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Amodio E, Belluzzo M, Genovese D, Palermo M, Pisciotta V, Vitale F. What 'case definition' for respiratory syncytial virus infection? Results of a systematic literature review to improve surveillance among the adults. J Public Health (Oxf) 2024; 46:326-334. [PMID: 38705841 DOI: 10.1093/pubmed/fdae066] [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: 09/09/2023] [Revised: 02/27/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Human respiratory syncytial virus (hRSV) is a leading cause of acute lower respiratory tract infection in frail individuals, including children, the elderly and immunocompromised people, with mild to severe symptoms. World Health Organization claims hRSV causes most elderly influenza-like illnesses (ILI) and severe acute respiratory infections (SARI). In this study, different case definitions for hRSV surveillance were examined for accuracy. METHODS The following search query ('Respiratory Syncytial Virus' OR 'RSV' OR 'hRSV' AND 'case definition') was used on PubMed/MEDLINE and Scopus with a 15-year-old baseline age restriction to conduct a systematic literature review. RESULTS Of 12 records, 58% employed the SARI definition, 50% the ILI definition and 42% the acute respiratory infection (ARI) definition, with some overlap. In young adults (18-64 years old), most studies show RSV prevalence between 6.25 and 72.54 cases per 1000 per year, and 19.23 to 98.5 in older adults. The outpatient ARI and hospitalized SARI criteria are particularly sensitive and specific. CONCLUSIONS Disease burden measurement requires a clear case definition; however, current literature is questionable. Currently, hRSV surveillance uses numerous case definitions with debatable accuracy. The epidemiology, clinical characteristics, and disease burden of hRSV are difficult to characterize without a standard surveillance case definition.
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Affiliation(s)
- Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Miriam Belluzzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Dario Genovese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Martina Palermo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Vincenzo Pisciotta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
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Rousogianni E, Perlepe G, Boutlas S, Rapti GG, Gouta E, Mpaltopoulou E, Mpaltopoulos G, Rouka E, Papagiannis D, Gourgoulianis KI. Proportions and Seasonal Patterns of Respiratory Viruses via Rapid Tests in Adults at a Greek Hospital (Oct. 2023-Mar. 2024). J Pers Med 2024; 14:824. [PMID: 39202015 PMCID: PMC11355584 DOI: 10.3390/jpm14080824] [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: 06/28/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Respiratory infections pose a major public health threat. The predominant viruses causing viral respiratory infections are influenza A and B (Flu-A, Flu-B), coronaviruses, respiratory syncytial virus (RSV), and adenovirus. This study aims to investigate the proportion of these cases via rapid antigen tests and assess seasonal patterns. METHODS Clinical samples were collected from symptomatic adults presenting to the Emergency and Respiratory Medicine Departments of the University Hospital of Larissa (UHL), Greece from 16 October 2023 to 31 March 2024. Nasal specimens were antigen-tested for Flu-A/B, SARS-CoV-2, RSV, and adenovirus. RESULTS The total sample of specimens collected was 1434, of which 739 (51.5%) were female and 695 were male (48.5%). The mean age of participants was 57 ± 5.5 years. Among the positive results, we recorded a proportion of 40.18% and 11.40% for influenza A and B, respectively, followed by 35.79% for SARS-CoV-2, 10.70% for RSV, and 1.93% for adenovirus. CONCLUSIONS In Greece, surveillance systems in infection control are underutilized. Rapid tests via multiple antigens can quickly identify viral infections, making them a valuable tool with financial benefits for health systems. Early detection of respiratory infections helps allocate resources efficiently, ensures adequate staff and facilities are available, and improves patient care through refined clinical management.
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Affiliation(s)
- Eleni Rousogianni
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
| | - Garyfallia Perlepe
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
| | - Stylianos Boutlas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
- Emergency Department, University Hospital of Larissa, 41334 Larissa, Greece
| | - Georgia G. Rapti
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
| | - Evdoxia Gouta
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
| | - Eleni Mpaltopoulou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
| | - Giorgos Mpaltopoulos
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
| | - Erasmia Rouka
- Department of Nursing, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Dimitrios Papagiannis
- Public Health & Vaccines Laboratory, Department of Nursing, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece;
| | - Konstantinos I. Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece (G.M.); (K.I.G.)
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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.
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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.
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Lee N, Smith S, Zelyas N, Klarenbach S, Zapernick L, Bekking C, So H, Yip L, Tipples G, Taylor G, Mubareka S. Burden of noninfluenza respiratory viral infections in adults admitted to hospital: analysis of a multiyear Canadian surveillance cohort from 2 centres. CMAJ 2021; 193:E439-E446. [PMID: 33782171 PMCID: PMC8099164 DOI: 10.1503/cmaj.201748] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Data on the outcomes of noninfluenza respiratory virus (NIRV) infections among hospitalized adults are lacking. We aimed to study the burden, severity and outcomes of NIRV infections in this population. METHODS: We analyzed pooled patient data from 2 hospital-based respiratory virus surveillance cohorts in 2 regions of Canada during 3 consecutive seasons (2015/16, 2016/17, 2017/18; n = 2119). We included patients aged ≥ 18 years who developed influenza-like illness or pneumonia and were hospitalized for management. We included patients confirmed positive for ≥ 1 virus by multiplex polymerase chain reaction assays (respiratory syncytial virus [RSV], human rhinovirus/enterovirus (hRV), human coronavirus (hCoV), metapneumovirus, parainfluenza virus, adenovirus, influenza viruses). We compared patient characteristics, clinical severity conventional outcomes (e.g., hospital length-of stay, 30-day mortality) and ordinal outcomes (5 levels: discharged, receiving convalescent care, acute ward or intensive care unit [ICU] care and death) for patients with NIRV infections and those with influenza. RESULTS: Among 2119 adults who were admitted to hospital, 1156 patients (54.6%) had NIRV infections (hRV 14.9%, RSV 12.9%, hCoV 8.2%) and 963 patients (45.4%) had influenza (n = 963). Patients with NIRVs were younger (mean 66.4 [standard deviation 20.4] yr), and more commonly had immunocompromising conditions (30.3%) and delay in diagnosis (median 4.0 [interquartile range (IQR) 2.0–7.0] days). Overall, 14.6% (12.4%–19.5%) of NIRV infections were acquired in hospital. Admission to ICU (18.2%, median 6.0 [IQR 3.0–13.0] d), hospital length-of-stay (median 5.0 [IQR 2.0–10.0] d) and 30-day mortality (8.4%; RSV 9.5%, hRV 6.6%, hCoV 9.2%) and the ordinal outcomes were similar for patients with NIRV infection and those with influenza. Age > 60 years, immunocompromised state and hospital-acquired viral infection were associated with worse outcomes. The estimated median cost per acute care admission was $6000 (IQR $2000–$16 000). INTERPRETATION: The burden of NIRV infection is substantial in adults admitted to hospital and associated outcomes may be as severe as for influenza, suggesting a need to prioritize therapeutics and vaccines for at-risk people.
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Affiliation(s)
- Nelson Lee
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont.
| | - Stephanie Smith
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Nathan Zelyas
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Scott Klarenbach
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Lori Zapernick
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Christian Bekking
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Helen So
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Lily Yip
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Graham Tipples
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Geoff Taylor
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont
| | - Samira Mubareka
- Division of Infectious Disease (Lee, Smith, Zapernick, Taylor), Department of Medicine, and Department of Laboratory Medicine and Pathology (Zelyas, Tipples), and Division of Nephrology (Klarenbach, So), Department of Medicine, University of Alberta, Edmonton, Alta.; Sunnybrook Research Institute (Bekking, Yip, Mubareka); Department of Laboratory Medicine and Pathobiology (Mubareka), University of Toronto, Toronto, Ont.
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