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Nuttens C, Moyersoen J, Curcio D, Aponte-Torres Z, Baay M, Vroling H, Gessner BD, Begier E. Differences Between RSV A and RSV B Subgroups and Implications for Pharmaceutical Preventive Measures. Infect Dis Ther 2024; 13:1725-1742. [PMID: 38971918 PMCID: PMC11266343 DOI: 10.1007/s40121-024-01012-2] [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: 10/20/2023] [Accepted: 06/21/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Understanding the differences between respiratory syncytial virus (RSV) subgroups A and B provides insights for the development of prevention strategies and public health interventions. We aimed to describe the structural differences of RSV subgroups, their epidemiology, and genomic diversity. The associated immune response and differences in clinical severity were also investigated. METHODS A literature review from PubMed and Google Scholar (1985-2023) was performed and extended using snowballing from references in captured publications. RESULTS RSV has two major antigenic subgroups, A and B, defined by the G glycoprotein. The RSV F fusion glycoprotein in the prefusion conformation is a major target of virus neutralizing antibodies and differs in surface exposed regions between RSV A and RSV B. The subgroups co-circulate annually, but there is considerable debate as to whether clinical severity is impacted by the subgroup of the infecting RSV strain. Large variations between the studies reporting RSV subgroup impact on clinical severity were observed. A tendency for higher disease severity may be attributed to RSV A but no consensus could be reached as to whether infection by one of the subgroup caused more severe outcomes. RSV genotype diversity decreased over the last two decades, and ON and BA have become the sole lineages detected for RSV A and RSV B, since 2014. No studies with data obtained after 2014 reported a difference in disease severity between the two subgroups. RSV F is relatively well conserved and highly similar between RSV A and B, but changes in the amino acid sequence have been observed. Some of these changes led to differences in F antigenic sites compared to reference F sequences (e.g., RSV/A Long strain), which are more pronounced in antigenic sites of the prefusion conformation of RSV B. Initial results from the second season after vaccination suggest specific RSV B efficacy wanes more rapidly than RSV A for RSV PreF-based monovalent vaccines. CONCLUSIONS RSV A and RSV B both contribute substantially to the global RSV burden. Both RSV subgroups cause severe disease and none of the available evidence to date suggests any differences in clinical severity between the subgroups. Therefore, it is important to implement measures effective at preventing disease due to both RSV A and RSV B to ensure impactful public health interventions. Monitoring overtime will be needed to assess the impact of waning antibody levels on subgroup-specific efficacy.
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Affiliation(s)
| | | | | | | | - Marc Baay
- Epidemiology & Pharmacovigilance, P95, Louvain, Belgium
| | - Hilde Vroling
- Epidemiology & Pharmacovigilance, P95, Louvain, Belgium
| | | | - Elizabeth Begier
- Scientific Affairs, Older Adult RSV Vaccine Program, Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Dublin, Ireland.
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Hamid S, Grajeda L, de Leon O, Lopez M, Maldonado H, Gomez A, Lopman B, Clasen T, McCracken J. Variability in the Timing of Respiratory Syncytial Virus Epidemics in Guatemala, 2008-2018. Influenza Other Respir Viruses 2024; 18:e13334. [PMID: 38980961 PMCID: PMC11232890 DOI: 10.1111/irv.13334] [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: 01/06/2024] [Revised: 05/12/2024] [Accepted: 05/19/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The description of local seasonality patterns in respiratory syncytial virus (RSV) incidence is important to guide the timing of administration of RSV immunization products. METHODS We characterized RSV seasonality in Guatemala using the moving epidemic method (MEM) with absolute counts of RSV-associated acute respiratory infections (ARI) from hospital surveillance in Santa Rosa and Quetzaltenango departments of Guatemala. RESULTS From Week 17 of 2008 through Week 16 of 2018, 8487 ARI cases tested positive for RSV by rRT-PCR. Season onsets varied up to 5 months; early seasons starting in late May to early August and finishing in September to November were most common, but late seasons starting in October to November and finishing in March to April were also observed. Both epidemic patterns had similar durations ranging from 4 to 6 months. Epidemic thresholds (the levels of virus activity that signal the onset and end of a seasonal epidemic) calculated prospectively using previous seasons' data captured between 70% and 99% of annual RSV detections. Onset weeks differed by 2-10 weeks, and offset weeks differed by 2-16 weeks between the two surveillance sites. CONCLUSIONS Variability in the timing of seasonal RSV epidemics in Guatemala demonstrates the difficulty in precisely predicting the timing of seasonal RSV epidemics based on onset weeks from past seasons and suggests that maximal reduction in RSV disease burden would be achieved through year-round vaccination and immunoprophylaxis administration to at-risk infants.
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Affiliation(s)
- Sarah Hamid
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Laura M. Grajeda
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
- Global Health Institute, College of Public HealthUniversity of GeorgiaAthensGeorgiaUSA
| | - Oscar de Leon
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
- Gangarosa Department of Environmental Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Maria Renee Lopez
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Herberth Maldonado
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Ana Beatriz Gomez
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Thomas F. Clasen
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Gangarosa Department of Environmental Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - John P. McCracken
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
- Global Health Institute, College of Public HealthUniversity of GeorgiaAthensGeorgiaUSA
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Cutrera R, d'Angela D, Orso M, Guadagni L, Vittucci AC, Bertoldi I, Polistena B, Spandonaro F, Carrieri C, Montuori EA, Iantomasi R, Orfeo L. Trends in hospitalizations of children with respiratory syncytial virus aged less than 1 year in Italy, from 2015 to 2019. Ital J Pediatr 2024; 50:119. [PMID: 38902751 PMCID: PMC11191168 DOI: 10.1186/s13052-024-01688-9] [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: 01/26/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) affects 60-80% of children below 1 year and it's the first cause of acute bronchiolitis. The aim of this study was to assess the trend and characteristics of hospitalizations for RSV infections in Italy. METHODS This is a retrospective study based on the Italian Hospital Discharge Record (HDR) database. We analysed HDRs from June 2015 to May 2019, considering two groups of infants: Group 1 had a confirmed diagnosis of RSV; Group 2 had a diagnosis of acute bronchiolitis not RSV-coded. RESULTS There were 67,746 overall hospitalizations (40.1% Group 1, and 59.9% Group 2). Hospitalization rate increased for Group 1 from 125 to 178 per 10,000 infants (+ 42.4%), and for Group 2 from 210 to 234 per 10,000 (+ 11.4%). The mean hospitalization length was 6.3 days in Group 1, longer than Group 2 (+ 1.0 day). A further analysis revealed that infants with heart disease or born premature had longer mean hospital stay compared to infants without risk factors (10.7 days versus 6.1 days, p < 0.0001; 34.0 days versus 6.1 days, p < 0.0001, respectively). Group 1 required more critical care (oxygen therapy and/or mechanical ventilation) than Group 2. We found that, in proportion to hospital admissions in pediatric and general hospitals, RSV was more frequently diagnosed in the first ones. The mean hospitalization cost increased for Group 1 (from € 2,483 to € 2,617) and Group 2 (from € 2,007 to € 2,180). CONCLUSIONS Our results confirmed that RSV pulmonary disease in infants is seasonal and often requires hospitalization. Our study suggested that RSV is responsible for an increasing hospitalization rate and related costs during the study period.
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Affiliation(s)
- Renato Cutrera
- Pediatric Pulmonology & Cystic Fibrosis Unit, Respiratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela d'Angela
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Orso
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy.
| | - Liliana Guadagni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Anna Chiara Vittucci
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Barbara Polistena
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Federico Spandonaro
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Ciro Carrieri
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
| | | | | | - Luigi Orfeo
- Neonatal Intensive Care Unit, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy
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Madewell ZJ, Hernandez-Romieu AC, Wong JM, Zambrano LD, Volkman HR, Perez-Padilla J, Rodriguez DM, Lorenzi O, Espinet C, Munoz-Jordan J, Frasqueri-Quintana VM, Rivera-Amill V, Alvarado-Domenech LI, Sainz D, Bertran J, Paz-Bailey G, Adams LE. Sentinel Enhanced Dengue Surveillance System - Puerto Rico, 2012-2022. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-29. [PMID: 38805389 PMCID: PMC11152364 DOI: 10.15585/mmwr.ss7303a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Problem/Condition Dengue is the most prevalent mosquitoborne viral illness worldwide and is endemic in Puerto Rico. Dengue's clinical spectrum can range from mild, undifferentiated febrile illness to hemorrhagic manifestations, shock, multiorgan failure, and death in severe cases. The disease presentation is nonspecific; therefore, various other illnesses (e.g., arboviral and respiratory pathogens) can cause similar clinical symptoms. Enhanced surveillance is necessary to determine disease prevalence, to characterize the epidemiology of severe disease, and to evaluate diagnostic and treatment practices to improve patient outcomes. The Sentinel Enhanced Dengue Surveillance System (SEDSS) was established to monitor trends of dengue and dengue-like acute febrile illnesses (AFIs), characterize the clinical course of disease, and serve as an early warning system for viral infections with epidemic potential. Reporting Period May 2012-December 2022. Description of System SEDSS conducts enhanced surveillance for dengue and other relevant AFIs in Puerto Rico. This report includes aggregated data collected from May 2012 through December 2022. SEDSS was launched in May 2012 with patients with AFIs from five health care facilities enrolled. The facilities included two emergency departments in tertiary acute care hospitals in the San Juan-Caguas-Guaynabo metropolitan area and Ponce, two secondary acute care hospitals in Carolina and Guayama, and one outpatient acute care clinic in Ponce. Patients arriving at any SEDSS site were eligible for enrollment if they reported having fever within the past 7 days. During the Zika epidemic (June 2016-June 2018), patients were eligible for enrollment if they had either rash and conjunctivitis, rash and arthralgia, or fever. Eligibility was expanded in April 2020 to include reported cough or shortness of breath within the past 14 days. Blood, urine, nasopharyngeal, and oropharyngeal specimens were collected at enrollment from all participants who consented. Diagnostic testing for dengue virus (DENV) serotypes 1-4, chikungunya virus, Zika virus, influenza A and B viruses, SARS-CoV-2, and five other respiratory viruses was performed by the CDC laboratory in San Juan. Results During May 2012-December 2022, a total of 43,608 participants with diagnosed AFI were enrolled in SEDSS; a majority of participants (45.0%) were from Ponce. During the surveillance period, there were 1,432 confirmed or probable cases of dengue, 2,293 confirmed or probable cases of chikungunya, and 1,918 confirmed or probable cases of Zika. The epidemic curves of the three arboviruses indicate dengue is endemic; outbreaks of chikungunya and Zika were sporadic, with case counts peaking in late 2014 and 2016, respectively. The majority of commonly identified respiratory pathogens were influenza A virus (3,756), SARS-CoV-2 (1,586), human adenovirus (1,550), respiratory syncytial virus (1,489), influenza B virus (1,430), and human parainfluenza virus type 1 or 3 (1,401). A total of 5,502 participants had confirmed or probable arbovirus infection, 11,922 had confirmed respiratory virus infection, and 26,503 had AFI without any of the arboviruses or respiratory viruses examined. Interpretation Dengue is endemic in Puerto Rico; however, incidence rates varied widely during the reporting period, with the last notable outbreak occurring during 2012-2013. DENV-1 was the predominant virus during the surveillance period; sporadic cases of DENV-4 also were reported. Puerto Rico experienced large outbreaks of chikungunya that peaked in 2014 and of Zika that peaked in 2016; few cases of both viruses have been reported since. Influenza A and respiratory syncytial virus seasonality patterns are distinct, with respiratory syncytial virus incidence typically reaching its annual peak a few weeks before influenza A. The emergence of SARS-CoV-2 led to a reduction in the circulation of other acute respiratory viruses. Public Health Action SEDSS is the only site-based enhanced surveillance system designed to gather information on AFI cases in Puerto Rico. This report illustrates that SEDSS can be adapted to detect dengue, Zika, chikungunya, COVID-19, and influenza outbreaks, along with other seasonal acute respiratory viruses, underscoring the importance of recognizing signs and symptoms of relevant diseases and understanding transmission dynamics among these viruses. This report also describes fluctuations in disease incidence, highlighting the value of active surveillance, testing for a panel of acute respiratory viruses, and the importance of flexible and responsive surveillance systems in addressing evolving public health challenges. Various vector control strategies and vaccines are being considered or implemented in Puerto Rico, and data from ongoing trials and SEDSS might be integrated to better understand epidemiologic factors underlying transmission and risk mitigation approaches. Data from SEDSS might guide sampling strategies and implementation of future trials to prevent arbovirus transmission, particularly during the expansion of SEDSS throughout the island to improve geographic representation.
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Riccò M, Corrado S, Bottazzoli M, Marchesi F, Gili R, Bianchi FP, Frisicale EM, Guicciardi S, Fiacchini D, Tafuri S. RSV Infection in Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis. EPIDEMIOLOGIA 2024; 5:221-249. [PMID: 38920751 PMCID: PMC11202732 DOI: 10.3390/epidemiologia5020016] [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: 04/02/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Respiratory diseases, including respiratory syncytial virus (RSV) infections, are common reasons for seeking healthcare among refugees and asylum seekers. A systematic review with meta-analysis was designed to appraise all the available evidence on RSV infections among individuals in refugee camps. Three medical databases (PubMed, Embase, and Scopus) as well as the preprint repository medRxiv.org were searched for eligible observational studies, and the collected cases were pooled in a random-effects meta-analysis model. Heterogeneity was assessed using the I2 statistics. Funnel plots and a regression analysis were calculated for analyzing reporting bias. Eventually, six studies were retrieved from three areas (Bangladesh, Thailand, and Kenya), with pooled estimates of 129.704 cases per 1000 samples (95% CI 66.393 to 237.986) for RSV compared to 110.287 per 1000 people for influenza A (95% CI 73.186 to 162.889), 136.398 cases per 1000 people (95% CI 84.510 to 212.741) for human adenovirus (HAdV), 69.553 per 1000 people (95% CI 49.802 to 96.343) for parainfluenzavirus (PIFV), and 60.338 per 1000 people (95% CI 31.933 to 111.109) for human metapneumovirus (hMPV). Using influenza A as a reference group, the risk for a positive specimen was greater for RSV (relative risk [RR] 1.514, 95% CI 1.396 to 1.641) and HAdV (RR 1.984, 95% CI 1.834 to 2.146) and lower for influenza B (RR 0.276, 95% CI: 0.239 to 0.319), PIFV (RR: 0.889, 95% CI 0.806 to 0.981), and hMPV (RR 0.594, 95% CI 0.534 to 0.662). In summary, high rates of RSV infections were documented among individuals sheltered in refugee camps, stressing the importance of specifically designed preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento Della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Garbagnate Milanese, Italy;
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Renata Gili
- Department of Prevention, Turin Local Health Authority, Via Silvio Pellico 19, 10125 Turin, Italy
| | | | | | - Stefano Guicciardi
- Health Directorate, Local Health Authority of Bologna, 40127 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy
| | - Daniel Fiacchini
- AST Ancona, Prevention Department, UOC Sorveglianza e Prevenzione Malattie Infettive e Cronico Degenerative, 60127 Ancona, Italy
| | - Silvio Tafuri
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
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Shan S, Zhang W, Gao H, Huang PY, Du Z, Bai Y, Lau YC, Chen D, Lau EHY, Nealon J, Wu P. Global Seasonal Activities of Respiratory Syncytial Virus Before the Coronavirus Disease 2019 Pandemic: A Systematic Review. Open Forum Infect Dis 2024; 11:ofae238. [PMID: 38770210 PMCID: PMC11103620 DOI: 10.1093/ofid/ofae238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Varied seasonal patterns of respiratory syncytial virus (RSV) have been reported worldwide. We conducted a systematic review on articles identified in PubMed reporting RSV seasonality based on data collected before 1 January 2020. RSV seasonal patterns were examined by geographic location, calendar month, analytic method, and meteorological factors including temperature and absolute humidity. Correlation and regression analyses were conducted to explore the relationship between RSV seasonality and study methods and characteristics of study locations. RSV seasons were reported in 209 articles published in 1973-2023 for 317 locations in 77 countries. Regular RSV seasons were similarly reported in countries in temperate regions, with highly variable seasons identified in subtropical and tropical countries. Longer durations of RSV seasons were associated with a higher daily average mean temperature and daily average mean absolute humidity. The global seasonal patterns of RSV provided important information for optimizing interventions against RSV infection.
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Affiliation(s)
- Songwei Shan
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Weixin Zhang
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Huizhi Gao
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pei-Yu Huang
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhanwei Du
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Yuan Bai
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Yiu-Chung Lau
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Dongxuan Chen
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Joshua Nealon
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
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Sansone V, Angelillo S, Licata F, Miraglia del Giudice G, Di Giuseppe G. Respiratory Syncytial Vaccination: Parents' Willingness to Vaccinate Their Children. Vaccines (Basel) 2024; 12:418. [PMID: 38675800 PMCID: PMC11054569 DOI: 10.3390/vaccines12040418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study was conducted to assess parents' willingness to vaccinate their children with the RSV vaccine and the key predictors of this intention among parents in Italy. METHODS Data were collected using an anonymous self-administered questionnaire from April to November 2023, targeting parents in public kindergartens and nursery schools in southern Italy. The survey assessed parents' socio-demographic characteristics, health-related details, their child's health status, attitudes toward RSV infection and its vaccine, and their source(s) of information. RESULTS A total of 404 parents agreed to participate in the study. Only 18.2% of participants were very concerned that their children could get infected by RSV, and this concern was more likely among parents whose child had been diagnosed with bronchiolitis, those who received information from HCWs, those who had heard of RSV, and those who needed additional information. Almost half (51.3%) were willing to vaccinate their child, and this inclination was more likely among fathers, employed parents, those with daughters, those who had heard of RSV, those who received information from HCWs, and those who needed additional information. CONCLUSIONS An educational campaign regarding a future RSV vaccine, especially about its safety and efficacy, is needed in order to improve parents' willingness.
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Affiliation(s)
- Vincenza Sansone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.S.); (G.M.d.G.)
| | - Silvia Angelillo
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (S.A.); (F.L.)
| | - Francesca Licata
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (S.A.); (F.L.)
| | - Grazia Miraglia del Giudice
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.S.); (G.M.d.G.)
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.S.); (G.M.d.G.)
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Scarpaci M, Bracaloni S, Esposito E, De Angelis L, Baglivo F, Casini B, Panatto D, Ogliastro M, Loconsole D, Chironna M, Pariani E, Pellegrinelli L, Pandolfi E, Croci I, Rizzo C. RSV Disease Burden in Primary Care in Italy: A Multi-Region Pediatric Study, Winter Season 2022-2023. Influenza Other Respir Viruses 2024; 18:e13282. [PMID: 38622776 PMCID: PMC11018906 DOI: 10.1111/irv.13282] [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: 10/22/2023] [Revised: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Human respiratory syncytial virus (RSV) is one of the most frequent causes of respiratory infections in children under 5 years of age, but its socioeconomic impact and burden in primary care settings is still little studied. METHODS During the 2022/2023 winter season, 55 pediatricians from five Italian regions participated in our community-based study. They collected a nasal swab for RSV molecular test from 650 patients under the age of 5 with acute respiratory infections (ARIs) and performed a baseline questionnaire. The clinical and socioeconomic burden of RSV disease in primary care was evaluated by two follow-up questionnaires completed by the parents of positive children on Days 14 and 30. RESULTS RSV laboratory-confirmed cases were 37.8% of the total recruited ARI cases, with RSV subtype B accounting for the majority (65.4%) of RSV-positive swabs. RSV-positive children were younger than RSV-negative ones (median 12.5 vs. 16.5 months). The mean duration of symptoms for all children infected by RSV was 11.47 ± 6.27 days. We did not observe substantial differences in clinical severity between the two RSV subtypes, but RSV-A positive patients required more additional pediatric examinations than RSV-B cases. The socioeconomic impact of RSV infection was considerable, causing 53% of children to be absent from school, 46% of parents to lose working days, and 25% of families to incur extra costs. CONCLUSIONS Our findings describe a baseline of the RSV disease burden in primary care in Italy before the introduction of upcoming immunization strategies.
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Affiliation(s)
- Michela Scarpaci
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Sara Bracaloni
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Enrica Esposito
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Luigi De Angelis
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Francesco Baglivo
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | | | | | - Daniela Loconsole
- Hygiene Section, Department of Interdisciplinary MedicineUniversity of Bari “A. Moro”BariItaly
| | - Maria Chironna
- Hygiene Section, Department of Interdisciplinary MedicineUniversity of Bari “A. Moro”BariItaly
| | - Elena Pariani
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | | | - Elisabetta Pandolfi
- Predictive and Preventive Medicine Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Ileana Croci
- Predictive and Preventive Medicine Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
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Fortunato F, Campanozzi A, Maffei G, Arena F, Carri VD, Rollo T, Lopalco PL, Martinelli D. Respiratory syncytial virus-associated hospitalizations among children: an Italian retrospective observational study. Ital J Pediatr 2024; 50:45. [PMID: 38454523 PMCID: PMC10921699 DOI: 10.1186/s13052-024-01617-w] [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: 12/21/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV), a single-stranded RNA virus, is a leading cause of hospitalization in infants, especially ≤ 2 months of life. In the light new immunization strategies adoption, we described epidemiological and clinical characteristics of RSV-associated hospitalizations in pediatric and neonatal intensive care units of the Policlinico Foggia Hospital, Apulia Region, Italy. METHODS Hospitalized children with a laboratory-confirmed RSV infection from 2011 to 2023 were retrospectively evaluated. Clinical information was collected from Hospital Discharge Registry in the period 2011-2020. The proportion of the hospitalization for acute respiratory infections (ARIs) associated to RSV was calculated and the hospitalization cost was analyzed by using the diagnosis-related group reimbursement rate. The anticipated impact of immunization either with monoclonal antibodies or maternal immunization on the number of hospitalizations was estimated. All analyses and quality assessment were performed using STATA/SE15.0. RESULTS A total of 1,005 RSV-cases were included in the study, of which 86.3% occurred between December-March. In the period 2011-2020, 832 RSV-cases were matched with the corresponding hospital admissions; 75.2% were aged < 1 year (49.6% 0-2 months). Bronchiolitis was the most frequent admission diagnosis occurring in 63.3% of patients; 25% of children were affected by a very severe RSV-disease. Younger age ≤ 2 months (OR:14.8, 95%CI:8.30-26.31, p = 0.000), higher length-of-hospital-stay (OR:1.01, 95%CI:1.0-1.02, p = 0.030) and history of prematurity (OR:4.4, 95%CI:1.57-12.11, p = 0.005) were associated with a higher disease severity. RSV caused 48.9% of ARIs among children < 1 year. The mean cost of an RSV-associated hospitalization was 3,036 euros/year, with the higher cost in the 0-2 months age group (4,225 euros/year). Immunization programs with nirsevimab could prevent 51.4 RSV hospitalizations/year and 18.1 very severe RSV disease/year in infants < 1 year of age. RSV vaccine could prevent 46.1 of hospitalizations/year caused by RSV within 180 days after birth. CONCLUSIONS Our study contributes to outlining the baseline profile of RSV-associated hospitalizations among Italian children by providing epidemiological/clinical/economic estimates. While awaiting new recommendations on immunization, healthcare-workers should persist in implementing public health measures and appropriate case management to control RSV seasonal epidemics. Strengthened laboratory RSV surveillance is needed to inform the implementation of the new immunization strategies.
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Affiliation(s)
- Francesca Fortunato
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy.
- Department of Medical and Surgical Sciences, Department of Hygiene, University of Foggia, Policlinico Riuniti University Hospital of Foggia, Ospedale "Colonnello D'Avanzo" Viale degli Aviatori, 2, 71122, Foggia, Italy.
| | - Angelo Campanozzi
- Pediatrics Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gianfranco Maffei
- Neonatology and Intensive Care Unit, Policlinico Foggia Hospital, Foggia, Italy
| | - Fabio Arena
- Microbiology and Virology Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Valeria Delli Carri
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Tiziana Rollo
- Microbiology and Virology Unit, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Domenico Martinelli
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
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10
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Jones CH, Jenkins MP, Adam Williams B, Welch VL, True JM. Exploring the future adult vaccine landscape-crowded schedules and new dynamics. NPJ Vaccines 2024; 9:27. [PMID: 38336933 PMCID: PMC10858163 DOI: 10.1038/s41541-024-00809-z] [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: 08/28/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Amidst the backdrop of the COVID-19 pandemic, vaccine innovation has garnered significant attention, but this field was already on the cusp of a groundbreaking renaissance. Propelling these advancements are scientific and technological breakthroughs, alongside a growing understanding of the societal and economic boons vaccines offer, particularly for non-pediatric populations like adults and the immunocompromised. In a departure from previous decades where vaccine launches could be seamlessly integrated into existing processes, we anticipate potentially than 100 novel, risk-adjusted product launches over the next 10 years in the adult vaccine market, primarily addressing new indications. However, this segment is infamous for its challenges: low uptake, funding shortfalls, and operational hurdles linked to delivery and administration. To unlock the societal benefits of this burgeoning expansion, we need to adopt a fresh perspective to steer through the dynamics sparked by the rapid growth of the global adult vaccine market. This article aims to provide that fresh perspective, offering a detailed analysis of the anticipated number of adult vaccine approvals by category and exploring how our understanding of barriers to adult vaccine uptake might evolve. We incorporated pertinent insights from external stakeholder interviews, spotlighting shifting preferences, perceptions, priorities, and decision-making criteria. Consequently, this article aspires to serve as a pivotal starting point for industry participants, equipping them with the knowledge to skillfully navigate the anticipated surge in both volume and complexity.
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Affiliation(s)
| | | | | | - Verna L Welch
- Pfizer Inc, 66 Hudson Boulevard, New York, NY, 10001, USA
| | - Jane M True
- Pfizer Inc, 66 Hudson Boulevard, New York, NY, 10001, USA.
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11
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Riccò M, Baldassarre A, Corrado S, Bottazzoli M, Marchesi F. Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023). EPIDEMIOLOGIA 2024; 5:41-79. [PMID: 38390917 PMCID: PMC10885116 DOI: 10.3390/epidemiologia5010004] [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: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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12
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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.
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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
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13
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Guo CY, Zhang Y, Zhang YY, Zhao W, Peng XL, Zheng YP, Fu YH, Yu JM, He JS. Comparative analysis of human respiratory syncytial virus evolutionary patterns during the COVID-19 pandemic and pre-pandemic periods. Front Microbiol 2023; 14:1298026. [PMID: 38111642 PMCID: PMC10725919 DOI: 10.3389/fmicb.2023.1298026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023] Open
Abstract
The COVID-19 pandemic has resulted in the implementation of strict mitigation measures that have impacted the transmission dynamics of human respiratory syncytial virus (HRSV). The measures also have the potential to influence the evolutionary patterns of the virus. In this study, we conducted a comprehensive analysis comparing genomic variations and evolving characteristics of its neutralizing antigens, specifically F and G proteins, before and during the COVID-19 pandemic. Our findings showed that both HRSV A and B exhibited an overall chronological evolutionary pattern. For the sequences obtained during the pandemic period (2019-2022), we observed that the HRSV A distributed in A23 genotype, but formed into three subclusters; whereas the HRSV B sequences were relatively concentrated within genotype B6. Additionally, multiple positively selected sites were detected on F and G proteins but none were located at neutralizing antigenic sites of the F protein. Notably, amino acids within antigenic site III, IV, and V of F protein remained strictly conserved, while some substitutions occurred over time on antigenic site Ø, I, II and VIII; substitution S389P on antigenic site I of HRSV B occurred during the pandemic period with nearly 50% frequency. However, further analysis revealed no substitutions have altered the structural conformations of the antigenic sites, the vial antigenicity has not been changed. We inferred that the intensive public health interventions during the COVID-19 pandemic did not affect the evolutionary mode of HRSV.
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Affiliation(s)
| | | | | | | | | | | | | | - Jie-mei Yu
- College of Life Sciences and Bioengineering, Beijing Jiaotong University, Beijing, China
| | - Jin-sheng He
- College of Life Sciences and Bioengineering, Beijing Jiaotong University, Beijing, China
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14
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Çağlar HT, Pekcan S, Yılmaz Aİ, Ünal G, Ercan F, Savaş S, Akcan ÖM, Ünsaçar MZ, Ünsaçar K, Özdemir M. The epidemiologic trend of respiratory syncytial virus has returned strongly to its origin after the pandemic: Five-year data from a single center. Pediatr Pulmonol 2023; 58:3582-3587. [PMID: 37737535 DOI: 10.1002/ppul.26696] [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: 06/15/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Only a few studies have investigated the frequency and severity of respiratory syncytial virus (RSV) infections after the end of the pandemic regulations. This study aims to investigate the frequency and severity of RSV infections before, during, and after the pandemic in Turkey. MATERIALS AND METHODS Patients under 18 years of age and those who tested positive for RSV between April 2018 and March 2023 were retrospectively reviewed. All patients were divided into three groups (pre-COVID-19, COVID-19, and post-COVID-19) according to admission date. Among inpatients, data were compared between the three groups to determine the impact of the pandemic on RSV epidemiology and clinical outcomes. RESULTS A total of 9567 patients were tested for RSV, of which 1073 (11.2%) were positive and included in the study. Hospitalization occurred in 447 (41.7%) patients. Inpatients were younger than outpatients (p < .000). Among the three inpatient pandemic groups, clinical outcomes were statistically significantly worse in the post-COVID-19 group than in the other two groups. SpO2 was lower (p < .000), inhaled salbutamol requirement was higher (p < .000), length of stay was longer (p = .031), and ICU admission was higher (p = .023). CONCLUSION Although the RSV trend changed within 2 years after the COVID-19 outbreak, it returned to its usual seasonality last year. After the repeal of all COVID-19 measures and the normal life began, the number of RSV-positive patients and RSV-related hospitalizations increased, and the clinical outcomes of RSV worsened. This may be a result of decreased herd immunity due to a change in society's attitude toward epidemic diseases.
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Affiliation(s)
- Hanife Tuğçe Çağlar
- Department of Pediatric Pulmonology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aslı İmran Yılmaz
- Department of Pediatric Pulmonology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Ercan
- Department of Pediatric Pulmonology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Suat Savaş
- Department of Pediatric Pulmonology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Özge Metin Akcan
- Department of Pediatric Infectious Diseases, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mahmut Ziya Ünsaçar
- Department of Pediatrics, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Kübra Ünsaçar
- Department of Pediatrics, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Özdemir
- Department of Medical Microbiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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15
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Jin Y, Zhang D, Deng K, Wu P, Yang D, Xie Z, Qiu W, Yu G. Role of the cAMP-PKA-NF-κB pathway in Mucin1 over-expression in A549 cells during Respiratory syncytial virus infection. BMC Infect Dis 2023; 23:845. [PMID: 38036963 PMCID: PMC10687811 DOI: 10.1186/s12879-023-08837-1] [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: 05/22/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the most common pathogen associated with acute lower respiratory tract infections in infants and young children worldwide. RSV commonly presents as bronchiolitis in young children; however, it can sometimes progress to pneumonia, respiratory failure, apnoea and even death. Although mucin1 (MUC1), a type of transmembrane glycoprotein present on airway epithelial surfaces, plays a crucial anti-inflammatory role in airway infections; however, its roles in RSV-associated acute lower respiratory tract infections have rarely been explored. In this study, we first revealed very high MUC1 protein levels in the exacerbation phase in sputum samples from children with RSV bronchiolitis. Because MUC1 is the downstream target of tumour necrosis factor-alpha (TNF-α) in RSV-infected A549 cells, we observed the inhibition of NF-κB activity, main downstream signalling of TNF-α and remarkably reduced levels of MUC1 in RSV-infected and TNF-α treated A549 cells. Furthermore, the cyclic adenosine monophosphate (cAMP) analogue (dbcAMP) downregulated the protein levels of p-IκBα and MUC1 in TNF-α-treated A549 cells. By contrast, a protein kinase A inhibitor (KT5720) up-regulated the levels of those proteins. dbcAMP and KT5720 had the same effects on MUC1 protein levels in RSV-infected A549 cells. In conclusion, we found that the cAMP-PKA-NF-κB pathway may play a role in the regulation of MUC-1 over-expression during RSV infection.
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Affiliation(s)
- Yingkang Jin
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Dongwei Zhang
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Kuimiao Deng
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Peiqiong Wu
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Diyuan Yang
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Zhiwei Xie
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Wenjun Qiu
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Guangyuan Yu
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
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16
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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.
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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.
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17
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Fyles F, Hill H, Duncan G, Carter E, Solórzano C, Davies K, McLellan L, Lesosky M, Dodd J, Finn A, McNamara PS, Lewis D, Bangert M, Vassilouthis N, Taylor M, Ferreira D, Collins AM. Surveillance towards preventing paediatric incidence of respiratory syncytial virus attributable respiratory tract infection in primary and secondary/tertiary healthcare settings in Merseyside, Cheshire and Bristol, UK. BMJ Open Respir Res 2023; 10:10/1/e001457. [PMID: 37277188 DOI: 10.1136/bmjresp-2022-001457] [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: 09/15/2022] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a common respiratory virus, particularly affecting children, and can cause respiratory infections such as croup and bronchiolitis. The latter is a leading cause of paediatric hospitalisation within the UK. Children <3 years of age and/or with underlying health conditions are more vulnerable to severe RSV infection.There are currently limited data on the incidence of laboratory-confirmed RSV, particularly within primary care settings and outside the typical 'RSV season', which in the Northern hemisphere tends to coincide with winter months. There is also a lack of data on the health economic impact of RSV infection on families and healthcare systems.This observational surveillance study aims to collect data on the incidence of laboratory-confirmed RSV-attributable respiratory tract infection (RTI) in children aged <3 years presenting to primary, secondary or tertiary care; it also aims to estimate the health economic and quality of life impact of RSV-attributable infection in this cohort. Such data will contribute to informing public health strategies to prevent RSV-associated infection, including use of preventative medications. METHODS AND ANALYSIS Parents/carers of children <3 years of age with RTI symptoms will consent for a respiratory sample (nasal swab) to be taken. Laboratory PCR testing will assess for the presence of RSV and/or other pathogens. Data will be obtained from medical records on demographics, comorbidities, severity of infection and hospitalisation outcomes. Parents will complete questionnaires on the impact of ongoing infection symptoms at day 14 and 28 following enrolment. The primary outcome is incidence of laboratory-confirmed RSV in children <3 years presenting to primary, secondary or tertiary care with RTI symptoms leading to health-seeking behaviours. Recruitment will be carried out from December 2021 to March 2023, encompassing two UK winter seasons and intervening months. ETHICS AND DISSEMINATION Ethical approval has been granted (21/WS/0142), and study findings will be published as per International Committee of Medical Journal Editors' guidelines.
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Affiliation(s)
- Fred Fyles
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gregory Duncan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Emma Carter
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lauren McLellan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Dodd
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adam Finn
- University of Bristol Medical School, Bristol, UK
| | - Paul Stephen McNamara
- Department of Child Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
| | | | | | | | | | - Daniela Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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18
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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.
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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
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Grace M, Colosia A, Wolowacz S, Panozzo C, Ghaswalla P. Economic burden of respiratory syncytial virus infection in adults: a systematic literature review. J Med Econ 2023:1-60. [PMID: 37167068 DOI: 10.1080/13696998.2023.2213125] [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] [Indexed: 05/13/2023]
Abstract
AIMS Capture the economic and healthcare resource utilization (HCRU) burden in older adults due to respiratory syncytial virus (RSV) infection. METHODS An electronic literature search of PubMed, Embase, the Cochrane Library, PsycINFO, and EconLit was conducted for studies of the cost and HCRU outcomes of RSV infection in adult patients, with no language or country restrictions. Search dates for primary studies were January 1, 2002-May 18, 2022. The methodological quality of included studies was assessed using a modification of the Critical Appraisal Skills Programme (CASP) checklist for economic studies and the Drummond checklist. RESULTS 42 studies were identified that reported cost or HCRU data associated with RSV infections, with geographic locations across North America, South America, Europe, Asia, and Oceania. Generally, hospitalization costs were highest in the United States (US). Driving factors of increased cost included older age, comorbidities, and length of stay. US studies found that the national direct cost burden of RSV hospitalizations was $1.3 billion for all adults and $1.5-$4.0 billion for adults aged ≥60 years (estimates for other countries were not identified). Studies estimating incremental costs for RSV cases versus controls and costs pre- and post-RSV infection demonstrated higher costs for RSV cases. Hospitalizations accounted for the majority of total costs.
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Affiliation(s)
- Mei Grace
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Ann Colosia
- RTI Health Solutions, Research Triangle Park, NC, USA
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20
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Stein RT, Zar HJ. RSV through the COVID-19 pandemic: Burden, shifting epidemiology, and implications for the future. Pediatr Pulmonol 2023; 58:1631-1639. [PMID: 36811330 DOI: 10.1002/ppul.26370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/20/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Respiratory syncytial virus (RSV) represents a major global healthcare burden, particularly in those under 5 years of age. There is no available vaccine, with treatment limited to supportive care or palivizumab for high-risk children. Additionally, although a causal relationship has not been established, RSV has been associated with the development of asthma or wheezing in some children. The COVID-19 pandemic and the introduction of nonpharmaceutical interventions (NPIs) have caused substantial changes to RSV seasonality and epidemiology. Many countries have experienced an absence of RSV during the time of a typical season, followed by an out-of-season surge upon relaxation of NPI use. These dynamics have disrupted traditional RSV disease patterns and assumptions, but also provide a unique opportunity to learn more about the transmission of RSV and other respiratory viruses, as well as inform future approaches to RSV preventive strategies. Here, we review the RSV burden and epidemiology through the COVID-19 pandemic and discuss how new data may affect future decisions regarding RSV prevention.
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Affiliation(s)
- Renato T Stein
- Infant Center, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,SA-MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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21
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Garba MA, Giwa FJ, Adelaiye H, Olorukooba AA, Abdullahi F, Makarfi H, Löwensteyn Y, Bont L, Abdurraheem F, Uudu E, Mudasir H, Mazur NI. Epidemiology of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Tract Infection among Hospitalized Under-5s in Northwestern Nigeria. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract
Objective Globally, 33 million cases of respiratory syncytial virus (RSV) infections occur annually among under-fives (5s). Ninety-nine percent of deaths from RSV occur in low- and middle-income countries. Under-five pneumonia mortality in Nigeria was estimated at 140,520 in 2017, but RSV epidemiological data are scant due to poor awareness and limited testing. Vaccines for RSV are currently under development and RSV mortality data from this high mortality, low resource setting are essential to maximizing the potential benefit of vaccination as well as promoting vaccine uptake. This study aimed to describe the epidemiology of RSV-associated acute lower respiratory tract infection (ALRTI) in children younger than 5 years in Zaria, Northwestern Nigeria.
Methods A prospective cohort study was conducted among children aged 1 month to 5 years who were hospitalized with ALRTI in the Emergency Pediatric Unit of a tertiary hospital in Zaria from November 2018 to October 2019. Naso-pharyngeal swabs were obtained for RSV testing using a point-of-care immunoassay technique.
Results Thirty-three percent (35/106) of the children had RSV-related ALRTI. The median age of RSV-positive cases was 8 months (IQR 3–14). Two-thirds of children (68.6%, 24/35) were below 12 months. The RSV mortality rate was 5.7% (2/35). RSV occurred in 10 months of the year with peaks in March and July.
Conclusion A third of admitted children with ALRTI were positive for RSV. Therefore RSV significantly contributes to childhood pneumonia and the dual seasonal peak observed in our study may have implications for vaccine implementation.
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Affiliation(s)
- Maria Ahuoiza Garba
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Fatima Jummai Giwa
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Hamdala Adelaiye
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Abiola Aira Olorukooba
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Fatima Abdullahi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Hauwa Makarfi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Yvette Löwensteyn
- Department of Pediatric Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Louis Bont
- Department of Pediatric Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fadlullah Abdurraheem
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Ehi Uudu
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Halima Mudasir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Natalie I Mazur
- Department of Pediatric Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
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22
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Infodemiology of RSV in Italy (2017-2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121984. [PMID: 36553427 PMCID: PMC9777371 DOI: 10.3390/children9121984] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate whether or not online queries for Respiratory Syncytial Virus (RSV) retrieved by means of Google Trends™ and the Italian Wikipedia analysis program mirror the occurrence of influenza-like illnesses (ILI), as reported by the Italian Influenza Surveillance network (InfluNet). Estimated rates for ILI in the general population and in the age groups 0−4 years and 5−14 years were obtained for the influenza seasons 2017−2018 to 2020−2021. Similarly, a weekly fraction of online searches was retrieved for a series of terms associated with Respiratory Syncytial Virus. Next, trends for daily visualization of Italian Wikipedia Pages for Human Respiratory Syncytial Virus, Pneumonia, Bronchiolitis, Influenza, and Respiratory Failure were similarly retrieved. The correlation of all search terms with ILI was analyzed by means of Spearman’s rank correlation analysis. Among search terms associated with the clinical diagnosis of Respiratory Syncytial Virus infections, the occurrence of ILI was highly correlated only with Bronchiolitis in the age group 0−4 years (β 0.210, p = 0.028), while more generic search terms, such as Bronchitis, fever, influenza, and Pneumonia, were identified as effective predictors of ILI, in general and by age groups. In a regression analysis modeled with ILIs as the outcome variable, daily visualizations for the Wikipedia pages on Bronchiolitis were identified as negative predictors for ILI in general (β = −0.152, p = 0.032), ILI in age group 0−4 years (β = −0.264, p = 0.001) and 5−14 years (β = −0.202, p = 0.006), while Influenza was characterized as a positive effector for ILIs in the age group 5−14 years (β = 0.245, p = 0.001). Interestingly, not only were the search terms extensively correlated with one another, but all of them were also characterized by autocorrelation through a Durbin-Watson test (all estimates DW < 2.0) In summary, our study identified a complicated pattern of data visualization as no clear association between rates of ILI in pediatric age group 0−4 and 5 to 14 years was actually found. Finally, our data stress that the infodemiology option may be quite problematic for assessing the time trend of RSV infections in Italy until more appropriate reporting will be made available, by sharing estimates of Lower Respiratory Tract Infections, and through a more accurate characterization of younger age groups.
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23
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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.
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24
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Bandeira T, Carmo M, Lopes H, Gomes C, Martins M, Guzman C, Bangert M, Rodrigues F, Januário G, Tomé T, Azevedo I. Burden and severity of children's hospitalizations by respiratory syncytial virus in Portugal, 2015-2018. Influenza Other Respir Viruses 2022; 17:e13066. [PMID: 36377322 PMCID: PMC9835409 DOI: 10.1111/irv.13066] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children and is of considerable burden on healthcare systems. Our study aimed to evaluate ALRI hospitalizations related to RSV in children in Portugal. METHODS We reviewed hospitalizations potentially related to RSV in children aged <5 years from 2015 to 2018, using anonymized administrative data covering all public hospital discharges in mainland Portugal. Three case definitions were considered: (a) RSV-specific, (b) (a) plus unspecified acute bronchiolitis (RSV-specific & Bronchiolitis), and (c) (b) plus unspecified ALRI (RSV-specific & ALRI). RESULTS A total of 9697 RSV-specific hospitalizations were identified from 2015 to 2018-increasing to 26 062 for RSV-specific & ALRI hospitalizations-of which 74.7% were during seasons 2015/2016-2017/2018 (November-March). Mean hospitalization rates per season were, for RSV-specific, RSV-specific & Bronchiolitis, and RSV-specific & ALRI, respectively, 5.6, 9.4, and 11.8 per 1000 children aged <5 years and 13.4, 22.5, and 25.9 in children aged <2 years. Most RSV-specific hospitalizations occurred in healthy children (94.9%) and in children aged <2 years (96.3%). Annual direct costs of €2.4 million were estimated for RSV-specific hospitalizations-rising to €5.1 million for RSV-specific & ALRI-mostly driven by healthy children (87.6%). CONCLUSION RSV is accountable for a substantial number of hospitalizations in children, especially during their first year of life. Hospitalizations are mainly driven by healthy children. The variability of the potential RSV burden across case definitions highlights the need for a universal RSV surveillance system to guide prevention strategies.
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Affiliation(s)
- Teresa Bandeira
- Centro Hospitalar Universitário Lisboa Norte, Faculdade de MedicinaUniversidade de Lisboa, CAMLLisbonPortugal
| | | | | | | | | | | | | | - Fernanda Rodrigues
- Hospital PediátricoCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal
| | - Gustavo Januário
- Hospital PediátricoCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal
| | - Teresa Tomé
- Centro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Inês Azevedo
- Faculdade de MedicinaUniversidade do Porto, Centro Hospitalar Universitário S. João; EPIUnit, Instituto de Saúde PúblicaPortoPortugal
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25
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I G Giamberardino H, O Pacheco AP, Pereira LA, Debur MDC, Genehold G, Raboni SM. Respiratory syncytial virus: host genetic susceptibility and factors associated with disease severity in a cohort of pediatric patients. J Trop Pediatr 2022; 68:6794268. [PMID: 36323460 DOI: 10.1093/tropej/fmac091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infections are the leading cause of hospitalization in young children. We assessed the epidemiology, severity, clinical characteristics, molecular profile and genetic factors of RSV infections compared to acute respiratory illness (ARI) caused by other respiratory viruses. METHODS Prospective cohort study was conducted from 2017 to 2018 with children under 2 years old hospitalized with ARI. Detection of respiratory viruses was carried out using RT-PCR. RSVs were genotyped via nucleotide sequencing, and host interleukin 28B (IL28B) single nucleotide polymorphisms (SNPs) were determined using SNP TaqMan® Genotyping Assays. RESULTS A total of 468 children were included; 288 (61.5%) had an infection by a single virus: 202 (70.1%) cases by RSV followed by rhinovirus 36 (12.5%) and influenza 16 (5.6%). Of the RSV cases, 36% were genotyped with a higher prevalence of RSV B (62.1%). The RSV group presented median age of 2.7 months (1.6-6.8), higher frequency in: intensive care unit admission (p = 0.004), mechanical ventilation use (p = 0.018), wheezing (p < 0.001), antimicrobial use (p < 0.001) and low oxygen saturation (p < 0.001). Prematurity (27.2%) was the most frequent comorbidity. RSV patients without comorbidities demonstrated a higher frequency in the combination of IL28B rs12979860 CT/IL28B rs8099917 TG and IL28B rs12979860 TT/IL28B rs8099917 TT genotypes. Viral coinfection was detected in 27 (5.7%) children, with the most frequent being RSV and rhinovirus (14.2%). CONCLUSIONS This study highlighted the burden of RSV infection in children under 2 years of age, without comorbidities, with a higher need for pediatric ICU admission. Some IL28B allele combinations had a significant association with RSV frequency of infections.
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Affiliation(s)
- Heloisa I G Giamberardino
- Graduate Program in Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil.,Epidemiology, Immunization and Infection Control Department, Hospital Pequeno Principe, Curitiba, Paraná 80250-060, Brazil
| | - Ana P O Pacheco
- Epidemiology, Immunization and Infection Control Department, Hospital Pequeno Principe, Curitiba, Paraná 80250-060, Brazil
| | - Luciane A Pereira
- Graduate Program in Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil.,Research and Molecular Biology of Microorganisms Laboratory, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil
| | - Maria do Carmo Debur
- Health Public Laboratory, Health State Secretary, Curitiba, Paraná 80045-155, Brazil
| | - Gustavo Genehold
- Research and Molecular Biology of Microorganisms Laboratory, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil
| | - Sonia M Raboni
- Research and Molecular Biology of Microorganisms Laboratory, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil.,Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil
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26
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Martinón-Torres F, Carmo M, Platero L, Drago G, López-Belmonte JL, Bangert M, Díez-Domingo J, Garcés-Sánchez M. Clinical and economic burden of respiratory syncytial virus in Spanish children: the BARI study. BMC Infect Dis 2022; 22:759. [PMID: 36175846 PMCID: PMC9520861 DOI: 10.1186/s12879-022-07745-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is a major cause of morbidity in children. However, its disease burden remains poorly understood, particularly outside of the hospital setting. Our study aimed to estimate the burden of medically attended acute lower respiratory infection (ALRI) cases potentially related to RSV in Spanish children. Longitudinal data from September 2017 to June 2018 of 51,292 children aged < 5 years old from the National Healthcare System (NHS) of two Spanish regions were used. 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). A total of 3460 medically attended ALRI cases potentially due to RSV were identified, of which 257 (7.4%), 164 (4.7%), and 3039 (87.8%) coded with RSV-specific, unspecific bronchiolitis, and unspecific ALRI codes, respectively. Medically attended RSV-specific and ALRI cases per 1000 children was 134.4 in the first year of life, 119.4 in the second, and 35.3 between 2 and 5 years old. Most cases were observed in otherwise healthy children (93.1%). Mean direct healthcare cost per medically attended RSV-specific and ALRI case was €1753 in the first year of life, €896 in the second, and €683 between 2 and 5 years old. Hospitalization was the main driver of these costs, accounting for 55.6%, 38.0% and 33.4%, in each respective age group. In RSV-specific cases, mean direct healthcare cost per medically attended case was higher, mostly due to hospitalization: €3362 in the first year of life (72.9% from hospitalizations), €3252 in the second (72.1%), and €3514 between 2 and 5 years old (74.2%). These findings suggest that hospitalization data alone will underestimate the RSV infections requiring medical care, as will relying only on RSV-specific codes. RSV testing and codification must be improved and preventive solutions adopted, to protect all infants, particularly during the first year of life.
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Affiliation(s)
- F Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela, Galicia, Spain. .,Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Rúa da Choupana, s/n, Santiago de Compostela, Galicia, 15706, A Coruña, Spain. .,CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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27
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Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet 2022; 400:392-406. [PMID: 35785792 DOI: 10.1016/s0140-6736(22)01016-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/27/2022] [Accepted: 05/26/2022] [Indexed: 02/06/2023]
Abstract
Viral bronchiolitis is the most common cause of admission to hospital for infants in high-income countries. Respiratory syncytial virus accounts for 60-80% of bronchiolitis presentations. Bronchiolitis is diagnosed clinically without the need for viral testing. Management recommendations, based predominantly on high-quality evidence, advise clinicians to support hydration and oxygenation only. Evidence suggests no benefit with use of glucocorticoids or bronchodilators, with further evidence required to support use of hypertonic saline in bronchiolitis. Evidence is scarce in the intensive care unit. Evidence suggests use of high-flow therapy in bronchiolitis is limited to rescue therapy after failure of standard subnasal oxygen only in infants who are hypoxic and does not decrease rates of intensive care unit admission or intubation. Despite systematic reviews and international clinical practice guidelines promoting supportive rather than interventional therapy, universal de-implementation of interventional care in bronchiolitis has not occurred and remains a major challenge.
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Affiliation(s)
- Stuart R Dalziel
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
| | - Libby Haskell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Franz E Babl
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Baraldi E, Checcucci Lisi G, Costantino C, Heinrichs JH, Manzoni P, Riccò M, Roberts M, Vassilouthis N. RSV disease in infants and young children: Can we see a brighter future? Hum Vaccin Immunother 2022; 18:2079322. [PMID: 35724340 DOI: 10.1080/21645515.2022.2079322] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a highly contagious seasonal virus and the leading cause of Lower Respiratory Tract Infections (LRTI), including pneumonia and bronchiolitis in children. RSV-related LRTI cause approximately 3 million hospitalizations and 120,000 deaths annually among children <5 years of age. The majority of the burden of RSV occurs in previously healthy infants. Only a monoclonal antibody (mAb) has been approved against RSV infections in a restricted group, leaving an urgent unmet need for a large number of children potentially benefiting from preventive measures. Approaches under development include maternal vaccines to protect newborns, extended half-life monoclonal antibodies to provide rapid long-lasting protection, and pediatric vaccines. RSV has been identified as a major global priority but a solution to tackle this unmet need for all children has yet to be implemented. New technologies represent the avenue for effectively addressing the leading-cause of hospitalization in children <1 years old.
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Affiliation(s)
- Eugenio Baraldi
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | | | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | - Matteo Riccò
- Dipartimento di Sanità Pubblica, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Respiratory Syncytial Virus in Pregnant Women: Systematic Review and Meta-Analysis. WOMEN 2022. [DOI: 10.3390/women2020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a highly contagious viral pathogen. In infants, it is usually listed among the main causes of medical referrals and hospitalizations, particularly among newborns. While waiting for the results of early randomized controlled trials on maternal vaccination against RSV, the present systematic review and meta-analysis aimed to collect available evidence on maternal RSV infections. According to the PRISMA statement, Pubmed, Embase, and pre-print archive medRxiv.og were searched for eligible studies published up to 1 April 2022. Raw data included the incidence of RSV infection among sampled pregnant women, and the occurrence of complications. Data were then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 5 studies for 282,918 pregnancies were retrieved, with a pooled prevalence of 0.2 per 100 pregnancies and 2.5 per 100 pregnancies with respiratory tract infections. Neither maternal deaths nor miscarriages were reported. Even though detailed data were available only for 6309 pregnancies and 33 RSV cases, infant outcomes such as low birth weight and preterm delivery were rare (in both cases 0.04%), but up to 9.1% in cases where RSV diagnosis was confirmed. No substantially increased risk for preterm delivery (RR 1.395; 95%CI 0.566 to 3.434) and giving birth to a low-birth-weight infant (RR 0.509; 95%CI 0.134 to 1.924) was eventually identified. Conclusions. Although RSV is uncommonly detected among pregnant women, incident cases were associated with a relatively high share of complications. However, heterogeneous design and the quality of retrieved reports stress the need for specifically designed studies.
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Out-of-Season Epidemic of Respiratory Syncytial Virus during the COVID-19 Pandemic: The High Burden of Child Hospitalization in an Academic Hospital in Southern Italy in 2021. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060848. [PMID: 35740785 PMCID: PMC9221938 DOI: 10.3390/children9060848] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
Respiratory syncytial virus (RSV) infection is the most common cause of hospitalization in young children. In the last 2 years, public health measures aimed at controlling the spread of SARS-CoV-2 have affected the epidemiology and seasonality of RSV worldwide. The aim of this descriptive retrospective observational study was to describe the characteristics of children hospitalized with RSV in an academic tertiary care hospital in Southern Italy in 2021. We also investigate the seasonal trends of RSV from 2017 to 2021. The demographic characteristics, comorbidities, clinical data, and coinfections were retrospectively evaluated. Compared with previous seasons, the 2021 outbreak of RSV was characterized by an increased number of patients, with a delayed peak observed in November. Overall, 179 children, including 128 (71.5%) aged <12 months, were hospitalized for RSV infection between August and December 2021. Ten children (5.6%) were admitted to the intensive care unit (ICU), all aged <5 months. One patient (0.5%) aged <1 month with severe comorbidities died. The severity of symptoms was significantly associated with younger age, underlying chronic disease, and the length of hospital stay (p < 0.05 each). History of prematurity was not significantly associated with the presence of coinfections. Because of the high burden of RSV infection and the expected larger RSV epidemics resulting from a greater number of RSV-naïve children, systematic epidemiological and virological surveillance is needed. Appropriate pathways for access to RSV prevention in all infants should also be introduced.
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Umuhoza T, Oyugi J, Mancuso JD, Ahmed A, Bulimo WD. Morbidity burden, seasonality and factors associated with the human respiratory syncytial virus, human parainfluenza virus, and human adenovirus infections in Kenya. IJID REGIONS 2021; 1:72-78. [PMID: 35757823 PMCID: PMC9216343 DOI: 10.1016/j.ijregi.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022]
Abstract
Human respiratory syncytial (HRSV), parainfluenza (HPIV) and adenoviruses (HAdV) These non-influenza viruses contributed to influenza-like illness morbidity burden HRSV, HPIV and HAdV infections had a significant impact on infants HRSV had a clear seasonal pattern, with cases peaking around April–May each year During the surveillance period, HRSV was associated with climate parameters
Background Human respiratory syncytial viruses (HRSV), human parainfluenza viruses (HPIV), and human adenoviruses (HAdVs) cause a substantial morbidity burden globally. Objective We sought to estimate morbidity burden, assess seasonality, and determine factors associated with these respiratory viruses in Kenya. Methods The data were obtained from Kenyan sites included in the Köppen-Geiger climate classification system. We defined the proportion of morbidity burden by descriptive analysis and visualized time-series data for January 2007–December 2013. Logistic regression was used to identify factors associated with infection outcomes. Results The morbidity burden for HRSV was 3.1%, HPIV 5.3% and HAdVs 3.3%. Infants were more likely to be infected than other age groups. HRSV exhibited seasonality with high occurrence in January–March (odds ratio[OR] = 2.73) and April–June (OR = 3.01). Hot land surface temperature (≥40 °C) was associated with HRSV infections (OR = 2.75), as was warmer air temperature (19-22.9 °C) (OR = 1.68), compared with land surface temperature (<30) and cooler air temperature (<19 °C) respectively. Moderate rainfall (150-200 mm) areas had greater odds of HRSV infection (OR = 1.32) than low rainfall (<150 mm). Conclusion HRSV, HPIV and HAdVs contributed to morbidity burden, and infants were significantly affected. HRSV had a clear seasonal pattern and were associated with climate parameters, unlike HPIV and HAdVs.
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Affiliation(s)
- Therese Umuhoza
- Institute of Tropical and Infectious Diseases, University of Nairobi
- Corresponding author: Therese Umuhoza, Institute of Tropical and Infectious Diseases, University of Nairobi, P.O. Box 19676 -00200, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi
| | - James D. Mancuso
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anwar Ahmed
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Wallace D. Bulimo
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
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Citron MP, McAnulty J, Callahan C, Knapp W, Fontenot J, Morales P, Flynn JA, Douglas CM, Espeseth AS. Transplacental Antibody Transfer of Respiratory Syncytial Virus Specific IgG in Non-Human Primate Mother-Infant Pairs. Pathogens 2021; 10:pathogens10111441. [PMID: 34832599 PMCID: PMC8624788 DOI: 10.3390/pathogens10111441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022] Open
Abstract
One approach to protect new-borns against respiratory syncytial virus (RSV) is to vaccinate pregnant women in the last trimester of pregnancy. The boosting of circulating antibodies which can be transferred to the foetus would offer immune protection against the virus and ultimately the disease. Since non-human primates (NHPs) have similar reproductive anatomy, physiology, and antibody architecture and kinetics to humans, we utilized this preclinical species to evaluate maternal immunization (MI) using an RSV F subunit vaccine. Three species of NHPs known for their ability to be infected with human RSV in experimental challenge studies were tested for RSV-specific antibodies. African green monkeys had the highest overall antibody levels of the old-world monkeys evaluated and they gave birth to offspring with anti-RSV titers that were proportional to their mother. These higher overall antibody levels are associated with greater durability found in their offspring. Immunization of RSV seropositive AGMs during late pregnancy boosts RSV titers, which consequentially results in significantly higher titers in the vaccinated new-borns compared to the new-borns of unvaccinated mothers. These findings, accomplished in small treatment group sizes, demonstrate a model that provides an efficient, resource sparing and translatable preclinical in vivo system for evaluating vaccine candidates for maternal immunization.
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Affiliation(s)
- Michael P. Citron
- Infectious Disease & Vaccines, Merck & Co., Inc., Kenilworth, NJ 07033, USA; (J.M.); (C.C.); (J.A.F.); (C.M.D.); (A.S.E.)
- Correspondence:
| | - Jessica McAnulty
- Infectious Disease & Vaccines, Merck & Co., Inc., Kenilworth, NJ 07033, USA; (J.M.); (C.C.); (J.A.F.); (C.M.D.); (A.S.E.)
| | - Cheryl Callahan
- Infectious Disease & Vaccines, Merck & Co., Inc., Kenilworth, NJ 07033, USA; (J.M.); (C.C.); (J.A.F.); (C.M.D.); (A.S.E.)
| | - Walter Knapp
- Safety Assessment and Laboratory Animal Resources, Merck & Co., Inc., Kenilworth, NJ 07033, USA;
| | - Jane Fontenot
- The New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, LA 70560, USA;
| | - Pablo Morales
- The Mannheimer Foundation, Homestead, FL 33034, USA;
| | - Jessica A. Flynn
- Infectious Disease & Vaccines, Merck & Co., Inc., Kenilworth, NJ 07033, USA; (J.M.); (C.C.); (J.A.F.); (C.M.D.); (A.S.E.)
| | - Cameron M. Douglas
- Infectious Disease & Vaccines, Merck & Co., Inc., Kenilworth, NJ 07033, USA; (J.M.); (C.C.); (J.A.F.); (C.M.D.); (A.S.E.)
| | - Amy S. Espeseth
- Infectious Disease & Vaccines, Merck & Co., Inc., Kenilworth, NJ 07033, USA; (J.M.); (C.C.); (J.A.F.); (C.M.D.); (A.S.E.)
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Azzari C, Baraldi E, Bonanni P, Bozzola E, Coscia A, Lanari M, Manzoni P, Mazzone T, Sandri F, Checcucci Lisi G, Parisi S, Piacentini G, Mosca F. Epidemiology and prevention of respiratory syncytial virus infections in children in Italy. Ital J Pediatr 2021; 47:198. [PMID: 34600591 PMCID: PMC8487331 DOI: 10.1186/s13052-021-01148-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.
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Affiliation(s)
- Chiara Azzari
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Bozzola
- Pediatric Disease Unit, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Alessandra Coscia
- Department of Public Health and Pediatric Sciences, Complex Structure Neonatology Unit, University of Turin, Turin, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studioru, University of Bologna, Bologna, Italy
| | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | | | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Maggiore Hospital, Bologna, Italy
| | | | | | - Giorgio Piacentini
- Department of Pediatrics, Pediatric Division, University Hospital of Verona, Verona, Italy
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Determination of genetic characterization and circulation pattern of Respiratory Syncytial Virus (RSV) in children with a respiratory infection, Tehran, Iran, during 2018-2019. Virus Res 2021; 305:198564. [PMID: 34530047 DOI: 10.1016/j.virusres.2021.198564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/01/2021] [Accepted: 09/05/2021] [Indexed: 11/21/2022]
Abstract
The RSV-associated disease accounts for a significant health burden particularly in infants and young children who need to be hospitalized. Since continuous surveillance of circulating RSV genotypes is crucial worldwide, this study aimed to investigate the genetic diversity of RSV circulating strains causing upper or lower acute respiratory infection. Our attention was geared towards studying the cases hospitalized or outpatient in children younger than 2 years of age in Iran during 2018/2019. In this study, nasopharyngeal swabs collected from 206 children who presented with respiratory infection symptoms, were admitted to the referral pediatric ward of Bahrami children's hospital in Tehran, Iran. RSV-positive samples were detected via Nested RT-PCR. The glycoprotein gene was sequenced, and virus genotypes were confirmed through phylogenetic analysis by the MEGA X program. A total of 74 (35.92%) samples tested positive for RSV. Among them, sequencing was done in 10 specimens from 2018 (RSV-A: RSV-B=4:6) and 19 specimens from 2019 (RSV-A: RSV-B=16:3). According to phylogenetic analysis, all RSV-A strains were assigned as ON1 genotype and RSV-B strains were assigned as BA9 genotype. A new N-glycosylation site in Iranian BA9 and positive selection in ON1 genotype was observed. Phylogenetic characterization of strains in the current study revealed co-circulation of ON1 and BA9 as the only prevalent genotypes of both RSV-A and -B groups.
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Simões EAF, Dani V, Potdar V, Crow R, Satav S, Chadha MS, Hessong D, Carosone-Link P, Palaskar S, Satav A. Mortality From Respiratory Syncytial Virus in Children Under 2 Years of Age: A Prospective Community Cohort Study in Rural Maharashtra, India. Clin Infect Dis 2021; 73:S193-S202. [PMID: 34472578 PMCID: PMC8411248 DOI: 10.1093/cid/ciab481] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although respiratory syncytial virus (RSV) is the most important viral cause of lower respiratory tract infection deaths in infants, there are few data on infant community deaths caused by RSV. METHODS This was an active surveillance of children younger than 2 years of age in 93 villages, 5 primary health centers, and 3 hospitals serving these villages. Village health workers and counselors at the health facilities monitored all lower respiratory tract infections (LRTIs) in consented subjects. Children with severe, or very severe LRTIs and all who died, had nasopharyngeal swabs collected for detection of RSV by molecular methods. RESULTS In the 12 134 subjects, there were 2064 episodes of severe LRTIs and 1732 of very severe LRTIs, of which 271 and 195, respectively, had RSV. Fifteen of 16 (94%) children with RSV died of LRTIs, 14 in the community and 1 in the hospital. The case fatality ratios for severe RSV LRTIs in the first 6 months of life were 3/52 (7.1%) and 1/36 (2.8%) in the community and hospital, respectively. Of those with very severe LRTIs in the community, 17.6% died. There were no very severe RSV LRTI hospital deaths. The adjusted RSV LRTI mortality rates ranged from 1.0 to 3.0/1000 child-years (CY) overall, and 2.0 to 6.1/1000 CY, accounting for 20% of the LRTI deaths and 10% of the postneonatal infant mortality. CONCLUSIONS Community deaths from RSV account for the majority of RSV LRTI deaths, and efforts at prevention should be preferentially directed at populations where access to care is limited.
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Affiliation(s)
- Eric A F Simões
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
- Centre for Global Health, Department of Epidemiology,Colorado School of Public Health, Aurora, Colorado, USA
| | - Vibhawari Dani
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Varsha Potdar
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Rowena Crow
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Shilpa Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Mandeep S Chadha
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Danielle Hessong
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Phyllis Carosone-Link
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Sameer Palaskar
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
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Demont C, Petrica N, Bardoulat I, Duret S, Watier L, Chosidow A, Lorrot M, Kieffer A, Lemaitre M. Economic and disease burden of RSV-associated hospitalizations in young children in France, from 2010 through 2018. BMC Infect Dis 2021; 21:730. [PMID: 34340679 PMCID: PMC8327424 DOI: 10.1186/s12879-021-06399-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the main cause of infant and child hospitalizations. The study objective is to estimate the RSV-associated hospitalizations and economic burden in young children in France to inform future preventive strategies. METHODS We conducted a retrospective analysis of RSV-associated hospitalizations data from the French Hospital database (PMSI-MCO) which covers the entire French population. All children aged < 5 years hospitalized with RSV ICD-10 codes (J210, J219, J45, J121, J205, R062) from 2010 to 2018, were included. Descriptive analyses were conducted by RSV seasons (Oct to March), by respiratory years (July to June) and per age groups. RESULTS On average 45,225 RSV-associated hospitalizations (range: 43,715 - 54,616) per season was reported in France, 69% among children < 1 year old. This represents 28% of all-cause hospitalizations that occurred among children < 1 year old, and less than 10% of all-cause hospitalizations in older children. Number of RSV-associated hospitalizations were similar for infants born during (Oct-March) or outside (April-September) their first RSV season. The highest risk being reported for infants born from September through November. The associated hospitalization cost increased between 2010 - 11 and 2017-18, from €93.2 million to €124.1 million, respectively, and infants < 1 year old represented 80% of the economic burden. CONCLUSION RSV is an important cause of child hospitalization in France. The burden on healthcare system is mainly driven by < 1 year olds, and preventive strategies should be implemented before the first RSV season.
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Affiliation(s)
- C. Demont
- grid.417924.dSanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - N. Petrica
- grid.434277.1IQVIA, 92400 Courbevoie, France
| | | | - S. Duret
- grid.434277.1IQVIA, 92400 Courbevoie, France
| | - L. Watier
- grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
| | - A. Chosidow
- grid.413776.00000 0004 1937 1098Department of Pediatrics, Armand Trousseau Hospital (AP-HP), 75012 Paris, France
| | - M. Lorrot
- grid.413776.00000 0004 1937 1098Department of Pediatrics, Armand Trousseau Hospital (AP-HP), 75012 Paris, France
| | - A. Kieffer
- grid.417924.dSanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - M. Lemaitre
- grid.434277.1IQVIA, 92400 Courbevoie, France
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Kim S, Williams TC, Viboud C, Campbell H, Chen J, Spiro DJ. RSV genomic diversity and the development of a globally effective RSV intervention. Vaccine 2021; 39:2811-2820. [PMID: 33895016 DOI: 10.1016/j.vaccine.2021.03.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of serious lower respiratory tract illness in infants and children and causes significant disease in the elderly and immunocompromised. Recently there has been an acceleration in the development of candidate RSV vaccines, monoclonal antibodies and therapeutics. However, the effects of RSV genomic variability on the implementation of vaccines and therapeutics remain poorly understood. To address this knowledge gap, the National Institute of Allergy and Infectious Diseases and the Fogarty International Center held a workshop to summarize what is known about the global burden and transmission of RSV disease, the phylogeographic dynamics and genomics of the virus, and the networks that exist to improve the understanding of RSV disease. Discussion at the workshop focused on the implications of viral evolution and genomic variability for vaccine and therapeutics development in the context of various immunization strategies. This paper summarizes the meeting, highlights research gaps and future priorities, and outlines what has been achieved since the meeting took place. It concludes with an examination of what the RSV community can learn from our understanding of SARS-CoV-2 genomics and what insights over sixty years of RSV research can offer the rapidly evolving field of COVID-19 vaccines.
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Affiliation(s)
- Sonnie Kim
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Thomas C Williams
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Cecile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | | | - David J Spiro
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
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Montgomery AS, Lustik MB, Jones MU, Horseman TS. Respiratory Viral Pathogens in Children Evaluated at Military Treatment Facilities in Oahu, Hawaii From 2014 to 2018: Seasonality and Climatic Factors. J Pediatric Infect Dis Soc 2021; 10:517-520. [PMID: 33219667 DOI: 10.1093/jpids/piaa131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022]
Abstract
Five-year retrospective analysis of respiratory viruses in children less than 18 years old at Tripler Army Medical Center and outlying clinics in Oahu. Respiratory syncytial virus and influenza A showed pronounced seasonality with peaks from September to December and December to March, respectively. Results provide a better understanding of the timing of viral preventive strategies in Oahu.
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Affiliation(s)
- Agnes S Montgomery
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Michael B Lustik
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Milissa U Jones
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Timothy S Horseman
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, Hawaii, USA
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Ramjith J, Roes KCB, Zar HJ, Jonker MA. Flexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling. BMC Med Res Methodol 2021; 21:17. [PMID: 33430789 PMCID: PMC7802241 DOI: 10.1186/s12874-020-01194-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Recurrent episodes of pneumonia are frequently modeled using extensions of the Cox proportional hazards model with the underlying assumption of time-constant relative risks measured by the hazard ratio. We aim to relax this assumption in a study on the effect of factors on the evolution of pneumonia incidence over time based on data from a South African birth cohort study, the Drakenstein child health study. Methods We describe and apply two models: a time-constant and a time-varying relative effects model in a piece-wise exponential additive mixed model’s framework for recurrent events. A more complex model that fits in the same framework is applied to study the continuously measured seasonal effects. Results We find that several risk factors (male sex, preterm birth, low birthweight, lower socioeconomic status, lower maternal education and maternal cigarette smoking) have strong relative effects that are persistent across time. When time-varying effects are allowed in the model, HIV exposure status (HIV exposed & uninfected versus HIV unexposed) shows a strong relative effect for younger children, but this effect weakens as children grow older, with a null effect reached from about 15 months. Weight-for-length at birth shows a time increasing relative effect. We also find that children born in the summer have a much higher risk of pneumonia in the 3-to-8-month age period compared with children born in winter. Conclusion This work highlights the usefulness of flexible modelling tools in recurrent events models. It avoids stringent assumptions and allows estimation and visualization of absolute and relative risks over time of key factors associated with incidence of pneumonia in young children, providing new perspectives on the role of risk factors such HIV exposure. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-020-01194-6).
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Affiliation(s)
- Jordache Ramjith
- Department for Health EvidenceBiostatistics Research GroupRadboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Kit C B Roes
- Department for Health EvidenceBiostatistics Research GroupRadboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Heather J Zar
- Department of Paediatrics and Child HealthRed Cross War Memorial Children's Hospital and SA-MRC unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marianne A Jonker
- Department for Health EvidenceBiostatistics Research GroupRadboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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40
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Elawar F, Oraby AK, Kieser Q, Jensen LD, Culp T, West FG, Marchant DJ. Pharmacological targets and emerging treatments for respiratory syncytial virus bronchiolitis. Pharmacol Ther 2020; 220:107712. [PMID: 33121940 DOI: 10.1016/j.pharmthera.2020.107712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022]
Abstract
RSV infection of the lower respiratory tract in infants is the leading cause of pediatric hospitalizations and second to malaria in causing infant deaths worldwide. RSV also causes substantial morbidity in immunocompromised and elderly populations. The only available therapeutic is a prophylactic drug called Palivizumab that is a humanized monoclonal antibody, given to high-risk infants. However, this intervention is expensive and has a limited impact on annual hospitalization rates caused by RSV. No vaccine is available, nor are efficacious antivirals to treat an active infection, and there is still no consensus on how infants with bronchiolitis should be treated during hospital admission. In this comprehensive review, we briefly outline the function of the RSV proteins and their suitability as therapeutic targets. We then discuss the most promising drug candidates, their inhibitory mechanisms, and whether they are in the process of clinical trials. We also briefly discuss the reasons for some of the failures in RSV therapeutics and vaccines. In summary, we provide insight into current antiviral development and the considerations toward producing licensed antivirals and therapeutics.
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Affiliation(s)
- Farah Elawar
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ahmed K Oraby
- Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada; Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Misr University for Science &Technology, Al-Motamayez District, 6th of October City, P.O. Box 77, Egypt
| | - Quinten Kieser
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Lionel D Jensen
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Tyce Culp
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Frederick G West
- Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - David J Marchant
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada.
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Grilc E, Prosenc Trilar K, Lajovic J, Sočan M. Determining the seasonality of respiratory syncytial virus in Slovenia. Influenza Other Respir Viruses 2020; 15:56-63. [PMID: 32656961 PMCID: PMC7767947 DOI: 10.1111/irv.12779] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background In Slovenia, the respiratory syncytial virus (RSV) surveillance is based on national laboratory data. The weeks with more than 10% of samples tested positive compose RSV epidemic season. The use of real‐time multiplex PCR, which identifies other respiratory pathogens in parallel with RSV, caused more testing but the percentage of RSV positives lowered. The 10% threshold was reached with delay, which raised concern about its suitability for defining RSV seasonality. Methods To describe the seasonality of RSV, the onset, offset and duration of the RSV epidemic season across 10 years (from week 40, 2008/2009 to week 39, 2017/2018), four calculative methods were deployed including moving epidemic method, MEM, and epidemiological parameters were compared. Results In 10 years, 10 969 (12%) out of 90 264 samples tested positive for RSV. The number of tested samples increased remarkably from the first to last season with a drop in the percentage of positive samples from 23% to 10%. The onset of RSV epidemic varied considerably regardless of the calculative method used (from 10 to 13 weeks). The unevenness in the RSV epidemic season end was also observed. The average duration of RSV epidemic season was the shortest when moving epidemic method has been used (15.7 weeks) and longest with ≥3% method (22.9 weeks). Conclusion The ≥3% calculative method could be used as an early warning of the RSV season. However, ≥7% calculative method was found to be reliable enough to define the epidemiological parameters of an ongoing season and to support public health response. The potential of the moving epidemic method should be further explored.
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Affiliation(s)
- Eva Grilc
- National Institute of Public Health, Ljubljana, Slovenia
| | | | | | - Maja Sočan
- National Institute of Public Health, Ljubljana, Slovenia
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Glatman-Freedman A, Kaufman Z, Applbaum Y, Dichtiar R, Steiman A, Gordon ES, Keinan-Boker L, Shohat T, Haklai Z. Respiratory Syncytial Virus hospitalization burden: a nation-wide population-based analysis, 2000-2017. J Infect 2020; 81:297-303. [PMID: 32504738 DOI: 10.1016/j.jinf.2020.05.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/02/2020] [Accepted: 05/31/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Respiratory Syncytial Virus (RSV) is a known cause of morbidity among young children, while RSV-related disease in the elderly is not fully recognized. Several RSV candidate vaccines for infants, pregnant women and adults are under development. We aimed to estimate nationwide age-specific hospitalizations and seasonal trends, to help determine the optimal age for vaccination. METHODS Hospitalizations with a primary RSV-related diagnoses were retrieved from the National Hospital Database for the years 2000-2017. Data were analyzed by year, month and age group to determine hospitalization rates and seasonal trends. RESULTS During the analysis period, 39,156 hospitalizations received primary RSV-related ICD-9 diagnostic codes. The highest mean yearly hospitalization rate occurred among infants <1 year of life (1,218.4 per 100,000). Within the first year of life, the highest mean yearly hospitalization rate was observed in the second month of life (3,541.5 hospitalizations per 100,000). Hospitalization rates for individuals ≥5 years old increased during the study period, primarily among patients ≥65 years of age, reaching hospitalization rate of 9 per 100,000 in 2017. A clear seasonal pattern was observed. CONCLUSIONS An effective vaccine for infants and pregnant women has the potential to reduce hospitalizations burden. RSV-related hospitalizations burden among adults requires additional research.
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Affiliation(s)
- Aharona Glatman-Freedman
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.
| | - Zalman Kaufman
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Applbaum
- Health Information Division, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ada Steiman
- Health Information Division, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel
| | - Ethel-Sherry Gordon
- Health Information Division, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Ziona Haklai
- Health Information Division, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel
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Drysdale SB, Barr RS, Rollier CS, Green CA, Pollard AJ, Sande CJ. Priorities for developing respiratory syncytial virus vaccines in different target populations. Sci Transl Med 2020; 12:eaax2466. [PMID: 32188721 PMCID: PMC7613568 DOI: 10.1126/scitranslmed.aax2466] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/25/2019] [Indexed: 01/13/2023]
Abstract
The development of an effective vaccine against respiratory syncytial virus (RSV) has been hampered by major difficulties that occurred in the 1960s when a formalin-inactivated vaccine led to increased severity of RSV disease after acquisition of the virus in the RSV season after vaccination. Recent renewed efforts to develop a vaccine have resulted in about 38 candidate vaccines and monoclonal antibodies now in clinical development. The target populations for effective vaccination are varied and include neonates, young children, pregnant women, and older adults. The reasons for susceptibility to infection in each of these groups may be different and, therefore, could require different vaccine types for induction of protective immune responses, adding a further challenge for vaccine development. Here, we review the current knowledge of RSV vaccine development for these target populations and propose a view and rationale for prioritizing RSV vaccine development.
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Affiliation(s)
- Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK.
- Institute of Infection and Immunity, St George's, University of London, London SW17 0RE, UK
| | - Rachael S Barr
- Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Christine S Rollier
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
| | - Christopher A Green
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Charles J Sande
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK.
- KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya
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Barbati F, Moriondo M, Pisano L, Calistri E, Lodi L, Ricci S, Giovannini M, Canessa C, Indolfi G, Azzari C. Epidemiology of Respiratory Syncytial Virus-Related Hospitalization Over a 5-Year Period in Italy: Evaluation of Seasonality and Age Distribution Before Vaccine Introduction. Vaccines (Basel) 2020; 8:vaccines8010015. [PMID: 31947976 PMCID: PMC7157234 DOI: 10.3390/vaccines8010015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/23/2019] [Accepted: 01/01/2020] [Indexed: 02/06/2023] Open
Abstract
Respiratory Syncytial Virus (RSV) is associated with most of the acute viral respiratory tract infections causing hospitalization with a peak during the first months of life. Many clinical trials of RSV vaccine candidates are being carried out. The aim of this study was to obtain epidemiologic information to give suggestions on target populations and prevention strategies before the introduction of new vaccines or monoclonal antibodies. We retrospectively evaluated, over a 5-year period (September 2014–August 2019), a population of hospitalized Italian children aged 0–6 years with a laboratory confirmed diagnosis of RSV infection. Risk factors, seasonality of RSV infection, distribution according to age, cases of coinfections and reinfections and cases needing Intensive Care Unit were evaluated. Hospitalizations due to RSV were 624 in the period under study. The peak was found between November and April, with 80.4% of cases recorded between December and February. 62.5% of cases were found in children under three months of age and 41% in children under 30 days old. The need for intensive care was associated with younger ages, with 70.9% of cases in children below three months of age. Unless the incoming vaccines demonstrate a strong herd protection effect, preventive strategies should be aimed at newborns or at maternal immunization.
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45
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Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.632224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Cai W, Tolksdorf K, Hirve S, Schuler E, Zhang W, Haas W, Buda S. Evaluation of using ICD-10 code data for respiratory syncytial virus surveillance. Influenza Other Respir Viruses 2019; 14:630-637. [PMID: 31206246 PMCID: PMC7578302 DOI: 10.1111/irv.12665] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 01/16/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection (ALRI) in young children. ICD‐10‐based syndromic surveillance can transmit data rapidly in a standardized way. Objectives We investigated the use of RSV‐specific ICD‐10 codes for RSV surveillance. Methods We performed a retrospective descriptive data analysis based on existing ICD‐10‐based surveillance systems for ALRI in primary and secondary care and a linked virological surveillance in Germany. We described RSV epidemiology and compared the epidemiological findings based on ICD‐10 and virological data. We calculated sensitivity and specificity of RSV‐specific ICD‐10 codes and in combination with ICD‐10 codes for acute respiratory infections (ARI) for the identification of laboratory‐confirmed RSV infections. Results Based on the ICD‐10 and virological data, epidemiology of RSV was described, and common findings were found. The RSV‐specific ICD‐10 codes had poor sensitivity 6% (95%‐CI: 3%‐12%) and high specificity 99.8% (95%‐CI: 99.6%‐99.9%). In children <5 years and in RSV seasons, the sensitivities of RSV‐specific ICD‐10 codes combined with general ALRI ICD‐10 codes J18.‐, J20.‐ and with J12.‐, J18.‐, J20.‐, J21.‐, J22 were moderate (44%, 95%‐CI: 30%‐59%). The specificities of both combinations remained high (91%, 95%‐CI: 86%‐94%; 90%, 95%‐CI: 85%‐94%). Conclusions The use of RSV‐specific ICD‐10 codes may be a useful indicator to describe RSV epidemiology. However, RSV‐specific ICD‐10 codes underestimate the number of actual RSV infections. This can be overcome by combining RSV‐specific and general ALRI ICD‐10 codes. Further investigations are required to validate this approach in other settings.
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Affiliation(s)
- Wei Cai
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Kristin Tolksdorf
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - Wenqing Zhang
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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