1
|
Wick M, Kliemt R, Poshtiban A, Kossack N, Diller GP, Soudani S, Bangert M, Kramer R, Damm O. Respiratory syncytial virus immunization patterns in Germany, 2015-2020. Hum Vaccin Immunother 2024; 20:2380110. [PMID: 39118394 PMCID: PMC11318726 DOI: 10.1080/21645515.2024.2380110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/28/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in infants and young children worldwide. Using routine statutory health insurance claims data including patients from all regions of Germany, we investigated the health-care resource use and costs associated with RSV prophylaxis with palivizumab in Germany. In the database, infants from the birth cohorts 2015-2019 eligible for palivizumab immunization were identified using codes of the 10th revision of the International Classification of Diseases (ICD-10). Health-care resource use and costs related to immunization were determined by inpatient and outpatient administrations. Over the study period, only 1.3% of infants received at least one dose of palivizumab in their first year of life. The mean number of doses per immunized infant was 4.6. From a third-party payer perspective, the mean costs of palivizumab per infant who received at least one dose in the first year of life was €5,435 in the birth cohorts 2015-2019. Despite the substantial risk of severe RSV infection, we found low rates of palivizumab utilization. Novel preventive interventions, featuring broader indications and single-dose administration per season, contribute to mitigating the burden of RSV disease across a more extensive infant population.
Collapse
Affiliation(s)
- Moritz Wick
- Evidence-based Medicine / Health Economics & Outcomes Research, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Roman Kliemt
- Health Services Research and Health Economics, WIG2 GmbH, Leipzig, Germany
| | - Anahita Poshtiban
- Evidence-based Medicine / Health Economics & Outcomes Research, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Nils Kossack
- Health Services Research and Health Economics, WIG2 GmbH, Leipzig, Germany
| | - Gerhard-Paul Diller
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
- Competence Network for Congenital Heart Defects, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Samira Soudani
- Health Economics & Value Assessment Vaccines, Sanofi Vaccines, Lyon, France
| | - Mathieu Bangert
- Health Economics & Value Assessment Vaccines, Sanofi Vaccines, Lyon, France
| | - Rolf Kramer
- Health Economics & Value Assessment Vaccines, Sanofi Vaccines, Lyon, France
| | - Oliver Damm
- Evidence-based Medicine / Health Economics & Outcomes Research, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| |
Collapse
|
2
|
Günen H, Alzaabi A, Bakhatar A, Al Mutairi S, Maneechotesuwan K, Tan D, Zeitouni M, Aggarwal B, Berzanskis A, Cintra O. Key Challenges to Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Southeast Asia, the Middle East, and North Africa: An Expert Perspective. Adv Ther 2024; 41:4312-4334. [PMID: 39312107 PMCID: PMC11480108 DOI: 10.1007/s12325-024-02954-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/22/2024] [Indexed: 10/16/2024]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a common, highly contagious pathogen and a leading cause of serious illness among infants and older adults. While existing scientific evidence has predominantly focused on the epidemiology and disease burden of RSV in infants, data in older adults remain limited in some countries, including those in Southeast Asia (SEA) and the Middle East and North Africa (MENA) region. Here, we outline the key challenges for understanding the burden of RSV in older adults in SEA and the MENA region and we propose opportunities for improving understanding and eventually reducing the impact of RSV. MAIN FINDINGS AND CONCLUSIONS A key challenge identified by the expert group, particularly in older adults, is a lack of awareness (among healthcare professionals, policy makers, and the public) of RSV burden and the associated risks for severe outcomes. This is often confounded by the complexities of underdiagnosis, surveillance limitations, and comorbidities. To address these issues, we suggest medical education initiatives for physicians in SEA and the MENA region to better understand the need to protect older adults from RSV, and encourage more widespread routine testing to better understand the burden of RSV. We also recommend surveillance studies in these regions to provide comprehensive and accurate epidemiological data on RSV in older adults. Finally, in the absence of current surveillance data in these regions, we propose extrapolating existing global data and local pediatric data to inform the likely burden of RSV in older adults. A graphical abstract is available with this article.
Collapse
Affiliation(s)
- Hakan Günen
- Süreyyapaşa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
| | - Ashraf Alzaabi
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | - Sana Al Mutairi
- College of Medicine, Kuwait University, Kuwait City, Kuwait
- Respiratory Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Kittipong Maneechotesuwan
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Daniel Tan
- University of the East College of Medicine, Quezon City, Philippines
| | - Mohammed Zeitouni
- Pulmonary Section, Department of Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | | | | |
Collapse
|
3
|
Fourati S, Reslan A, Bourret J, Casalegno JS, Rahou Y, Chollet L, Pillet S, Tremeaux P, Dossou NC, Gault E, Salmona M, Imbert-Marcille BM, Mirand A, Larrat S, Moisan A, Marot S, Schnuriger A, Veyrenche N, Engelmann I, Handala L, Henry A, Stephan V, Brichler S, Avettand-Fenoel V, Zemali N, Lefeuvre C, Pronier C, Deroche L, Jaffar-Bandjee MC, Mouna L, Francois C, Regueme A, Hartard C, Rogez S, Gallais F, Ly A, Rodriguez C, Dos Santos G, Simon-Loriere E, Schwartz O, Buchrieser J, Pawlotsky JM, Lemoine F, Audureau E, Rameix-Welti MA. Genotypic and phenotypic characterisation of respiratory syncytial virus after nirsevimab breakthrough infections: a large, multicentre, observational, real-world study. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00570-X. [PMID: 39419046 DOI: 10.1016/s1473-3099(24)00570-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Nirsevimab, a long-acting monoclonal antibody, has been approved for the prevention of respiratory syncytial virus (RSV) infection in infants. In France, more than 210 000 single doses were administered in infants younger than 1 year during the 2023-24 season. In this context, the selection and spread of escape variants might be a concern. Here, we aimed to characterise RSV associated with breakthrough infection. METHODS We did a multicentre, national, observational study in France during the 2023-24 RSV season in RSV-infected infants (aged <1 year) who either received or did not receive a dose of nirsevimab before their first RSV season. We excluded infants with insufficient information about nirsevimab treatment or without parental consent. We used respiratory samples collected in each laboratory for full-length RSV RNA sequencing to analyse changes in the nirsevimab binding site Ø. We tested clinical RSV isolates for neutralisation by nirsevimab. We analysed F candidate substitutions by fusion-inhibition assay. FINDINGS Of the 695 RSV infected infants, we analysed 545 (78%) full-length RSV genome sequences: 260 (48%) from nirsevimab-treated breakthrough infections (236 [91%] RSV-A and 24 [9%] RSV-B) and 285 (52%) from untreated RSV-infected infants (236 [83%] RSV-A and 49 [17%] RSV-B). Analysis of RSV-A did not reveal any substitution in site Ø known to be associated with resistance to nirsevimab. Two (8%) of 24 RSV-B breakthrough infections had resistance-associated substitutions: F:N208D (dominant resistance-associated substitution) and a newly described F:I64M plus F:K65R combination (minority resistance-associated substitution), both of which induced high levels of resistance in the fusion-inhibition assay. INTERPRETATION This study is, to the best of our knowledge, the largest genotypic and phenotypic surveillance study of nirsevimab breakthrough infections to date. Nirsevimab breakthrough variants remain very rare despite the drug's widespread use. The detection of resistance-associated substitutions in the RSV-B F protein highlights the importance of active molecular surveillance. FUNDING ANRS Maladies Infectieuses Emergentes and the French Ministry of Health and Prevention.
Collapse
Affiliation(s)
- Slim Fourati
- Department of Virology, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Université Paris-Est-Créteil, Créteil, France; INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France.
| | - Alawiya Reslan
- M3P, UMR 1173 (2I), INSERM, Université de Versailles St Quentin, Université Paris Saclay, Paris, France; M3P Centre National de Référence Virus des Infections Respiratoire Institut Pasteur Université Paris Cité, Paris, France
| | - Jérome Bourret
- M3P Centre National de Référence Virus des Infections Respiratoire Institut Pasteur Université Paris Cité, Paris, France
| | - Jean-Sébastien Casalegno
- Laboratoire de Virologie, Institut des Agents Infectieux, Centre de Biologie et Pathologie Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon France, France
| | - Yannis Rahou
- M3P, UMR 1173 (2I), INSERM, Université de Versailles St Quentin, Université Paris Saclay, Paris, France; M3P Centre National de Référence Virus des Infections Respiratoire Institut Pasteur Université Paris Cité, Paris, France
| | - Lionel Chollet
- Laboratoire de Biologie Médicale Centre Hospitalier Intercommunal de Toulon, Toulon, France
| | - Sylvie Pillet
- Service des Agents Infectieux et d'Hygiène-Plateau de Biologie Hôpital Nord-CHU de Saint-Etienne, France, Saint-Etienne, France
| | - Pauline Tremeaux
- Laboratoire de Virologie, CHU Toulouse, France, Toulouse France, France
| | - Nefert Candace Dossou
- Normandie, INSERM, Normandie Univ, DYNAMICURE UMR1311, CHU Caen, Department of Virology, Caen, France
| | - Elyanne Gault
- M3P, UMR 1173 (2I), INSERM, Université de Versailles St Quentin, Université Paris Saclay, Paris, France; Virology Department, Hôpital Ambroise Paré, Paris, France
| | - Maud Salmona
- Virology Department, Hôpital Saint Louis, INSIGHT U976, INSERM, Université Paris-Cité, Paris, France
| | | | - Audrey Mirand
- Virology Department, CHU de Clermont-Ferrand, Clermond-Ferrand, France
| | - Sylvie Larrat
- Université Grenoble Alpes, Laboratoire de Virologie, Institut de Biologie-Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Alice Moisan
- Université Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Université, DYNAMICURE UMR 1311, CHU Rouen, Department of Virology, Rouen, France
| | - Stéphane Marot
- Sorbonne Université; APHP Virologie Pitié-Salpêtrière, Paris Ile de France, France
| | - Aurélie Schnuriger
- Sorbonne Université, APHP Virologie St Antoine, Tenon, Trousseau, Paris Ile de France, France
| | | | - Ilka Engelmann
- Pathogenesis and Control of Chronic and Emerging Infections, Université Montpellier, INSERM, Établissement Français du Sang, CHU Montpellier, Montpellier, France
| | - Lynda Handala
- Virology Unit, Department of Bacteriology, Virology and Hospital Hygiene, University Hospital of Tours, Tours, France
| | - Amandine Henry
- Laboratoire de Biologie Médicale, Microbiologie, CH Victor Dupouy, Argenteuil, France
| | | | - Ségolène Brichler
- Service de Microbiologie Clinique, CHU Avicenne, AP-HP, Bobigny, Bobigny, France
| | | | - Nael Zemali
- CHU de Bordeaux, Service de Virologie, Bordeaux, France
| | | | | | - Luc Deroche
- Virology Department, CHU de Poitiers, Poitiers, France
| | | | - Lina Mouna
- Virology Department, Hôpital Paul Brousse, INSERM U1193, AP-HP, Université Paris Saclay, Paris, France
| | - Catherine Francois
- Laboratoire de Virologie, Centre de Biologie Humaine-CHU Amiens, Université Picardie Jules Verne, Amiens, France
| | - Alexandre Regueme
- Université Lille, CHU de Lille, Laboratoire de Virologie ULR3610, Lille, France
| | - Cédric Hartard
- Laboratoire de Virologie, CHRU de Nancy Brabois, Université de LorraineVandœuvre-lès-Nancy, France
| | - Sylvie Rogez
- Virology Department, CHU de Limoges, Limoges, France
| | | | - Arnaud Ly
- Department of Virology, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Christophe Rodriguez
- Department of Virology, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Université Paris-Est-Créteil, Créteil, France; INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France
| | | | - Etienne Simon-Loriere
- Evolutionary Genomics of RNA Viruses, Institut Pasteur, Université Paris Cité, Paris, France
| | - Olivier Schwartz
- Virus and Immunity Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Julian Buchrieser
- Virus and Immunity Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jean-MiIchel Pawlotsky
- Department of Virology, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Université Paris-Est-Créteil, Créteil, France; INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France
| | - Frédéric Lemoine
- M3P Centre National de Référence Virus des Infections Respiratoire Institut Pasteur Université Paris Cité, Paris, France; Bioinformatics and Biostatistics Hub, Institut Pasteur, Université Paris Cité, Paris, France
| | - Etienne Audureau
- Université Paris-Est-Créteil, Créteil, France; Clinical Research Unit Mondor, Hôpitaux Universitaires Henri Mondor, AP-HP, IMRB INSERM U955, Team CEpiA, Créteil, France
| | | |
Collapse
|
4
|
Han HJ, Ryu D, Kim JY, Jang S, Suh HS. Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study. BMC Infect Dis 2024; 24:1152. [PMID: 39396944 PMCID: PMC11472633 DOI: 10.1186/s12879-024-09971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 09/20/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease. METHODS This retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV. RESULTS Out of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 - 1,261) and full-term infants ($ 606; 95% CI: 583-630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk-shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics. CONCLUSION Our findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden.
Collapse
Affiliation(s)
- Hyun Jin Han
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Dahye Ryu
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Ju Young Kim
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Semin Jang
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
- College of Pharmacy, The University of Texas at Austin, Austin, TX, 78712 , USA
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea.
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea.
- College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea.
| |
Collapse
|
5
|
von Linstow ML, Rudolfsen JH, Olsen J, Skovdal M, Staerke NB. Burden of disease and cost of illness of infants less than 6 months of age hospitalised with respiratory syncytial virus in Denmark - a 10-year national register-based study. BMC Infect Dis 2024; 24:1098. [PMID: 39363313 PMCID: PMC11448205 DOI: 10.1186/s12879-024-09975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 09/23/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of hospitalisation in infants aged ≤ 6 months in Western countries. Nearly 1,500 infants under six months of age are hospitalised with RSV annually in Denmark. This nationwide study describes the healthcare resource utilisation and costs related to RSV hospitalisation in this vulnerable age group. METHODS RSV cases were identified in the Danish National Patient Register. Infants were included if they at the age of 0-5 months had a (1) respiratory related hospital admission (duration > 12 h), (2) within 10 days of a positive RSV test, (3) between January 2013 and December 2022. Each case was matched with five individuals never diagnosed with RSV on age, sex, region of residence, birth (pre/full term), number of siblings < 7 years old, and parents' education. An episode of RSV was defined as the seven days prior to hospitalisation to 30 days after initial hospitalisation. Study outcomes included contacts with hospital and primary care, and total healthcare costs defined as the sum cost of hospital care, primary care, and prescription medicine. Cost and contacts attributable to RSV was calculated in a diff-in-diff framework, as the difference between case and reference group. RESULTS The study population comprised of 8,428 RSV cases and 41,725 reference individuals. Cases generated 1.58 (p < 0.001) attributable inpatient contacts, 0.84 (p < 0.001) outpatient contacts, and 1.19 (p < 0.001) primary care contacts during their RSV episode. An additional 0.6 (p < 0.001) inpatient, 1.08 (p < 0.001) outpatient and 2.42 (p < 0.001) primary care contacts were attributed to RSV in the year following the RSV episode. Total cost of an RSV episode was EUR 2,997 (p < 0.001) with an additional EUR 1,428 (p < 0.001) in the following year. CONCLUSION RSV hospitalisations of infants are associated with substantial healthcare utilisation and costs. The same pattern was observed in the year following the RSV episode. If the new RSV prevention options are introduced nationwide, the overall burden of RSV is expected to be substantially reduced in the future.
Collapse
Affiliation(s)
- Marie-Louise von Linstow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark.
| | | | | | | | | |
Collapse
|
6
|
Mortensen GL, Charkaluk ML. Parental knowledge about respiratory syncytial virus and attitudes toward infant immunization with monoclonal antibodies in France. Arch Pediatr 2024:S0929-693X(24)00137-4. [PMID: 39261198 DOI: 10.1016/j.arcped.2024.07.003] [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: 06/25/2023] [Revised: 01/25/2024] [Accepted: 07/01/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND AND AIM Respiratory syncytial virus (RSV) is a leading cause of hospitalization of infants with respiratory infections. A new immunization using monoclonal antibodies (mAbs) may offer protection against RSV infections. A study was conducted across eight countries to gain insight into parental awareness of RSV, their sources of child health information, and attitudes toward infant immunization against RSV using mAbs. This paper presents the findings from France. METHODS In 2021, a survey was conducted in eight countries among expecting and current parents with children younger than 24 months of age. Eligible respondents included parents who were open to childhood immunizations, i.e., they had given or planned to give their children "all," "most," or "some" immunizations. RESULTS In France, the survey respondents had high adoption rates for childhood immunizations. Key drivers behind these high rates were the desire to protect their children from severe diseases and adherence to mandatory immunizations, whereas concerns about safety were the main barriers. While general practitioners and pediatricians were key sources of advice on child health, many parents also requested information about immunizations from health authorities and nurses. Sources of advice varied with parental age, gender, educational level, and income. The majority of parents had no knowledge about mAbs or passive immunization, and the overall awareness of RSV was low. When informed about RSV and mAbs, most parents held neutral to positive attitudes toward nirsevimab for their infants if recommended by a healthcare professional and/or included in the immunization program. These findings were further confirmed by the 60 %-80 % uptake rates of nirsevimab following the introduction in September 2023.
Collapse
|
7
|
Stucki M, Lenzin G, Agyeman PK, Posfay-Barbe KM, Ritz N, Trück J, Fallegger A, Oberle SG, Martyn O, Wieser S. Inpatient burden of respiratory syncytial virus (RSV) in Switzerland, 2003 to 2021: an analysis of administrative data. Euro Surveill 2024; 29:2400119. [PMID: 39328156 PMCID: PMC11484346 DOI: 10.2807/1560-7917.es.2024.29.39.2400119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/13/2024] [Indexed: 09/28/2024] Open
Abstract
BackgroundRespiratory syncytial virus (RSV) is a leading cause of acute respiratory infections and hospitalisations in infants (age < 1 year) and young children. Little is known on RSV epidemiology and related inpatient healthcare resource use (HCRU) in Switzerland.AimTo explore RSV-related hospitalisations, inpatient HCRU and medical costs in all age groups, and risk factors for infant hospitalisations in Switzerland.MethodsWe used national hospital registry data from 2003 to 2021 identifying RSV cases with ICD-10-GM codes, and described demographic characteristics, HCRU and associated medical costs of RSV inpatients. The effect of risk factors on infant hospitalisation was estimated with logistic regression.ResultsWe observed a general increase and biannual pattern in RSV hospitalisations between 2003/04 and 2018/19, with 3,575 hospitalisations in 2018/19 and 2,487 in 2019/20 before numbers declined in 2020/21 (n = 902). Around two thirds of all hospitalisations occurred in infants. Mean (median) age was 118 (85) days in hospitalised infants and 74 (77) years in hospitalised adult patients (> 18 years); 7.2% of cases required intensive care unit stay. Mean inpatient medical costs were estimated at EUR 8,046. Most (90.8%) hospitalised infants with RSV were born after 35 weeks of gestation without bronchopulmonary dysplasia or congenital heart disease. Low birth weight, gestational age and congenital disorders were associated with a higher risk for hospitalisation.ConclusionsRSV leads to a substantial number of hospitalisations and peaks in hospital capacity utilisation. Measures to protect all infants from an RSV hospitalisation are essential in addressing this public health challenge.
Collapse
Affiliation(s)
- Michael Stucki
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Golda Lenzin
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Philipp Ka Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klara M Posfay-Barbe
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicole Ritz
- Children's Hospital of Central Switzerland, Department of Paediatrics and Infectious Diseases Unit and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
| | - Johannes Trück
- Divisions of Allergy and Immunology, University Children's Hospital and Children's Research Center, University of Zurich (UZH), Zurich, Switzerland
| | | | | | - Oliver Martyn
- Sanofi A/S, Vaccines Medical Affairs, Copenhagen, Denmark
| | - Simon Wieser
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| |
Collapse
|
8
|
Poshtiban A, Wick M, Bangert M, Damm O. Burden of respiratory syncytial virus (RSV) infection in Germany: a systematic review. BMC Infect Dis 2024; 24:844. [PMID: 39164625 PMCID: PMC11337829 DOI: 10.1186/s12879-024-09758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection and hospitalizations among infants, young children, and the elderly. This systematic literature review aimed to summarize the epidemiological and economic burden estimates of RSV infection at any age in Germany. METHODS We conducted a systematic literature search to identify full-text articles published from 2003 to 2023 and reporting data on the epidemiological or economic burden of RSV in Germany. Based on pre-specified eligibility criteria, data on incidence, rates of hospital and intensive care unit (ICU) admission, clinical manifestation, underlying conditions, seasonality, health care resource use and costs were extracted. RESULTS After screening 315 full-text articles, we included 42 articles in the review. The characteristics of the included studies were heterogenous regarding study population, setting, age groups and RSV-related outcome measures. The most frequently reported epidemiological outcome measures were RSV detection rate (n = 33), followed by clinical manifestation (n = 19), seasonality (n = 18), and underlying conditions of RSV infection (n = 13). RSV detection rates were reported across heterogenous study populations, ranging from 5.2 to 55.4% in pediatric inpatient cases and from 2.9 to 14% in adult inpatient cases. All articles that reported RSV detection rates across several age groups demonstrated the highest burden in infants and young children. Few articles reported RSV-related outcome measures distinctively for the outpatient setting. Health care resource use, such as hospital length of stay, ICU admission rate and treatment of patients with RSV infection were described in 23 articles, of which only one study quantified associated costs from 1999 to 2003 for children ≤ 3 years. In-hospital ICU admission rates varied between 3.6 and 45%, depending on population characteristics as age and underlying conditions. CONCLUSIONS This systematic review revealed that RSV imposes substantial disease burden in infants, young children, and the elderly in Germany, whereby infants are particularly affected. To date, there has been limited exploration of the impact of RSV infection on healthy children or the elderly in Germany. Given their notably high reported burden in studies, the medical and economic RSV burden in these groups should move more into focus.
Collapse
Affiliation(s)
- Anahita Poshtiban
- Sanofi-Aventis Deutschland GmbH, Lützowstr. 107, 10785, Berlin, Germany.
| | - Moritz Wick
- Sanofi-Aventis Deutschland GmbH, Lützowstr. 107, 10785, Berlin, Germany
| | | | - Oliver Damm
- Sanofi-Aventis Deutschland GmbH, Lützowstr. 107, 10785, Berlin, Germany
| |
Collapse
|
9
|
Egeskov-Cavling AM, van Wijhe M, Yakimov V, Johannesen CK, Pollard AJ, Trebbien R, Bybjerg-Grauholm J, Fischer TK. Genome-wide Association Study of Susceptibility to Respiratory Syncytial Virus Hospitalization in Young Children <5 Years of age. J Infect Dis 2024; 230:e333-e341. [PMID: 37666001 PMCID: PMC11326809 DOI: 10.1093/infdis/jiad370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/22/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Worldwide, respiratory syncytial virus (RSV) infections are among the most common causes of infant hospitalization. Host genetic factors influencing the risk and severity of RSV infection are not well known. METHODS We conducted a genome-wide association study (GWAS) to investigate single-nucleotide polymorphisms (SNPs) associated with severe RSV infections using a nested case-control design based on 2 Danish cohorts. We compared SNPs from 1786 children hospitalized with RSV to 45 060 controls without an RSV-coded hospitalization. We performed gene-based testing, tissue enrichment, gene-set enrichment, and a meta-analysis of the 2 cohorts. Finally, an analysis of potential associations between the severity of RSV infection and genetic markers was performed. RESULTS We did not detect any significant genome-wide associations between SNPs and RSV infection or the severity of RSV. We did find potential loci associated with RSV infections on chromosome 5 in 1 cohort but failed to replicate any signals in both cohorts. CONCLUSIONS Despite being the largest GWAS of severe RSV infection, we did not detect any genome-wide significant loci. This may be an indication of a lack of power or an absence of signal. Future studies might include mild illness and need to be larger to detect any significant associations.
Collapse
Affiliation(s)
- Amanda Marie Egeskov-Cavling
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen
- Department of Clinical Research, Nordsjællands Hospital, Hilleroed
| | - Maarten van Wijhe
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen
- Department of Science and Environment, Roskilde University
| | - Victor Yakimov
- Neonatal Genetics, Statens Serum Institut, Copenhagen, Denmark
| | - Caroline Klint Johannesen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen
- Department of Clinical Research, Nordsjællands Hospital, Hilleroed
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and National Institute for Health and Care Research Oxford Biomedical Research Centre, United Kingdom
| | - Ramona Trebbien
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen
| | | | - Thea Kølsen Fischer
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen
- Department of Clinical Research, Nordsjællands Hospital, Hilleroed
- Department of Public Health, University of Copenhagen, Denmark
| |
Collapse
|
10
|
Pérez-Rubio A, Mestre-Ferrandiz J, López-Belmonte JL, Diaz-Aguiló A, Lorenzo-Herrero S, Crespo C. Impact of twelve immunization-preventable infectious diseases on population health using disability-adjusted life years (DALYs) in Spain. BMC Infect Dis 2024; 24:779. [PMID: 39103777 DOI: 10.1186/s12879-024-09637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The objective of this study is to estimate the burden of selected immunization-preventable infectious diseases in Spain using the Burden of Communicable Diseases in Europe (BCoDE) methodology, as well as focusing on the national immunization programme and potential new inclusions. METHODS The BCoDE methodology relies on an incidence and pathogen-based approach to calculate disease burden via disability-adjusted life year (DALY) estimates. It considers short and long-term sequelae associated to an infection via outcome trees. The BCoDE toolkit was used to populate those trees with Spanish-specific incidence estimates, and de novo outcome trees were developed for four infections (herpes zoster, rotavirus, respiratory syncytial virus [RSV], and varicella) not covered by the toolkit. Age/sex specific incidences were estimated based on data from the Spanish Network of Epidemiological Surveillance; hospitalisation and mortality rates were collected from the Minimum Basic Data Set. A literature review was performed to design the de novo models and obtain the rest of the parameters. The methodology, assumptions, data inputs and results were validated by a group of experts in epidemiology and disease modelling, immunization and public health policy. RESULTS The total burden of disease amounted to 163.54 annual DALYs/100,000 population. Among the selected twelve diseases, respiratory infections represented around 90% of the total burden. Influenza exhibited the highest burden, with 110.00 DALYs/100,000 population, followed by invasive pneumococcal disease and RSV, with 25.20 and 10.57 DALYs/100,000 population, respectively. Herpes zoster, invasive meningococcal disease, invasive Haemophilus influenza infection and hepatitis B virus infection ranked lower with fewer than 10 DALYs/100,000 population each, while the rest of the infections had a limited burden (< 1 DALY/100,000 population). A higher burden of disease was observed in the elderly (≥ 60 years) and children < 5 years, with influenza being the main cause. In infants < 1 year, RSV represented the greatest burden. CONCLUSIONS Aligned with the BCoDE study, the results of this analysis show a persisting high burden of immunization-preventable respiratory infections in Spain and, for the first time, highlight a high number of DALYs due to RSV. These estimates provide a basis to guide prevention strategies and make public health decisions to prioritise interventions and allocate healthcare resources in Spain.
Collapse
Affiliation(s)
| | | | | | | | | | - Carlos Crespo
- Axentiva Solutions, Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
| |
Collapse
|
11
|
Martinón‐Torres F, Gutierrez C, Cáceres A, Weber K, Torres A. How Does the Burden of Respiratory Syncytial Virus Compare to Influenza in Spanish Adults? Influenza Other Respir Viruses 2024; 18:e13341. [PMID: 38923767 PMCID: PMC11194680 DOI: 10.1111/irv.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) and influenza infections cause significant annual morbidity and mortality worldwide in at-risk populations. This study is aimed at assessing hospital burden and healthcare resource utilization (HRU) of RSV and influenza in adults in Spain. METHODS Data were obtained from the Projected Hospitalisation Database of inpatient episodes (ages: younger adults 18-50 and 51-64 years; older adults 65-74, 75-84, and ≥ 85 years) during 2015, 2017, and 2018 in Spanish public hospitals. Incidence, mean hospitalization, and HRU assessments, including length of stay (LOS), intensive care unit (ICU) usage, and age-standardized mortality rates, were collected and stratified by age group, with analyses focusing on the adult population (≥ 18 years old). RESULTS Mean hospitalization rate in the population across all years was lower in individuals with RSV versus influenza (7.2/100,000 vs. 49.7/100,000 individuals). ICU admissions and median LOS were similar by age group for both viruses. Age-standardized mortality was 6.3/100,000 individuals and 6.1/100,000 individuals in patients with RSV and influenza, respectively, and mortality rates were similar in older adults (≥ 65 years) for both viruses. CONCLUSIONS RSV and influenza infection were associated with considerable HRU. There is a substantial disease burden for RSV infection in older adults ≥ 65 years. While RSV hospitalization rates in adults reported here appeared lower than influenza, RSV is still underdiagnosed in the hospital setting and its incidence might be similar to, or higher than, influenza.
Collapse
Affiliation(s)
- Federico Martinón‐Torres
- Translational Pediatrics and Infectious DiseasesHospital Clínico Universitario de Santiago de CompostelaSantiago de CompostelaSpain
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group, Instituto de Investigación Sanitaria de SantiagoUniversidad de SantiagoSantiago de CompostelaSpain
- Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | | | - Ana Cáceres
- Infectious Diseases and VaccinesJanssen‐CilagMadridSpain
| | - Karin Weber
- Global Medical Affairs IDVJanssen‐CilagViennaAustria
| | - Antoni Torres
- Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
- Department of PneumonologyHospital Clinic of BarcelonaBarcelonaSpain
- Pulmonology DepartmentAugust Pi i Sunyer Biomedical Research Institute (IDIBAPS)BarcelonaSpain
- ICREA Academia, Life and Medical SciencesUniversitat de BarcelonaBarcelonaSpain
| |
Collapse
|
12
|
Lodi L, Catamerò F, Voarino M, Barbati F, Moriondo M, Nieddu F, Sarli WM, Citera F, Astorino V, Pelosi C, Quaranta F, Stocco S, Canessa C, Lastrucci V, Ricci S, Indolfi G, Azzari C. Epidemiology of respiratory syncytial virus in hospitalized children over a 9-year period and preventive strategy impact. Front Pharmacol 2024; 15:1381107. [PMID: 38841370 PMCID: PMC11150665 DOI: 10.3389/fphar.2024.1381107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Background: Respiratory Syncytial Virus (RSV) is the primary cause of respiratory infections and hospitalizations in young children globally, leading to substantial disease burden and mortality. The aim of the present study was to review and provide updates on how the SARS-CoV-2 pandemic have significantly influenced RSV epidemiology on hospitalized children due to RSV infection. A potential impact of the available preventive strategies on the same population were provided. Methods: All children aged 0-6 years hospitalized at Meyer Children's Hospital IRCCS for RSV infection from September 2014 to March 2023 were retrospectively recorded. Seasonal trends before and after SARS-CoV-2 pandemic, age distribution, ICU admission and co-infections, comorbidities and prematurity were retrieved. Predictions on the number of hospitalizations avoided by the deployment of different preventive strategies were provided. Results: A total of 1,262 children with RSV infection were included in the study. The 70% of them had less than 1 year-of-age at the moment of hospitalization and almost 50% less than 3 months. In the post-pandemic seasons, a 317% increase in the number of hospitalizations was recorded with a significant increase in older children compared to the pre-pandemic seasons. ICU support was required for 22% of children, the majority of whom were under 3 months of age. Almost 16% of hospitalized children were born preterm and only 27% of hospitalized children had prior comorbidities. The rate of comorbidities among RSV hospitalized children increased with age. Nirsevimab prophylaxis could have prevented more than 46% of hospitalizations in this cohort. A preventive strategy addressing also children aged 7 months to 6 years of age with co-existing comorbidities would increase that rate above 57%. Discussion: The identification of RSV hospitalization-related features is informing the decision-maker for the deployment of the wisest preventive approach on a population scale.
Collapse
Affiliation(s)
- Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
| | | | - Marta Voarino
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Federica Barbati
- Immunology Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
- Pediatrics and Neonatology Unit, Santo Stefano Hospital, AUSL Toscana Centro, Prato, Italy
| | - Maria Moriondo
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesco Nieddu
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Walter Maria Sarli
- Immunology Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesco Citera
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Valeria Astorino
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Caterina Pelosi
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesca Quaranta
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Silvia Stocco
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Clementina Canessa
- Immunology Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Vieri Lastrucci
- Epidemiology Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Giuseppe Indolfi
- Department of Neurofarba, University of Florence, Florence, Italy
- Liver Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Department of Pediatrics, Meyer Children’s Hospital IRCCS, Florence, Italy
| |
Collapse
|
13
|
Mazela J, Jackowska T, Czech M, Helwich E, Martyn O, Aleksiejuk P, Smaga A, Glazewska J, Wysocki J. Epidemiology of Respiratory Syncytial Virus Hospitalizations in Poland: An Analysis from 2015 to 2023 Covering the Entire Polish Population of Children Aged under Five Years. Viruses 2024; 16:704. [PMID: 38793586 PMCID: PMC11126078 DOI: 10.3390/v16050704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important cause of childhood hospitalizations. The aim of the study was to estimate the rates of RSV-related hospitalizations in children aged less than 5 years in Poland. METHODS This retrospective observational cohort study was based on data obtained from the National Health Fund in Poland regarding all acute respiratory tract infections and RSV-coded admissions of children (age < 5 years) to public hospitals between July 2015 and June 2023. Patients were stratified based on the following age groups: 0-1 month, 2-3 months, 4-6 months, 7-12 months, 13-24 months, and 25-60 months. RESULTS The number of RSV-related hospitalizations increased every season, both before and through the ending phase of the coronavirus disease 2019 (COVID-19) pandemic. The COVID-19 pandemic was associated with a shift in the seasonality pattern of RSV infection. Hospitalization rates per 1000 inhabitants were the highest for children aged 0-12 months, reaching 47.3 in the 2022/23 season. Within this group, the highest hospitalization rate was observed for children aged 2-3 months-94.9 in the 2022/23 season. During the ending phase of the COVID-19 pandemic, the observed increase in admission rates was 2-, 4-, and 5-fold the pre-COVID rate for children aged <12 months, 12-24 months, and 25-60 months, respectively. CONCLUSIONS In Poland, RSV infections cause a significant burden in hospitalized children aged less than 5 years. RSV-related hospitalizations were most frequent in children aged less than 1 year. The COVID-19 pandemic was associated with a shift in the seasonality pattern of RSV infections. After the pandemic, more RSV-related hospitalizations were observed in older children (aged 13 months and older) vs. the pre-pandemic phase.
Collapse
Affiliation(s)
- Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences in Poznan, 60-535 Poznan, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Marcin Czech
- Department of Pharmacoeconomics, Hospital Infection Control Team, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Ewa Helwich
- Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Oliver Martyn
- Sanofi A/S, Vaccines Medical Affairs, DK-2100 København, Denmark;
| | - Pawel Aleksiejuk
- Sanofi Sp. z o.o., Vaccines Medical Affairs, 01-211 Warsaw, Poland
| | - Anna Smaga
- PEX Sp. z o.o., 02-796 Warsaw, Poland; (A.S.); (J.G.)
- National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | | | - Jacek Wysocki
- Department of Preventive Medicine, Poznan University of Medical Sciences at Poznan, 61-701 Poznan, Poland;
| |
Collapse
|
14
|
Hak SF, Venekamp RP, Wildenbeest JG, Bont LJ. Outpatient respiratory syncytial virus infections and novel preventive interventions. Curr Opin Pediatr 2024; 36:171-181. [PMID: 38085019 PMCID: PMC10919273 DOI: 10.1097/mop.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE OF REVIEW With interventions to prevent respiratory syncytial virus (RSV) infection within reach, this review aims to provide healthcare professionals with the latest information necessary to inform parents and assess the potential impact of RSV prevention on everyday practice. We address frequently asked questions for parental counseling. RECENT FINDINGS Numerous studies emphasize the major burden of RSV on young children, parents, healthcare and society. In the first year of life, about 14% of healthy term infants visit a doctor and 2% require hospitalization due to RSV. In older children (1--5 years), RSV infections and associated morbidity (wheeze, acute otitis media) are major drivers of outpatient visits. A novel maternal RSV vaccine and long-acting mAb can provide protection during infants' first months of life. This maternal vaccine showed 70.9% efficacy against severe RSV infection within 150 days after birth; the mAb nirsevimab reduces medically attended RSV infections by 79.5% within 150 days after administration. Both gained regulatory approval in the USA (FDA) and Europe (EMA). SUMMARY Novel RSV immunizations hold promise to reduce the RSV burden in infants, with substantial impact on everyday practice. Tailored parental guidance will be instrumental for successful implementation. Awaiting pediatric vaccines, RSV infections beyond infancy will still pose a significant outpatient burden.
Collapse
Affiliation(s)
- Sarah F. Hak
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center Utrecht
| | - Roderick P. Venekamp
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Joanne G. Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center Utrecht
| | - Louis J. Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center Utrecht
- Respiratory Syncytial Virus NETwork (ReSViNET) Foundation, Zeist, The Netherlands
| |
Collapse
|
15
|
Servadio M, Finocchietti M, Vassallo C, Cipelli R, Heiman F, Di Lucchio G, Oresta B, Addis A, Belleudi V. An epidemiological investigation of high-risk infants for Respiratory Syncytial Virus infections: a retrospective cohort study. Ital J Pediatr 2024; 50:56. [PMID: 38528568 DOI: 10.1186/s13052-024-01627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Respiratory Syncytial Virus (RSV) infections may lead to severe consequences in infants born preterm with breathing problems (such as bronchopulmonary dysplasia (BPD) and respiratory distress syndrome (RDS)) or congenital heart diseases (CHD). Since studies investigating the influence of different gestational age (WGA) and concomitant specific comorbidities on the burden of RSV infections are scarce, the present study aimed to better characterize these high-risk populations in the Italian context. METHODS This retrospective, longitudinal and record-linkage cohort study involved infants born between 2017 and 2019 in Lazio Region (Italy) and is based on data extracted from administrative databases. Each infant was exclusively included in one of the following cohorts: (1) BPD-RDS (WGA ≤35 with or without CHD) or (2) CHD (without BPD and/or RDS) or (3) Preterm (WGA ≤35 without BPD (and/or RDS) or CHD). Each cohort was followed for 12 months from birth. Information related to sociodemographic at birth, and RSV and Undetermined Respiratory Agents (URA) hospitalizations and drug consumption at follow-up were retrieved and described. RESULTS A total of 8,196 infants were selected and classified as 1,084 BPD-RDS, 3,286 CHD and 3,826 Preterm. More than 30% of the BPD-RDS cohort was composed by early preterm infants (WGA ≤ 29) in contrast to the Preterm cohort predominantly constitute by moderate preterm infants (98.2%), while CHD infants were primarily born at term (83.9%). At follow-up, despite the cohorts showed similar proportions of RSV hospitalizations, in BPD-RDS cohort hospitalizations were more frequently severe compared to those occurred in the Preterm cohort (p<0.01), in the BPD-RDS cohort was also found the highest proportion of URA hospitalizations (p<0.0001). In addition, BPD-RDS infants, compared to those of the remaining cohorts, received more frequently prophylaxis with palivizumab (p<0.0001) and were more frequently treated with adrenergics inhalants, and glucocorticoids for systemic use. CONCLUSIONS The assessment of the study clinical outcomes highlighted that, the demographic and clinical characteristics at birth of the study cohorts influence their level of vulnerability to RSV and URA infections. As such, continuous monitoring of these populations is necessary in order to ensure a timely organization of health care system able to respond to their needs in the future.
Collapse
Affiliation(s)
- Michela Servadio
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
- IQVIA Solutions Italy S.r.l., Milan, Italy
| | - Marco Finocchietti
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
| | | | | | | | | | - Bianca Oresta
- AstraZeneca S.p.A. - Medical Department, Milan, Italy
| | - Antonio Addis
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy.
| | - Valeria Belleudi
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
| |
Collapse
|
16
|
Raghuveer TS, Zackula R. Nirsevimab for Prevention of RSV Hospitalizations in Infants. N Engl J Med 2024; 390:1152. [PMID: 38507765 DOI: 10.1056/nejmc2400983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
| | - Rosalee Zackula
- University of Kansas School of Medicine-Wichita, Wichita, KS
| |
Collapse
|
17
|
Bøås H, Havdal LB, Størdal K, Døllner H, Leegaard TM, Bekkevold T, Flem E, Inchley C, Nordbø SA, Rojahn AE, Debes S, Barstad B, Haarr E, Kran AMB. No association between disease severity and respiratory syncytial virus subtypes RSV-A and RSV-B in hospitalized young children in Norway. PLoS One 2024; 19:e0298104. [PMID: 38466702 PMCID: PMC10927124 DOI: 10.1371/journal.pone.0298104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/13/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE There is conflicting evidence whether subtypes of Respiratory syncytial virus have different seasonality or are differentially associated with clinical severity. We aimed to explore the associations between disease severity and RSV subtypes RSV-A and RSV-B and to describe the circulation of RSV subtypes pattern by season and age. METHODS Active prospective hospital surveillance for RSV-A and RSV-B in children <59 months of age was conducted during 2015-2018. All febrile children 12-59 months of age were enrolled, whereas children <12 months were eligible if presenting with fever or respiratory symptoms. Risk factors and upper and lower respiratory tract infection was identified by linkage to national registry data and analyzed using penalized maximum likelihood logistic regression. RESULTS Both RSV-A and B were found to co-circulate throughout all three study seasons, and no clear seasonal pattern was identified. Likewise, we found no association between sex or measures of severity with RSV-A or RSV-B. There was significantly more RSV-A than RSV-B among children with comorbidities. CONCLUSIONS No association was found between disease severity or sex and RSV subtypes RSV-A and RSV-B in hospitalized young children in Norway.
Collapse
Affiliation(s)
- Håkon Bøås
- Norwegian Institute of Public Health, Oslo, Norway
| | - Lise Beier Havdal
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Ketil Størdal
- Department of Pediatrics, Østfold Hospital, Grålum, Norway
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henrik Døllner
- Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Truls Michael Leegaard
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine - Campus Ahus, University of Oslo, Oslo, Norway
| | | | - Elmira Flem
- Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher Inchley
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Svein Arne Nordbø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs University Hospital, Trondheim, Norway
| | | | - Sara Debes
- Department of Medical Microbiology, Østfold Hospital, Grålum, Norway
| | - Bjørn Barstad
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Elisebet Haarr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Anne-Marte Bakken Kran
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | | |
Collapse
|
18
|
Grant WB. Vitamin D and viral infections: Infectious diseases, autoimmune diseases, and cancers. ADVANCES IN FOOD AND NUTRITION RESEARCH 2024; 109:271-314. [PMID: 38777416 DOI: 10.1016/bs.afnr.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Viruses can cause many human diseases. Three types of human diseases caused by viruses are discussed in this chapter: infectious diseases, autoimmune diseases, and cancers. The infectious diseases included in this chapter include three respiratory tract diseases: influenza, COVID-19, and respiratory syncytial virus. In addition, the mosquito-borne dengue virus diseases are discussed. Vitamin D can reduce risk, severity, and mortality of the respiratory tract diseases and possibly for dengue virus. Many autoimmune diseases are initiated by the body's reaction to a viral infection. The protective role of vitamin D in Epstein-Barr virus-related diseases such as multiple sclerosis is discussed. There are a few cancers linked to viral infections. Such cancers include cervical cancer, head and neck cancers, Hodgkin's and non-Hodgkin's lymphoma, and liver cancer. Vitamin D plays an important role in reducing risk of cancer incidence and mortality, although not as strongly for viral-linked cancers as for other types of cancer.
Collapse
Affiliation(s)
- William B Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, USA.
| |
Collapse
|
19
|
Abushahin A, Toma H, Alnaimi A, Abu-Hasan M, Alneirab A, Alzoubi H, Belavendra A, Janahi I. Impact of COVID‑19 pandemic restrictions and subsequent relaxation on the prevalence of respiratory virus hospitalizations in children. BMC Pediatr 2024; 24:91. [PMID: 38302912 PMCID: PMC10835825 DOI: 10.1186/s12887-024-04566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and the consequently adopted worldwide control measures have resulted in global changes in the epidemiology and severity of other respiratory viruses. We compared the number and severity of viral acute lower respiratory tract infection (ALRTI) hospitalizations and determined changes in causative respiratory pathogens before, during, and after the pandemic among young children in Qatar. METHODS In this single-center retrospective study, we reviewed data of children ≤ 36 months old who were admitted to Sidra Medicine in Qatar with a viral ALRTI during winter seasons (September-April) between 2019 and 2023. The study period was divided into three distinct seasons based on the pandemic-imposed restrictions as follows: (1) the period between September 2019 and April 2020 was considered the pre-COVID-19 pandemic season; (2) the periods between September 2020 and April 2021, and the period between January and April 2022 were considered the COVID-19 pandemic seasons; and (3) the periods between September 2022 and April 2023 was considered the post-COVID-19 pandemic season. RESULTS During the COVID-19 season, 77 patients were admitted, compared with 153 patients during the pre-COVID-19 season and 230 patients during the post-COVID-19 season. RSV was the dominant virus during the pre-COVID-19 season, with a detection rate of 50.9%. RSV infection rate dropped significantly during the COVID-19 season to 10.4% and then increased again during the post-COVID-19 season to 29.1% (P < 0.001). Rhinovirus was the dominant virus during the COVID-19 (39.1%) and post-COVID-19 seasons (61%) compared to the pre-COVID-19 season (31.4%) (P < 0.001). The average length of hospital stay was significantly longer in the post-COVID-19 season than in the pre-COVID-19 and COVID-19 seasons (P < 0.001). No significant differences in the pediatric intensive care unit (PICU) admission rate (P = 0.22), PICU length of stay (p = 0.479), or respiratory support requirements were detected between the three seasons. CONCLUSION Our study showed reduced viral ALRTI hospitalizations in Qatar during the COVID-19 pandemic with reduced RSV detection. An increase in viral ALRTI hospitalizations accompanied by a resurgence of RSV circulation following the relaxation of COVID-19 restrictions was observed without changes in disease severity.
Collapse
Affiliation(s)
- Ahmed Abushahin
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar.
- Weill Cornel Medicine-Qatar (WCM-Q), Doha, Qatar.
| | - Haneen Toma
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
| | - Amal Alnaimi
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
- Weill Cornel Medicine-Qatar (WCM-Q), Doha, Qatar
| | - Mutasim Abu-Hasan
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
| | - Abdullah Alneirab
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
| | - Hadeel Alzoubi
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
| | - Antonisamy Belavendra
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
| | - Ibrahim Janahi
- Department of Pediatric Medicine, Division of Pulmonology, Sidra Medicine, Doha, Qatar
- Weill Cornel Medicine-Qatar (WCM-Q), Doha, Qatar
| |
Collapse
|
20
|
Cedrone F, Montagna V, Del Duca L, Camplone L, Mazzocca R, Carfagnini F, Ancona A, Santangelo OE, Fortunato V, Di Martino G. Epidemiology of Bronchiolitis and Respiratory Syncytial Virus and Analysis of Length of Stay from 2015 to 2022: Retrospective Observational Study of Hospital Discharge Records from an Italian Southern Province before and during the COVID-19 Pandemic. Diseases 2024; 12:17. [PMID: 38248368 PMCID: PMC10814154 DOI: 10.3390/diseases12010017] [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: 09/30/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Severe respiratory infections, including pneumonia or bronchiolitis, caused by RSV can range from mild upper respiratory tract infections to those leading to hospitalization and serious complications such as respiratory failure in children. High-risk groups, such as premature infants and infants with underlying medical conditions, have a higher susceptibility to severe RSV disease. We conducted a retrospective study from years 2015 to 2022 in the Local Health Authority (LHA) of Pescara that counts about 320,000 inhabitants, with the aim to evaluate the burden of RSV infection, focusing on the incidence, hospitalization, and characteristics that may prolong hospital stays. METHODS All hospitalizations from 2015 to 2022 were extracted from the hospital discharge record. The monthly hospitalization rates were calculated and standardized by gender and age for the population resident in the Province of Pescara on 1 January 2015. RESULTS During the study period, 31,837 admissions were reported among patients aged less than 6 years. Of those, 520 hospitalizations were referred for bronchiolitis. Monthly admission rates highlighted the seasonality of bronchiolitis admissions, with higher rates in the months from December to March in all study years included. The winter seasons of years 2021 and 2022 reported a surge in bronchiolitis incidence, with a rate of 4.0/1000 (95% CI 2.964-5.146) in December 2021 and 4.0 (95% CI 2.891-5.020) in December 2022. CONCLUSIONS Bronchiolitis represents an important cause of hospitalization among patients aged less than 6 years. The incidence was particularly increased during the winter seasons in years 2021 and 2022.
Collapse
Affiliation(s)
- Fabrizio Cedrone
- Hospital Healthcare Management, Local Health Autority of Pescara, Via Renato Paolini, 65124 Pescara, Italy; (L.D.D.); (F.C.); (V.F.)
| | - Vincenzo Montagna
- Postgraduate School of Hygiene and Preventive Medicine, Università Politecnica delle Marche, 60100 Ancona, Italy;
| | - Livio Del Duca
- Hospital Healthcare Management, Local Health Autority of Pescara, Via Renato Paolini, 65124 Pescara, Italy; (L.D.D.); (F.C.); (V.F.)
| | - Laura Camplone
- Postgraduate School of Hygiene and Preventive Medicine, University of L’Aquila, 67100 L’Aquila, Italy; (L.C.); (R.M.)
| | - Riccardo Mazzocca
- Postgraduate School of Hygiene and Preventive Medicine, University of L’Aquila, 67100 L’Aquila, Italy; (L.C.); (R.M.)
| | - Federica Carfagnini
- Hospital Healthcare Management, Local Health Autority of Pescara, Via Renato Paolini, 65124 Pescara, Italy; (L.D.D.); (F.C.); (V.F.)
| | - Angela Ancona
- School of Hygiene and Preventive Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | | | - Valterio Fortunato
- Hospital Healthcare Management, Local Health Autority of Pescara, Via Renato Paolini, 65124 Pescara, Italy; (L.D.D.); (F.C.); (V.F.)
| | - Giuseppe Di Martino
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Unit of Hygiene, Epidemiology and Public Health, Local Health Authority of Pescara, 65100 Pescara, Italy
| |
Collapse
|
21
|
Ramzali M, Salimi V, Cheraghali F, Hosseini SD, Yasaghi M, Samadizadeh S, Rastegar M, Nakstad B, Tahamtan A. Epidemiology and clinical features of respiratory syncytial virus (RSV) infection in hospitalized children during the COVID-19 pandemic in Gorgan, Iran. Health Sci Rep 2024; 7:e1787. [PMID: 38186938 PMCID: PMC10764657 DOI: 10.1002/hsr2.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection in infants and young children. Given the altered circulation patterns of respiratory viruses during the coronavirus disease pandemic-2019 (COVID-19), the study aimed to evaluate epidemiology and clinical features of RSV infections in hospitalized children during the COVID-19 pandemic in Gorgan, northeastern Iran. Molecular epidemiology studies on respiratory viral infections are necessary to monitor circulating viruses, disease severity, and clinical symptoms, in addition to early warning of new outbreaks. Methods Overall, 411 respiratory swab samples from hospitalized children from October 2021 to March 2022 were collected at Taleghani Children's Hospital, Gorgan, Iran. The incidence of RSV, as well as the circulating subgroups and genotypes, were investigated and confirmed using PCR methods. Additionally, all samples tested for severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) and influenza, and demographic and clinical data were analyzed using SPSS software. Results The share of RSV, SARS-CoV-2, and influenza among hospitalized children with acute lower respiratory infections (ALRI) were 27%, 16.5%, and 4.1%, respectively. The RSV subgroup A (genotype ON1) was dominant over subgroup B (genotype BA9), with more severe clinical symptoms. Compared with the prepandemic era there were high numbers of hospitalized SARS-CoV-2 positive children and low numbers of other respiratory viruses. Despite this, the prevalence of ALRI-related RSV-disease among hospitalized children in our specialized pediatric center was higher than COVID-19 disease in the same cohort. Conclusions Studying the epidemiology of respiratory viruses and determining the circulating strains can contribute to effective infection control and treatment strategies.
Collapse
Affiliation(s)
- Mahnaz Ramzali
- Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
- Department of Microbiology, School of MedicineGolestan University of Medical SciencesGorganIran
| | - Vahid Salimi
- Department of Virology, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Fatemeh Cheraghali
- Department of Pediatrics, School of Medicine, Taleghani Children's HospitalGolestan University of Medical SciencesGorganIran
| | - Seyedeh Delafruz Hosseini
- Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
- Department of Microbiology, School of MedicineGolestan University of Medical SciencesGorganIran
| | - Mohammad Yasaghi
- Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
- Department of Microbiology, School of MedicineGolestan University of Medical SciencesGorganIran
| | - Saeed Samadizadeh
- Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
- Department of Microbiology, School of MedicineGolestan University of Medical SciencesGorganIran
| | - Mostafa Rastegar
- Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
- Department of Microbiology, School of MedicineGolestan University of Medical SciencesGorganIran
| | - Britt Nakstad
- Department of Pediatric and Adolescent HealthUniversity of BotswanaGaboroneBotswana
- Division of Paediatric and Adolescent Medicine, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Alireza Tahamtan
- Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
- Department of Microbiology, School of MedicineGolestan University of Medical SciencesGorganIran
| |
Collapse
|
22
|
Abrams EM, Doyon-Plourde P, Davis P, Brousseau N, Irwin A, Siu W, Killikelly A. Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2024; 50:1-15. [PMID: 38511049 PMCID: PMC10949905 DOI: 10.14745/ccdr.v50i12a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Passive immunization products for infants and pregnant women and people have sparked interest in understanding Canada's respiratory syncytial virus (RSV) burden. This rapid review examines RSV burden of disease in infants, young children and pregnant women and people. Methods Electronic databases were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit admissions, deaths and preterm labour associated with RSV. We also contacted Canadian respiratory virus surveillance experts for additional data. Results Overall, 17 studies on infants and young children and 10 studies on pregnant women and people were included, in addition to primary surveillance data from one Canadian territory (Yukon). There were higher rates of medical utilization for infants than older children. Hospitalization rates were highest in infants under six months (more than 1% annually), with 5% needing intensive care unit admission, but mortality was low. Severe outcomes often occurred in healthy full-term infants and burden was higher than influenza. Respiratory syncytial virus attack rate was 10%-13% among pregnant women and people. Only one study found a higher hospitalization rate in pregnant women and people compared to non-pregnant women and people. Limited evidence was found on intensive care unit admission, death and preterm birth for pregnant women and people. Conclusion While risk of severe outcomes is larger in high-risk infants and children, healthcare burden is greatest in healthy term infants. The RSV severity for pregnant women and people appears to be similar to that for non-pregnant women and people.
Collapse
Affiliation(s)
- Elissa M Abrams
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology, Winnipeg, MB
- University of British Columbia, Department of Pediatrics, Division of Allergy and Immunology, Vancouver, BC
| | | | - Phaedra Davis
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | | | - Andrea Irwin
- Yukon Communicable Disease Control, Health and Social Services, Government of Yukon, Whitehorse, YT
| | - Winnie Siu
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | - April Killikelly
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
| |
Collapse
|
23
|
Del Riccio M, Spreeuwenberg P, Osei-Yeboah R, Johannesen CK, Fernandez LV, Teirlinck AC, Wang X, Heikkinen T, Bangert M, Caini S, Campbell H, Paget J. Burden of Respiratory Syncytial Virus in the European Union: estimation of RSV-associated hospitalizations in children under 5 years. J Infect Dis 2023; 228:1528-1538. [PMID: 37246724 PMCID: PMC10681872 DOI: 10.1093/infdis/jiad188] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/24/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND No overall estimate of respiratory syncytial virus (RSV)-associated hospitalizations in children aged under 5 years has been published for the European Union (EU). We aimed to estimate the RSV hospitalization burden in children aged under 5 years in EU countries and Norway, by age group. METHODS We collated national RSV-associated hospitalization estimates calculated using linear regression models via the RESCEU project for Denmark, England, Finland, Norway, the Netherlands, and Scotland, 2006-2018. Additional estimates were obtained from a systematic review. Using multiple imputation and nearest neighbor matching methods, we estimated overall RSV-associated hospitalizations and rates in the EU. RESULTS Additional estimates for 2 countries (France and Spain) were found in the literature. In the EU, an average of 245 244 (95% confidence interval [CI], 224 688-265 799) yearly hospital admissions with a respiratory infection per year were associated with RSV in children aged under 5 years, with most cases occurring among children aged under 1 year (75%). Infants aged under 2 months represented the most affected group (71.6 per 1000 children; 95% CI, 66.6-76.6). CONCLUSIONS Our findings will help support decisions regarding prevention efforts and represent an important benchmark to understand changes in the RSV burden following the introduction of RSV immunization programs in Europe.
Collapse
Affiliation(s)
- Marco Del Riccio
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Richard Osei-Yeboah
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Xin Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Saverio Caini
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| |
Collapse
|
24
|
Martín-Latorre MDM, Martínez-Campos L, Martín-González M, Castro-Luna G, Lozano-Paniagua D, Nievas-Soriano BJ. Comparison of Easy-to-Use Bronchiolitis Scores in the Post-COVID-19 Era-An Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1834. [PMID: 38136036 PMCID: PMC10742179 DOI: 10.3390/children10121834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
In the post-restrictions COVID-19 period, the incidence of bronchiolitis in infants has increased considerably. Several scores determine the degree of severity of the bronchiolitis episode, but few are clinician-friendly. The main aim of this research was to find the easy-to-use score that most accurately estimated the severity of patients' infections according to their clinical situations and most accurately predicted the need for hospital admission. An observational cross-sectional study was performed in a reference pediatric hospital during the post-restrictions period of the COVID-19 pandemic (2021 and 2022). A comparison was made between the severity estimate provided by five international acute bronchiolitis scales and the clinical severity of the acute bronchiolitis episode. Three hundred and seventy-seven patients participated in the investigation, with a mean age of 5.68 months; 68.7% of the participants had a mild episode of bronchiolitis, 24.5% had a moderate episode, and 6.9% had a severe episode. The severity estimated by the Tal scale modified by McCallum showed a statistically significant correlation with the clinical severity established by clinical criteria (0.836; p < 0.001). It showed a high correlation with other international scores, such as the Wang score (0.820; p < 0.05) and the Wood-Downes-Ferrés score (0.936; p < 0.001). In the multivariate analysis, the constituent variables of the modified Tal score appeared in the final model that predicts the need for hospital admission. In the context of increased incidence after COVID-19, the Tal score modified by McCallum is an easy-to-use measuring instrument that presents an excellent concordance with the clinical severity estimated at first care contact. It also offers a more significant prediction of the need for hospital admission.
Collapse
Affiliation(s)
- María del Mar Martín-Latorre
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - Leticia Martínez-Campos
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - Manuel Martín-González
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
- Nursing, Physiotherapy, and Medicine Department, University of Almeria, 04120 Almeria, Spain;
| | - Gracia Castro-Luna
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - David Lozano-Paniagua
- Nursing, Physiotherapy, and Medicine Department, University of Almeria, 04120 Almeria, Spain;
| | | |
Collapse
|
25
|
Niekler P, Goettler D, Liese JG, Streng A. Hospitalizations due to respiratory syncytial virus (RSV) infections in Germany: a nationwide clinical and direct cost data analysis (2010-2019). Infection 2023:10.1007/s15010-023-02122-8. [PMID: 37973718 DOI: 10.1007/s15010-023-02122-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Clinical and direct medical cost data on RSV-related hospitalizations are relevant for public health decision-making. We analyzed nationwide data on RSV-coded hospitalizations from Germany in different age and risk groups. METHODS Assessment of RSV-coded hospitalizations (ICD-10-GM RSV-code J12.1/J20.5/J21.0 as primary discharge diagnosis) from 01/2010 to 12/2019, using remote data retrieval from the Hospital Statistics Database of the German Federal Statistical Office. RESULTS Overall, 205,352 RSV-coded hospitalizations (198,139 children < 18 years, 1,313 adults, 5,900 seniors > 59 years) were reported (median age < 1 year, IQR 0; 1; 56% males, 32% with RSV pneumonia). Annual median RSV-coded hospitalization incidence was 24.8/100,000 persons (IQR 21.3; 27.5); children reported a median incidence of 145.8 (IQR 130.9; 168.3). Between 2010 and 2019, hospitalization incidence increased 1.7-fold/15.1-fold/103-fold in children/adults/seniors. Adults and seniors reported higher rates of underlying chronic conditions, complications, and intensive care treatment than children; of 612 in-hospital fatalities, 103/51/458 occurred in children/adults/seniors. Per-patient mean costs varied between 3286€ ± 4594 in 1-4-year-olds and 7215€ ± 13,564 among adults. Increased costs were associated with immune disorders (2.55-fold increase compared to those without), nervous system disorders (2.66-fold), sepsis (7.27-fold), ARDS (12.85-fold), intensive care (4.60-fold) and ECMO treatment (16.88-fold). CONCLUSION The economic burden of RSV-related hospitalizations in Germany is substantial, even when only considering cases with RSV-coded as the primary discharge diagnosis. Children represented the vast majority of RSV-coded hospitalizations. However, adults and seniors hospitalized for RSV were at a higher risk of severe complications, required more costly treatments, and had higher fatality rates; although their RSV-coded hospitalization incidence showed a clear upward trend since 2017, their true hospitalization incidence is still likely to be underestimated due to lack of routine RSV testing in these age groups. Hence, new treatments and vaccines for RSV ideally should also target adults and seniors in addition to children.
Collapse
Affiliation(s)
- Patricia Niekler
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| |
Collapse
|
26
|
Langedijk AC, Bont LJ. Respiratory syncytial virus infection and novel interventions. Nat Rev Microbiol 2023; 21:734-749. [PMID: 37438492 DOI: 10.1038/s41579-023-00919-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
The large global burden of respiratory syncytial virus (RSV) respiratory tract infections in young children and older adults has gained increased recognition in recent years. Recent discoveries regarding the neutralization-specific viral epitopes of the pre-fusion RSV glycoprotein have led to a shift from empirical to structure-based design of RSV therapeutics, and controlled human infection model studies have provided early-stage proof of concept for novel RSV monoclonal antibodies, vaccines and antiviral drugs. The world's first vaccines and first monoclonal antibody to prevent RSV among older adults and all infants, respectively, have recently been approved. Large-scale introduction of RSV prophylactics emphasizes the need for active surveillance to understand the global impact of these interventions over time and to timely identify viral mutants that are able to escape novel prophylactics. In this Review, we provide an overview of RSV interventions in clinical development, highlighting global disease burden, seasonality, pathogenesis, and host and viral factors related to RSV immunity.
Collapse
Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
- ReSViNET Foundation, Zeist, the Netherlands.
| |
Collapse
|
27
|
Pierangeli A, Piralla A, Uceda Renteria S, Giacomel G, Lunghi G, Pagani E, Giacobazzi E, Vian E, Biscaro V, Piccirilli G, Lazzarotto T, Menzo S, Ferreri ML, Novazzi F, Petrarca L, Licari A, Ferrari G, Oliveto G, Antonelli G, Binda S, Galli C, Pellegrinelli L, Pariani E, Baldanti F. Multicenter epidemiological investigation and genetic characterization of respiratory syncytial virus and metapneumovirus infections in the pre-pandemic 2018-2019 season in northern and central Italy. Clin Exp Med 2023; 23:2725-2737. [PMID: 36522554 PMCID: PMC9754777 DOI: 10.1007/s10238-022-00973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) cause a high burden of disease, particularly in children and the elderly. With the aim to add knowledge on RSV and HMPV infections in Italy, a prospective, multicenter study was conducted by eight centers of the Working Group on Respiratory Virus Infections (GLIViRe), from December 2018-April 2019. Weekly distribution and patients' demographic and clinical data were compared in 1300 RSV and 222 HMPV-positive cases. Phylogenetic analysis of the G-glycoprotein coding region was performed to characterize circulating strains. RSV positivity ranged from 6.4% in outpatients of all ages to 31.7% in hospitalized children; HMPV positivity was 4-1.2% with no age-association. RSV season peaked in February and ended in mid-April: HMPV circulation was higher when RSV decreased in early spring. RSV was more frequent in infants, whereas HMPV infected comparatively more elderly adults; despite, their clinical course was similar. RSV-B cases were two-thirds of the total and had similar clinical severity compared to RSV-A. Phylogenetic analysis showed the circulation of RSV-A ON1 variants and the predominance of RSV-B genotype BA10. HMPV genotype A2c was the prevalent one and presented insertions of different lengths in G. This first multicenter Italian report on seasonality, age-specific distribution, and clinical presentation of RSV and HMPV demonstrated their substantial disease burden in young patients but also in the elderly. These data may provide the basis for a national respiratory virus surveillance network.
Collapse
Affiliation(s)
- Alessandra Pierangeli
- Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, V.Le Porta Tiburtina, 28; 00185, Rome, Italy
| | - Antonio Piralla
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Uceda Renteria
- Virology Unit, Clinical Laboratory, Foundation IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Giovanni Giacomel
- Virology Unit, Clinical Laboratory, Foundation IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Giovanna Lunghi
- Virology Unit, Clinical Laboratory, Foundation IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Elisabetta Pagani
- Laboratorio Aziendale Di Microbiologia E Virologia, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Elisabetta Giacobazzi
- Laboratorio Aziendale Di Microbiologia E Virologia, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Elisa Vian
- Microbiology Unit, Hospital of Treviso (AULSS2), Treviso, Italy
| | - Valeria Biscaro
- Microbiology Unit, Hospital of Treviso (AULSS2), Treviso, Italy
| | - Giulia Piccirilli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Tiziana Lazzarotto
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Menzo
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
| | - Monica Lucia Ferreri
- Virology Laboratory, Azienda Ospedaliera Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Federica Novazzi
- Ospedale Di Circolo E Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Amelia Licari
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Guglielmo Ferrari
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Oliveto
- Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, V.Le Porta Tiburtina, 28; 00185, Rome, Italy
| | - Guido Antonelli
- Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, V.Le Porta Tiburtina, 28; 00185, Rome, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fausto Baldanti
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
28
|
Bouckaert N, Lefèvre M, Van den Heede K, Van de Voorde C. RSV Burden and Its Impact on Pediatric Inpatient Bed Occupancy in Belgium: An Analysis of National Hospital Claims Data. Pediatr Infect Dis J 2023; 42:857-861. [PMID: 37463354 DOI: 10.1097/inf.0000000000004038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infections represent a substantial burden on pediatric services during winter. While the morbidity and financial burden of RSV are well studied, less is known about the organizational impact on hospital services (ie, impact on bed capacity and overcrowding and variation across hospitals). METHODS Retrospective analysis of the population-wide Belgian Hospital Discharge Data Set for the years 2017 and 2018 (including all hospital sites with pediatric inpatient services), covering all RSV-associated (RSV-related International Classification of Diseases, 10th Version, Clinical Modification diagnoses) inpatient hospitalization by children under 5 years old as well as all-cause acute hospitalizations in pediatric wards. RESULTS RSV hospitalizations amount to 68.3 hospitalizations per 1000 children less than 1 year and 5.0 per 1000 children 1-4 years of age and are responsible for 20%-40% of occupied beds during the peak period (November-December). The mean bed occupancy rate over the entire year (2018) varies across hospitals from 22.8% to 85.1% and from 30.4% to 95.1% during the peak period. Small-scale pediatric services (<25 beds) are more vulnerable to the volatility of occupancy rates. Forty-six hospital sites have daily occupancy rates above 100% (median of 9 days). Only in 1 of 23 geographically defined hospital networks these high occupancy rates are on the same calendar days. CONCLUSIONS Pediatric services tend to be over-dimensioned to deal with peak activity mainly attributable to RSV. RSV immunization can substantially reduce pediatric capacity requirements. Enhanced collaboration in regional networks is an alternative strategy to deal with peaks and reduce capacity needs.
Collapse
Affiliation(s)
- Nicolas Bouckaert
- From the Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan, Brussels, Belgium
| | | | | | | |
Collapse
|
29
|
Munro AP, Martinón-Torres F, Drysdale SB, Faust SN. The disease burden of respiratory syncytial virus in Infants. Curr Opin Infect Dis 2023; 36:379-384. [PMID: 37610444 PMCID: PMC10487373 DOI: 10.1097/qco.0000000000000952] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW To describe the current global burden of respiratory syncytial virus (RSV) in infants and its implications for morbidity, health resources and economic costs. RECENT FINDINGS New prophylactic therapies are on the horizon for RSV in the form of long-acting monoclonal antibodies suitable for healthy infants and maternal immunizations. SUMMARY Despite being responsible for significant global infant morbidity and mortality, until recently there have been no effective therapeutics available for healthy infants to protect them from RSV. Several new drugs are likely to be available within the next few years which could help relieve a huge burden on healthcare systems over the coming winters.
Collapse
Affiliation(s)
- Alasdair P.S. Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela
- Genetics, Vaccines and Paediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London
- Department of Paediatrics, St George's University Hospital NHS Foundation Trust, London, UK
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
30
|
Boccalini S, Bonito B, Salvati C, Del Riccio M, Stancanelli E, Bruschi M, Ionita G, Iamarino J, Bentivegna D, Buscemi P, Ciardi G, Cosma C, Stacchini L, Conticello C, Bega M, Schirripa A, Paoli S, Bertizzolo L, Parisi S, Trippi F, Bonanni P, Bechini A. Human Respiratory Syncytial Virus Epidemiological Burden in Pediatric Outpatients in Italy: A Systematic Review. Vaccines (Basel) 2023; 11:1484. [PMID: 37766160 PMCID: PMC10534716 DOI: 10.3390/vaccines11091484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Human respiratory syncytial virus (hRSV) is a key contributor to lower respiratory tract infections (LRTIs), affecting children aged 0-5 years and often leading to outpatient visits, emergency department utilization, and hospitalization. With the development of hRSV vaccines for mitigation, understanding the epidemiological impact of hRSV infections among 0-5-year-old pediatric outpatients in Italy is crucial. METHODS This systematic review conducted searches on PubMed, Embase, Scopus, and the International HTA Database, yielding 20,845 English and Italian records from January 2000 to July 2022. RESULTS Six eligible articles were identified following inclusion and exclusion criteria. These studies demonstrated hRSV-positivity proportions ranging from 18% to 41% in pediatric outpatients with respiratory infections. However, data comparability was hindered by diverse diagnostic approaches, data sources, sample populations, and study designs. Notably, hRSV-positivity showed temporal variability, rising from 23.8% (2001-2002) to 40.6% (2019-2020). This trend could stem from evolving epidemiological factors, heightened clinician awareness in hRSV diagnosis, or more sensitive molecular techniques. CONCLUSION As the first review of its kind, this study underscores the need for more comprehensive data to inform effective preventive strategies against hRSV-related burdens in pediatric outpatients.
Collapse
Affiliation(s)
- Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Cristina Salvati
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Marco Del Riccio
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Enrica Stancanelli
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Mario Bruschi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Giulia Ionita
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Johanna Iamarino
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Davide Bentivegna
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Primo Buscemi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Giulia Ciardi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Claudia Cosma
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Lorenzo Stacchini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Cristiana Conticello
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Manjola Bega
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Annamaria Schirripa
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Sonia Paoli
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | | | - Salvatore Parisi
- Sanofi, Medical Affairs, Viale L. Bodio, 37/b, 20158 Milan, Italy
| | - Francesca Trippi
- Sanofi, Medical Affairs, Viale L. Bodio, 37/b, 20158 Milan, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| |
Collapse
|
31
|
Martinón-Torres F, Navarro-Alonso JA, Garcés-Sánchez M, Soriano-Arandes A. The Path Towards Effective Respiratory Syncytial Virus Immunization Policies: Recommended Actions. Arch Bronconeumol 2023; 59:581-588. [PMID: 37414639 DOI: 10.1016/j.arbres.2023.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
The respiratory syncytial virus (RSV) causes a substantial burden worldwide. After over six decades of research, there is finally a licensed immunization option that can protect the broad infant population, and other will follow soon. RSV immunization should be in place from season 2023/2024 onwards. Doing so requires thoughtful but swift steps. This paper reflects the view of four immunization experts on the efforts being made across the globe to accommodate the new immunization options and provides recommendations organized around five priorities: (I) documenting the burden of RSV in specific populations; (II) expanding RSV diagnostic capacity in clinical practice; (III) strengthening RSV surveillance; (IV) planning for the new preventive options; (V) achieving immunization targets. Overall, Spain has been a notable example of converting RSV prevention into a national desideratum and has pioneered the inclusion of RSV in some of the regional immunization calendars for infants facing their first RSV season.
Collapse
Affiliation(s)
- Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela, Galicia, Spain; Genetics, Vaccines and Paediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | | | | | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
| |
Collapse
|
32
|
Alqahtani MH, Alqahtani MF, Asiri M, Alghamdi S, Alshagawi Z, Alzahrani S. Bronchiolitis in Infants; Five Years' Experience of a Teaching Hospital. Infect Drug Resist 2023; 16:5647-5664. [PMID: 37662975 PMCID: PMC10473431 DOI: 10.2147/idr.s385615] [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: 08/19/2022] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Background Bronchiolitis is a clinical syndrome affecting the lower respiratory tract of infants and toddlers <2 years old. Variability in clinical profile and response to therapy in children with Bronchiolitis calls for studying the different clinical aspects of local patient population. Aim The goal of our study is to determine the clinical presentation, past medical history, hospitalization course and prognosis in children below two years of age who have been hospitalized in King Fahad University Hospital over the last five years. Materials and Methods A retrospective chart review based on electronic health records of all Bronchiolitis-related hospitalization of infants and toddlers below two years of age, covering the period between January 1, 2015, to April 26, 2020. Results Out of a total of 446 children <2 years of age, 202 were female (45.4%), and 243 were male (54.6%). Although the length of hospital stay was almost equal between the sexes, there was a significant (p-value=0.01) increase in length of intensive care unit stay among females compared to males. Furthermore, there was a significant prolongation in the duration of ventilator usage among females (p value = 0.062). Out of fifty-five patients admitted to the ICU, 83.63% of them were 12 months of age and below. Conclusion Our results show a significant increase in length of ICU and ventilator use among females compared to males. It also shows that infants younger than 12 months account for most ICU admissions. These findings, among many others, may help pediatricians formulate a better diagnostic and therapeutic pathways.
Collapse
Affiliation(s)
- Mohammad Hussain Alqahtani
- Pediatrics Department, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Al Khobar, Saudia Arabia
| | - Mohammad Faraj Alqahtani
- Pediatrics Department, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Al Khobar, Saudia Arabia
| | - Mohammed Asiri
- Pediatrics Department, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Al Khobar, Saudia Arabia
| | - Saad Alghamdi
- Pediatrics Department, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Al Khobar, Saudia Arabia
| | - Ziyad Alshagawi
- Pediatrics Department, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Al Khobar, Saudia Arabia
| | - Saleh Alzahrani
- Pediatrics Department, Imam Abdulrahman Bin Faisal University King Fahd Hospital of the University, Al Khobar, Saudia Arabia
| |
Collapse
|
33
|
Ajayi OO, Ajufo A, Ekpa QL, Alabi PO, Babalola F, Omar ZTO, Ekanem M, Ezuma-Ebong C, Ogunshola OS, Akahara DE, Manandhar S, Okobi OE. Evaluation of Bronchiolitis in the Pediatric Population in the United States of America and Canada: A Ten-Year Review. Cureus 2023; 15:e43393. [PMID: 37706121 PMCID: PMC10495256 DOI: 10.7759/cureus.43393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
Abstract
Bronchiolitis is a well-known viral infection among the pediatric population, significantly impacting hospitalization rates. The COVID-19 pandemic profoundly affected respiratory viral infections, including bronchiolitis, as various mitigation measures were implemented. In this study, we analyzed bronchiolitis cases during the pandemic and post-pandemic period, aiming to identify changes in management guidelines and their incidence and management over the last 10 years. Moreover, we explored the relationship between bronchiolitis and COVID-19, a virus that gained rapid notoriety worldwide. By analyzing data from pediatric populations in Canada and the USA, we sought to understand the role of varying seasons in the peak periods of bronchiolitis infections. The comprehensive review's results will provide valuable insights into bronchiolitis dynamics within the context of the COVID-19 pandemic. Our aim is to better comprehend the interplay between bronchiolitis, COVID-19, and seasonal variations, ultimately contributing to a deeper understanding of this respiratory viral infection and informing future management strategies. Furthermore, these findings can assist healthcare professionals in preparing for and responding to potential fluctuations in bronchiolitis cases in the post-pandemic era.
Collapse
Affiliation(s)
- Olamide O Ajayi
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Afomachukwu Ajufo
- Internal Medicine and Pediatrics, All Saints University, Roseau, DMA
| | - Queen L Ekpa
- General Practice, Conestoga College, Kitchener, CAN
| | - Peace O Alabi
- Pediatrics, University of Abuja Teaching Hospital, Abuja, NGA
| | - Funmilola Babalola
- Epidemiology and Public Health, Texas Department of State Health Services, San Antonio, USA
| | | | - Medara Ekanem
- General Medicine, Babcock University Teaching Hospital, Ogun, NGA
| | | | | | | | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| |
Collapse
|
34
|
Bracht M, Rodgers-Gray B, Bacchini F, Paes BA. Understanding Policy Decisions and Their Implications Regarding Preventive Interventions for Respiratory Syncytial Virus (RSV) Infection in Canadian Infants: A Primer for Nurses. Neonatal Netw 2023; 42:291-302. [PMID: 37657806 DOI: 10.1891/nn-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 09/03/2023]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of morbidity and hospitalization in young children, and prevention is the primary management strategy. At present, palivizumab, a monoclonal antibody providing immediate passive immunity, rather than a vaccine that induces active immunity, is the only preventive intervention used in routine practice internationally. In Canada, access varies across the country. Prophylaxis policies are mainly driven by cost-effectiveness analyses, and it is crucial that the full costs and benefits of any intervention are captured. Positive results from a new Canadian cost-effectiveness analysis of palivizumab will help address the current inequality in use while providing a framework for future models of RSV preventives. Nurses are the principal educators for parents about the risks of childhood RSV and optimal prevention via basic hygiene, behavioral and environmental measures, and seasonal prophylaxis. Nurses should be provided not only with regular, up-to-date, and accurate information on RSV and the clinical aspects of emerging interventions but be informed on the decision-making governing the use of preventive strategies.
Collapse
|
35
|
Pacheco GA, Andrade CA, Gálvez NM, Vázquez Y, Rodríguez-Guilarte L, Abarca K, González PA, Bueno SM, Kalergis AM. Characterization of the humoral and cellular immunity induced by a recombinant BCG vaccine for the respiratory syncytial virus in healthy adults. Front Immunol 2023; 14:1215893. [PMID: 37533867 PMCID: PMC10390696 DOI: 10.3389/fimmu.2023.1215893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The human respiratory syncytial virus (hRSV) is responsible for most respiratory tract infections in infants. Even though currently there are no approved hRSV vaccines for newborns or infants, several candidates are being developed. rBCG-N-hRSV is a vaccine candidate previously shown to be safe in a phase I clinical trial in adults (clinicaltrials.gov identifier #NCT03213405). Here, secondary immunogenicity analyses were performed on these samples. Methods PBMCs isolated from immunized volunteers were stimulated with hRSV or mycobacterial antigens to evaluate cytokines and cytotoxic T cell-derived molecules and the expansion of memory T cell subsets. Complement C1q binding and IgG subclass composition of serum antibodies were assessed. Results Compared to levels detected prior to vaccination, perforin-, granzyme B-, and IFN-γ-producing PBMCs responding to stimulus increased after immunization, along with their effector memory response. N-hRSV- and mycobacterial-specific antibodies from rBCG-N-hRSV-immunized subjects bound C1q. Conclusion Immunization with rBCG-N-hRSV induces cellular and humoral immune responses, supporting that rBCG-N-hRSV is immunogenic and safe in healthy individuals. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/, identifier NCT03213405.
Collapse
Affiliation(s)
- Gaspar A. Pacheco
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina A. Andrade
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás M.S. Gálvez
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yaneisi Vázquez
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Linmar Rodríguez-Guilarte
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katia Abarca
- Millennium Institute on Immunology and Immunotherapy, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Enfermedades Infecciosas e Inmunología Pediá trica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo A. González
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
36
|
Dervaux B, Van Berleere M, Lenne X, Wyckaert M, Dubos F. Impact of RSV test positivity, patient characteristics, and treatment characteristics on the cost of hospitalization for acute bronchiolitis in a French university medical center (2010-2015). Front Pediatr 2023; 11:1126229. [PMID: 37528879 PMCID: PMC10390249 DOI: 10.3389/fped.2023.1126229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background In young children, respiratory syncytial virus (RSV)-related bronchiolitis is typically more severe than other respiratory tract infections, with a greater need for oxygen therapy and respiratory support. Few studies have compared the cost of hospitalization with regard to virological status. The objective of this study was to compare the costs of hospitalization for RSV-positive vs. RSV-negative bronchiolitis in a French university medical center between 2010 and 2015. Methods The cost models were compared using conventional goodness-of-fit criteria. Covariates included the characteristics of the patients, pre-existing respiratory and non-respiratory comorbidities, superinfections, medical care provided, and the length of stay. Results RSV was detected in 679 (58.3%) of the 1,164 hospital stays by children under 2 years with virological data. Oxygen therapy and respiratory support were twice as frequent for the RSV-positive cases. The median hospitalization cost was estimated at €3,248.4 (interquartile range: €2,572.1). The cost distribution was positively skewed with a variation coefficient (CV = standard deviation/mean) greater than one (mean = €4,212.9, standard deviation = €5,047, CV = 1.2). In univariate analyses, there was no significant cost difference between the RSV-positive and RSV-negative cases. In the best multivariate model, the significant positive effect of RSV positivity on cost waned after the introduction of medical care variables and the length of stay. The results were sensitive to the specification of the model. Conclusions It was impossible to firmly conclude that hospitalization costs were higher for the RSV-positive cases.
Collapse
Affiliation(s)
- Benoit Dervaux
- CHU Lille, Direction de la Recherche et de l’Innovation, Lille, France
| | | | - Xavier Lenne
- CHU Lille, Département d’Information Médicale, Lille, France
| | - Marine Wyckaert
- CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France
| | - François Dubos
- CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France
- Univ Lille, ULR 2694 - Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| |
Collapse
|
37
|
Martinón-Torres F, Carmo M, Platero L, Drago G, López-Belmonte JL, Bangert M, Díez-Domingo J. Clinical and economic hospital burden of acute respiratory infection (BARI) due to respiratory syncytial virus in Spanish children, 2015-2018. BMC Infect Dis 2023; 23:385. [PMID: 37291530 DOI: 10.1186/s12879-023-08358-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in children, causing frequent outpatient visits and hospitalizations. Our study aimed to describe the clinical and direct economic burden of ALRI hospitalizations related to RSV in children in Spain and the characteristics of patients and their episodes. In this retrospective study, ALRI hospitalizations in children aged < 5 years for 2015-2018 were reviewed using anonymized administrative public hospital discharge data from Spain. Three case definitions were considered: (a) RSV-specific; (b) RSV-specific and unspecified acute bronchiolitis (RSV-specific and bronchiolitis); and (c) RSV-specific and unspecified ALRI (RSV-specific and ALRI). The study reported a mean of 36,743 yearly admissions potentially due to RSV, resulting in a mean annual cost of €87.1 million. RSV-specific codes accounted for 39.2% of cases, unspecified acute bronchiolitis for 20.1%, and other unspecified ALRI codes for the remaining 40.6%. The mean hospitalization rate per 1,000 children was 55.5 in the first year of life, 16.0 in the second, and 5.4 between 24 and 59 months. A considerable proportion of cases occurred in children under two years old (> 80.4%) and even during the first year of life (> 61.7%). Otherwise healthy children accounted for 92.9% of hospitalizations and 83.3% of costs during the period. Children born preterm accounted for 1.3% of hospitalizations and 5.7% of costs. The findings revealed that RSV still contributes to a high burden on the Spanish health care system. Children under one year of age and otherwise healthy term infants accounted for most of the substantial clinical and economic burden of RSV. Current evidence potentially underestimates the true epidemiology and burden of severe RSV infection; thus, further studies focusing on the outpatient setting are needed.
Collapse
Affiliation(s)
- F Martinón-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Rúa da Choupana, S/N, Santiago de Compostela, 15706, Galicia, A Coruña, Spain.
| | | | | | | | | | | | | |
Collapse
|
38
|
Baldassarre ME, Loconsole D, Centrone F, Caselli D, Martire B, Quartulli L, Acquafredda A, D'Amato G, Maffei G, Latorre G, Riganti A, Di Noia M, Chironna M, Laforgia N. Hospitalization for bronchiolitis in children aged ≤ 1year, Southern Italy, year 2021: need for new preventive strategies? Ital J Pediatr 2023; 49:66. [PMID: 37280662 DOI: 10.1186/s13052-023-01455-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Bronchiolitis is a major cause of hospitalization in infants, particularly in the first six months of life, with approximately 60-80% of admissions due to respiratory syncytial virus (RSV) infection. Currently, no prophylactic options are available for healthy infants. The present study aimed at describing the demographic, clinical, and epidemiological characteristics of infants hospitalized for bronchiolitis in the Apulia region of Italy in 2021. METHODS From January to December 2021, data on children aged 0-12 months admitted for bronchiolitis in nine neonatal or pediatric units covering 61% of pediatric beds of hospitals in the Apulia region of Italy were analyzed. Demographic data, comorbidities, need for oxygen support, length of hospital stay, palivizumab administration, and outcomes were collected. For the purpose of the analysis, patients were divided into those aged 0-3 months and > 3 months. A multivariate logistic regression model was used to explore associations between the need for oxygen support and sex, age, comorbidities, history of prematurity, length of hospital stay, and palivizumab administration. RESULTS This study included 349 children aged 0-12 months admitted for bronchiolitis, with a peak of hospitalization in November (7.4 cases/1,000 children). Of these patients, 70.5% were RSV positive, 80.2% were aged 0-3 months, and 73.1% required oxygen support. Moreover, 34.9% required observation in the sub-intensive care unit, and 12.9% in the intensive care unit. Of the infants who required intensive care, 96.9% were aged 0-3 months and 78.8% were born at term. Three patients required mechanical ventilation and one, who required Extra Corporeal Membrane Oxygenation, died. Children aged 0-3 months were more likely to show dyspnea, need oxygen support, and have a longer hospital stay. CONCLUSIONS The present study showed that almost all of the children who required intensive care support were aged ≤ 3 months and most were born at term. Therefore, this age group remains the highest risk group for severe bronchiolitis. Preventive measures such as single-dose monoclonal antibody immunoprophylaxis, and maternal and childhood vaccination against RSV, may reduce the high public health burden of bronchiolitis.
Collapse
Affiliation(s)
- Maria Elisabetta Baldassarre
- Unit of Neonatology and Intensive Care, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| | - Daniela Loconsole
- Hygiene Section, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| | - Francesca Centrone
- Hygiene Section, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| | - Desiree Caselli
- Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, 70124, Italy
| | - Baldassarre Martire
- Unit of Pediatrics and Neonatology, "Monsignor Dimiccoli" Hospital, Barletta, BT, Italy
| | | | - Angelo Acquafredda
- Unit of Pediatrics and Neonatology, "G. Tatarella" Hospital, Cerignola, Foggia, Italy
| | | | - Gianfranco Maffei
- Neonatology and Intensive Care Unit, "Ospedali Riuniti" Hospital, Foggia, Italy
| | - Giuseppe Latorre
- Neonatology and Intensive Care Unit, "Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Anita Riganti
- Neonatology Unit, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | | | - Maria Chironna
- Hygiene Section, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy.
| | - Nicola Laforgia
- Unit of Neonatology and Intensive Care, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| |
Collapse
|
39
|
Fontes V, Ferreira H, Ribeiro M, Pinheiro A, Maramaldo C, Pereira E, Batista L, Júnior A, Lobato L, Silva F, Sousa L, Lima W, Lima C, Soczek S, Carvalho R, Santos M, Fernandes E, Sousa E, Neto L. High Incidence of Respiratory Syncytial Virus in Children with Community-Acquired Pneumonia from a City in the Brazilian Pre-Amazon Region. Viruses 2023; 15:1306. [PMID: 37376604 PMCID: PMC10305439 DOI: 10.3390/v15061306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Although fewer children have been affected by the severe form of the coronavirus disease 2019 (COVID-19), community-acquired pneumonia (CAP) continues to be the leading global cause of child hospitalizations and deaths. AIM This study investigated the incidence of respiratory syncytial virus (RSV) as well its subtypes (RSV A and B), adenovirus (ADV), rhinovirus (HRV), metapneumovirus (HMPV), coronavirus (NL63, OC43, 229E and HKU1), parainfluenza virus subtypes (PI1, PI2 and PI3), bocavirus and influenza A and B viruses (FluA and FluB) in children diagnosed with CAP during the COVID-19 pandemic. METHODS A total of 200 children with clinically confirmed CAP were initially recruited, of whom 107 had negative qPCR results for SARS-CoV-2 and were included in this study. Viral subtypes were identified using a real-time polymerase chain reaction in the nasopharyngeal swab samples. RESULTS Viruses were identified in 69.2% of the patients. RSV infections were the most frequently identified (65.4%), with type RSV B being the most prevalent (63.5%). In addition, HCoV 229E and HRV were detected in 6.5% and 3.7% of the patients, respectively. RSV type B was associated with severe acute respiratory infection (ARI) and a younger age (less than 24 months). CONCLUSIONS New strategies for preventing and treating viral respiratory infections, particularly RSV infections, are necessary.
Collapse
Affiliation(s)
- Valéria Fontes
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Hivylla Ferreira
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
| | - Marilene Ribeiro
- Hospital of Federal University of Maranhão, HU-UFMA, São Luís, MA 65020-070, Brazil
| | - Aruanã Pinheiro
- Postdoctoral Program in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Carlos Maramaldo
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
| | - Eduardo Pereira
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Luís Batista
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | - Antonio Júnior
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | - Luis Lobato
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
- Post-Graduate Programme in Tropical Medicine, FIOCRUZ-RJ, Rio de Janeiro, RJ 21040-360, Brazil
| | - Fabiano Silva
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
- Post-Graduate Programme in Tropical Medicine, FIOCRUZ-RJ, Rio de Janeiro, RJ 21040-360, Brazil
| | - Luis Sousa
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
| | - Washington Lima
- Post-Graduate Programme in Biodiversity and Biotechnology (BIONORTE), CEUMA University, São Luís, MA 65075-120, Brazil
| | - Claudia Lima
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Suzany Soczek
- Post-Graduate Programme in Biotechnology Applied to Child and Adolescent Health, Pelé Pequeno Príncipe Research Institute, Curitiba, PR 80250-060, Brazil
| | - Rafael Carvalho
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | | | - Elizabeth Fernandes
- Post-Graduate Programme in Biotechnology Applied to Child and Adolescent Health, Pelé Pequeno Príncipe Research Institute, Curitiba, PR 80250-060, Brazil
| | - Eduardo Sousa
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | - Lidio Neto
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
- Post-Graduate Programme in Biodiversity and Biotechnology (BIONORTE), CEUMA University, São Luís, MA 65075-120, Brazil
| |
Collapse
|
40
|
Nievas-Soriano BJ, Martín-Latorre MDM, Martín-González M, Manzano-Agugliaro F, Castro-Luna G. Worldwide research trends on bronchiolitis in pediatrics. Pediatr Pulmonol 2023. [PMID: 37154529 DOI: 10.1002/ppul.26453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to a significant increase in cases of bronchiolitis among children. As a result, there has been a corresponding increase in the number of publications on this topic. It is essential to examine the main areas of focus within the scientific literature to understand the current trends in research on pediatric bronchiolitis. This research aims to analyze the types of scientific advances related to pediatric bronchiolitis, the research trends being pursued, and the countries and research institutions leading these efforts. By understanding these aspects of bronchiolitis research, we can better understand the current state of knowledge and identify areas where further research is needed. METHODS To conduct a bibliometric analysis of the scientific literature on pediatric bronchiolitis, all relevant publications were retrieved from the Scopus database. The Scopus API and the SW VosViewer software with optimized modularity functions were used. This analysis was intended to provide a comprehensive overview of the current state of research on this topic, including the types of scientific advances being developed, the research trends being pursued, and the countries and research institutions leading these efforts. RESULTS A total of 3810 publications were reviewed. We observed an increasing number of publications, particularly in recent years. Of these, 73.7% were articles, 95% were written in English, and 29.4% were from the United States. The main keywords used in these publications included: human, bronchiolitis, child, preschool, preschool child, major clinical study, controlled study, pneumonia, asthma, adolescent, hospitalization, infant, and newborn. These keywords were grouped into six clusters: outpatient management, long-term consequences, etiology, intensive care management, diagnostic methods, and the main cluster, which focused on hospital treatment and clinical studies. CONCLUSIONS The bibliometric analysis of bronchiolitis research in pediatrics reveals that there has been a significant increase in the number of publications on this topic, particularly in recent years. Most of these publications are articles written in English and published in the United States. The main keywords used in these studies relate to various aspects of bronchiolitis, including diagnosis, treatment, and long-term consequences. The results of this analysis suggest that bronchiolitis is a topic of significant interest and concern for researchers and practitioners in the field of pediatrics and that further research is needed to improve our understanding and management of this condition.
Collapse
Affiliation(s)
| | | | | | | | - Gracia Castro-Luna
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almeria, Spain
| |
Collapse
|
41
|
Robino C, Toncelli G, Sorrentino LA, Fioccola A, Tedesco B, Giugni C, L'Erario M, Ricci Z. Fluid balance in critically ill children with lower respiratory tract viral infection: a cohort study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2023; 3:10. [PMID: 37386553 DOI: 10.1186/s44158-023-00093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Increasing evidence has associated positive fluid balance of critically ill patients with poor outcomes. The aim of this study was to explore the pattern of daily fluid balances and their association with outcomes in critically ill children with lower respiratory tract viral infection. METHODS A retrospective single-center study was conducted, in children supported with high-flow nasal cannula, non-invasive ventilation, or invasive ventilation. Median (interquartile range) daily fluid balances, cumulative fluid overload (FO) and peak FO variation, indexed as the % of admission body weight, over the first week of Pediatric Intensive Care Unit admission, and their association with the duration of respiratory support were assessed. RESULTS Overall, 94 patients with a median age of 6.9 (1.9-18) months, and a respiratory support duration of 4 (2-7) days, showed a median (interquartile range) daily fluid balance of 18 (4.5-19.5) ml/kg at day 1, which decreased up to day 3 to 5.9 (- 14 to 24.9) ml/kg and increased to 13 (- 11 to 29.9) ml/kg at day 7 (p = 0.001). Median cumulative FO% was 4.6 (- 0.8 to 11) and peak FO% was 5.7 (1.9-12.4). Daily fluid balances, once patients were stratified according to the respiratory support, were significantly lower in those requiring mechanical ventilation (p = 0.003). No correlation was found between all examined fluid balances and respiratory support duration or oxygen saturation, even after subgroup analysis of patients with invasive mechanical ventilation, or respiratory comorbidities, or bacterial coinfection, or of patients under 1 year old. CONCLUSIONS In a cohort of children with bronchiolitis, fluid balance was not associated with duration of respiratory support or other parameters of pulmonary function.
Collapse
Affiliation(s)
- Chiara Robino
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Guido Toncelli
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Laura Arianna Sorrentino
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
| | - Antonio Fioccola
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
| | - Brigida Tedesco
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Cristina Giugni
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Manuela L'Erario
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Zaccaria Ricci
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy.
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
| |
Collapse
|
42
|
Bernstein DI, Mejias A, Rath B, Woods CW, Deeter JP. Summarizing Study Characteristics and Diagnostic Performance of Commercially Available Tests for Respiratory Syncytial Virus: A Scoping Literature Review in the COVID-19 Era. J Appl Lab Med 2023; 8:353-371. [PMID: 35854475 PMCID: PMC9384538 DOI: 10.1093/jalm/jfac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Nonpharmaceutical interventions to prevent the spread of coronavirus disease 2019 also decreased the spread of respiratory syncytial virus (RSV) and influenza. Viral diagnostic testing in patients with respiratory tract infections (RTI) is a necessary tool for patient management; therefore, sensitive and specific tests are required. This scoping literature review aimed to summarize the study characteristics of commercially available sample-to-answer RSV tests. CONTENT PubMed and Embase were queried for studies reporting on the diagnostic performance of tests for RSV in patients with RTI (published January 2005-January 2021). Information on study design, patient and setting characteristics, and published diagnostic performance of RSV tests were extracted from 77 studies that met predefined inclusion criteria. A literature gap was identified for studies of RSV tests conducted in adult-only populations (5.3% of total subrecords) and in outpatient (7.5%) or household (0.8%) settings. Overall, RSV tests with analytical time >30 min had higher published sensitivity (62.5%-100%) vs RSV tests with analytical time ≤30 min (25.7%-100%); this sensitivity range could be partially attributed to the different modalities (antigen vs molecular) used. Molecular-based rapid RSV tests had higher published sensitivity (66.7%-100%) and specificity (94.3%-100%) than antigen-based RSV tests (sensitivity: 25.7%-100%; specificity:80.3%-100%). SUMMARY This scoping review reveals a paucity of literature on studies of RSV tests in specific populations and settings, highlighting the need for further assessments. Considering the implications of these results in the current pandemic landscape, the authors preliminarily suggest adopting molecular-based RSV tests for first-line use in these settings.
Collapse
Affiliation(s)
- David I Bernstein
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Asuncion Mejias
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Barbara Rath
- Vienna Vaccine Safety Initiative, Berlin, Germany
- Université de Bourgogne Franche-Comté, Besançon, France
- ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Christopher W Woods
- ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- Infectious Diseases Division, Duke University Medical Center, Durham, NC, USA
| | - Jamie Phillips Deeter
- ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- Roche Diagnostics Corporation, Indianapolis, IN, USA
| |
Collapse
|
43
|
Mineva GM, Purtill H, Dunne CP, Philip RK. Impact of breastfeeding on the incidence and severity of respiratory syncytial virus (RSV)-associated acute lower respiratory infections in infants: a systematic review highlighting the global relevance of primary prevention. BMJ Glob Health 2023; 8:bmjgh-2022-009693. [PMID: 36746518 PMCID: PMC9906265 DOI: 10.1136/bmjgh-2022-009693] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/07/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the principal cause of acute lower respiratory infections (ALRI) among infants worldwide, and an important cause of morbidity, hospitalisation and mortality. While infants are universally exposed to RSV, most mortality occurs among normal term infants from low-income and middle-income countries. Breastfeeding has been suggested to have a protective effect against RSV infection. This study aims to determine the association of breastfeeding on the frequency and severity of RSV-associated ALRI among infants. METHODS A systematic review was conducted using keywords and Medical Subject Headings on MEDLINE, PubMed, Google Scholar, EMBASE, MedRxiv and Cochrane Central Register of Controlled Trials. Full-text articles published in English from 2000 to 2021 that studied exclusively or partially breastfed infants who developed RSV-associated ALRI <12 months of age were included. Covidence software-based evidence extraction and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines were followed. Quality of evidence was analysed using UK National Service Framework grading and the risk-of-bias assessment using Robvis. RESULTS Among 1368 studies screened, 217 qualified full-text review and 198 were excluded based on pre-agreed criteria. Nineteen articles published from 12 countries that included 16 787 infants from 31 countries (of which 8 middle-income) were retained for analysis. Results indicate that non-breastfeeding practices pose a significant risk for severe RSV-associated ALRI and hospitalisation. Exclusive breastfeeding for >4-6 months significantly lowered hospitalisation, length of stay, supplemental oxygen demand and admission to intensive care units. CONCLUSION In the context of no effective or standardised treatment for established RSV-associated ALRI, available evidence suggest that breastfeeding is associated with lower frequency and severity of RSV-associated ALRI, based on observational studies of variable grades of evidence and risk-of-bias. With both exclusive and partial breastfeeding benefiting infants who develop RSV-associated ALRI, breastfeeding should be promoted globally as an adjunct primary prevention; in addition to emerging immunoprophylaxis and maternal immunisation strategies.
Collapse
Affiliation(s)
- Gabriela M Mineva
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland
| | - Helen Purtill
- Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick School of Medicine, Limerick, Ireland
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland .,Division of Neonatology, Department of Paediatrics, University of Limerick School of Medicine, Limerick, Ireland
| |
Collapse
|
44
|
Regassa BT, Gebrewold LA, Mekuria WT, Kassa NA. Molecular epidemiology of respiratory syncytial virus in children with acute respiratory illnesses in Africa: A systematic review and meta-analysis. J Glob Health 2023; 13:04001. [PMID: 36637855 PMCID: PMC9840062 DOI: 10.7189/jogh.13.04001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Globally, the respiratory syncytial virus (RSV) is the most common etiologic agent of acute respiratory illnesses in children. However, its burden has not been well addressed in developing countries. We aimed to estimate the molecular epidemiology of RSV in children less than 18 years of age with acute respiratory infections in Africa by conducting a systematic review and meta-analysis. Methods We systematically searched PubMed, Scopus, CINAHL, and Global Index Medicus databases to identify studies published from January 1, 2002, to April 27, 2022, following the PRISMA 2020 guideline. We assessed the study quality using the Joanna Brigg's Institute (JBI) critical appraisal checklists. We conducted a qualitative synthesis by describing the characteristics of included studies and performed the quantitative synthesis with random effects model using STATA-14. We checked for heterogeneity with Q statistics, quantified by I2, and determined the prediction interval. We performed subgroup analyses to explain the sources of heterogeneity and assessed publication biases by funnel plots augmented with Egger's test. Results Eighty-eight studies with 105 139 participants were included in the review. The overall pooled prevalence of RSV in children <18 years of age was 23% (95% confidence interval (CI) = 20, 25%). Considerable heterogeneity was present across the included studies. The adjusted prediction interval was found to be 19%-27%. Heterogeneities were explained by subgroups analyses. The highest prevalence of RSV was found among inpatients, 28% (95% CI = 25, 31%) compared with inpatients/outpatients and outpatients, with statistically significant differences (P < 0.01). The RSV estimate was also highest among those with acute lower respiratory tract illnesses (ALRTIs), 28% (95% CI = 25, 31%) compared with acute upper respiratory tract illnesses (AURTIs) and both acute upper/lower respiratory manifestations, with statistically different prevalence (P < 0.01). RSV infection estimates in each sub-region of Africa were statistically different (P < 0.01). There were no statistically significant differences in RSV infections by designs, specimen types, and specimen conditions, despite them contributing to heterogeneity. Conclusions We found a high prevalence of RSV in pediatric populations with acute respiratory tract illnesses in Africa, highlighting that the prevention and control of RSV infections in children deserve more attention. Registration PROSPERO CRD42022327054.
Collapse
Affiliation(s)
- Belay Tafa Regassa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ethiopia
| | - Lami Abebe Gebrewold
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ethiopia
| | - Wagi Tosisa Mekuria
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ethiopia
| | - Nega Assefa Kassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Ethiopia
| |
Collapse
|
45
|
Turalde-Mapili MWR, Mapili JAL, Turalde CWR, Pagcatipunan MR. The efficacy and safety of nirsevimab for the prevention of RSV infection among infants: A systematic review and meta-analysis. Front Pediatr 2023; 11:1132740. [PMID: 37082704 PMCID: PMC10110918 DOI: 10.3389/fped.2023.1132740] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is a leading cause of morbidity and mortality among infants with a global incidence of 9.5% and a mortality rate of 2.2%. The management of RSV infection is mainly supportive and, aside from emerging monoclonal antibodies, there has been no benefit of most preventive measures. Recent evidence suggests the potential of nirsevimab in preventing RSV infection. Objective This study aims to determine the efficacy and safety of nirsevimab in preventing RSV infection among infants using a review of relevant clinical trials. Methods We performed a random-effects meta-analysis among infants comparing nirsevimab injection vs. placebo. MEDLINE, CENTRAL, Scopus, and ClinicalTrials.gov were searched for relevant trials from inception to June 2022. The selected studies were assessed for risk of bias using the Revised Cochrane Risk-of-Bias (RoB2) tool and for quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results Two studies were included. Data analysis showed that among infants, nirsevimab given before the RSV season significantly reduced the risk of medically attended RSV-related infection (RR: 0.26; 95% CI: 0.18-0.38) and the risk of hospitalization due to RSV infection (RR: 0.24; 95% CI: 0.13-0.47). There was no difference in terms of adverse events leading to death (RR: 0.78, 95% CI: 0.20-2.98) and adverse events of special interest (RR: 0.92, 95% CI: 0.25-3.38). Conclusions The use of nirsevimab to prevent RSV infections and hospitalization shows its promising potential, but studies on its cost-effectiveness are lacking. We recommend that further studies be done to look into the applicability and cost-effectiveness of nirsevimab.
Collapse
Affiliation(s)
- Maria Wilma R. Turalde-Mapili
- Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jerahmeel Aleson L. Mapili
- Department of Medicine, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Christian Wilson R. Turalde
- Department of Physiology, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
- Correspondence: Christian Wilson R. Turalde
| | - Marimel R. Pagcatipunan
- Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
46
|
Heppe Montero M, Gil-Prieto R, Walter S, Aleixandre Blanquer F, Gil De Miguel Á. Burden of severe bronchiolitis in children up to 2 years of age in Spain from 2012 to 2017. Hum Vaccin Immunother 2022; 18:1883379. [PMID: 33653212 PMCID: PMC8920124 DOI: 10.1080/21645515.2021.1883379] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022] Open
Abstract
Bronchiolitis represents a heavy burden of disease in children under 2 years of age in our society due to the high infectivity of the Respiratory Syncytial Virus [RSV] and the vulnerability of the youngest children.The objective of this retrospective epidemiological study was to show the burden of severe bronchiolitis in Spain through population-based estimates of hospitalizations due to bronchiolitis in children up to 24 months old during a 6-year period (2012-2017).A total of 100,115 cases of bronchiolitis required hospitalization in Spain from 2012 to 2017. Most cases of bronchiolitis that required hospitalization were in infants under 3 months of age. The hospitalization rate for bronchiolitis for children under 1 year of age was 3,838.27 per 100,000 healthy children. During the 6-year study period, a total of 82 deaths due to bronchiolitis were reported among hospitalized infants. Among these deaths, more than 50% were in patients younger than 3 months of age. The annual average cost to the National Health Care System was €58 M, with a mean hospitalization cost of €3,512 per case.
Collapse
Affiliation(s)
- Marco Heppe Montero
- Medicine and Public Health Department, Universidad Rey Juan Carlos, Madrid, Spain
- Pediatrics Service, Hospital General Universitario de Elda, Alicante, Spain
| | - Ruth Gil-Prieto
- Medicine and Public Health Department, Universidad Rey Juan Carlos, Madrid, Spain
| | - Stefan Walter
- Medicine and Public Health Department, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Ángel Gil De Miguel
- Medicine and Public Health Department, Universidad Rey Juan Carlos, Madrid, Spain
| |
Collapse
|
47
|
Preventing Respiratory Syncytial Virus in Children in France: A Narrative Review of the Importance of a Reinforced Partnership Between Parents, Healthcare Professionals, and Public Health Authorities. Infect Dis Ther 2022; 12:317-332. [PMID: 36520324 PMCID: PMC9753881 DOI: 10.1007/s40121-022-00737-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
The highly contagious respiratory syncytial virus (RSV) is responsible for up to approximately 50,000 hospitalisations during each RSV season in children aged under 5 years in France, with the burden greatest in infants younger than 1 year who were born at term. There is a need for a strategy to universally protect young children from RSV infection, and thereby reduce the pressure that RSV places every year on RSV-infected children, their parents, and French healthcare systems. Potential strategies currently undergoing clinical investigation include passive immunisation via maternal vaccination or administration of long-acting monoclonal antibodies at or soon after birth, followed by vaccination later in infancy or childhood. An ongoing partnership and collaboration between parents, public health authorities, and frontline primary healthcare will need to be reinforced once these new RSV prevention strategies are available, to facilitate their use and ensure that all children receive adequate protection from the start of their first RSV season.
Collapse
|
48
|
Predicting prolonged length of stay in hospitalized children with respiratory syncytial virus. Pediatr Res 2022; 92:1780-1786. [PMID: 35301421 DOI: 10.1038/s41390-022-02008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/25/2022] [Accepted: 02/15/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in children. This study aimed to predict the prolonged length of stay in children admitted to hospital with RSV. METHODS Children aged <2 years with RSV in the National Inpatient Sample (NIS) were included in the analyses. The primary outcome was prolonged length of stay (≥90th percentile). Logistic regression models were developed using data from 2016; internal validation was completed using a bootstrapped sample. Data from 2017 were used to validate out-of-sample discrimination and calibration of the models. RESULTS The sample included 9589 children; 1054 had prolonged length of stay (≥7 days). Children who were younger, transferred from another hospital, and required intubation during admission had a higher risk of prolonged length of stay. The prediction model included age, transport, intubation, comorbidities, hospital location, and teaching status. The area under the receiver operating characteristic curve was 0.73, demonstrating good predictive ability. The model performed similarly in external validation. CONCLUSIONS Variables that predict the prolonged length of stay for RSV include younger age, transport, intubation, comorbidities, hospital location, and teaching status. This can be used to predict children who will have a prolonged length of stay when hospitalized for RSV. IMPACT There are no recommended treatments for RSV; medical care involves supportive treatment such as oxygen delivery, hydration, and antipyretics. The clinical course is difficult to predict, partially attributable to the supportive nature of care and the sparsity of evidence-based therapies for this population. A prediction model was developed, demonstrating variables that predict prolonged length of stay in RSV hospitalizations, including age, interhospital transport, intubation, comorbidities, hospital location, and teaching status. The model was developed with a sample size of 9589 that is representative of all hospitalizations in the United States.
Collapse
|
49
|
Caffarelli C, Santamaria F, Piro E, Basilicata S, Delle Cave V, Cipullo M, Bernasconi S, Corsello G. New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine. Ital J Pediatr 2022; 48:189. [PMID: 36435791 PMCID: PMC9701393 DOI: 10.1186/s13052-022-01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022] Open
Abstract
In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Simona Basilicata
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valeria Delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marilena Cipullo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
| |
Collapse
|
50
|
Impact of COVID-19 Pandemic and Lockdown on the Epidemiology of RSV-Mediated Bronchiolitis: Experience from Our Centre. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111723. [PMID: 36360451 PMCID: PMC9688686 DOI: 10.3390/children9111723] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
Background: The COVID-19 pandemic has dramatically affected the global epidemiology of other infectious respiratory diseases, leading to a significant decrease in their incidence. Hence, we aimed to characterize the epidemiology of RSV-bronchiolitis in children. Methods: children aged ≤2 years diagnosed with RSV-mediated bronchiolitis admitted to our Unit from October 2018 to December 2021, were retrospectively enrolled. Results: We included 95 patients (M/F = 46/49; mean age 7.56 ± 6.6 months). Specifically, 17 infants in 2018, 34 in 2019, 0 during 2020 lockdown, 1 during 2020 post-lockdown, and 43 in 2021. Incidence was significantly lower in 2020 compared with 2018, 2019 and 2021 (p < 0.05). No differences were found concerning need for respiratory support. Discussion: Several factors related to SARS-CoV-2 pandemic, especially restrictive measures, may have contributed to a significant reduction in hospitalizations due to RSV. The new outbreak in RSV infection-related hospitalizations reported between October and December 2021 has been suggested it may be due to an increased number of susceptible individuals to RSV infection. Conclusion: The experience of the SARS-CoV-2 outbreak has led to a marked decrease in other viral respiratory infections, such as RSV. This may pave the way for new approaches in preventing respiratory infections, highlighting the role of preventive measures.
Collapse
|