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Zhang XL, Zhang X, Hua W, Xie ZD, Liu HM, Zhang HL, Chen BQ, Chen Y, Sun X, Xu Y, Shu SN, Zhao SY, Shang YX, Cao L, Jia YH, Lin LN, Li J, Hao CL, Dong XY, Lin DJ, Xu HM, Zhao DY, Zeng M, Chen ZM, Huang LS. Expert consensus on the diagnosis, treatment, and prevention of respiratory syncytial virus infections in children. World J Pediatr 2024; 20:11-25. [PMID: 38064012 PMCID: PMC10828005 DOI: 10.1007/s12519-023-00777-9] [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: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections and is responsible for about 3 million hospitalizations and more than 100,000 deaths annually in children younger than 5 years, representing a major global healthcare burden. There is a great unmet need for new agents and universal strategies to prevent RSV infections in early life. A multidisciplinary consensus development group comprising experts in epidemiology, infectious diseases, respiratory medicine, and methodology aims to develop the current consensus to address clinical issues of RSV infections in children. DATA SOURCES The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, using variations in terms for "respiratory syncytial virus", "RSV", "lower respiratory tract infection", "bronchiolitis", "acute", "viral pneumonia", "neonatal", "infant" "children", and "pediatric". RESULTS Evidence-based recommendations regarding diagnosis, treatment, and prevention were proposed with a high degree of consensus. Although supportive care remains the cornerstone for the management of RSV infections, new monoclonal antibodies, vaccines, drug therapies, and viral surveillance techniques are being rolled out. CONCLUSIONS This consensus, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of RSV infections. Further improvements in the management of RSV infections will require generating the highest quality of evidence through rigorously designed studies that possess little bias and sufficient capacity to identify clinically meaningful end points.
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Affiliation(s)
- Xian-Li Zhang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Hua
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Zheng-De Xie
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Han-Min Liu
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hai-Lin Zhang
- Department of Pediatric Pulmonology, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bi-Quan Chen
- Department of Infectious Disease, Anhui Provincial Children's Hospital, Hefei, China
| | - Yuan Chen
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Yi Xu
- Department of Infectious Disease, Guangzhou Women and Children's Medicine Center, Guangzhou Medicine University, Guangzhou, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shun-Ying Zhao
- Department of Respiratory Disease, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yun-Xiao Shang
- Department of Pediatric Respiratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Cao
- Respiratory Department, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yan-Hui Jia
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Luo-Na Lin
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Chuang-Li Hao
- Department of Respirology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiao-Yan Dong
- Department of Respiratory, Children's Hospital of Shanghai, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dao-Jiong Lin
- Department of Infectious Disease, Hainan Women and Children's Medical Center, Haikou, China
| | - Hong-Mei Xu
- Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - De-Yu Zhao
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| | - Zhi-Min Chen
- Department of Respiratory Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China.
| | - Li-Su Huang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China.
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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.
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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
- Address correspondence to this author at: 9115 Hague Rd, Indianapolis, IN 46250-0457, USA. Fax: 317-348-4320; E-mail:
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Park CE. Diagnostic Methods of Respiratory Virus Infections and Infection Control. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2021. [DOI: 10.15324/kjcls.2021.53.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan, Korea
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Cantais A, Mory O, Plat A, Giraud A, Pozzetto B, Pillet S. Analytical performances of the BD Veritor™ System for the detection of respiratory syncytial virus and influenzaviruses A and B when used at bedside in the pediatric emergency department. J Virol Methods 2019; 270:66-69. [PMID: 31047969 DOI: 10.1016/j.jviromet.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/18/2022]
Abstract
This study aims to evaluate the analytical performance of the BD Veritor™ rapid diagnostic assays (RDTs) for respiratory syncytial virus (RSV) and influenzaviruses when performed 24/7 at bedside by nurses in the pediatric emergency department (PED). The study was performed between 14/10/2015 and 19/03/2016 on nasopharyngeal aspirates (NPAs) collected from children consulting at the PED of the University Hospital of Saint-Etienne for bronchiolitis (RSV detection) or flu-like syndrome (influenzaviruses A/B detection). NPAs were tested 24/7 at the PED with the RDT and then sent to the Infectious Agents Department for routine analyses, first by immunofluorescence assay (IFA), then by nucleic acid amplification test (NAAT) considered as the gold standard in case of discrepancy between RDT and IFA results. For RSV detection, 205 NPAs was analyzed; the overall concordance between RDT and routine assays was of 97.6% (200/205). The sensitivity (Se), specificity (Sp), negative predictive value (NPV) and positive predictive value (PPV) were of 97.6% (160/164), 97.6% (40/41), 90.9% (40/44) and 99.4% (160/161), respectively. A total of 419 NPA was tested for influenzaviruses. For influenzavirus A, the overall concordance was of 98.8% (414/419); Se, Sp, NPV and PPV were of 100% (41/41), 98.7% (373/378), 100% (373/373) and 89.1% (41/46), respectively. For influenzavirus B, the overall concordance was of 97.9% (410/419); Se, Sp, NPV and PPV were of 96.6% (172/178), 98.8% (238/241), 97.5% (238/244) and 98.3% (172/175), respectively. Due to their excellent performances and their easy handle by non-laboratory personnel, these RDTs can be warmly recommended as point of care assays at the PED.
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Affiliation(s)
- Aymeric Cantais
- Pediatric Emergency Department, University Hospital of Saint-Etienne, France; Laboratory Group on Mucosal Immunity and Pathogens (GIMAP EA3064), Faculty of Medicine of Saint-Etienne, University of Lyon, France
| | - Olivier Mory
- Pediatric Emergency Department, University Hospital of Saint-Etienne, France
| | - Aurélie Plat
- Pediatric Emergency Department, University Hospital of Saint-Etienne, France
| | - Antoine Giraud
- Pediatric Emergency Department, University Hospital of Saint-Etienne, France
| | - Bruno Pozzetto
- Laboratory Group on Mucosal Immunity and Pathogens (GIMAP EA3064), Faculty of Medicine of Saint-Etienne, University of Lyon, France; Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sylvie Pillet
- Laboratory Group on Mucosal Immunity and Pathogens (GIMAP EA3064), Faculty of Medicine of Saint-Etienne, University of Lyon, France; Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France.
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Vandamme S, Van Cleempoel S, Michiels M, Goossens H, Jansens H, Matheeussen V. Comparison of the Coris Influ A + B K-SeT® and BD Veritor Flu A + B® for rapid detection of influenza viruses in respiratory samples from 3 consecutive flu seasons in Belgium. Diagn Microbiol Infect Dis 2019; 94:227-230. [PMID: 30827806 DOI: 10.1016/j.diagmicrobio.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Sarah Vandamme
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Shauni Van Cleempoel
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Mindy Michiels
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Herman Goossens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Hilde Jansens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections. Clin Microbiol Rev 2018; 32:32/1/e00042-18. [PMID: 30541871 DOI: 10.1128/cmr.00042-18] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Respiratory viral infections are associated with a wide range of acute syndromes and infectious disease processes in children and adults worldwide. Many viruses are implicated in these infections, and these viruses are spread largely via respiratory means between humans but also occasionally from animals to humans. This article is an American Society for Microbiology (ASM)-sponsored Practical Guidance for Clinical Microbiology (PGCM) document identifying best practices for diagnosis and characterization of viruses that cause acute respiratory infections and replaces the most recent prior version of the ASM-sponsored Cumitech 21 document, Laboratory Diagnosis of Viral Respiratory Disease, published in 1986. The scope of the original document was quite broad, with an emphasis on clinical diagnosis of a wide variety of infectious agents and laboratory focus on antigen detection and viral culture. The new PGCM document is designed to be used by laboratorians in a wide variety of diagnostic and public health microbiology/virology laboratory settings worldwide. The article provides guidance to a rapidly changing field of diagnostics and outlines the epidemiology and clinical impact of acute respiratory viral infections, including preferred methods of specimen collection and current methods for diagnosis and characterization of viral pathogens causing acute respiratory tract infections. Compared to the case in 1986, molecular techniques are now the preferred diagnostic approaches for the detection of acute respiratory viruses, and they allow for automation, high-throughput workflows, and near-patient testing. These changes require quality assurance programs to prevent laboratory contamination as well as strong preanalytical screening approaches to utilize laboratory resources appropriately. Appropriate guidance from laboratorians to stakeholders will allow for appropriate specimen collection, as well as correct test ordering that will quickly identify highly transmissible emerging pathogens.
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Chatzis O, Darbre S, Pasquier J, Meylan P, Manuel O, Aubert JD, Beck-Popovic M, Masouridi-Levrat S, Ansari M, Kaiser L, Posfay-Barbe KM, Asner SA. Burden of severe RSV disease among immunocompromised children and adults: a 10 year retrospective study. BMC Infect Dis 2018; 18:111. [PMID: 29510663 PMCID: PMC5838875 DOI: 10.1186/s12879-018-3002-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) recipients, with less known about other immunocompromised patients. Methods Ten-year retrospective cohort study of immunocompromised patients presenting with RSV disease documented at University Hospitals of Lausanne and Geneva. Severe RSV-related outcomes referred to RSV documented respiratory conditions requiring hospital admission, presenting as lower respiratory tract infection (LRTI) or pneumonia. We used multivariable logistic regression to assess clinical and laboratory correlates of severe RSV disease. Results From 239 RSV-positive immunocompromised in and out-patients 175 were adults and 64 children of whom 111 (47.8%) presented with LRTI, which resulted in a 38% (89/239) admission rate to hospital. While immunocompromised children were more likely to be admitted to hospital compared to adults (75% vs 62.9%, p = 0.090), inpatients admitted to the intensive care unit (17/19) or those who died (11/11) were mainly adults. From multivariable analyses, adults with solid tumors (OR 5.2; 95% CI: 1.4–20.9 P = 0.015) or those requiring chronic immunosuppressive treatments mainly for rheumatologic conditions (OR 4.1; 95% CI: 1.1–16.0; P = 0.034) were significantly more likely to be admitted to hospital compared to hematopoietic stem cell (HSCT) recipients. Bacterial co-infection was significantly and consistently associated with viral LRTI and pneumonia. Conclusions From our findings, RSV-related disease results in a significant burden among adults requiring chronic immunosuppressive treatments for rheumatological conditions and those with solid tumors. As such, systematic screening for respiratory viruses, should be extended to other immunocompromised populations than HSCT recipients. Electronic supplementary material The online version of this article (10.1186/s12879-018-3002-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Chatzis
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephanie Darbre
- Department of Paediatrics, Paediatric Infectious Disease Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
| | - Pascal Meylan
- Department of Laboratories, Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Department of Medicine, Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Surgery, Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - John David Aubert
- Unit of Pulmonary transplantation, Pulmonology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Department of Pediatrics, Paediatric Hematology and Oncology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Marc Ansari
- Paediatric Hematology and Oncology Unit, Division of General Pediatrics, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Department of Medicine, Infectious Diseases Service, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Genetical and Laboratory Medicine, Virology Laboratory, Laboratory Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandra A Asner
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Medicine, Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland. .,Department of Pediatrics, Pediatric Infectious Disease Unit, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment. Clin Microbiol Rev 2017; 30:277-319. [PMID: 27903593 DOI: 10.1128/cmr.00010-16] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is a significant cause of hospitalization of children in North America and one of the leading causes of death of infants less than 1 year of age worldwide, second only to malaria. Despite its global impact on human health, there are relatively few therapeutic options available to prevent or treat RSV infection. Paradoxically, there is a very large volume of information that is constantly being refined on RSV replication, the mechanisms of RSV-induced pathology, and community transmission. Compounding the burden of acute RSV infections is the exacerbation of preexisting chronic airway diseases and the chronic sequelae of RSV infection. A mechanistic link is even starting to emerge between asthma and those who suffer severe RSV infection early in childhood. In this article, we discuss developments in the understanding of RSV replication, pathogenesis, diagnostics, and therapeutics. We attempt to reconcile the large body of information on RSV and why after many clinical trials there is still no efficacious RSV vaccine and few therapeutics.
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