (75% vs 62.9%, p = 0.090), inpatients admitted to the intensive care unit (17/19) or those who died (11/11) were mainly adults. From multivariable analyses, adults with solid tumors (OR 5.2; 95% CI: 1.4–20.9 P = 0.015) or those requiring chronic immunosuppressive treatments mainly for rheumatologic conditions (OR 4.1; 95% CI: 1.1–16.0; P = 0.034) were significantly more likely to be admitted to hospital compared to hematopoietic stem cell (HSCT) recipients. Bacterial co-infection was significantly and consistently associated with viral LRTI and pneumonia. Conclusions From our findings, RSV-related disease results in a significant burden among adults requiring chronic immunosuppressive treatments for rheumatological conditions and those with solid tumors. As such, systematic screening for respiratory viruses, should be extended to other immunocompromised populations than HSCT recipients. Electronic supplementary material The online version of this article (10.1186/s12879-018-3002-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Chatzis
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephanie Darbre
- Department of Paediatrics, Paediatric Infectious Disease Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
| | - Pascal Meylan
- Department of Laboratories, Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Department of Medicine, Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Surgery, Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - John David Aubert
- Unit of Pulmonary transplantation, Pulmonology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Department of Pediatrics, Paediatric Hematology and Oncology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Marc Ansari
- Paediatric Hematology and Oncology Unit, Division of General Pediatrics, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Department of Medicine, Infectious Diseases Service, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Genetical and Laboratory Medicine, Virology Laboratory, Laboratory Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandra A Asner
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Medicine, Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland. .,Department of Pediatrics, Pediatric Infectious Disease Unit, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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109
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Bayer L, Fertey J, Ulbert S, Grunwald T. Immunization with an adjuvanted low-energy electron irradiation inactivated respiratory syncytial virus vaccine shows immunoprotective activity in mice. Vaccine 2018; 36:1561-1569. [DOI: 10.1016/j.vaccine.2018.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 12/23/2022]
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110
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Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA, Groome MJ, Cohen C, Moyes J, Thorburn K, Thamthitiwat S, Oshitani H, Lupisan SP, Gordon A, Sánchez JF, O'Brien KL, Gessner BD, Sutanto A, Mejias A, Ramilo O, Khuri-Bulos N, Halasa N, de-Paris F, Pires MR, Spaeder MC, Paes BA, Simões EAF, Leung TF, da Costa Oliveira MT, de Freitas Lázaro Emediato CC, Bassat Q, Butt W, Chi H, Aamir UB, Ali A, Lucero MG, Fasce RA, Lopez O, Rath BA, Polack FP, Papenburg J, Roglić S, Ito H, Goka EA, Grobbee DE, Nair H, Bont LJ. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series. LANCET GLOBAL HEALTH 2018; 5:e984-e991. [PMID: 28911764 PMCID: PMC5599304 DOI: 10.1016/s2214-109x(17)30344-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/11/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023]
Abstract
Background Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data. Methods In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms “RSV”, “respiratory syncytial virus”, or “respiratory syncytial viral” combined with “mortality”, “fatality”, “death”, “died”, “deaths”, or “CFR” for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables. Findings We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3–11·0) in low-income or lower middle-income countries, 4·0 years (2·0–10·0) in upper middle-income countries, and 7·0 years (3·6–16·8) in high-income countries. Interpretation This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nienke M Scheltema
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Angela Gentile
- Department of Epidemiology, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Florencia Lucion
- Department of Epidemiology, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - D James Nokes
- Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK
| | - Patrick K Munywoki
- Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Nursing Sciences, Pwani University, Kilifi, Kenya
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle J Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kentigern Thorburn
- Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, UK
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
| | - Socorro P Lupisan
- Research Institute for Tropical Medicine, Alabang Muntinlupa City, Metro Manila Philippines
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, MI, USA
| | - José F Sánchez
- Department of Medicine, Hospital Infantil Manuel de Jesus Rivera, Managua, Nicaragua
| | - Katherine L O'Brien
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Asuncion Mejias
- Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus, OH, USA; Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Octavio Ramilo
- Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus, OH, USA; Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Najwa Khuri-Bulos
- Department of Pediatrics, University of Jordan, Aljubeiha, Amman, Jordan
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fernanda de-Paris
- Molecular Biology Laboratory, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil
| | - Márcia Rosane Pires
- Infection Control Commission, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil
| | - Michael C Spaeder
- Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bosco A Paes
- Neonatal Division, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Eric A F Simões
- Department of Pediatrics and Center for Global Health, University of Colorado, Aurora, CO, USA
| | - Ting F Leung
- Department of Paediatrics, Faculty of Medicine and Chinese University of Hong Kong-University Medical Center Utrecht Joint Research Laboratory of Respiratory Virus and Immunobiology, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | | | | | - Quique Bassat
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Warwick Butt
- Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Hsin Chi
- Department of Pediatric Infectious Disease, MacKay Children's Hospital, Taipei, Taiwan
| | - Uzma Bashir Aamir
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Alabang Muntinlupa City, Metro Manila Philippines
| | | | - Olga Lopez
- Hospital Dr. Ernesto Torres Galdames, Iquique, Chile
| | - Barbara A Rath
- Vienna Vaccine Safety Initiative, Berlin, Germany; University of Nottingham School of Medicine, Nottingham, UK
| | | | - Jesse Papenburg
- Department of Microbiology, Division of Pediatric Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Srđan Roglić
- Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Hisato Ito
- Department of Pediatrics, Nantan General Hospital, Ueno, Yagichoyagi, Nantan-shi, Kyoto, Japan
| | - Edward A Goka
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Julius Clinical Science, Zeist, Netherlands
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Louis J Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands; ReSViNET Respiratory Syncytial Virus Network, Utrecht, Netherlands.
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111
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Pangesti KNA, Abd El Ghany M, Walsh MG, Kesson AM, Hill-Cawthorne GA. Molecular epidemiology of respiratory syncytial virus. Rev Med Virol 2018; 28. [PMID: 29377415 DOI: 10.1002/rmv.1968] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 01/10/2023]
Abstract
Respiratory syncytial virus (RSV) is a major cause of viral acute respiratory tract infections in young children. The virus is characterised by distinct seasonality that is dependent upon the latitude and its ability to cause reinfection. Respiratory syncytial virus demonstrates a complex molecular epidemiology pattern as multiple strains and/or genotypes cocirculate during a single epidemic. Previous studies have investigated the relationship between RSV genetic diversity, reinfection, and clinical features. Here, we review the evidence behind this relationship together with the impact that the advancement of whole genome sequencing will have upon our understanding and the need for reconsidering the classification of RSV genotypes.
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Affiliation(s)
| | - Moataz Abd El Ghany
- Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - Michael G Walsh
- Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - Alison M Kesson
- Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
| | - Grant A Hill-Cawthorne
- School of Public Health, The University of Sydney, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
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112
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Attenuated Human Parainfluenza Virus Type 1 Expressing the Respiratory Syncytial Virus (RSV) Fusion (F) Glycoprotein from an Added Gene: Effects of Prefusion Stabilization and Packaging of RSV F. J Virol 2017; 91:JVI.01101-17. [PMID: 28835504 DOI: 10.1128/jvi.01101-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/21/2017] [Indexed: 11/20/2022] Open
Abstract
Human respiratory syncytial virus (RSV) is the most prevalent worldwide cause of severe respiratory tract infection in infants and young children. Human parainfluenza virus type 1 (HPIV1) also causes severe pediatric respiratory illness, especially croup. Both viruses lack vaccines. Here, we describe the preclinical development of a bivalent RSV/HPIV1 vaccine based on a recombinant HPIV1 vector, attenuated by a stabilized mutation, that expresses RSV F protein modified for increased stability in the prefusion (pre-F) conformation by previously described disulfide bond (DS) and hydrophobic cavity-filling (Cav1) mutations. RSV F was expressed from the first or second gene position as the full-length protein or as a chimeric protein with its transmembrane and cytoplasmic tail (TMCT) domains substituted with those of HPIV1 F in an effort to direct packaging in the vector particles. All constructs were recovered by reverse genetics. The TMCT versions of RSV F were packaged in the rHPIV1 particles much more efficiently than their full-length counterparts. In hamsters, the presence of the RSV F gene, and in particular the TMCT versions, was attenuating and resulted in reduced immunogenicity. However, the vector expressing full-length RSV F from the pre-N position was immunogenic for RSV and HPIV1. It conferred complement-independent high-quality RSV-neutralizing antibodies at titers similar to those of wild-type RSV and provided protection against RSV challenge. The vectors exhibited stable RSV F expression in vitro and in vivo In conclusion, an attenuated rHPIV1 vector expressing a pre-F-stabilized form of RSV F demonstrated promising immunogenicity and should be further developed as an intranasal pediatric vaccine.IMPORTANCE RSV and HPIV1 are major viral causes of acute pediatric respiratory illness for which no vaccines or suitable antiviral drugs are available. The RSV F glycoprotein is the major RSV neutralization antigen. We used a rHPIV1 vector, bearing a stabilized attenuating mutation, to express the RSV F glycoprotein bearing amino acid substitutions that increase its stability in the pre-F form, the most immunogenic form that elicits highly functional virus-neutralizing antibodies. RSV F was expressed from the pre-N or N-P gene position of the rHPIV1 vector as a full-length protein or as a chimeric form with its TMCT domain derived from HPIV1 F. TMCT modification greatly increased packaging of RSV F into the vector particles but also increased vector attenuation in vivo, resulting in reduced immunogenicity. In contrast, full-length RSV F expressed from the pre-N position was immunogenic, eliciting complement-independent RSV-neutralizing antibodies and providing protection against RSV challenge.
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113
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Tang JW, Lam TT, Zaraket H, Lipkin WI, Drews SJ, Hatchette TF, Heraud JM, Koopmans MP. Global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance. THE LANCET. INFECTIOUS DISEASES 2017; 17:e320-e326. [PMID: 28457597 PMCID: PMC7164797 DOI: 10.1016/s1473-3099(17)30238-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 01/13/2023]
Abstract
Together with influenza, the non-influenza RNA respiratory viruses (NIRVs), which include respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus, represent a considerable global health burden, as recognised by WHO's Battle against Respiratory Viruses initiative. By contrast with influenza viruses, little is known about the contemporaneous global diversity of these viruses, and the relevance of such for development of pharmaceutical interventions. Although far less advanced than for influenza, antiviral drugs and vaccines are in different stages of development for several of these viruses, but no interventions have been licensed. This scarcity of global genetic data represents a substantial knowledge gap and impediment to the eventual licensing of new antiviral drugs and vaccines for NIRVs. Enhanced genetic surveillance will assist and boost research and development into new antiviral drugs and vaccines for these viruses. Additionally, understanding the global diversity of respiratory viruses is also part of emerging disease preparedness, because non-human coronaviruses and paramyxoviruses have been listed as priority concerns in a recent WHO research and development blueprint initiative for emerging infectious diseases. In this Personal View, we explain further the rationale for expanding the genetic database of NIRVs and emphasise the need for greater investment in this area of research.
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Affiliation(s)
- Julian W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK; Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, UK.
| | - Tommy T Lam
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Beirut, Lebanon
| | - W Ian Lipkin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Steven J Drews
- Alberta Provincial Laboratory for Public Health, University of Alberta, Edmonton, AB, Canada
| | - Todd F Hatchette
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | | | - Marion P Koopmans
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, Netherlands
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114
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Hogan AB, Campbell PT, Blyth CC, Lim FJ, Fathima P, Davis S, Moore HC, Glass K. Potential impact of a maternal vaccine for RSV: A mathematical modelling study. Vaccine 2017; 35:6172-6179. [PMID: 28967522 DOI: 10.1016/j.vaccine.2017.09.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 11/16/2022]
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory morbidity and one of the main causes of hospitalisation in young children. While there is currently no licensed vaccine for RSV, a vaccine candidate for pregnant women is undergoing phase 3 trials. We developed a compartmental age-structured model for RSV transmission, validated using linked laboratory-confirmed RSV hospitalisation records for metropolitan Western Australia. We adapted the model to incorporate a maternal RSV vaccine, and estimated the expected reduction in RSV hospitalisations arising from such a program. The introduction of a vaccine was estimated to reduce RSV hospitalisations in Western Australia by 6-37% for 0-2month old children, and 30-46% for 3-5month old children, for a range of vaccine effectiveness levels. Our model shows that, provided a vaccine is demonstrated to extend protection against RSV disease beyond the first three months of life, a policy using a maternal RSV vaccine could be effective in reducing RSV hospitalisations in children up to six months of age, meeting the objective of a maternal vaccine in delaying an infant's first RSV infection to an age at which severe disease is less likely.
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Affiliation(s)
- Alexandra B Hogan
- Research School of Population Health, The Australian National University, 62 Mills Rd, The Australian National University, Acton ACT 2601, Australia.
| | - Patricia T Campbell
- Doherty Epidemiology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Infection and Immunity, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Rd, Parkville 3052, Victoria, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Princess Margaret Hospital for Children, Roberts Rd, Subiaco, Perth, WA 6008, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia; Department of Infectious Disease and PathWest Department of Microbiology, Princess Margaret Hospital for Children, Roberts Rd, Subiaco, WA 6008, Australia
| | - Faye J Lim
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia
| | - Stephanie Davis
- Research School of Population Health, The Australian National University, 62 Mills Rd, The Australian National University, Acton ACT 2601, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia
| | - Kathryn Glass
- Research School of Population Health, The Australian National University, 62 Mills Rd, The Australian National University, Acton ACT 2601, Australia
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115
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Midgley CM, Haynes AK, Baumgardner JL, Chommanard C, Demas SW, Prill MM, Abedi GR, Curns AT, Watson JT, Gerber SI. Determining the Seasonality of Respiratory Syncytial Virus in the United States: The Impact of Increased Molecular Testing. J Infect Dis 2017; 216:345-355. [PMID: 28859428 DOI: 10.1093/infdis/jix275] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/01/2017] [Indexed: 12/11/2022] Open
Abstract
Background In the United States, the seasonality of respiratory syncytial virus (RSV) has traditionally been defined on the basis of weeks during which antigen-based tests detect RSV in >10% of specimens (hereafter, the "10% threshold"). Because molecular testing has become more widely used, we explored the extent of polymerase chain reaction (PCR)-based RSV testing and its impact on determining the seasonality of RSV. Methods We assessed antigen- and PCR-based RSV reports submitted to the National Respiratory and Enteric Virus Surveillance System during July 2005-June 2015. To characterize RSV seasons by using PCR-based reports, we assessed the traditional 10% threshold; subsequently, we developed 3 methods based on either PCR-based detections or the percentage of positive test results. Results The annual number of PCR-based reports increased 200-fold during 2005-2015, while the annual number of antigen-based reports declined. The weekly percentage of specimens positive for RSV by PCR was less than that for antigen-detection tests; accordingly, the 10% threshold excluded detections by PCR and so was imprecise for characterizing RSV seasons. Among our PCR-specific approaches, the most sensitive and consistent method captured 96%-98% of annual detections within a season, compared with 82%-94% captured using the traditional method. Conclusions PCR-based reports are increasingly relevant for RSV surveillance and determining the seasonality of RSV. These PCR-specific methods provide a more comprehensive understanding of RSV trends, particularly in settings where testing and reporting are most active. Diagnostic practices will vary by locality and should be understood before choosing which method to apply.
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Affiliation(s)
- Claire M Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.,Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | | | - Jason L Baumgardner
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Sara W Demas
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mila M Prill
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Aaron T Curns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - John T Watson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
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116
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Shi T, McAllister DA, O'Brien KL, Simoes EAF, Madhi SA, Gessner BD, Polack FP, Balsells E, Acacio S, Aguayo C, Alassani I, Ali A, Antonio M, Awasthi S, Awori JO, Azziz-Baumgartner E, Baggett HC, Baillie VL, Balmaseda A, Barahona A, Basnet S, Bassat Q, Basualdo W, Bigogo G, Bont L, Breiman RF, Brooks WA, Broor S, Bruce N, Bruden D, Buchy P, Campbell S, Carosone-Link P, Chadha M, Chipeta J, Chou M, Clara W, Cohen C, de Cuellar E, Dang DA, Dash-Yandag B, Deloria-Knoll M, Dherani M, Eap T, Ebruke BE, Echavarria M, de Freitas Lázaro Emediato CC, Fasce RA, Feikin DR, Feng L, Gentile A, Gordon A, Goswami D, Goyet S, Groome M, Halasa N, Hirve S, Homaira N, Howie SRC, Jara J, Jroundi I, Kartasasmita CB, Khuri-Bulos N, Kotloff KL, Krishnan A, Libster R, Lopez O, Lucero MG, Lucion F, Lupisan SP, Marcone DN, McCracken JP, Mejia M, Moisi JC, Montgomery JM, Moore DP, Moraleda C, Moyes J, Munywoki P, Mutyara K, Nicol MP, Nokes DJ, Nymadawa P, da Costa Oliveira MT, Oshitani H, Pandey N, Paranhos-Baccalà G, Phillips LN, Picot VS, Rahman M, Rakoto-Andrianarivelo M, Rasmussen ZA, Rath BA, Robinson A, Romero C, Russomando G, Salimi V, Sawatwong P, Scheltema N, Schweiger B, Scott JAG, Seidenberg P, Shen K, Singleton R, Sotomayor V, Strand TA, Sutanto A, Sylla M, Tapia MD, Thamthitiwat S, Thomas ED, Tokarz R, Turner C, Venter M, Waicharoen S, Wang J, Watthanaworawit W, Yoshida LM, Yu H, Zar HJ, Campbell H, Nair H. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017; 390:946-958. [PMID: 28689664 PMCID: PMC5592248 DOI: 10.1016/s0140-6736(17)30938-8] [Citation(s) in RCA: 1504] [Impact Index Per Article: 214.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/07/2017] [Accepted: 03/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. METHODS We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. FINDINGS We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6-50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7-3·8) hospital admissions, and 59 600 (48 000-74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2-1·7) hospital admissions, and 27 300 (UR 20 700-36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600-149 400). Incidence and mortality varied substantially from year to year in any given population. INTERPRETATION Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MS, USA
| | | | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Evelyn Balsells
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sozinho Acacio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Martin Antonio
- Medical Research Council Unit The Gambia, Basse, The Gambia
| | - Shally Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow (UP), India
| | - Juliet O Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Eduardo Azziz-Baumgartner
- International Centre for Diarrhoeal Disease Research, Bangladesh; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vicky L Baillie
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alfredo Barahona
- Hospital Materno Infantil Jose Domingo de Obaldia, Ciudad De David, Chiriqui, Panama
| | - Sudha Basnet
- Center for International Health, University of Bergen, Norway; Department of Child Health, Tribhuvan University Institute of Medicine, Nepal
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; ICREA, Pg Lluís Companys 23, 08010 Barcelona, Spain
| | - Wilma Basualdo
- Hospital General Pediátrico Niños de Acosta Ñu, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Godfrey Bigogo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Louis Bont
- Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | | | - W Abdullah Brooks
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MS, USA; International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Shobha Broor
- All India Institute of Medical Sciences, New Delhi, India
| | - Nigel Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Dana Bruden
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centres for Disease Control and Prevention, Anchorage, AK, USA
| | - Philippe Buchy
- Institute Pasteur Cambodia, Children's Hospital Colorado, Aurora, CO, USA; GSK Vaccines Singapore, Children's Hospital Colorado, Aurora, CO, USA
| | - Stuart Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Phyllis Carosone-Link
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | | | | | - Monidarin Chou
- Rodolphe Merieux Laboratory, Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Wilfrido Clara
- Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Duc-Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Maria Deloria-Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MS, USA
| | - Mukesh Dherani
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tekchheng Eap
- Department of Pneumology, National Pediatric Hospital, Phnom Penh, Cambodia
| | | | | | | | | | - Daniel R Feikin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Angela Gentile
- Epidemiology Department, Austral University and Ricardo Gutiérrez Children Hospital, Argentina
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Doli Goswami
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MS, USA; International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Sophie Goyet
- Institute Pasteur Cambodia, Children's Hospital Colorado, Aurora, CO, USA
| | - Michelle Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Stephen R C Howie
- Medical Research Council Unit The Gambia, Basse, The Gambia; Department of Paediatrics, University of Auckland, Auckland, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jorge Jara
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Imane Jroundi
- ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Unit of Training and Research in Public Health, School of Medicine and Pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | | | | | - Karen L Kotloff
- Department of Pediatrics and Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Romina Libster
- Fundacion INFANT, Buenos Aires, Argentina; Vanderbilt University, Nashville, TN, USA; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Olga Lopez
- Hospital Dr Ernesto Torres Galdames, Iquique, Chile
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Florencia Lucion
- Epidemiology Department, Austral University and Ricardo Gutiérrez Children Hospital, Argentina
| | - Socorro P Lupisan
- Research Institute for Tropical Medicine-Department of Health, Philippines
| | - Debora N Marcone
- Centro de Educación Médica envestigaciones Clínicas "CEMIC", Argentina
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Mario Mejia
- Ministry of Public Health and Social Welfare, Guatemala
| | | | - Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - David P Moore
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cinta Moraleda
- ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick Munywoki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Pwani University, Kilifi, Kenya
| | | | - Mark P Nicol
- Division of Medical Microbiology, University of Cape Town and National Health Laboratory Services, South Africa
| | - D James Nokes
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK
| | | | | | - Histoshi Oshitani
- Tohoku University Graduate School of Medicine, Department of Virology, Miyagi Prefecture, Japan
| | - Nitin Pandey
- Department of Pediatrics, King George's Medical University, Lucknow (UP), India
| | - Gláucia Paranhos-Baccalà
- Emerging Pathofens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Lia N Phillips
- Emory University, Rollins School of Public Health, AT, USA
| | - Valentina Sanchez Picot
- Emerging Pathofens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | | | | | - Zeba A Rasmussen
- Fogarty International Center Division of International Epidemiology and Population Studies, NIH, Bethesda, MD, USA
| | - Barbara A Rath
- Department of Pediatrics, Charité University Medical Center, Berlin, Germany
| | | | - Candice Romero
- United States Naval Medical Research Unit No. 6, Callao, Peru
| | - Graciela Russomando
- Departamento de Biología Molecular y Genética, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asuncion, Paraguay
| | - Vahid Salimi
- School of Public Health, Virology Department, Tehran University of Medical Sciences, Iran
| | - Pongpun Sawatwong
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Nienke Scheltema
- Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | | | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK
| | - Phil Seidenberg
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kunling Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Beijing, China
| | - Rosalyn Singleton
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centres for Disease Control and Prevention, Anchorage, AK, USA; Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Tor A Strand
- Center for International Health, University of Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | | | | | - Milagritos D Tapia
- Department of Pediatrics and Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Somsak Thamthitiwat
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Elizabeth D Thomas
- Fogarty International Center Division of International Epidemiology and Population Studies, NIH, Bethesda, MD, USA
| | - Rafal Tokarz
- Centre for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA
| | - Claudia Turner
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Marietjie Venter
- Centre for Viral Zoonosis, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Sunthareeya Waicharoen
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Thailand
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Wanitda Watthanaworawit
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Heather J Zar
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK; Public Health Foundation of India, New Delhi, India.
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117
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Transplacental transfer of maternal respiratory syncytial virus (RSV) antibody and protection against RSV disease in infants in rural Nepal. J Clin Virol 2017; 95:90-95. [PMID: 28903080 PMCID: PMC5625849 DOI: 10.1016/j.jcv.2017.08.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most important viral cause of pneumonia in children. RSV-specific antibody (ab) protects infants from disease, and may be increased by a potential strategy of maternal RSV vaccination. OBJECTIVES To describe the effect of RSV antibody on RSV infection risk in infants in a resource-limited setting. STUDY DESIGN In a prospective study in Nepal, women were enrolled during pregnancy and maternal and infant cord blood were collected at birth. Weekly surveillance for respiratory illness was performed from birth to 180days. Nasal swabs were tested for RSV by PCR and serum was tested using an RSV antibody microneutralization assay. Antibody concentrations at time of RSV infection were estimated based on a decay rate of 0.026 log2/day. RESULTS Cord:maternal RSV antibody transfer ratio was 1.03 (0.88-1.19), with RSV antibody concentration of log2 11.3 and log2 11.7 in 310 paired maternal and infant samples, respectively. Cord blood RSV antibody was log2 12.1 versus 11.6 in those with or without RSV infection (P=0.86). Among infants with RSV infection, estimated RSV antibody concentration at time of infection did not differ in infants with upper (n=8; log2 10.7) versus lower respiratory tract infection (n=21; log2 9.8; P=0.37). Cord blood RSV antibody concentrations did not correlate with age at primary RSV infection (R=0.11; P=0.57). CONCLUSIONS Transplacental transfer of RSV antibody from mother to the fetus was highly efficient in mother-infant pairs in rural Nepal, though higher antibody concentrations were not protective against earlier or more severe RSV infection in infants.
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Stockwell MS, Cano M, Jakob K, Broder KR, Gyamfi-Bannerman C, Castaño PM, Lewis P, Barrett A, Museru OI, Castellanos O, LaRussa PS. Feasibility of Text Message Influenza Vaccine Safety Monitoring During Pregnancy. Am J Prev Med 2017; 53:282-289. [PMID: 28495223 PMCID: PMC6675451 DOI: 10.1016/j.amepre.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/20/2017] [Accepted: 03/16/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The feasibility and accuracy of text messaging to monitor events after influenza vaccination throughout pregnancy and the neonatal period has not been studied, but may be important for seasonal and pandemic influenza vaccines and future maternal vaccines. METHODS This prospective observational study was conducted during 2013-2014 and analyzed in 2015-2016. Enrolled pregnant women receiving inactivated influenza vaccination at a gestational age <20 weeks were sent text messages intermittently through participant-reported pregnancy end to request fever, health events, and neonatal outcomes. Text message response rates, Day 0-2 fever (≥100.4°F), health events, and birth/neonatal outcomes were assessed. RESULTS Most (80.2%, n=166) eligible women enrolled. Median gestational age was 8.9 (SD=3.9) weeks at vaccination. Response rates remained high (80.0%-95.2%). Only one Day 0-2 fever was reported. Women reported via text both pregnancy- and non-pregnancy-specific health events, not all associated with medical visits. Most pregnancy-specific events in the electronic medical record (EMR) were reported via text message. Of all enrollees, 84.9% completed the study (131 reported live birth, ten reported pregnancy loss). Two losses reported via text were not medically attended; there was one additional EMR-identified loss. Gestational age and weight at birth were similar between text message-reported and EMR-abstracted data and 95% CIs were overlapping for proportions of prematurity, low birth weight, small for gestational age, and major birth defects, as identified by text message-reported versus EMR-abstracted plus text message-reported versus EMR-abstracted data only. CONCLUSIONS This study demonstrated the feasibility of text messaging for influenza vaccine safety surveillance sustained throughout pregnancy. In these women receiving inactivated influenza vaccination during pregnancy, post-vaccination fever was infrequent and a typical pattern of maternal and neonatal health outcomes was observed.
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Affiliation(s)
- Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, New York; Mailman School Public Health, Columbia University, New York, New York; NewYork Presbyterian Hospital, New York, New York.
| | - Maria Cano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen Jakob
- Department of Pediatrics, Columbia University, New York, New York
| | - Karen R Broder
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Paige Lewis
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Barrett
- Department of Pediatrics, Columbia University, New York, New York
| | - Oidda I Museru
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Philip S LaRussa
- Department of Pediatrics, Columbia University, New York, New York
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119
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Karron RA, Zar HJ. Determining the outcomes of interventions to prevent respiratory syncytial virus disease in children: what to measure? THE LANCET RESPIRATORY MEDICINE 2017; 6:65-74. [PMID: 28865676 DOI: 10.1016/s2213-2600(17)30303-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 02/02/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of viral acute lower respiratory tract illness (LRTI) in young children, and a major cause of hospital admissions and health-care utilisation globally. Substantial efforts have been made to develop RSV vaccines and vaccine-like monoclonal antibodies to prevent acute RSV LRTI. Prevention of acute disease could improve long-term lung health, with potential effects on wheezing, asthma, and chronic lung disease. This Personal View describes assessments that should be initiated during clinical trials and continued after licensure to fully evaluate the effect of RSV preventive interventions. These assessments include recording the incidence of RSV-specific LRTI and all-cause LRTI through two RSV seasons, and assessment of the prevalence and severity of recurrent wheezing or asthma in children aged up to 6 years. Standardised assessments in diverse settings are needed to fully determine the effect of interventions for the prevention of RSV disease.
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Affiliation(s)
- Ruth A Karron
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather J Zar
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Nguyen VH, Dubot-Pérès A, Russell FM, Dance DAB, Vilivong K, Phommachan S, Syladeth C, Lai J, Lim R, Morpeth M, Mayxay M, Newton PN, Richet H, De Lamballerie X. Acute respiratory infections in hospitalized children in Vientiane, Lao PDR - the importance of Respiratory Syncytial Virus. Sci Rep 2017; 7:9318. [PMID: 28839157 PMCID: PMC5571090 DOI: 10.1038/s41598-017-09006-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/14/2017] [Indexed: 01/12/2023] Open
Abstract
The Human respiratory syncytial virus (RSV) is one of the most important viral pathogens, causing epidemics of acute respiratory infection (ARI), especially bronchiolitis and pneumonia, in children worldwide. To investigate the RSV burden in Laos, we conducted a one-year study in children <5 years old admitted to Mahosot Hospital, Vientiane Capital, to describe clinical and epidemiological characteristics and predictive factors for severity of RSV-associated ARI. Pooled nasal and throat swabs were tested using multiplex real-time PCR for 33 respiratory pathogens (FTD® kit). A total of 383 patients were included, 277 (72.3%) of whom presented with pneumonia. 377 (98.4%) patients were positive for at least one microorganism, of which RSV was the most common virus (41.0%), with a peak observed between June and September, corresponding to the rainy season. Most RSV inpatients had pneumonia (84.1%), of whom 35% had severe pneumonia. Children <3-months old were a high-risk group for severe pneumonia, independently of RSV infection. Our study suggests that RSV infection is frequent in Laos and commonly associated with pneumonia in hospitalized young children. Further investigations are required to provide a better overall view of the Lao nationwide epidemiology and public health burden of RSV infection over time.
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Affiliation(s)
- Van Hoan Nguyen
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille university - IRD190 - Inserm 1207 - EHESP), Marseille, France
- Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France
- Department of Infectious Diseases, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Audrey Dubot-Pérès
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille university - IRD190 - Inserm 1207 - EHESP), Marseille, France.
- Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France.
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Old Road Campus, University of Oxford, Oxford, United Kingdom.
| | - Fiona M Russell
- Dept. of Paediatrics, The University of Melbourne, Melbourne, Australia
- Pneumococcal Research Group, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Old Road Campus, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Keoudomphone Vilivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
| | - Souphatsone Phommachan
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
| | - Chanthaphone Syladeth
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
| | - Jana Lai
- Pneumococcal Research Group, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - Ruth Lim
- Pneumococcal Research Group, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Melinda Morpeth
- Dept. of Paediatrics, The University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR, Vientiane, Laos
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Old Road Campus, University of Oxford, Oxford, United Kingdom
| | - Hervé Richet
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille university - IRD190 - Inserm 1207 - EHESP), Marseille, France
| | - Xavier De Lamballerie
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille university - IRD190 - Inserm 1207 - EHESP), Marseille, France
- Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France
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Seasonal immunisation against respiratory syncytial virus disease. LANCET PUBLIC HEALTH 2017; 2:e344-e345. [DOI: 10.1016/s2468-2667(17)30122-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/19/2022]
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Cromer D, van Hoek AJ, Newall AT, Pollard AJ, Jit M. Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England. LANCET PUBLIC HEALTH 2017; 2:e367-e374. [PMID: 28804787 PMCID: PMC5541134 DOI: 10.1016/s2468-2667(17)30103-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5-10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers. METHODS We performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year. FINDINGS We estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9-12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89-0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208-232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168-219), £81 (76-86), and £54 (51-57), respectively. INTERPRETATION Nearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Deborah Cromer
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Albert Jan van Hoek
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,National Institute of Health Research, Oxford Biomedical Research Centre, Children's Hospital, Oxford, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Modelling and Economics Unit, Public Health England, London, UK
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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124
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Villafana T, Falloon J, Griffin MP, Zhu Q, Esser MT. Passive and active immunization against respiratory syncytial virus for the young and old. Expert Rev Vaccines 2017; 16:1-13. [PMID: 28525961 DOI: 10.1080/14760584.2017.1333425] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants worldwide and also causes significant disease in the elderly. Despite 60 years of RSV research and vaccine development, there is only one approved medicine to prevent RSV infections. Palivizumab, a monoclonal antibody (mAb) against the RSV fusion (F) protein, is indicated for preterm infants and children at high-risk for RSV infections. It is an active time in RSV vaccine and mAb development with 14 vaccines and 2 mAbs currently being tested in clinical trials as of 13 February 2017. Active vaccination of women in the third trimester or passive immunization of infants with a mAb are particularly attractive approaches as the most severe disease occurs within the first 6 months of life. Areas covered: Here, we review current approaches for preventing RSV in the young and old, describe proposed clinical endpoints for studies in pediatric and adult clinical trials and highlight results from recent and ongoing clinical studies. Expert commentary: With 16 candidates in clinical development, approval of the first RSV vaccine or mAb for the prevention of RSV in all infants or the elderly is likely to occur in the next five years.
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Affiliation(s)
| | | | | | - Qing Zhu
- a MedImmune LLC , Gaithersburg , MD , USA
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125
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Trenholme AA, Best EJ, Vogel AM, Stewart JM, Miller CJ, Lennon DR. Respiratory virus detection during hospitalisation for lower respiratory tract infection in children under 2 years in South Auckland, New Zealand. J Paediatr Child Health 2017; 53:551-555. [PMID: 28430397 DOI: 10.1111/jpc.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/17/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
AIM To describe respiratory virus detection in children under 2 years of age in a population admitted with lower respiratory infection and to assess correlation with measures of severity. METHODS Nasopharyngeal aspirates from infants admitted with lower respiratory tract infection (n = 1645) over a 3-year time period were tested by polymerase chain reaction. We collected epidemiological and clinical data on all children. We assessed the correlation of presence of virus with length of hospital stay, intensive care admission and consolidation on chest X-ray. RESULTS Of the children admitted 34% were Maori, 43% Pacific and 75% lived in areas in the bottom quintile for socio-economic deprivation. A virus was found in 94% of those tested including 30% with multiple viruses. Picornavirus was present in 59% including 34% as the sole virus. Respiratory syncytial virus was found in 39%. Virus co-detection was not associated with length of stay, chest X-ray changes or intensive care unit admission. CONCLUSION In this disadvantaged predominately Maori and Pacific population, picornavirus is commonly found as a sole virus, respiratory syncytial virus is frequent but immunisation preventable influenza is infrequent. We did not find that co-detection of viruses was linked to severity.
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Affiliation(s)
- Adrian A Trenholme
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Emma J Best
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Paediatric Infectious Diseases Department, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Alison M Vogel
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Joanna M Stewart
- Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand
| | - Charissa J Miller
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Diana R Lennon
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand.,Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Paediatric Infectious Diseases Department, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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Kamigaki T, Aldey PP, Mercado ES, Tan AG, Javier JB, Lupisan SP, Oshitani H, Tallo VL. Estimates of influenza and respiratory syncytial virus incidences with fraction modeling approach in Baguio City, the Philippines, 2012-2014. Influenza Other Respir Viruses 2017; 11:311-318. [PMID: 28371393 PMCID: PMC5485869 DOI: 10.1111/irv.12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Estimation of the incidences of influenza and respiratory syncytial virus (RSV) infection is important for disease control. Previous estimate in the city showed a substantial burden of influenza in both outpatients and inpatients while it did not account for individuals who do not seek medical attention nor RSV. PATIENTS/METHODS A total of 17 674 influenza-like illness (ILI) and 13 242 severe acute respiratory illness (SARI) cases were recruited, and samples were collected from 6267 and 2962 of ILI and SARI cases, respectively. RT-PCR assays were performed to detect influenza and RSV in the samples. A health-seeking behavior survey was conducted from February 2014 to April 2014 to estimate the fraction of infected individuals who did not seek medical attention between rainy and dry season. RESULTS Average influenza and RSV incidence rates in outpatients were 1.6 and 1.4 per 1000 individuals, respectively, and the highest incidence rate for both viruses was found in the of 6-23 month age group. Average influenza and RSV hospitalization incidence rates were 1.7 and 1.9 per 1000 individuals, respectively. Further, we estimated that the incidence rates of influenza and RSV in individuals who did not seek medical attention were threefold and 1.6-fold those in the medically attended population. CONCLUSIONS Respiratory syncytial virus and influenza pose a substantial disease burden, particularly in hospitalized cases. The implementation of either a community-based approach or an enhanced surveillance system in combination with a community survey will allow a better understanding of the disease burdens of RSV and influenza in the Philippines.
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Affiliation(s)
- Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Portia P Aldey
- Department of Epidemiology and Biostatistics, Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Edelwisa S Mercado
- Molecular Biology Laboratory, Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Alvin G Tan
- Department of Epidemiology and Biostatistics, Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jenaline B Javier
- Department of Epidemiology and Biostatistics, Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Socorro P Lupisan
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Veronica L Tallo
- Department of Epidemiology and Biostatistics, Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
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Zhuang L, Chen LF, Zhang YB, Liu Z, Xiao XH, Tang W, Wang GC, Song WJ, Li YL, Li MM. Watsonianone A from Rhodomyrtus tomentosa Fruit Attenuates Respiratory-Syncytial-Virus-Induced Inflammation In Vitro. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2017; 65:3481-3489. [PMID: 28436225 DOI: 10.1021/acs.jafc.7b00537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Respiratory syncytial virus (RSV) is one of the most common respiratory pathogens. Immoderate inflammation plays a great role in causing RSV-induced diseases. In the present study, watsonianone A, isolated from the fruit of Rhodomyrtus tomentosa (Ait.) Hassk, was found to show a good inhibitory effect on RSV-induced NO production, with a half-maximal inhibitory concentration of 37.2 ± 1.6 μM. Enzyme-linked immunosorbent assay and fluorescence quantitative polymerase chain reaction analyses indicated that watsonianone A markedly reduced both mRNA and protein levels of tumor necrosis factor α, interleukin 6, and monocyte chemoattractant protein 1 in RSV-infected RAW264.7 cells. Mechanistically, watsonianone A inhibited nuclear factor κB (NF-κB) activation by suppressing IκBα phosphorylation. Further analysis revealed that watsonianone A activated the thioredoxin system and decreased intracellular reactive oxygen species (ROS) levels, which are closely associated with NF-κB activation in RSV-infected cells. These results reveal that watsonianone A can attenuate RSV-induced inflammation via the suppression of ROS-sensitive inflammatory signaling.
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Affiliation(s)
- Ling Zhuang
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Li-Feng Chen
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Yu-Bo Zhang
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Zhong Liu
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Xu-Hui Xiao
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Wei Tang
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Guo-Cai Wang
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Wen-Jun Song
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Yao-Lan Li
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
| | - Man-Mei Li
- Institute of Traditional Chinese Medicine and Natural Products, College of Pharmacy, and ‡Guangdong Provincial Key Laboratory of Bioengineering Medicine, College of Life Science and Technology, Jinan University , Guangzhou, Guangdong 510632, People's Republic of China
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Achten NB, Wu P, Bont L, Blanken MO, Gebretsadik T, Chappell JD, Wang L, Yu C, Larkin EK, Carroll KN, Anderson LJ, Moore ML, Sloan CD, Hartert TV. Interference Between Respiratory Syncytial Virus and Human Rhinovirus Infection in Infancy. J Infect Dis 2017; 215:1102-1106. [PMID: 28368456 PMCID: PMC5426371 DOI: 10.1093/infdis/jix031] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) and human rhinovirus (HRV) are the most common viruses associated with acute respiratory tract infections in infancy. Viral interference is important in understanding respiratory viral circulation and the impact of vaccines. METHODS To study viral interference, we evaluated cases of RSV and HRV codetection by polymerase chain reaction in 2 prospective birth cohort studies (the Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure [INSPIRE] study and the Tennessee Children's Respiratory Initiative [TCRI]) and a double-blinded, randomized, controlled trial (MAKI), using adjusted multivariable regression analyses. RESULTS Among 3263 respiratory tract samples, 24.5% (798) and 37.3% (1216) were RSV and HRV positive, respectively. The odds of HRV infection were significantly lower in RSV-infected infants in all cohorts, with adjusted odds ratios of 0.30 (95% confidence interval [CI], .22-.40 in the INSPIRE study, 0.18 (95% CI, .11-.28) in the TCRI (adjusted for disease severity), and 0.34 (95% CI, .16-.72) in the MAKI trial. HRV infection was significantly more common among infants administered RSV immunoprophylaxis, compared with infants who did not receive immunoprophylaxis (OR, 1.65; 95% CI, 1.65-2.39). CONCLUSIONS A negative association of RSV on HRV codetection was consistently observed across populations, seasons, disease severity, and geographical regions. Suppressing RSV infection by RSV immunoprophylaxis might increase the risk of having HRV infection.
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Affiliation(s)
- Niek B Achten
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, the Netherlands
| | - Pingsheng Wu
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine
| | - Louis Bont
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, the Netherlands
| | - Maarten O Blanken
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, the Netherlands
| | | | | | | | | | - Emma K Larkin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine
| | - Kecia N Carroll
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Larry J Anderson
- Department of Pediatrics, Emory University, Atlanta, Georgia; and
| | - Martin L Moore
- Department of Pediatrics, Emory University, Atlanta, Georgia; and
| | - Chantel D Sloan
- Department of Health Science, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Tina V Hartert
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine
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129
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Ali A, Yousafzai MT, Waris R, Jafri F, Aziz F, Abbasi IN, Zaidi A. RSV associated hospitalizations in children in Karachi, Pakistan: Implications for vaccine prevention strategies. J Med Virol 2017; 89:1151-1157. [PMID: 28092107 DOI: 10.1002/jmv.24768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/27/2016] [Accepted: 12/27/2016] [Indexed: 11/09/2022]
Abstract
Major progress is being made in vaccines against Respiratory Syncytial Virus (RSV), with multiple vaccine candidates currently in the clinical phase of development. Making an investment case for public sector financing of RSV vaccine will require estimation of burden, cost-effectiveness, and impact. The aim of this study is to determine the proportion, age distribution and clinical spectrum of RSV associated hospitalizations in children in Karachi, Pakistan. A three years prospective study was conducted at the Aga Khan University Hospital in Karachi, a city of 20 million in south Pakistan, from August 2009 to June 2012. Children less than five years old admitted with acute respiratory infections (ARI) were enrolled. Throat swabs were collected and tested for RSV using real-time PCR. Multivariable log binomial regression analysis was performed to identify the associated factors of RSV infection. Out of 1150 children enrolled, RSV was detected among 223 (19%). Highest rate of RSV detection was in young infants less than 3 months of age (48/168, 29%), which accounted for 22% of all RSV detected. Most common diagnosis in RSV positive infants (<12 months of age) was bronchiolitis followed by pneumonia, while in older children between the ages of one and 5 years of age, pneumonia and asthma were the most common diagnosis. Although identified year-round, RSV was most prevalent from August to October with peak in September, coinciding with the rainy season. This study identified RSV to be independently associated with younger age (P = 0.036), rainy season (P < 0.001), post-tussive emesis (P = 0.008), intubation (P = 0.003), and discharge diagnosis of bronchiolitis (P = 0.004). Vaccines against RSV that target this age group are likely to yield remarkable benefit.
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Affiliation(s)
- Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | | | - Rabbia Waris
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Fatima Jafri
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Fatima Aziz
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Imran Naeem Abbasi
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Anita Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
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130
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Preclinical evaluation of bacterially produced RSV-G protein vaccine: Strong protection against RSV challenge in cotton rat model. Sci Rep 2017; 7:42428. [PMID: 28186208 PMCID: PMC5301242 DOI: 10.1038/srep42428] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/09/2017] [Indexed: 12/01/2022] Open
Abstract
In current study, we evaluated the safety and protective efficacy of recombinant unglycosylated RSV G protein ectodomain produced in E. coli (in presence and absence of oil-in-water adjuvant) in a preclinical RSV susceptible cotton rat challenge model compared to formaldehyde inactivated RSV (FI-RSV) and live RSV experimental infection. The adjuvanted G protein vaccine induced robust neutralization antibody responses comparable to those generated by live RSV infection. Importantly, adjuvanted G protein significantly reduced viral loads in both the lungs and nose at early time points following viral challenge. Antibody kinetics determined by Surface Plasmon Resonance showed that adjuvanted G generated 10-fold higher G-binding antibodies compared to non-adjvuanted G vaccine and live RSV infection, which correlated strongly with both neutralization titers and viral load titers in the nose and lungs post-viral challenge. Antibody diversity analysis revealed immunodominant antigenic sites in the N- and C-termini of the RSV-G protein, that were boosted >10-fold by adjuvant and inversely correlated with viral load titers. Enhanced lung pathology was observed only in animals vaccinated with FI-RSV, but not in animals vaccinated with unadjuvanted or adjuvanted RSV-G vaccine after viral challenge. The bacterially produced unglycosylated G protein could be developed as a protective vaccine against RSV disease.
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131
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Expression and antigenicity of recombinant human respiratory syncytial virus glycoproteins having different affinity tags. Protein Expr Purif 2016; 132:1-8. [PMID: 28042093 DOI: 10.1016/j.pep.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 12/27/2016] [Accepted: 12/28/2016] [Indexed: 11/21/2022]
Abstract
Human respiratory syncytial virus (HRSV) is a main cause of lower respiratory tract infections in infants and the elderly. Glycoprotein (G) is major antigen on the viral surface, and plays a key role for virus entry. Therefore, purification of the glycoprotein of HRSV is critical for the development of HRSV vaccine and serological diagnosis. In this study, we report the design and characterization of glycoprotein engineered rationally to enhance the protein solubility and to facilitate efficient purification. We permuted HRSV glycoproteins with two tags: (i) an immunoglobulin (Ig) M signal peptide and a protein A B domain tag to render HRSV glycoprotein secret into the culture media and (ii) a foldon and 6 × histidine tag with or without transmembrane domain. Three recombinant baculoviruses were constructed: (i) transmembrane-truncated HRSV glycoprotein (amino acid positions 66-298) inserted with the N-terminal IgM signal peptide and protein A B domain (MG-GΔTM), (ii) truncated HRSV glycoprotein (amino acid positions 66-298) fused with a C-terminal foldon and 6 × histidine tag (GΔTM-FH), and (iii) full-length HRSV glycoprotein (amino acid positions 1-298) fused with a C-terminal foldon and 6 × histidine tag (G-FH). Highly soluble recombinant MG-GΔTM protein was clearly purified using one-step affinity chromatography with IgG-sepharose resin, whereas the recombinant G-FH protein and truncated GΔTM-FH were purified partially using nickel-resin. Although, the antigenicity of GΔTM-FH was stronger than highly mannose-rich MG-GΔTM protein, MG-GΔTM induced neutralizing antibodies efficiently in the mice to protect from infectious HRSV.
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132
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Wathuo M, Medley GF, Nokes D, Munywoki PK. Quantification and determinants of the amount of respiratory syncytial virus (RSV) shed using real time PCR data from a longitudinal household study. Wellcome Open Res 2016. [DOI: 10.12688/wellcomeopenres.10284.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A better understanding of respiratory syncytial virus (RSV) epidemiology requires realistic estimates of RSV shedding patterns, quantities shed, and identification of the related underlying factors. Methods: RSV infection data arise from a cohort study of 47 households with 493 occupants, in coastal Kenya, during the 2009/2010 RSV season. Nasopharyngeal swabs were taken every 3 to 4 days and screened for RSV using a real time polymerase chain reaction (PCR) assay. The amount of virus shed was quantified by calculating the ‘area under the curve’ using the trapezoidal rule applied to rescaled PCR cycle threshold output. Multivariable linear regression was used to identify correlates of amount of virus shed. Results: The median quantity of virus shed per infection episode was 29.4 (95% CI: 15.2, 54.2) log10 ribonucleic acid (RNA) copies. Young age (<1 year), presence of upper respiratory symptoms, intra-household acquisition of infection, an individual’s first infection episode in the RSV season, and having a co-infection of RSV group A and B were associated with increased amount of virus shed. Conclusions: The findings provide insight into which groups of individuals have higher potential for transmission, information which may be useful in designing RSV prevention strategies.
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133
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Wathuo M, Medley GF, Nokes DJ, Munywoki PK. Quantification and determinants of the amount of respiratory syncytial virus (RSV) shed using real time PCR data from a longitudinal household study. Wellcome Open Res 2016; 1:27. [PMID: 28066826 PMCID: PMC5218551 DOI: 10.12688/wellcomeopenres.10284.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A better understanding of respiratory syncytial virus (RSV) epidemiology requires realistic estimates of RSV shedding patterns, quantities shed, and identification of the related underlying factors. Methods RSV infection data arise from a cohort study of 47 households with 493 occupants, in coastal Kenya, during the 2009/2010 RSV season. Nasopharyngeal swabs were taken every 3 to 4 days and screened for RSV using a real time polymerase chain reaction (PCR) assay. The amount of virus shed was quantified by calculating the 'area under the curve' using the trapezoidal rule applied to rescaled PCR cycle threshold output. Multivariable linear regression was used to identify correlates of amount of virus shed. Results The median quantity of virus shed per infection episode was 29.4 (95% CI: 15.2, 54.2) log10 ribonucleic acid (RNA) copies. Young age (<1 year), presence of upper respiratory symptoms, intra-household acquisition of infection, an individual's first infection episode in the RSV season, and having a co-infection of RSV group A and B were associated with increased amount of virus shed. Conclusions The findings provide insight into which groups of individuals have higher potential for transmission, information which may be useful in designing RSV prevention strategies.
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Affiliation(s)
- Miriam Wathuo
- KEMRI - Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - D James Nokes
- KEMRI - Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya.,School of Life Sciences and SBIDER, University of Warwick, Coventry, UK
| | - Patrick K Munywoki
- KEMRI - Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya.,Department of Nursing Sciences, Pwani University, Kilifi, Kenya
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134
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Abstract
Pulmonary infections remain a major cause of infant and child mortality worldwide and are responsible for a substantial burden of morbidity. During the 2015 European Respiratory Society International Congress in Amsterdam, some of the main findings from peer-reviewed articles addressing this topic that were published in the preceding 12 months were reviewed in a Paediatric Clinical Year in Review session. The following article highlights some of the insights provided by these articles into the complex interactions of the human host with the extensive and dynamic populations of microorganisms that call an individual "home".
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Affiliation(s)
- Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Subiaco, Australia
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135
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Vitelli A, Nicosia A. Virus vs. virus: adenovirus vectored vaccine to defeat respiratory syncytial virus. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:489. [PMID: 28149851 PMCID: PMC5233505 DOI: 10.21037/atm.2016.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Alfredo Nicosia
- ReiThera Srl, Rome, Italy
- CEINGE, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, University Federico II, Naples, Italy
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136
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Abstract
Respiratory syncytial virus (RSV) is the most common cause of US infant hospitalization. Additionally, RSV is responsible for 10,000 deaths annually among the elderly across the United States, and accounts for nearly as many hospitalizations as influenza. Currently, several RSV vaccine candidates are under development to target different age groups. To evaluate the potential effectiveness of age-specific vaccination strategies in averting RSV incidence, we developed a transmission model that integrates data on daily infectious viral load and changes of behavior associated with RSV symptoms. Calibrating to RSV weekly incidence rates in Texas, California, Colorado, and Pennsylvania, we show that in all states considered, an infected child under 5 y of age is more than twice as likely as a person over 50 y of age to transmit the virus. Geographic variability in the effectiveness of a vaccination program across states arises from interplay between seasonality patterns, population demography, vaccination uptake, and vaccine mechanism of action. Regardless of these variabilities, our analysis showed that allocating vaccine to children under 5 y of age would be the most efficient strategy per dose to avert RSV in both children and adults. Furthermore, due to substantial indirect protection, the targeting of children is even predicted to reduce RSV in the elderly more than directly vaccinating the elderly themselves. Our results can help inform ongoing clinical trials and future recommendations on RSV vaccination.
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137
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Englund JA, Chu HY. Vaccines Against Respiratory Syncytial Virus: The Time Has Come. J Infect Dis 2016; 215:4-7. [PMID: 27694634 DOI: 10.1093/infdis/jiw455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Janet A Englund
- Pediatric Infectious Diseases, Seattle Children's Research Institute.,Department of Medicine, University of Washington, Seattle
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle
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138
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Atwell JE, Geoghegan S, Karron RA, Polack FP. Clinical Predictors of Critical Lower Respiratory Tract Illness Due to Respiratory Syncytial Virus in Infants and Children: Data to Inform Case Definitions for Efficacy Trials. J Infect Dis 2016; 214:1712-1716. [DOI: 10.1093/infdis/jiw447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
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139
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Fitchett EJA, Seale AC, Vergnano S, Sharland M, Heath PT, Saha SK, Agarwal R, Ayede AI, Bhutta ZA, Black R, Bojang K, Campbell H, Cousens S, Darmstadt GL, Madhi SA, Meulen AST, Modi N, Patterson J, Qazi S, Schrag SJ, Stoll BJ, Wall SN, Wammanda RD, Lawn JE. Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI): an extension of the STROBE statement for neonatal infection research. THE LANCET. INFECTIOUS DISEASES 2016; 16:e202-e213. [PMID: 27633910 DOI: 10.1016/s1473-3099(16)30082-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/14/2016] [Accepted: 04/28/2016] [Indexed: 12/22/2022]
Abstract
Neonatal infections are estimated to account for a quarter of the 2·8 million annual neonatal deaths, as well as approximately 3% of all disability-adjusted life-years. Despite this burden, few data are available on incidence, aetiology, and outcomes, particularly regarding impairment. We aimed to develop guidelines for improved scientific reporting of observational neonatal infection studies, to increase comparability and to strengthen research in this area. This checklist, Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE- NI), is an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. STROBE-NI was developed following systematic reviews of published literature (1996-2015), compilation of more than 130 potential reporting recommendations, and circulation of a survey to relevant professionals worldwide, eliciting responses from 147 professionals from 37 countries. An international consensus meeting of 18 participants (with expertise in infectious diseases, neonatology, microbiology, epidemiology, and statistics) identified priority recommendations for reporting, additional to the STROBE statement. Implementation of these STROBE-NI recommendations, and linked checklist, aims to improve scientific reporting of neonatal infection studies, increasing data utility and allowing meta-analyses and pathogen-specific burden estimates to inform global policy and new interventions, including maternal vaccines.
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Affiliation(s)
| | - Anna C Seale
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Stefania Vergnano
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Michael Sharland
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Adejumoke I Ayede
- Department of Paediatrics, College Of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Robert Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kalifa Bojang
- Medical Research Council, The Gambia Unit, Banjul, The Gambia
| | - Harry Campbell
- Centre for Global Health Research, University of Edinburgh, Edinburgh, UK
| | - Simon Cousens
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit & DST/NRF Vaccine Preventable Diseases, Faculty Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Neena Modi
- Royal College of Paediatrics and Child Health, London, UK; Department of Medicine, Section of Neonatal Medicine, Imperial College London, London, UK
| | - Janna Patterson
- Maternal, Newborn, and Child Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara J Stoll
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stephen N Wall
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - Robinson D Wammanda
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
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140
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Immunogenicity of RSV F DNA Vaccine in BALB/c Mice. Adv Virol 2016; 2016:7971847. [PMID: 27688769 PMCID: PMC5027326 DOI: 10.1155/2016/7971847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023] Open
Abstract
Respiratory syncytial virus (RSV) causes severe acute lower respiratory tract disease leading to numerous hospitalizations and deaths among the infant and elderly populations worldwide. There is no vaccine or a less effective drug available against RSV infections. Natural RSV infection stimulates the Th1 immune response and activates the production of neutralizing antibodies, while earlier vaccine trials that used UV-inactivated RSV exacerbated the disease due to the activation of the allergic Th2 response. With a focus on Th1 immunity, we developed a DNA vaccine containing the native RSV fusion (RSV F) protein and studied its immune response in BALB/c mice. High levels of RSV specific antibodies were induced during subsequent immunizations. The serum antibodies were able to neutralize RSV in vitro. The RSV inhibition by sera was also shown by immunofluorescence analyses. Antibody response of the RSV F DNA vaccine showed a strong Th1 response. Also, sera from RSV F immunized and RSV infected mice reduced the RSV infection by 50% and 80%, respectively. Our data evidently showed that the RSV F DNA vaccine activated the Th1 biased immune response and led to the production of neutralizing antibodies, which is the desired immune response required for protection from RSV infections.
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141
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Bont L, Checchia PA, Fauroux B, Figueras-Aloy J, Manzoni P, Paes B, Simões EAF, Carbonell-Estrany X. Defining the Epidemiology and Burden of Severe Respiratory Syncytial Virus Infection Among Infants and Children in Western Countries. Infect Dis Ther 2016; 5:271-98. [PMID: 27480325 PMCID: PMC5019979 DOI: 10.1007/s40121-016-0123-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The REGAL (RSV [respiratory syncytial virus] Evidence-a Geographical Archive of the Literature) series provides a comprehensive review of the published evidence in the field of RSV in Western countries over the last 20 years. This first of seven publications covers the epidemiology and burden of RSV infection. METHODS A systematic review was undertaken for articles published between Jan 1, 1995 and Dec 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov. Studies reporting data for hospital visits/admissions for RSV infection among children (≤18 years of age), as well as studies reporting RSV-associated morbidity, mortality, and risk factors were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. RESULT 2315 studies were identified of which 98 were included. RSV was associated with 12-63% of all acute respiratory infections (ARIs) and 19-81% of all viral ARIs causing hospitalizations in children (high SOE). Annual RSV hospitalization (RSVH) rates increased with decreasing age and varied by a factor of 2-3 across seasons (high SOE). Studies were conflicting on whether the incidence of RSVH has increased, decreased, or remained stable over the last 20 years (moderate SOE). Length of hospital stay ranged from 2 to 11 days, with 2-12% of cases requiring intensive care unit admission (moderate SOE). Case-fatality rates were <0.5% (moderate SOE). Risk factors associated with RSVH included: male sex; age <6 months; birth during the first half of the RSV season; crowding/siblings; and day-care exposure (high SOE). CONCLUSION RSV infection remains a major burden on Western healthcare systems and has been associated with significant morbidity. Further studies focusing on the epidemiology of RSV infection (particularly in the outpatient setting), the impact of co-infection, better estimates of case-fatality rates and associated risk factors (all currently moderate/low SOE) are needed to determine the true burden of disease. FUNDING Abbvie.
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Affiliation(s)
- Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Texas, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Manzoni
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
| | - Eric A F Simões
- Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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142
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Joyce MG, Zhang B, Ou L, Chen M, Chuang GY, Druz A, Kong WP, Lai YT, Rundlet EJ, Tsybovsky Y, Yang Y, Georgiev IS, Guttman M, Lees CR, Pancera M, Sastry M, Soto C, Stewart-Jones GB, Thomas PV, Van Galen JG, Baxa U, Lee KK, Mascola JR, Graham BS, Kwong PD. Iterative structure-based improvement of a fusion-glycoprotein vaccine against RSV. Nat Struct Mol Biol 2016; 23:811-820. [PMID: 27478931 PMCID: PMC5016229 DOI: 10.1038/nsmb.3267] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/24/2016] [Indexed: 11/09/2022]
Abstract
Structure-based design of vaccines, particularly the iterative optimization used so successfully in the structure-based design of drugs, has been a long-sought goal. We previously developed a first-generation vaccine antigen called DS-Cav1, comprising a prefusion-stabilized form of the fusion (F) glycoprotein, which elicits high-titer protective responses against respiratory syncytial virus (RSV) in mice and macaques. Here we report the improvement of DS-Cav1 through iterative cycles of structure-based design that significantly increased the titer of RSV-protective responses. The resultant second-generation 'DS2'-stabilized immunogens have their F subunits genetically linked, their fusion peptides deleted and their interprotomer movements stabilized by an additional disulfide bond. These DS2 immunogens are promising vaccine candidates with superior attributes, such as their lack of a requirement for furin cleavage and their increased antigenic stability against heat inactivation. The iterative structure-based improvement described here may have utility in the optimization of other vaccine antigens.
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Affiliation(s)
- M. Gordon Joyce
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Baoshan Zhang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Li Ou
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Man Chen
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Gwo-Yu Chuang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Aliaksandr Druz
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Wing-Pui Kong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Yen-Ting Lai
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Emily J. Rundlet
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Yaroslav Tsybovsky
- Electron Microscopy Laboratory, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Yongping Yang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ivelin S. Georgiev
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Miklos Guttman
- Department of Medicinal Chemistry, University of Washington, Seattle, Washington
| | - Christopher R. Lees
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marie Pancera
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mallika Sastry
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Cinque Soto
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Guillaume B.E. Stewart-Jones
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul V. Thomas
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Joseph G. Van Galen
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ulrich Baxa
- Electron Microscopy Laboratory, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Kelly K. Lee
- Department of Medicinal Chemistry, University of Washington, Seattle, Washington
| | - John R. Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Barney S. Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Peter D. Kwong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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143
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Comeau JL, Chan J, Macartney KK. New Vaccines on the Horizon. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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144
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Neonatal infections: Case definition and guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 34:6038-6046. [PMID: 27491687 PMCID: PMC5139809 DOI: 10.1016/j.vaccine.2016.03.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
Abstract
Maternal vaccination is an important area of research and requires appropriate and internationally comparable definitions and safety standards. The GAIA group, part of the Brighton Collaboration was created with the mandate of proposing standardised definitions applicable to maternal vaccine research. This study proposes international definitions for neonatal infections. The neonatal infections GAIA working group performed a literature review using Medline, EMBASE and the Cochrane collaboration and collected definitions in use in neonatal and public health networks. The common criteria derived from the extensive search formed the basis for a consensus process that resulted in three separate definitions for neonatal blood stream infections (BSI), meningitis and lower respiratory tract infections (LRTI). For each definition three levels of evidence are proposed to ensure the applicability of the definitions to different settings. Recommendations about data collection, analysis and presentation are presented and harmonized with the Brighton Collaboration and GAIA format and other existing international standards for study reporting.
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145
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Chin VK, Atika Aziz NA, Hudu SA, Harmal NS, Syahrilnizam A, Jalilian FA, Zamberi S. Design and validation of small interfering RNA on respiratory syncytial virus M2-2 gene: A potential approach in RNA interference on viral replication. J Virol Methods 2016; 236:117-125. [PMID: 27432115 DOI: 10.1016/j.jviromet.2016.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 12/21/2022]
Abstract
Human respiratory syncytial virus (RSV) is the leading cause of severe lower respiratory tract infection in infants and young children globally and is a significant pathogen of the elderly and immunocompromised. The M2-2 protein of respiratory syncytial virus (RSV) is particularly important in regulation of viral RNA transcription and replication that could be a potential anti-viral candidate against RSV infection. In this study, we designed and validated siRNAs that specifically target the RSV M2-2 gene. Four siRNAs targeting different regions of the M2-2 gene were designed using web tool. In-vitro evaluation of silencing effect was performed by using RSV infected Vero cell line. Viral M2-2 linked GFP recombinant plasmid was co-transfected with non-targeted siRNA, Pooled siRNA, siRNA 1, siRNA 2, siRNA 3 and siRNA 4 using synthetic cationic polymer. The silencing effect of M2-2 gene at the protein level was measured both qualitatively and quantitatively by using fluorescence microscopy and flow cytometry. Meanwhile, the silencing effect at the mRNA level was assessed by using RT-qPCR. This study showed that all four designed siRNAs can effectively and efficiently silence M2-2 gene. siRNA 2 showed the highest (98%) silencing effect on protein level and siRNA 4 with 83.1% at the mRNA level. The viral assay showed no significant cytopathic effects observed after 6days post-infection with siRNAs. In conclusion, this study showed the effectiveness of siRNA in silencing M2-2 gene both at the protein and mRNA level which could potentially be used as a novel therapeutic agent in the treatment of RSV infection. However, further study is warranted to investigate the silencing effect of M2-2 protein and inhibition of RSV infection.
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Affiliation(s)
- V K Chin
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Nur A Atika Aziz
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Shuaibu A Hudu
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia; Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University Sokoto, Nigeria
| | - Nabil S Harmal
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - A Syahrilnizam
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Farid A Jalilian
- Department of Microbiology, Faculty of Medicine, Ilam University, Banganjab, llam, Iran
| | - S Zamberi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
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146
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Cunningham S, Nair H, Campbell H. Deciphering clinical phenotypes in acute viral lower respiratory tract infection: Bronchiolitis is not an island. Thorax 2016; 71:679-80. [DOI: 10.1136/thoraxjnl-2016-209012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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147
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Abstract
There is a growing appreciation for the role of vaccines in confronting the problem of antimicrobial resistance (AMR). Vaccines can reduce the prevalence of resistance by reducing the need for antimicrobial use and can reduce its impact by reducing the total number of cases. By reducing the number of pathogens that may be responsible for a particular clinical syndrome, vaccines can permit the use of narrower-spectrum antibiotics for empirical therapy. These effects may be amplified by herd immunity, extending protection to unvaccinated persons in the population. Because much selection for resistance is due to selection on bystander members of the normal flora, vaccination can reduce pressure for resistance even in pathogens not included in the vaccine. Some vaccines have had disproportionate effects on drug-resistant lineages within the target species, a benefit that could be more deliberately exploited in vaccine design. We describe the effects of current vaccines in controlling AMR, survey some vaccines in development with the potential to do so further, and discuss strategies to amplify these benefits. We conclude with a discussion of research and policy priorities to more fully enlist vaccines in the battle against AMR.
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148
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Novel Respiratory Syncytial Virus-Like Particle Vaccine Composed of the Postfusion and Prefusion Conformations of the F Glycoprotein. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:451-9. [PMID: 27030590 PMCID: PMC4895010 DOI: 10.1128/cvi.00720-15] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/19/2016] [Indexed: 02/02/2023]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of severe respiratory disease in infants and children and represents an important global health burden for the elderly and the immunocompromised. Despite decades of research efforts, no licensed vaccine for RSV is available. We have developed virus-like particle (VLP)-based RSV vaccines assembled with the human metapneumovirus (hMPV) matrix protein (M) as the structural scaffold and the RSV fusion glycoprotein (F) in either the postfusion or prefusion conformation as its prime surface immunogen. Vaccines were composed of postfusion F, prefusion F, or a combination of the two conformations and formulated with a squalene-based oil emulsion as adjuvant. Immunization with these VLP vaccines afforded full protection against RSV infection and prevented detectable viral replication in the mouse lung after challenge. Analyses of lung cytokines and chemokines showed that VLP vaccination mostly induced the production of gamma interferon (IFN-γ), a marker of the Th1-mediated immune response, which is predominantly required for viral protection. Conversely, immunization with a formalin-inactivated RSV (FI-RSV) vaccine induced high levels of inflammatory chemokines and cytokines of the Th2- and Th17-mediated types of immune responses, as well as severe lung inflammation and histopathology. The VLP vaccines showed restricted production of these immune mediators and did not induce severe bronchiolitis or perivascular infiltration as seen with the FI-RSV vaccine. Remarkably, analysis of the serum from immunized mice showed that the VLP vaccine formulated using a combination of postfusion and prefusion F elicited the highest level of neutralizing antibody and enhanced the Th1-mediated immune response.
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149
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Nair H, Ramilo O, Eichler I, Pelfrene E, Mejias A, Polack FP, Pouwels KB, Langley JM, Nunes M, van der Maas N, Kragten–Tabatabaie L, Baraldi E, Heikkinen T, Fauroux B, Sharland M, Park C, Manzoni P, Papadopoulos NG, Martinón–Torres F, Stein R, Bont L. Meeting Report: Harmonization of RSV therapeutics – from design to performance. J Glob Health 2016. [PMCID: PMC4920015 DOI: 10.7189/jogh.06.010205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Harish Nair
- Center for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, Edinburgh, UK
| | - Octavio Ramilo
- Paediatric Infectious Diseases, Nationwide Children’s Hospital, and The Ohio State University, Columbus, Ohio, United States of America
| | | | | | - Asuncion Mejias
- Paediatric Infectious Diseases, Nationwide Children’s Hospital, and The Ohio State University, Columbus, Ohio, United States of America
| | - Fernando P Polack
- Fundacion INFANT, Buenos Aires, Argentina
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Koen B. Pouwels
- Modelling & Economics Unit, Public Health England, London, UK
- Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, the Netherlands
| | - Joanne M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
| | - Marta Nunes
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicoline van der Maas
- Department Epidemiology and Surveillance of the National Immunisation Programme, CIb–RIVM, the Netherlands
| | | | - Eugenio Baraldi
- Women’s and Children’s Health Department, Unit of Respiratory Medicine and Allergy, Padova, Italy
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Brigitte Fauroux
- Noninvasive ventilation and Sleep Unit, Necker Pediatric University Hospital, Paris Descartes University, Paris, France
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George’s University London, UK
| | | | - Paolo Manzoni
- Neonatology and Neonatal Intensive Care Unit, S Anna Hospital, Torino, Italy
| | - Nikolaos G. Papadopoulos
- University of Manchester, Manchester, UK
- Allergy Dept 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Federico Martinón–Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hóspital Clínico Universitario de Santiago de Compostela, University of Santiago, La Coruña
| | - Renato Stein
- Pediatric Pulmonology Unit, Pontifícia Universidade Católica RS, Porto Alegre, Brazil
| | - Louis Bont
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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150
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Advances in RSV vaccine research and development – A global agenda. Vaccine 2016; 34:2870-2875. [DOI: 10.1016/j.vaccine.2016.03.109] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/24/2016] [Indexed: 12/22/2022]
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