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La EM, Bunniran S, Garbinsky D, Reynolds M, Schwab P, Poston S, Harrington L. Respiratory syncytial virus knowledge, attitudes, and perceptions among adults in the United States. Hum Vaccin Immunother 2024; 20:2303796. [PMID: 38297921 PMCID: PMC10841020 DOI: 10.1080/21645515.2024.2303796] [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: 10/06/2023] [Accepted: 01/07/2024] [Indexed: 02/02/2024] Open
Abstract
Respiratory syncytial virus (RSV) is associated with considerable morbidity and mortality among older adults (aged ≥60 years) and adults with certain chronic conditions in the United States (US). Despite this burden, no previous studies have assessed the knowledge, attitudes, and perceptions (KAP) of RSV among these populations. This study evaluates RSV-related KAP among US adults at increased risk of severe RSV infection. A cross-sectional, web-based survey was administered from May to June 2022 to better understand respiratory infection- and RSV-related KAP among US adults who are at risk of severe RSV infection. The survey included ≥200 adults in each of 4 subgroups: adults aged 60-89 years, and adults aged 18-59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes mellitus. Survey responses were analyzed descriptively overall and by subgroup, with exploratory logistic regression modeling used to evaluate characteristics associated with RSV awareness and concern. Among the 827 survey respondents, only 43.3% had ever heard of RSV (n = 358/827). The study identified key knowledge gaps (e.g. bacterial vs. viral nature of respiratory infections, RSV seasonality, common RSV symptoms, extent to which RSV causes respiratory infections in specific patient populations). Although 33.7% of RSV-aware adults (n = 120/356) reported being worried/very worried about RSV, 67.3% (n = 241/358) rarely consider RSV as a potential cause of their cold/flu-like symptoms. Results from this study highlight important knowledge gaps related to RSV, perceived risk, and severity of RSV. Findings can be used to support the development of tailored education efforts to support RSV prevention.
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Affiliation(s)
| | - Su Bunniran
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Phil Schwab
- RTI Health Solutions, Research Triangle Park, NC, USA
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Patel DA, Marcum ZA, Chansakul A, Toyip A, Nerney K, Panozzo CA, St Laurent S, Mehta D, Ghaswalla P. Economic burden of cardiorespiratory hospitalizations associated with respiratory syncytial virus among United States adults in 2017-2019. Hum Vaccin Immunother 2024; 20:2364493. [PMID: 38982719 PMCID: PMC11238920 DOI: 10.1080/21645515.2024.2364493] [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: 03/01/2024] [Accepted: 06/02/2024] [Indexed: 07/11/2024] Open
Abstract
Morbidity and mortality caused by respiratory syncytial virus (RSV) in older adults and those with underlying health conditions can be potentially alleviated through vaccination. To assist vaccine policy decision-makers and payers, we estimated the annual economic burden of RSV-associated cardiorespiratory hospitalizations among insured US adults aged ≥18 y in the Merative MarketScan claims database from September through August of 2017-2018 and 2018-2019. Negative binomial regression models were used to estimate the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. This number was multiplied by mean cardiorespiratory hospitalization costs to estimate total costs for RSV-associated cardiorespiratory hospitalizations. Number and cost for International Classification of Diseases (ICD)-coded RSV hospitalizations were quantified from MarketScan. In 2017-2018 and 2018-2019, respectively, 18,515,878 and 16,462,120 adults with commercial or Medicare supplemental benefits were assessed. In 2017-2018, 301,248 cardiorespiratory hospitalizations were observed; 0.32% had RSV-specific ICD codes, costing $44,916,324, and 5.52% were RSV-associated cardiorespiratory hospitalizations, costing $734,078,602 (95% CI: $460,826,580-$1,103,358,799). In 2018-2019, 215,525 cardiorespiratory hospitalizations were observed; 0.34% had RSV-specific ICD codes, costing $33,053,105, and 3.14% were RSV-associated cardiorespiratory hospitalizations, costing $287,549,472 (95% CI: $173,377,778-$421,884,259). RSV contributes to substantial economic burden of cardiorespiratory hospitalizations among US adults. Modeling excess risk using viral positivity data provides a comprehensive estimation of RSV hospitalization burden and associated costs, compared with relying on ICD diagnosis codes alone.
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Affiliation(s)
| | | | | | | | | | - Catherine A Panozzo
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Samantha St Laurent
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Darshan Mehta
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Parinaz Ghaswalla
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
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Ferguson M, Schwarz TF, Núñez SA, Rodríguez-García J, Mital M, Zala C, Schmitt B, Toursarkissian N, Mazarro DO, Großkopf J, Voors-Pette C, Mehta H, Hailemariam HA, de Heusch M, Salaun B, Damaso S, David MP, Descamps D, Hill J, Vandermeulen C, Hulstrøm V. Noninferior Immunogenicity and Consistent Safety of Respiratory Syncytial Virus Prefusion F Protein Vaccine in Adults 50-59 Years Compared to ≥60 Years of Age. Clin Infect Dis 2024:ciae364. [PMID: 39099093 DOI: 10.1093/cid/ciae364] [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: 02/29/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND The adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVPreF3 OA) is approved in adults aged ≥60 years. We evaluated RSVPreF3 OA immunogenicity and safety in adults aged 50-59 years without or with increased risk for RSV disease due to specific chronic medical conditions. METHODS This observer-blind, phase 3, noninferiority trial included adults aged 50-59 years, stratified into 2 subcohorts: those with and those without predefined, stable, chronic medical conditions leading to an increased risk for RSV disease. Participants in both subcohorts were randomized 2:1 to receive RSVPreF3 OA or placebo. A control group of adults aged ≥60 years received RSVPreF3 OA. Primary outcomes were RSV-A and RSV-B neutralization titers (geometric mean titer ratios and sero-response rate differences) 1 month post-vaccination in 50-59-year-olds versus ≥60-year-olds. Cell-mediated immunity and safety were also assessed. RESULTS The exposed population included 1152 participants aged 50-59 years and 381 participants aged ≥60 years. RSVPreF3 OA was immunologically noninferior in 50-59-year-olds versus ≥60-year-olds; noninferiority criteria were met for RSV-A and RSV-B neutralization titers in those with and those without increased risk for RSV disease. Frequencies of RSVPreF3-specific polyfunctional CD4+ T cells increased substantially from pre- to 1 month post-vaccination. Most solicited adverse events had mild-to-moderate intensity and were transient. Unsolicited and serious adverse event rates were similar in all groups. CONCLUSIONS RSVPreF3 OA was immunologically noninferior in 50-59-year-olds compared to ≥60-year-olds, in whom efficacy was previously demonstrated. The safety profile in 50-59-year-olds was consistent with that in ≥60-year-olds. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT05590403.
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Affiliation(s)
| | - Tino F Schwarz
- Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg Mitte, Würzburg, Germany
| | | | - Juan Rodríguez-García
- Preventive Medicine Department, Immunocompromised Patient Immunization Unit, Son Espases University Hospital, Palma de Mallorca, Mallorca, Balearic Islands, Spain
| | - Marek Mital
- Agnieszka Mital Centrum Badan Clinic, Elblag, Poland
| | - Carlos Zala
- Vacunar, Sede Las Cañitas, Buenos Aires, Argentina
| | | | | | - Dolores Ochoa Mazarro
- Clinical Pharmacology Department, Hospital Universitario De La Princesa, Instituto de Investigación Sanitaria La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Hemalini Mehta
- Clinical Research Institute, Minneapolis, Minnesota, USA
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Clark R, Davies S, Labrador J, Loubet P, Natalini Martínez S, Moríñigo HM, Nicolas JF, Vera MP, Rämet M, Rebollo-Rodrigo MH, Sanz-Muñoz I, Dezutter N, Germain S, David MP, Jayadev A, Hailemariam HA, Kotb S, Meyer N. Safety and Immunogenicity of Respiratory Syncytial Virus Prefusion F Protein Vaccine when Co-administered with Adjuvanted Seasonal Quadrivalent Influenza Vaccine in Older Adults: A Phase 3 Randomized Trial. Clin Infect Dis 2024:ciae365. [PMID: 39099085 DOI: 10.1093/cid/ciae365] [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: 03/12/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND We evaluated co-administration of adjuvanted seasonal quadrivalent influenza vaccine (FLU-aQIV) and respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVPreF3 OA) in ≥65-year-olds. METHODS This phase 3, open-label trial randomized ≥65-year-olds to receive FLU-aQIV and RSVPreF3 OA concomitantly (Co-Ad) or sequentially, 1 month apart (Control). Primary objectives were to demonstrate the non-inferiority of FLU-aQIV and RSVPreF3 OA co-administration versus sequential administration in terms of hemagglutination inhibition (HI) titers for each FLU-aQIV strain and RSV-A and RSV-B neutralization titers, 1 month post-vaccination. Reactogenicity and safety were also assessed. RESULTS Overall, 1045 participants were vaccinated (Co-Ad: 523; Control: 522). Non-inferiority of FLU-aQIV and RSVPreF3 OA co-administration versus sequential administration was demonstrated in terms of HI titers for the A/Victoria(H1N1), B/Victoria, and B/Yamagata influenza strains and RSV-A neutralization titers (upper limits [ULs] of 95% confidence intervals [CIs] for adjusted geometric mean titer [GMT] ratios [Control/Co-Ad] ≤1.50) but not for A/Darwin(H3N2) HI titers (95% CI UL = 1.53). The immune response to A/Darwin(H3N2) was further assessed post-hoc using a microneutralization assay; the post-vaccination adjusted GMT ratio (Control/Co-Ad) was 1.23 (95% CI: 1.06-1.42, ie, UL ≤1.50), suggesting an adequate immune response to A/Darwin(H3N2) following co-administration. RSV-B neutralization titers were comparable between groups (95% CI UL for adjusted GMT ratio ≤1.50). Solicited adverse events were mostly mild or moderate and transient; unsolicited and serious adverse event rates were balanced between groups. CONCLUSIONS Adjuvanted FLU-aQIV and RSVPreF3 OA had acceptable reactogenicity/safety profiles when co-administered in ≥65-year-olds, without clinically relevant interference with the immune responses to either vaccine. CLINICAL TRIALS REGISTRATION NCT05568797.
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Affiliation(s)
| | - Sam Davies
- South Gloucestershire Medical Research Unit, Bristol, United Kingdom
| | - Jorge Labrador
- Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - Paul Loubet
- Department of Infectious and Tropical Diseases, VBIC (Bacterial Virulence and Chronic Infection), INSERM, University of Montpellier, CHU Nimes, Nimes, France
| | | | - Helena Moza Moríñigo
- Departamento de Medicina Preventiva y Salud Pública, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jean-François Nicolas
- Department of Allergology of Clinical Immunology, Lyon Sud University Hospital, CIRI, INSERM U1111, University Lyon1, Pierre-Bénite, France
| | | | - Mika Rämet
- Finnish Vaccine Research Ltd. and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Maria Henar Rebollo-Rodrigo
- Servicio de Medicina Preventiva y Salud Pública, University Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Iván Sanz-Muñoz
- National Influenza Centre, Valladolid, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León, Soria, Spain
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Buynak R, Cannon K, DeAtkine D, Kirby J, Usdan L, Bhavsar A, Gérard C, Kuznetsova A, Jayadev A, Amare H, Valenciano S, Meyer N. Randomized, Open-Label Phase 3 Study Evaluating Immunogenicity, Safety, and Reactogenicity of RSVPreF3 OA Coadministered with FLU-QIV-HD in Adults Aged ≥ 65. Infect Dis Ther 2024; 13:1789-1805. [PMID: 38981954 PMCID: PMC11266338 DOI: 10.1007/s40121-024-00985-4] [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: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) and influenza pose major disease burdens in older adults due to an aging immune system and comorbidities; seasonal overlap exists between these infections. In 2023, the RSV prefusion protein F3 older adult (RSVPreF3 OA) vaccine was first approved in the USA as a single dose for prevention of lower respiratory tract disease due to RSV in adults aged ≥ 60 years. The vaccine has since been approved in the European Union and elsewhere. RSVPreF3 OA and FLU-QIV-HD could be coadministered if immunogenicity, safety, and reactogenicity are not affected. METHODS This open-label, randomized (1:1), controlled, phase 3 study in 1029 adults aged ≥ 65 years in the USA evaluated the immunogenicity (up to 1 month after last vaccine dose) and safety (up to 6 months after last vaccine dose) of RSVPreF3 OA coadministered with FLU-QIV-HD (co-ad group) versus FLU-QIV-HD alone followed by RSVPreF3 OA at a separate visit 1 month later (control group). Non-inferiority criterion was defined as an upper limit of the two-sided 95% confidence interval of the geometric mean titer (GMT) group ratio (control/co-ad) ≤ 1.5. Secondary endpoints included safety and reactogenicity. RESULTS Proportions of participants across age categories between groups and proportions of male (50.4%) and female (49.6%) participants were well balanced; most participants were white (68.7%). Group GMT ratios for RSV-A neutralizing titers, hemagglutination inhibition titers for four influenza vaccine strains, and RSV-B neutralizing titers were non-inferior in the co-ad group versus the control group. No clinically meaningful differences in local or systemic solicited and unsolicited adverse events (AEs), serious AEs, and potential immune-mediated diseases were identified. The most common solicited AEs in both groups were injection-site pain and myalgia. CONCLUSION In adults aged ≥ 65 years, coadministration of RSVPreF3 OA and FLU-QIV-HD was immunogenically non-inferior to the sequential administration of both vaccines 1 month apart, and had clinically acceptable safety and reactogenicity profile. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT05559476.
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Affiliation(s)
| | - Kevin Cannon
- Accellacare Clinical Research, Wilmington, NC, USA
| | | | - John Kirby
- Summit Medical Group, Jefferson City, TN, USA
| | - Lisa Usdan
- Clinical Neuroscience Solution Healthcare, Memphis, TN, USA
| | - Amit Bhavsar
- GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
| | | | | | | | - Hiwot Amare
- GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
| | | | - Nadia Meyer
- GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
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Chen KYA, van Ingen T, Smith BT, Fitzpatrick T, Whelan M, Parpia AS, Alessandrini J, Buchan SA. Neighborhood-Level Burden of Social Risk Factors on Respiratory Syncytial Virus Hospitalization in Ontario, Canada, 2016-2019. Open Forum Infect Dis 2024; 11:ofae384. [PMID: 39100531 PMCID: PMC11298255 DOI: 10.1093/ofid/ofae384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Background Beyond clinical risk factors, little is known about the impact of social determinants on respiratory syncytial virus (RSV) burden. Our study aimed to estimate RSV-related hospitalization rates across sociodemographic and housing characteristics. Methods We conducted a population-based study of all RSV-related hospitalizations in Ontario, Canada, between September 1, 2016, and August 31, 2019, using validated hospital discharge codes and census data. Crude and age-standardized annualized RSV incidence rates and rate ratios (RRs) were estimated for a range of individual-level demographics and neighborhood-level measures of marginalization and housing characteristics. Results Overall, the annual RSV-related hospitalization rate was 27 per 100 000, with the highest rates observed in children age <12 months (1049 per 100 000) and 12-23 months (294 per 100 000) and adults age ≥85 years (155 per 100 000). Higher RSV-related hospitalization rates were associated with increasing marginalization quintile (Q) of material resources (RR, 1.4; Q5: 33 per 100 000 vs Q1: 24 per 100 000) and household instability (RR, 1.5; Q5: 31 per 100 000 vs Q1: 22 per 100 000). Conclusions The burden of RSV-related hospitalization was greatest in young children and older adults, with variation by sociodemographic and housing factors. Understanding the role of these social factors is crucial for informing equitable preventive program delivery.
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Affiliation(s)
- Kitty Y A Chen
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Fitzpatrick
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Alyssa S Parpia
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sheshadri A, Evans SE. Respiratory Syncytial Virus Vaccination in the Adult Pulmonary Patient. Chest 2024:S0012-3692(24)00705-0. [PMID: 38885895 DOI: 10.1016/j.chest.2024.05.025] [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: 03/08/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
TOPIC IMPORTANCE Since its discovery in 1957, respiratory syncytial virus (RSV) has been widely recognized as a common and deadly pathogen. Although early studies focused on the impact of RSV on the health of children, more recent data show that RSV imposes a significant burden on individuals aged ≥ 70 years. RSV also substantially harms the health of individuals with cardiopulmonary diseases. REVIEW FINDINGS Early efforts to develop an RSV vaccine were hampered by toxicity due to antibody-enhanced viral pneumonia and a lack of efficacy in vaccines that targeted the postfusion configuration of the F fusion protein, which is crucial to the pathogenesis of RSV-mediated injury. A newer wave of vaccines has targeted a stabilized prefusion F protein, generating effective neutralizing antibodies and reducing the burden of mild and severe RSV lower respiratory tract injury. This review focuses on the burden of RSV in patients with pulmonary diseases, highlights the tumultuous path from the early days of RSV vaccine development to the modern era, and offers insights into key gaps in knowledge that must be addressed to adequately protect the vulnerable population of patients with severe pulmonary diseases. SUMMARY RSV vaccination with bivalent RSVPreF or RSVPreF3OA, which target the stabilized prefusion F protein, can be broadly recommended to adults with pulmonary diseases aged ≥ 60 years. However, more data are needed to understand how these vaccinations affect key clinical outcomes in individuals with pulmonary disease.
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Affiliation(s)
- Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Scott E Evans
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ison MG, Papi A, Athan E, Feldman RG, Langley JM, Lee DG, Leroux-Roels I, Martinon-Torres F, Schwarz TF, van Zyl-Smit RN, Verheust C, Dezutter N, Gruselle O, Fissette L, David MP, Kostanyan L, Hulstrøm V, Olivier A, Van der Wielen M, Descamps D. Efficacy and Safety of Respiratory Syncytial Virus (RSV) Prefusion F Protein Vaccine (RSVPreF3 OA) in Older Adults Over 2 RSV Seasons. Clin Infect Dis 2024; 78:1732-1744. [PMID: 38253338 PMCID: PMC11175669 DOI: 10.1093/cid/ciae010] [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: 10/06/2023] [Revised: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The adjuvanted RSV prefusion F protein-based vaccine (RSVPreF3 OA) was efficacious against RSV-related lower respiratory tract disease (RSV-LRTD) in ≥60-years-olds over 1 RSV season. We evaluated efficacy and safety of 1 RSVPreF3 OA dose and of 2 RSVPreF3 OA doses given 1 year apart against RSV-LRTD over 2 RSV seasons post-dose 1. METHODS In this phase 3, blinded trial, ≥60-year-olds were randomized (1:1) to receive RSVPreF3 OA or placebo pre-season 1. RSVPreF3 OA recipients were re-randomized (1:1) to receive a second RSVPreF3 OA dose (RSV_revaccination group) or placebo (RSV_1dose group) pre-season 2; participants who received placebo pre-season 1 received placebo pre-season 2 (placebo group). Efficacy of both vaccine regimens against RSV-LRTD was evaluated over 2 seasons combined (confirmatory secondary objective, success criterion: lower limits of 2-sided CIs around efficacy estimates >20%). RESULTS The efficacy analysis comprised 24 967 participants (RSV_1dose: 6227; RSV_revaccination: 6242; placebo: 12 498). Median efficacy follow-up was 17.8 months. Efficacy over 2 seasons of 1 RSVPreF3 OA dose was 67.2% (97.5% CI: 48.2-80.0%) against RSV-LRTD and 78.8% (95% CI: 52.6-92.0%) against severe RSV-LRTD. Efficacy over 2 seasons of a first dose followed by revaccination was 67.1% (97.5% CI: 48.1-80.0%) against RSV-LRTD and 78.8% (95% CI: 52.5-92.0%) against severe RSV-LRTD. Reactogenicity/safety of the revaccination dose were similar to dose 1. CONCLUSIONS One RSVPreF3 OA dose was efficacious against RSV-LRTD over 2 RSV seasons in ≥60-year-olds. Revaccination 1 year post-dose 1 was well tolerated but did not seem to provide additional efficacy benefit in the overall study population. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov: NCT04886596.
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Affiliation(s)
| | - Alberto Papi
- Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy
| | - Eugene Athan
- Barwon Health, University Hospital Geelong, Geelong, Australia
- Centre for Innovation in Infectious Diseases and Immunology Research, Deakin University, Geelong, Australia
| | | | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Isabel Leroux-Roels
- Center for Vaccinology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Tino F Schwarz
- Institute of Laboratory Medicine and Vaccination Center, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany
| | - Richard N van Zyl-Smit
- Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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9
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Hönemann M, Maier M, Frille A, Thiem S, Bergs S, Williams TC, Mas V, Lübbert C, Pietsch C. Respiratory Syncytial Virus in Adult Patients at a Tertiary Care Hospital in Germany: Clinical Features and Molecular Epidemiology of the Fusion Protein in the Severe Respiratory Season of 2022/2023. Viruses 2024; 16:943. [PMID: 38932235 PMCID: PMC11209376 DOI: 10.3390/v16060943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
Following an interseasonal rise in mainly pediatric respiratory syncytial virus (RSV) cases in Germany in 2021, an exceptionally high number of adult cases was observed in the subsequent respiratory season of 2022/2023. The aim of this study was to compare the clinical presentation of RSV infections in the pre- and post-SARS-CoV-2 pandemic periods. Additionally, the local epidemiology of the RSV fusion protein was analyzed at a molecular genetic and amino acid level. RSV detections in adults peaked in calendar week 1 of 2023, 8 weeks earlier than the earliest peak observed in the three pre-pandemic seasons. Although the median age of the adult patients was not different (66.5 vs. 65 years), subtle differences between both periods regarding comorbidities and the clinical presentation of RSV cases were noted. High rates of comorbidities prevailed; however, significantly lower numbers of patients with a history of lung transplantation (p = 0.009), chronic kidney disease (p = 0.013), and immunosuppression (p = 0.038) were observed in the 2022/2023 season. In contrast, significantly more lower respiratory tract infections (p < 0.001), in particular in the form of pneumonia (p = 0.015) and exacerbations of obstructive lung diseases (p = 0.008), were detected. An ICU admission was noted for 23.7% of all patients throughout the study period. Sequence analysis of the fusion protein gene revealed a close phylogenetic relatedness, regardless of the season of origin. However, especially for RSV-B, an accumulation of amino acid point substitutions was noted, including in antigenic site Ø. The SARS-CoV-2 pandemic had a tremendous impact on the seasonality of RSV, and the introduction of new vaccination and immunization strategies against RSV warrants further epidemiologic studies of this important pathogen.
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Affiliation(s)
- Mario Hönemann
- Virology Department, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Johannisalle 30, 04103 Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Melanie Maier
- Virology Department, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Johannisalle 30, 04103 Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Armin Frille
- Department of Respiratory Medicine, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Stephanie Thiem
- Virology Department, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Johannisalle 30, 04103 Leipzig, Germany
| | - Sandra Bergs
- Virology Department, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Johannisalle 30, 04103 Leipzig, Germany
| | - Thomas C. Williams
- Child Life and Health, University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Vicente Mas
- Centro Nacional de Microbiología and CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, C/ Sinesio Delgado, 4, 28029 Madrid, Spain
| | - Christoph Lübbert
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Corinna Pietsch
- Virology Department, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Johannisalle 30, 04103 Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
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10
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Lee YL, Hsieh SM, Lin YT, Shie SS, Yang CJ, Hsueh PR. Burden of respiratory syncytial virus in older adults in Taiwan: An expert perspective on knowledge gaps. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00101-4. [PMID: 38839543 DOI: 10.1016/j.jmii.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
The burden of respiratory syncytial virus (RSV) infection among older adults in Taiwan is not well understood due to a scarcity of published epidemiological data. Nonetheless, the increasing proportion of older adults is anticipated to translate to increased burden of RSV infection, presenting a challenge to the healthcare system. Thus, an expert meeting was convened among a panel of infectious disease specialists from Taiwan to evaluate the existing local evidence and data gaps related to RSV infection in older adults (aged ≥50 years), and propose steps to generating evidence on disease burden among this population. Overall, there are few studies on the clinical and economic burden of RSV infection in Taiwan, and existing data are limited by small sample sizes and highly selected populations. Inconsistent RSV testing practices among older adults contribute to under-diagnosis and under-reporting, driven by limitations to reimbursement policies that discourage proactive RSV testing in older adults, and the lack of appropriate, targeted RSV treatment. Crucially, the paucity of epidemiological data may perpetuate a lack of awareness of RSV among clinicians and the public, hinder investments into RSV testing at a policymaker level, and thereby impede implementation of consistent diagnostic practices, precluding a deeper understanding of RSV. To overcome these challenges, it is imperative to prioritize generation of epidemiological data to establish the burden of RSV infection among older adults in Taiwan. Such data would also support a multi-stakeholder group in assessing the impact of future RSV-related interventions, such as educational initiatives and preventative strategies including vaccines.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan; School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, Division of Infectious Diseases, National Taiwan University Hospital, Taipei City, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Internal Medicine, Chang-Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chia-Jui Yang
- Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, China Medical University, Taichung City, Taiwan.
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11
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Rademacher J, Therre M, Hinze CA, Buder F, Böhm M, Welte T. Association of respiratory infections and the impact of vaccinations on cardiovascular diseases. Eur J Prev Cardiol 2024; 31:877-888. [PMID: 38205961 DOI: 10.1093/eurjpc/zwae016] [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: 11/29/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
Influenza, pneumococcal, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus infections are important causes of high morbidity and mortality in the elderly. Beyond the burden of infectious diseases, they are also associated with several non-infectious complications like cardiovascular events. A growing body of evidence in prospective studies and meta-analyses has shown the impact of influenza and pneumococcal vaccines on types of cardiovascular outcomes in the general population. Influenza vaccination showed a potential benefit for primary and secondary prevention of cardiovascular diseases across all ages. A reduced risk of cardiovascular events for individuals aged 65 years and older was associated with pneumococcal vaccination. Despite scientific evidence on the effectiveness, safety, and benefits of the vaccines and recommendations to vaccinate elderly patients and those with risk factors, vaccination rates remain sub-optimal in this population. Doubts about vaccine necessity or efficacy and concerns about possible adverse events in patients and physicians refer to delayed acceptance. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years. The aim of this review paper is to summarize the effect of vaccination in the field of cardiovascular disease to achieve a higher vaccination rate in this patient population.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
| | - Markus Therre
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Christopher Alexander Hinze
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Felix Buder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
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12
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Howa A, Zhu Y, Wyatt D, Markus T, Chappell J, Halasa N, Trabue C, Schaffner W, Grijalva C, Talbot H. Estimating the Undetected Burden of Respiratory Syncytial Virus Hospitalizations in Adults Through Capture-Recapture Methods. Influenza Other Respir Viruses 2024; 18:e13299. [PMID: 38700006 PMCID: PMC11066857 DOI: 10.1111/irv.13299] [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: 02/19/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Traditional surveillance systems may underestimate the burden caused by respiratory syncytial virus (RSV). Capture-recapture methods provide alternatives for estimating the number of RSV-related hospitalizations in a population. METHODS Capture-recapture methods were used to estimate the number of RSV-related hospitalizations in adults in Middle Tennessee from two independent hospitalization surveillance systems during consecutive respiratory seasons from 2016-2017 to 2019-2020. Data from the Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) and the Emerging Infections Program (EIP) were used. Annual RSV hospitalization rates were calculated using the capture-recapture estimates weighted by hospitals' market share divided by the corresponding census population. RESULTS Using capture-recapture methods, the estimated overall adult hospitalization rates varied from 8.3 (95% CI: 5.9-15.4) RSV-related hospitalizations per 10,000 persons during the 2016-2017 season to 28.4 (95% CI: 18.2-59.0) hospitalizations per 10,000 persons in the 2019-2020 season. The proportion of hospitalizations that HAIVEN determined ranged from 8.7% to 36.7% of the total capture-recapture estimated hospitalization, whereas EIP detected 23.5% to 52.7% of the total capture-recapture estimated hospitalizations. CONCLUSION Capture-recapture estimates showed that individual traditional surveillance systems underestimated the hospitalization burden in adults. Using capture-recapture allows for a more comprehensive estimate of RSV hospitalizations.
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Affiliation(s)
- Amanda C. Howa
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Yuwei Zhu
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Dayna Wyatt
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Tiffanie Markus
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James D. Chappell
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Natasha Halasa
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christopher H. Trabue
- Department of MedicineUniversity of Tennessee College of MedicineNashvilleTennesseeUSA
| | - William Schaffner
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Carlos G. Grijalva
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - H. Keipp Talbot
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
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Thomas CM, Raman R, Schaffner W, Markus TM, Ndi D, Fill MMA, Dunn JR, Talbot HK. Respiratory Syncytial Virus Hospitalizations Associated With Social Vulnerability by Census Tract: An Opportunity for Intervention? Open Forum Infect Dis 2024; 11:ofae184. [PMID: 38680605 PMCID: PMC11055400 DOI: 10.1093/ofid/ofae184] [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: 01/10/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause hospitalization in young children and older adults. With vaccines and monoclonal antibody prophylaxis increasingly available, identifying social factors associated with severe illnesses can guide mitigation efforts. Methods Using data collected by the RSV Hospitalization Surveillance Network from 2016 to 2023, we identified RSV hospitalizations in Tennessee. We linked hospitalization information (eg, patient demographic characteristics and outcome) with population-level variables (eg, social vulnerability and health care insurance coverage) from publicly available data sets using census tract of residence. Hospitalization incidence was calculated and stratified by period (2016-2020 and 2020-2023). We modeled social vulnerability effect on hospitalization incidence using Poisson regression. Results Among 2687 RSV hospitalizations, there were 677 (25.2%) intensive care unit admissions and 38 (1.4%) deaths. The highest RSV hospitalization incidences occurred among children aged <5 years and adults aged ≥65 years: 272.8 per 100 000 person-years (95% CI, 258.6-287.0) and 60.6 (95% CI, 56.0-65.2), respectively. Having public health insurance was associated with higher hospitalization incidence as compared with not having public insurance: 60.5 per 100 000 person-years (95% CI, 57.6-63.4) vs 14.3 (95% CI, 13.4-15.2). Higher hospitalization incidence was associated with residing in a census tract in the most socially vulnerable quartile vs the least vulnerable quartile after adjusting for age, sex, and period (incidence rate ratio, 1.4; 95% CI, 1.3-1.6). Conclusions RSV hospitalization was associated with living in more socially vulnerable census tracts. Population measures of social vulnerability might help guide mitigation strategies, including vaccine and monoclonal antibody promotion and provision to reduce RSV hospitalization.
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Affiliation(s)
- Christine M Thomas
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Rameela Raman
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tiffanie M Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle Ndi
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary-Margaret A Fill
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, Tennessee, USA
| | - John R Dunn
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, Tennessee, USA
| | - H Keipp Talbot
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Rios-Guzman E, Simons LM, Dean TJ, Agnes F, Pawlowski A, Alisoltanidehkordi A, Nam HH, Ison MG, Ozer EA, Lorenzo-Redondo R, Hultquist JF. Deviations in RSV epidemiological patterns and population structures in the United States following the COVID-19 pandemic. Nat Commun 2024; 15:3374. [PMID: 38643200 PMCID: PMC11032338 DOI: 10.1038/s41467-024-47757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
Respiratory Syncytial Virus (RSV) is a leading cause of acute respiratory tract infection, with the greatest impact on infants, immunocompromised individuals, and older adults. RSV prevalence decreased substantially in the United States (US) following the implementation of COVID-19-related non-pharmaceutical interventions but later rebounded with abnormal seasonality. The biological and epidemiological factors underlying this altered behavior remain poorly defined. In this retrospective cohort study from 2009 to 2023 in Chicago, Illinois, US, we examined RSV epidemiology, clinical severity, and genetic diversity. We found that changes in RSV diagnostic platforms drove increased detections in outpatient settings post-2020 and that hospitalized adults infected with RSV-A were at higher risk of intensive care admission than those with RSV-B. While population structures of RSV-A remained unchanged, RSV-B exhibited a genetic shift into geographically distinct clusters. Mutations in the antigenic regions of the fusion protein suggest convergent evolution with potential implications for vaccine and therapeutic development.
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Affiliation(s)
- Estefany Rios-Guzman
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Lacy M Simons
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Taylor J Dean
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Francesca Agnes
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Anna Pawlowski
- Northwestern Medicine Enterprise Data Warehouse, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Arghavan Alisoltanidehkordi
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Hannah H Nam
- Department of Infectious Diseases, University of California - Irvine, Orange, CA, 92868, USA
| | - Michael G Ison
- Division of Microbiology and Infectious Diseases (DMID), National Institute of Health, Rockville, MD, 20852, USA
| | - Egon A Ozer
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Ramon Lorenzo-Redondo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Judd F Hultquist
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA.
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15
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Malik A, Szpunar S, Sharma M, Johnson LB, Saravolatz L, Bhargava A. Predictors of prolonged length of stay in adult patients with respiratory syncytial virus infections - a multi-center historical cohort study. Front Microbiol 2024; 15:1385439. [PMID: 38638901 PMCID: PMC11024437 DOI: 10.3389/fmicb.2024.1385439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Objectives Several studies have reported risk factors for severe disease and mortality in hospitalized adults with RSV infections. There is limited information available regarding the factors that affect the duration of a patient's hospital length of stay (LOS). Methods This was a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using the International Classification of Diseases, Tenth Revision 10 codes for RSV infection. Mean LOS was computed; prolonged LOS was defined as greater than the mean. Results We included 360 patients with a mean age (SD) of 69.9 ± 14.7 years, 63.6% (229) were female and 63.3% (228) of white race. The mean hospital LOS was 7.1 ± 5.4 days. Factors associated with prolonged LOS in univariable analysis were old age, body mass index (BMI), smoking status, Charlson Weighted Index of Comorbidity (CWIC), home oxygen, abnormal chest x-ray (CXR), presence of sepsis, use of oxygen, and antibiotics at the time of presentation. Predictors for prolonged LOS on admission in multivariable analysis were age on admission (p < 0.001), smoking status (p = 0.001), CWIC (p = 0.038) and abnormal CXR (p = 0.043). Interpretation Our study found that age on admission, smoking history, higher CWIC and abnormal CXR on admission were significantly associated with prolonged LOS among adult patients hospitalized with RSV infection. These findings highlight the significance of promptly recognizing and implementing early interventions to mitigate the duration of hospitalization for adult patients suffering from RSV infection.
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Affiliation(s)
- Ambreen Malik
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, United States
| | - Mamta Sharma
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Leonard B. Johnson
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
- Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital, Detroit, MI, United States
| | - Louis Saravolatz
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
- Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital, Detroit, MI, United States
| | - Ashish Bhargava
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
- Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital, Detroit, MI, United States
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16
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Molnar D, La EM, Verelst F, Poston S, Graham J, Van Bellinghen LA, Curran D. Public Health Impact of the Adjuvanted RSVPreF3 Vaccine for Respiratory Syncytial Virus Prevention Among Older Adults in the United States. Infect Dis Ther 2024; 13:827-844. [PMID: 38507143 PMCID: PMC11058166 DOI: 10.1007/s40121-024-00939-w] [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: 12/12/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract disease in older adults, resulting in substantial morbidity and mortality. METHODS This study estimates the public health impact of vaccination with the adjuvanted RSVPreF3 vaccine among adults aged ≥ 60 years in the United States (US). A static, multi-cohort Markov model was used to estimate RSV-related outcomes over a 3-year time horizon for scenarios with and without one-time RSV vaccination. The base-case analysis assumed the same vaccination coverage as for influenza vaccines, with key epidemiology and vaccine inputs obtained from the published literature and phase 3 clinical trial results for the adjuvanted RSVPreF3 vaccine. Model outcomes included the clinical burden of RSV (symptomatic RSV acute respiratory illness [RSV-ARI] cases [classified as upper or lower respiratory tract disease], pneumonia complications, and mortality) and RSV-related healthcare resource use (hospitalizations, emergency department visits, outpatient visits, and antibiotic prescriptions). RESULTS In the base-case analysis, approximately 56.7 million adults aged ≥ 60 years received the vaccine, resulting in 2,954,465 fewer symptomatic RSV-ARI cases over 3 years compared with no vaccination, including 321,019 fewer X-ray confirmed pneumonia cases and 16,660 fewer RSV-related deaths. Vaccination also prevented a substantial number of RSV-related hospitalizations (203,891), emergency department visits (164,060), outpatient visits (1,577,586), and antibiotic prescriptions (1,343,915) over the 3-year period. A considerable public health impact was observed across a range of sensitivity analyses. CONCLUSIONS These findings highlight the potential of the adjuvanted RSVPreF3 vaccine to substantially reduce RSV disease burden among US older adults aged ≥ 60 years.
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Loubet P, Fernandes J, de Pouvourville G, Sosnowiez K, Elong A, Guilmet C, Omichessan H, Bureau I, Fagnani F, Emery C, Abou Chakra CN. Respiratory syncytial virus-related hospital stays in adults in France from 2012 to 2021: A national hospital database study. J Clin Virol 2024; 171:105635. [PMID: 38215557 DOI: 10.1016/j.jcv.2023.105635] [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: 10/29/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes lower respiratory tract infections (LRTI) that may lead to hospitalization or death. The present study aimed to assess the burden of RSV infections in hospitalized adults. METHODS RSV-related hospitalizations were identified from the nationwide hospital claims database in France (PMSI) from 2012 to 2021 using ICD-10 codes J12.1, J20.5, J21.0 or B97.4, and outcomes assessment focused on 2016-2020. In-hospital outcomes included length of stay, need for intensive care (ICU) and in-hospital all-cause mortality. Post-discharge outcomes included 30-day readmission for decompensation, 90-day RSV-related readmission, and 30 and 60-day in-hospital mortality. RESULTS A cumulated number of 17 483 RSV-related stays were identified representing a rate of 72.0 cases per million stays. The outcomes assessment included 12,987 patients: 55.8 % were females and the mean age was 74.1 ± 16.4 years, with 57 % ≥ 75 years. Most of patients (78.6 %) had at least one comorbidity, mainly chronic respiratory (56.3 %) and cardiovascular diseases (41.3 %), or diabetes (23.5 %). A co-infection was found in 22.4 %, primarily bacterial (12 %). The mean length of stay was 12.3 ± 13.1 days. Overall, 10.9 % were admitted to an ICU and in-hospital mortality was 7.3 %. In-hospital outcomes were higher in cases of co-infection. Among 12 033 patients alive at discharge from the index stay, 6.5 % were readmitted with RSV within 90 days, 8.1 % for decompensation within 30 days, and 5.6 % died within 60-day. CONCLUSION This study demonstrated the high burden of RSV infections in older adults and those with chronic conditions, and the need for preventive strategies.
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Affiliation(s)
- Paul Loubet
- Service des Maladies Infectieuses et Tropicales, CHU Nîmes Carémeau, Université de Montpellier, Nîmes, France.
| | | | | | - Katia Sosnowiez
- Department of Medical Affairs, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Anne Elong
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Caroline Guilmet
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Hanane Omichessan
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
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18
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Boattini M, Almeida A, Comini S, Bianco G, Cavallo R, Costa C. From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults. Viruses 2024; 16:531. [PMID: 38675874 PMCID: PMC11053843 DOI: 10.3390/v16040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory syncytial virus (RSV) is increasingly recognized as being implicated in acute illness in older adults, with a significant weight in hospitalizations for respiratory illness and death. By means of a best-evidence review, this paper aims to investigate whether RSV can be considered a forgotten pathogen in older patients, looking at trends in the literature volume and exploring possible epidemiological and clinical features underlying the focus given to it. We then present an assessment of its disease burden and present and future strategies for its reduction, particularly in light of the recent availability of new vaccines.
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Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - André Almeida
- Department of Internal Medicine 4, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-024 Lisbon, Portugal;
- NOVA Medical School, Universidade Nova de Lisboa, Centro Clínico Académico de Lisboa, 1169-056 Lisbon, Portugal
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, 60035 Jesi, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Department of Experimental Medicine, University of Salento, Via Provinciale Monteroni n. 165, 73100 Lecce, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
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19
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Correa RA, Arancibia F, De Ávila Kfouri R, Chebabo A, García G, Gutiérrez Robledo LM, Lopardo G, Nemerovsky J, Pérez CM, Rendon A, Ruiz-Palacios GM, Aggarwal B, Berzanskis A, Cintra O. Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps. Pulm Ther 2024; 10:1-20. [PMID: 38358618 PMCID: PMC10881952 DOI: 10.1007/s41030-024-00253-3] [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: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.
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Affiliation(s)
- Ricardo Amorim Correa
- Medical School, Pulmonology and Thoracic Surgery Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Arancibia
- Pulmonary Department, Instituto Nacional del Tórax and Clínica Santa María, Santiago de Chile, Chile
| | - Renato De Ávila Kfouri
- Pediatric Infectious Disease Specialist, Brazilian Pediatric Society and Brazilian Immunization, São Paulo, Brazil
| | - Alberto Chebabo
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luis Miguel Gutiérrez Robledo
- National Institute of Medical Sciences and Nutrition "S Zubiran" and National Institute of Geriatric Medicine, Mexico City, Mexico
| | - Gustavo Lopardo
- Infectious Diseases Department, Hospital Bernardo Houssay, Buenos Aires, Argentina
| | - Julio Nemerovsky
- Geriatrician Physician, Argentine Society of Gerontology and Geriatrics, Buenos Aires, Argentina
| | - Carlos M Pérez
- Faculty of Medicine and Science, Universidad San Sebastian, Santiago, Chile
| | - Adrian Rendon
- Universidad Autonoma de Nuevo León, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Monterrey, Mexico
| | - Guillermo M Ruiz-Palacios
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
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20
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Redondo E, Rivero-Calle I, Mascarós E, Ocaña D, Jimeno I, Gil Á, Linares M, Onieva-García MÁ, González-Romo F, Yuste J, Martinón-Torres F. Respiratory Syncytial Virus Vaccination Recommendations for Adults Aged 60 Years and Older: The NeumoExperts Prevention Group Position Paper. Arch Bronconeumol 2024; 60:161-170. [PMID: 38311509 DOI: 10.1016/j.arbres.2024.01.004] [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: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.
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Affiliation(s)
- Esther Redondo
- Infectious, Migrant, Vaccines and Preventive Activities Group of SEMERGEN, International Healthcare Centre of the City Council of Madrid, Madrid, Spain
| | - Irene Rivero-Calle
- Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Mascarós
- Health Department, Hospital la Fe, Primary Care Centre Arquitecto Tolsá, Valencia, Spain
| | - Daniel Ocaña
- Primary Care, Health Care Centre Algeciras, Algeciras, Spain
| | - Isabel Jimeno
- Primary Care Health Centre Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain
| | - Ángel Gil
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Manuel Linares
- Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación io, Madrid, Spain
| | - María Ángeles Onieva-García
- Preventive Medicine and Public Health Unit, Hospital Universitario Reina Sofía, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
| | - Fernando González-Romo
- Clinical Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - José Yuste
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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21
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Law J, Sorrento C, Saxena A. Vaccination updates and special considerations for systemic lupus erythematosus patients. Curr Opin Rheumatol 2024; 36:148-153. [PMID: 37976046 DOI: 10.1097/bor.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW We review the latest guidelines and note special considerations for systemic lupus erythematosus (SLE) patients when approaching vaccination against SARS-CoV-2, influenza, pneumococcus, herpes zoster, and potentially respiratory syncytial virus (RSV) vaccine in the future. RECENT FINDINGS SLE patients have unique infectious risks due to newer treatments and the nature of the disease itself. It is important to balance the benefit of additional protective immunity from updated vaccines against the possible risk of disease activity exacerbations. SUMMARY It is important to continuously evaluate the safety and immunogenicity of updated vaccines specifically for SLE patients. Additionally, the newly approved RSV vaccine should be considered for this population to reduce severe respiratory illness.
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Affiliation(s)
- Jammie Law
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
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22
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Feldman RG, Antonelli-Incalzi R, Steenackers K, Lee DG, Papi A, Ison MG, Fissette L, David MP, Maréchal C, Van der Wielen M, Kostanyan L, Hulstrøm V. Respiratory Syncytial Virus Prefusion F Protein Vaccine Is Efficacious in Older Adults With Underlying Medical Conditions. Clin Infect Dis 2024; 78:202-209. [PMID: 37698366 PMCID: PMC10810713 DOI: 10.1093/cid/ciad471] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Older adults with chronic cardiorespiratory or endocrine/metabolic conditions are at increased risk of respiratory syncytial virus (RSV)-related acute respiratory illness (RSV-ARI) and severe respiratory disease. In an ongoing, randomized, placebo-controlled, multicountry, phase 3 trial in ≥60-year-old participants, an AS01E-adjuvanted RSV prefusion F protein-based vaccine (RSVPreF3 OA) was efficacious against RSV-related lower respiratory tract disease (RSV-LRTD), severe RSV-LRTD, and RSV-ARI. We evaluated efficacy and immunogenicity among participants with coexisting cardiorespiratory or endocrine/metabolic conditions that increase the risk of severe RSV disease ("conditions of interest"). METHODS Medically stable ≥60-year-old participants received 1 dose of RSVPreF3 OA or placebo. Efficacy against first RSV-LRTD and RSV-ARI episodes was assessed in subgroups with/without coexisting cardiorespiratory or endocrine/metabolic conditions of interest. Immunogenicity was analyzed post hoc in these subgroups. RESULTS In total, 12 467 participants received RSVPreF3 OA and 12 499 received placebo. Of these, 39.6% (RSVPreF3 OA) and 38.9% (placebo) had ≥1 coexisting condition of interest. The median efficacy follow-up was 6.7 months. Efficacy against RSV-LRTD was high in participants with ≥1 condition of interest (94.6%), ≥1 cardiorespiratory (92.1%), ≥1 endocrine/metabolic (100%), and ≥2 conditions of interest (92.0%). Efficacy against RSV-ARI was 81.0% in participants with ≥1 condition of interest (88.1% for cardiorespiratory, 79.4% for endocrine/metabolic conditions) and 88.0% in participants with ≥2 conditions of interest. Postvaccination neutralizing titers were at least as high in participants with ≥1 condition of interest as in those without. CONCLUSIONS RSVPreF3 OA was efficacious against RSV-LRTD and RSV-ARI in older adults with coexisting medical conditions associated with an increased risk of severe RSV disease. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov: NCT04886596.
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Affiliation(s)
| | | | - Katie Steenackers
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Alberto Papi
- Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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23
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Schaerlaekens S, Jacobs L, Stobbelaar K, Cos P, Delputte P. All Eyes on the Prefusion-Stabilized F Construct, but Are We Missing the Potential of Alternative Targets for Respiratory Syncytial Virus Vaccine Design? Vaccines (Basel) 2024; 12:97. [PMID: 38250910 PMCID: PMC10819635 DOI: 10.3390/vaccines12010097] [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: 12/12/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Respiratory Syncytial Virus (RSV) poses a significant global health concern as a major cause of lower respiratory tract infections (LRTIs). Over the last few years, substantial efforts have been directed towards developing vaccines and therapeutics to combat RSV, leading to a diverse landscape of vaccine candidates. Notably, two vaccines targeting the elderly and the first maternal vaccine have recently been approved. The majority of the vaccines and vaccine candidates rely solely on a prefusion-stabilized conformation known for its highly neutralizing epitopes. Although, so far, this antigen design appears to be successful for the elderly, our current understanding remains incomplete, requiring further improvement and refinement in this field. Pediatric vaccines still have a long journey ahead, and we must ensure that vaccines currently entering the market do not lose efficacy due to the emergence of mutations in RSV's circulating strains. This review will provide an overview of the current status of vaccine designs and what to focus on in the future. Further research into antigen design is essential, including the exploration of the potential of alternative RSV proteins to address these challenges and pave the way for the development of novel and effective vaccines, especially in the pediatric population.
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Affiliation(s)
- Sofie Schaerlaekens
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
| | - Lotte Jacobs
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
| | - Kim Stobbelaar
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
- Pediatrics Department, Antwerp University Hospital (UZA), Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
- Infla-Med Centre of Excellence, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
- Infla-Med Centre of Excellence, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium
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24
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Kwetkat A, Leischker A, Endres AS, Heppner HJ. [After the COVID-19 pandemic-Which new vaccinations for adults are available or coming soon?]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:79-85. [PMID: 38108878 DOI: 10.1007/s00108-023-01640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
The accumulation of respiratory infections in the winter months repeatedly highlights the relevance of prevention through vaccination, even beyond a pandemic. Current developments in this field are therefore highly relevant, particularly for older people who are more susceptible to infections due to immune senescence and comorbidities. The Standing Committee on Vaccination (STIKO) has responded accordingly by recommending the 20-valent pneumococcal conjugate vaccine PCV20 for standard and indication vaccination of adults. Furthermore, new vaccines against respiratory syncytial virus (RSV) infections are available for which the STIKO has not yet issued a recommendation. The development of other more effective and more immunogenic vac2cines is being driven in particular by new technologies, such as mRNA or vector vaccines. Various higher valent pneumococcal vaccine candidates and, for example, universal influenza vaccines are also already in development.
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Affiliation(s)
- A Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück GmbH, Am Finkenhügel 1, 49076, Osnabrück, Deutschland.
- Universität Osnabrück, Osnabrück, Deutschland.
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland.
| | - A Leischker
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland
- Asklepios Klinik Wandsbek, Hamburg, Deutschland
| | - A-S Endres
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin, Berlin, Deutschland
| | - H J Heppner
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth, Bayreuth, Deutschland
- Medizincampus Oberfranken, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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25
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Houle SKD, Andrew MK. RSV vaccination in older adults: Addressing vaccine hesitancy using the 3C model. Can Pharm J (Ott) 2024; 157:39-44. [PMID: 38125630 PMCID: PMC10729719 DOI: 10.1177/17151635231210879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/23/2023] [Indexed: 12/23/2023]
Abstract
The first vaccine against respiratory syncytial virus (RSV) targeting older adults was approved for use in Canada in August 2023. As a frequent first point of contact for Canadians seeking advice on vaccination and the most common setting for the administration of influenza vaccines, community pharmacies will also play a role in RSV vaccination efforts. To address vaccine hesitancy confidently and effectively, pharmacists must be equipped with knowledge of the factors that affect a person's decision on whether to be vaccinated or not. The 3C Model of Vaccine Hesitancy summarizes these as complacency, confidence and convenience. This article introduces the model and describes the often-underrecognized relevance of RSV to older adults, including risk factors and burden of disease. It also reviews the history and status of vaccine development and approval and presents clinical trial data to equip pharmacists to discuss RSV vaccination with older adults who express vaccine hesitancy.
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Affiliation(s)
| | - Melissa K. Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
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26
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Boon H, Meinders A, van Hannen EJ, Tersmette M, Schaftenaar E. Comparative analysis of mortality in patients admitted with an infection with influenza A/B virus, respiratory syncytial virus, rhinovirus, metapneumovirus or SARS-CoV-2. Influenza Other Respir Viruses 2024; 18:e13237. [PMID: 38249443 PMCID: PMC10796251 DOI: 10.1111/irv.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024] Open
Abstract
Background While influenza virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are recognised as a cause of severe illness and mortality, clinical interest for respiratory syncytial virus (RSV), rhinovirus and human metapneumovirus (hMPV) infections is still limited. Methods We conducted a retrospective database study comparing baseline characteristics and 30-day mortality in a large cohort of adult patients admitted for an overnight stay or longer with an influenza virus (A/B), rhinovirus, hMPV, RSV or SARS-CoV-2 infection. For non-SARS-CoV-2 viruses, data were included for the period July 2017-February 2020. For SARS-CoV-2, data between March 2020 and March 2022 were included. Results Covariate-adjusted 30-day mortality following RSV, hMPV or rhinovirus infections was substantial (crude mortality 8-10%) and comparable with mortality following hospitalisation with an influenza A virus infection. Mortality following a SARS-CoV-2 infection was consistently higher than for any other respiratory virus, at any point in time (crude mortality 14-25%). Odds of mortality for SARS-CoV-2 compared with influenza A declined from 4.9 to 1.7 over the course of the pandemic. Patients with SARS-CoV-2 infection had less comorbidity than patients with other respiratory virus infections and were more often male. In this cohort, age was related to mortality following hospitalisation, while an association with comorbidity was not apparent. Conclusions With the exception of SARS-CoV-2 infections, we find the clinical outcome of common respiratory virus infections requiring hospitalisation more similar than often assumed. The observed mortality from SARS-CoV-2 was significantly higher, but the difference with other respiratory viruses became less distinct over time.
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Affiliation(s)
- Hanneke Boon
- Department of Medical Microbiology and ImmunologySt. Antonius Hospitalthe Netherlands
| | - Arend‐Jan Meinders
- Department of Internal MedicineSt. Antonius Hospitalthe Netherlands
- Intensive Care UnitSt. Antonius Hospitalthe Netherlands
| | - Erik Jan van Hannen
- Department of Medical Microbiology and ImmunologySt. Antonius Hospitalthe Netherlands
| | - Matthijs Tersmette
- Department of Medical Microbiology and ImmunologySt. Antonius Hospitalthe Netherlands
| | - Erik Schaftenaar
- Department of Medical Microbiology and ImmunologySt. Antonius Hospitalthe Netherlands
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27
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Hultquist J, Rios-Guzman E, Simons L, Dean T, Agnes F, Pawlowski A, Alisoltanidehkordi A, Nam H, Ison M, Ozer E, Lorenzo-Redondo R. Altered RSV Epidemiology and Genetic Diversity Following the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3712859. [PMID: 38168164 PMCID: PMC10760306 DOI: 10.21203/rs.3.rs-3712859/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Respiratory Syncytial Virus (RSV) is a leading cause of acute respiratory tract infection, with greatest impact on infants, immunocompromised individuals, and older adults. RSV prevalence decreased substantially following the implementation of non-pharmaceutical interventions to mitigate the COVID-19 pandemic but later rebounded with initially abnormal seasonality. The biological and epidemiological factors underlying this altered behavior remain poorly defined. In this retrospective cohort study, we examined RSV epidemiology, clinical severity, and genetic diversity in the years surrounding the COVID-19 pandemic. We found that changes in RSV diagnostic platforms drove increased detections in outpatient settings after 2020 and that hospitalized adults with RSV-A were at higher risk of needing intensive care than those with RSV-B. While the population structure of RSV-A remained unchanged, the population structure of RSV-B shifted in geographically distinct clusters. Mutations in the antigenic regions of the fusion protein suggest convergent evolution with potential implications for vaccine and therapeutic development.
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28
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Wilson E, Goswami J, Baqui AH, Doreski PA, Perez-Marc G, Zaman K, Monroy J, Duncan CJA, Ujiie M, Rämet M, Pérez-Breva L, Falsey AR, Walsh EE, Dhar R, Wilson L, Du J, Ghaswalla P, Kapoor A, Lan L, Mehta S, Mithani R, Panozzo CA, Simorellis AK, Kuter BJ, Schödel F, Huang W, Reuter C, Slobod K, Stoszek SK, Shaw CA, Miller JM, Das R, Chen GL. Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults. N Engl J Med 2023; 389:2233-2244. [PMID: 38091530 DOI: 10.1056/nejmoa2307079] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) can cause substantial morbidity and mortality among older adults. An mRNA-based RSV vaccine, mRNA-1345, encoding the stabilized RSV prefusion F glycoprotein, is under clinical investigation. METHODS In this ongoing, randomized, double-blind, placebo-controlled, phase 2-3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive one dose of mRNA-1345 (50 μg) or placebo. The two primary efficacy end points were the prevention of RSV-associated lower respiratory tract disease with at least two signs or symptoms and with at least three signs or symptoms. A key secondary efficacy end point was the prevention of RSV-associated acute respiratory disease. Safety was also assessed. RESULTS Overall, 35,541 participants were assigned to receive the mRNA-1345 vaccine (17,793 participants) or placebo (17,748). The median follow-up was 112 days (range, 1 to 379). The primary analyses were conducted when at least 50% of the anticipated cases of RSV-associated lower respiratory tract disease had occurred. Vaccine efficacy was 83.7% (95.88% confidence interval [CI], 66.0 to 92.2) against RSV-associated lower respiratory tract disease with at least two signs or symptoms and 82.4% (96.36% CI, 34.8 to 95.3) against the disease with at least three signs or symptoms. Vaccine efficacy was 68.4% (95% CI, 50.9 to 79.7) against RSV-associated acute respiratory disease. Protection was observed against both RSV subtypes (A and B) and was generally consistent across subgroups defined according to age and coexisting conditions. Participants in the mRNA-1345 group had a higher incidence than those in the placebo group of solicited local adverse reactions (58.7% vs. 16.2%) and of systemic adverse reactions (47.7% vs. 32.9%); most reactions were mild to moderate in severity and were transient. Serious adverse events occurred in 2.8% of the participants in each trial group. CONCLUSIONS A single dose of the mRNA-1345 vaccine resulted in no evident safety concerns and led to a lower incidence of RSV-associated lower respiratory tract disease and of RSV-associated acute respiratory disease than placebo among adults 60 years of age or older. (Funded by Moderna; ConquerRSV ClinicalTrials.gov number, NCT05127434.).
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Affiliation(s)
- Eleanor Wilson
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jaya Goswami
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Abdullah H Baqui
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Pablo A Doreski
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Gonzalo Perez-Marc
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Khalequ Zaman
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jorge Monroy
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Christopher J A Duncan
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Mugen Ujiie
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Mika Rämet
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Lina Pérez-Breva
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Ann R Falsey
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Edward E Walsh
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Rakesh Dhar
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Lauren Wilson
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jiejun Du
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Parinaz Ghaswalla
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Archana Kapoor
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Lan Lan
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Shraddha Mehta
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Runa Mithani
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Catherine A Panozzo
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Alana K Simorellis
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Barbara J Kuter
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Florian Schödel
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Wenmei Huang
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Caroline Reuter
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Karen Slobod
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Sonia K Stoszek
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Christine A Shaw
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jacqueline M Miller
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Rituparna Das
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Grace L Chen
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
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29
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Quarg C, Jörres RA, Engelhardt S, Alter P, Budweiser S. Characteristics and outcomes of patients hospitalized for infection with influenza, SARS-CoV-2 or respiratory syncytial virus in the season 2022/2023 in a large German primary care centre. Eur J Med Res 2023; 28:568. [PMID: 38053110 DOI: 10.1186/s40001-023-01482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND In 2022/2023, Influenza A and Respiratory Syncytial Virus (RSV) reappeared in hospitalized patients, which was in parallel to ongoing SARS-CoV-2 infections. The aim of our study was to compare the characteristics and outcomes of these infections during the same time. METHODS We included patients of all ages with a positive polymerase chain reaction (PCR) test for Influenza A/B, RSV, or SARS-CoV-2 virus hospitalized in the neurological, internal or paediatric units of the RoMed Hospital Rosenheim, Germany, between October 1st 2022 and February 28th 2023. RESULTS A total of 906 patients were included (45.6% female; median age 68.0 years; 21.9% Influenza A, 48.2% SARS-CoV-2, 28.3% RSV). Influenza B (0.2%) and co-infections (1.5%) played a minor role. In patients aged ≥ 18 years (n = 637, 71%), Influenza A, SARS-CoV-2 and RSV groups differed in age (median 72, 79, 76 years, respectively; p < 0.001). Comorbidities, particularly asthma and COPD, were most prevalent for RSV. 103 patients were admitted to the intensive care unit (ICU) (16.3% Influenza A, 15.3% SARS-CoV-2, 19.2% RSV; p = 0.649), 56 died (6.8% Influenza A, 9% SARS-CoV-2, 11.1% RSV; p = 0.496). RSV showed the highest frequencies of low-flow oxygen supplementation for admission and stay. Differences in the length of stay were minor (median 7 days). Conversely, in patients aged < 18 years (n = 261, 28,8%), 19.5%, 17.6% and 60.2% were in the Influenza A, SARS-CoV-2 and RSV groups, respectively; 0.4% showed Influenza B and 2.3% co-infections. 17 patients were admitted to ICU (3.9% Influenza A, 9.6% RSV, 0% SARS-CoV-2); none died. RSV showed the highest frequencies of high- and low-flow oxygen supplementation, SARS-CoV-2 the lowest. CONCLUSION When comparing infections with Influenza, SARS-CoV-2 and RSV in the winter 2022/2023 in hospitalized adult patients, rates of ICU admission and mortality were similar. RSV showed the highest frequencies of obstructive airway diseases, and of oxygen supplementation. The latter was also true in children/adolescents, in whom RSV dominated. Thus, in the situation of declining importance of SARS-CoV-2, RSV showed a disease burden that was relatively higher than that from Influenza and SARS-CoV-2 across ages, and this might be relevant for the seasons coming.
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Affiliation(s)
- C Quarg
- Department of Internal Medicine III, Division of Pneumology and Respiratory Medicine, RoMed Hospital Rosenheim, Ellmaierstraße 23, 83022, Rosenheim, Germany
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Member of the German Center for Lung Research (DZL), LMU Hospital, Comprehensive Pneumology Center Munich (CPC-M), Ziemssenstraße 1, 80336, Munich, Germany
| | - S Engelhardt
- Department of Internal Medicine III, Division of Pneumology and Respiratory Medicine, RoMed Hospital Rosenheim, Ellmaierstraße 23, 83022, Rosenheim, Germany
| | - P Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Germany, Member of the German Center for Lung Research (DZL), University of Marburg (UMR), Baldingerstraße, 35043, Marburg, Germany
| | - S Budweiser
- Department of Internal Medicine III, Division of Pneumology and Respiratory Medicine, RoMed Hospital Rosenheim, Ellmaierstraße 23, 83022, Rosenheim, Germany.
- University Hospital Regensburg, Regensburg, Germany.
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30
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Bouzid D, Visseaux B, Ferré VM, Peiffer-Smadja N, Le Hingrat Q, Loubet P. Respiratory syncytial virus in adults with comorbidities: an update on epidemiology, vaccines, and treatments. Clin Microbiol Infect 2023; 29:1538-1550. [PMID: 37666450 DOI: 10.1016/j.cmi.2023.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is widely known as a frequent cause of respiratory distress among adults, particularly in older people. Recent years have witnessed several improvements in respiratory virus detection, leading to more questions about therapeutic management strategies. OBJECTIVES This narrative review focuses on the RSV burden in older people and adults with risk factors and provides an update on the main recent developments regarding managing this infection. SOURCES A comprehensive PubMed search was conducted till August 2023 to identify studies on RSV among the adult population. We included observational studies, RCTs on vaccines, and different therapies. CONTENT This review should give clinicians an overview of RSV epidemiology and burden among older people and adults with pre-existing risk factors, the most recent randomized clinical trials on RSV vaccines, and the existing data on the different therapeutics existing and under development. IMPLICATIONS There is a growing body of evidence on RSV burden in adults. The landscape of preventive and curative treatments is quickly evolving.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Emergency Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Benoit Visseaux
- Laboratoire Cerba, Infectious Diseases Department, Saint Ouen l'Aumône, France
| | - Valentine Marie Ferré
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Infectious Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Virology Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Quentin Le Hingrat
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Infectious Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Paul Loubet
- Université de Montpellier, VBMI, Inserm U1047, Nîmes, France; Department of Infectious and Tropical Diseases, CHU Nîmes, Université de Montpellier, Nîmes, France.
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31
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Havers FP, Whitaker M, Melgar M, Chatwani B, Chai SJ, Alden NB, Meek J, Openo KP, Ryan PA, Kim S, Lynfield R, Shaw YP, Barney G, Tesini BL, Sutton M, Talbot HK, Olsen KP, Patton ME. Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023. Am J Transplant 2023; 23:2000-2007. [PMID: 37863432 DOI: 10.1016/j.ajt.2023.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.
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Affiliation(s)
- Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC.
| | - Michael Whitaker
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Bhoomija Chatwani
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Eagle Health Analytics, LLC., Atlanta, Georgia
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California; Career Epidemiology Field Officer Program, CDC
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Kyle P Openo
- Emory University School of Medicine, Atlanta, Georgia; Georgia Emerging Infections Program, Georgia Department of Public Health; Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Sue Kim
- Michigan Department of Health & Human Services
| | | | | | | | - Brenda L Tesini
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Monica E Patton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
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32
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Bartsch YC, Cizmeci D, Yuan D, Mehta N, Tolboom J, De Paepe E, van Heesbeen R, Sadoff J, Comeaux CA, Heijnen E, Callendret B, Alter G, Bastian AR. Vaccine-induced antibody Fc-effector functions in humans immunized with a combination Ad26.RSV.preF/RSV preF protein vaccine. J Virol 2023; 97:e0077123. [PMID: 37902399 PMCID: PMC10688327 DOI: 10.1128/jvi.00771-23] [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: 05/24/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
IMPORTANCE Respiratory syncytial virus (RSV) can cause serious illness in older adults (i.e., those aged ≥60 years). Because options for RSV prophylaxis and treatment are limited, the prevention of RSV-mediated illness in older adults remains an important unmet medical need. Data from prior studies suggest that Fc-effector functions are important for protection against RSV infection. In this work, we show that the investigational Ad26.RSV.preF/RSV preF protein vaccine induced Fc-effector functional immune responses in adults aged ≥60 years who were enrolled in a phase 1/2a regimen selection study of Ad26.RSV.preF/RSV preF protein. These results demonstrate the breadth of the immune responses induced by the Ad26.RSV.preF/RSV preF protein vaccine.
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Affiliation(s)
- Yannic C. Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Dansu Yuan
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Nickita Mehta
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Jeroen Tolboom
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, the Netherlands
| | | | - Roy van Heesbeen
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, the Netherlands
| | - Jerald Sadoff
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, the Netherlands
| | - Christy A. Comeaux
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, the Netherlands
| | - Esther Heijnen
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, the Netherlands
| | - Benoit Callendret
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, the Netherlands
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
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Osei-Yeboah R, Spreeuwenberg P, Del Riccio M, Fischer TK, Egeskov-Cavling AM, Bøås H, van Boven M, Wang X, Lehtonen T, Bangert M, Campbell H, Paget J. Estimation of the Number of Respiratory Syncytial Virus-Associated Hospitalizations in Adults in the European Union. J Infect Dis 2023; 228:1539-1548. [PMID: 37246742 PMCID: PMC10681866 DOI: 10.1093/infdis/jiad189] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in adults that can result in hospitalizations. Estimating RSV-associated hospitalization is critical for planning RSV-related healthcare across Europe. METHODS We gathered RSV-associated hospitalization estimates from the RSV Consortium in Europe (RESCEU) for adults in Denmark, England, Finland, Norway, Netherlands, and Scotland from 2006 to 2017. We extrapolated these estimates to 28 European Union (EU) countries using nearest-neighbor matching, multiple imputations, and 2 sets of 10 indicators. RESULTS On average, 158 229 (95% confidence interval [CI], 140 865-175 592) RSV-associated hospitalizations occur annually among adults in the EU (≥18 years); 92% of these hospitalizations occur in adults ≥65 years. Among 75-84 years, the annual average is estimated at 74 519 (95% CI, 69 923-79 115) at a rate of 2.24 (95% CI, 2.10-2.38) per 1000. Among ≥85 years, the annual average is estimated at 37 904 (95% CI, 32 444-43 363) at a rate of 2.99 (95% CI, 2.56-3.42). CONCLUSIONS Our estimates of RSV-associated hospitalizations in adults are the first analysis integrating available data to provide the disease burden across the EU. Importantly, for a condition considered in the past to be primarily a disease of young children, the average annual hospitalization estimate in adults was lower but of a similar magnitude to the estimate in young children (0-4 years): 158 229 (95% CI, 140 865-175 592) versus 245 244 (95% CI, 224 688-265 799).
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Affiliation(s)
- Richard Osei-Yeboah
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Marco Del Riccio
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Postgraduate Medical School in Public Health, University of Florence, Italy
| | - Thea K Fischer
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen, Denmark
| | - Amanda Marie Egeskov-Cavling
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen, Denmark
| | - Håkon Bøås
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Xin Wang
- School of Public Health, Nanjing Medical University, China
| | - Toni Lehtonen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki
| | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Merritt TN, Pei J, Leung DW. Pathogenicity and virulence of human respiratory syncytial virus: Multifunctional nonstructural proteins NS1 and NS2. Virulence 2023:2283897. [PMID: 37964591 DOI: 10.1080/21505594.2023.2283897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Human respiratory syncytial virus (hRSV) is a major cause of acute lower respiratory tract infections in children under the age of two as well as in the elderly and immunocompromised worldwide. Despite its discovery over 60 years ago and the global impact on human health, limited specific and effective prophylactic or therapeutic options have been available for hRSV infections. Part of the lack of treatment options is attributed to the legacy of vaccine failure in the 1960s using a formalin-inactivated RSV (FI-RSV), which led to enhancement of disease post exposure to hRSV infection and hampered subsequent development of vaccine candidates. Recent FDA approval of a vaccine for older adults and impending approval for a maternal vaccine are major advancements but leaves children between 6 months and 5 years of age unprotected. Part of this limitation can be attributed to a lack of complete understanding of the factors that contribute to hRSV pathogenesis. The nonstructural proteins NS1 and NS2 are multifunctional virulence factors that are unique to hRSV and that play critical roles during hRSV infection, including antagonizing interferon (IFN) signalling to modulate host responses to hRSV infection. However, the molecular mechanisms by which the nonstructural proteins mediate their IFN inhibitory functions have not been completely defined. Current progress on the characterization of NS1 and NS2 during infection provides deeper insight into their roles. Furthermore, reverse genetics systems for hRSV provide a viable strategy to generate attenuated viruses by introduction of select mutations while maintaining immunogenicity required to elicit a long-term protective response. Here we will review the current state of knowledge of the nonstructural proteins, their contributions to RSV pathogenesis, and their potential as targets for therapeutic development.
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Affiliation(s)
- Trudy N Merritt
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jingjing Pei
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Daisy W Leung
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Njue A, Nuabor W, Lyall M, Margulis A, Mauskopf J, Curcio D, Kurosky S, Gessner BD, Begier E. Systematic Literature Review of Risk Factors for Poor Outcomes Among Adults With Respiratory Syncytial Virus Infection in High-Income Countries. Open Forum Infect Dis 2023; 10:ofad513. [PMID: 38033988 PMCID: PMC10686344 DOI: 10.1093/ofid/ofad513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Identification of risk factors for severe respiratory syncytial virus (RSV) disease in adults could facilitate their appropriate vaccine recommendations. We conducted a systematic literature review (last 10 years in PubMed/Embase) to identify quantitative estimates of risk factors for severe RSV infection outcomes in high-income countries. Severe outcomes from RSV infection included hospitalization, excess mortality, lower respiratory tract infection, or a composite measure: severe RSV, which included these outcomes and others, such as mechanical ventilation and extended hospital stay. Among 1494 articles screened, 26 met eligibility criteria. We found strong evidence that the following increased the risk of severe outcomes: age, preexisting comorbid conditions (eg, cardiac, pulmonary, and immunocompromising diseases, as well as diabetes and kidney disease), and living conditions (socioeconomic status and nursing home residence). The frequency of severe outcomes among younger adults with comorbidities was generally similar to that experienced by older adults, suggesting that immunosenescence and chronic conditions are both contributing factors for elevated risk. Trial registration PROSPERO (CRD42022315239).
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Affiliation(s)
- Annete Njue
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Weyinmi Nuabor
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Matthew Lyall
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Andrea Margulis
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Josephine Mauskopf
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Daniel Curcio
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Samantha Kurosky
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Bradford D Gessner
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Elizabeth Begier
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
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36
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Havers FP, Whitaker M, Melgar M, Chatwani B, Chai SJ, Alden NB, Meek J, Openo KP, Ryan PA, Kim S, Lynfield R, Shaw YP, Barney G, Tesini BL, Sutton M, Talbot HK, Olsen KP, Patton ME. Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1075-1082. [PMID: 37796742 PMCID: PMC10564327 DOI: 10.15585/mmwr.mm7240a1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - RSV-NET Surveillance Team
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Eagle Health Analytics, LLC., Atlanta, Georgia; California Emerging Infections Program, Oakland, California; Career Epidemiology Field Officer Program, CDC; Colorado Department of Public Health & Environment; Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut; Emory University School of Medicine, Atlanta, Georgia; Georgia Emerging Infections Program, Georgia Department of Public Health; Atlanta Veterans Affairs Medical Center, Decatur, Georgia; Maryland Department of Health; Michigan Department of Health & Human Services; Minnesota Department of Health; New Mexico Department of Health; New York State Department of Health; University of Rochester School of Medicine and Dentistry, Rochester, New York; Public Health Division, Oregon Health Authority; Vanderbilt University Medical Center, Nashville, Tennessee; Salt Lake County Health Department, Salt Lake City, Utah
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37
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Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, Havers FP. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. Am J Transplant 2023; 23:1631-1640. [PMID: 37778868 DOI: 10.1016/j.ajt.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Respiratory syncytial virus (RSV) is a cause of severe respiratory illness in older adults. In May 2023, the Food and Drug Administration approved the first vaccines for prevention of RSV-associated lower respiratory tract disease in adults aged ≥60 years. Since May 2022, the Advisory Committee on Immunization Practices (ACIP) Respiratory Syncytial Virus Vaccines Adult Work Group met at least monthly to review available evidence regarding the safety, immunogenicity, and efficacy of these vaccines among adults aged ≥60 years. On June 21, 2023, ACIP voted to recommend that adults aged ≥60 years may receive a single dose of an RSV vaccine, using shared clinical decision-making. This report summarizes the body of evidence considered for this recommendation and provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years. RSV vaccines have demonstrated moderate to high efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults; postmarketing surveillance will direct future guidance.
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Affiliation(s)
- Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC.
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Lauren E Roper
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sarah S Long
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
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38
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Simon S, Joean O, Welte T, Rademacher J. The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus. Eur Respir Rev 2023; 32:230034. [PMID: 37673427 PMCID: PMC10481333 DOI: 10.1183/16000617.0034-2023] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Exacerbations of COPD are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression and death. At least 70% of COPD exacerbations are infectious in origin, with respiratory viruses identified in approximately 30% of cases. Despite long-standing recommendations to vaccinate patients with COPD, vaccination rates remain suboptimal in this population.Streptococcus pneumoniae is one of the leading morbidity and mortality causes of lower respiratory tract infections. The Food and Drug Administration recently approved pneumococcal conjugate vaccines that showed strong immunogenicity against all 20 included serotypes. Influenza is the second most common virus linked to severe acute exacerbations of COPD. The variable vaccine efficacy across virus subtypes and the impaired immune response are significant drawbacks in the influenza vaccination strategy. High-dose and adjuvant vaccines are new approaches to tackle these problems. Respiratory syncytial virus is another virus known to cause acute exacerbations of COPD. The vaccine candidate RSVPreF3 is the first authorised for the prevention of RSV in adults ≥60 years and might help to reduce acute exacerbations of COPD. The 2023 Global Initiative for Chronic Lung Disease report recommends zoster vaccination to protect against shingles for people with COPD over 50 years.
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Affiliation(s)
- Susanne Simon
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
| | - Oana Joean
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
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39
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Ruckwardt TJ. The road to approved vaccines for respiratory syncytial virus. NPJ Vaccines 2023; 8:138. [PMID: 37749081 PMCID: PMC10519952 DOI: 10.1038/s41541-023-00734-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
After decades of work, several interventions to prevent severe respiratory syncytial virus (RSV) disease in high-risk infant and older adult populations have finally been approved. There were many setbacks along the road to victory. In this review, I will discuss the impact of RSV on human health and how structure-based vaccine design set the stage for numerous RSV countermeasures to advance through late phase clinical evaluation. While there are still many RSV countermeasures in preclinical and early-stage clinical trials, this review will focus on products yielding long-awaited efficacy results. Finally, I will discuss some challenges and next steps needed to declare a global victory against RSV.
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Affiliation(s)
- Tracy J Ruckwardt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, 20892, USA.
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40
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Trauth J. [Respiratory viral infections : Under special consideration of severe acute respiratory syndrome coronavirus 2 and influenza viruses]. Med Klin Intensivmed Notfmed 2023; 118:445-453. [PMID: 37642653 DOI: 10.1007/s00063-023-01050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 08/31/2023]
Abstract
Respiratory viruses cause the highest number of morbidities and deaths annually among all infectious pathogens. This article discusses the current epidemiology, pathogenesis, risk factors, and drug treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses, respiratory syncytial virus (RSV), and other respiratory viruses. The SARS-CoV‑2 and influenza are preventable with vaccines and a first vaccine against RSV is available since 08/2023. For infections with SARS-CoV‑2 and influenza, a stage-specific (antiviral) drug treatment is also recommended. Due to the high and commonly underestimated disease burden caused by RSV, it must be hoped that antiviral substances will be found in the future. In patients at risk, particular attention should be paid to an adequate vaccination status against respiratory pathogens and if there is clinical suspicion of a viral airway infection, the pathogen should be promptly identified and, if necessary, specific treatment should be carried out. Now that effective vaccinations and antiviral drugs are available, the challenge is to use them for all patients at risk and thus really prevent avoidable infections, severe courses and long-term sequelae.
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Affiliation(s)
- Janina Trauth
- Universitätsklinikum Gießen und Marburg GmbH, Medizinische Klinik V für Innere Medizin m.S. Infektiologie und Krankenhaushygiene, Justus-Liebig-Universität Gießen, Klinikstr 33, 35392, Gießen, Deutschland.
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41
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Mac S, Shi S, Millson B, Tehrani A, Eberg M, Myageri V, Langley JM, Simpson S. Burden of illness associated with Respiratory Syncytial Virus (RSV)-related hospitalizations among adults in Ontario, Canada: A retrospective population-based study. Vaccine 2023; 41:5141-5149. [PMID: 37422377 DOI: 10.1016/j.vaccine.2023.06.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Globally, RSV is a common viral pathogen that causes 64 million acute respiratory infections annually. Our objective was to determine the incidence of hospitalization, healthcare resource use and associated costs of adults hospitalized with RSV in Ontario, Canada. METHODS To describe the epidemiology of adults hospitalized with RSV, we used a validated algorithm applied to a population-based healthcare utilization administrative dataset in Ontario, Canada. We created a retrospective cohort of incident hospitalized adults with RSV between September 2010 and August 2017 and followed each person for up to two years. To determine the burden of illness associated with hospitalization and post-discharge healthcare encounters each RSV-admitted patient was matched to two unexposed controls based on demographics and risk factors. Patient demographics were described and mean attributable 6-month and 2-year healthcare costs (2019 Canadian dollars) were estimated. RESULTS There were 7,091 adults with RSV-associated hospitalizations between 2010 and 2019 with a mean age of 74.6 years; 60.4 % were female. RSV-coded hospitalization rates increased from 1.4 to 14.6 per 100,000 adults between 2010-2011 and 2018-2019. The mean difference in healthcare costs between RSV-admitted patients and matched controls was $28,260 (95 % CI: $27,728 - $28,793) in the first 6 months and $43,721 over 2 years (95 % CI: $40,383 - $47,059) post-hospitalization. CONCLUSIONS RSV hospitalizations among adults increased in Ontario between 2010/11 to 2018/19 RSV seasons. RSV hospitalizations in adults were associated with increased attributable short-term and long-term healthcare costs compared to matched controls. Interventions that could prevent RSV in adults may reduce healthcare burden.
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Affiliation(s)
| | | | | | | | | | | | - Joanne M Langley
- Canadian Center for Vaccinology (Dalhousie University, IWK Health and Nova Scotia Health) Halifax, Nova Scotia, Canada
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42
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Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, Havers FP. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:793-801. [PMID: 37471262 PMCID: PMC10360650 DOI: 10.15585/mmwr.mm7229a4] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Respiratory syncytial virus (RSV) is a cause of severe respiratory illness in older adults. In May 2023, the Food and Drug Administration approved the first vaccines for prevention of RSV-associated lower respiratory tract disease in adults aged ≥60 years. Since May 2022, the Advisory Committee on Immunization Practices (ACIP) Respiratory Syncytial Virus Vaccines Adult Work Group met at least monthly to review available evidence regarding the safety, immunogenicity, and efficacy of these vaccines among adults aged ≥60 years. On June 21, 2023, ACIP voted to recommend that adults aged ≥60 years may receive a single dose of an RSV vaccine, using shared clinical decision-making. This report summarizes the body of evidence considered for this recommendation and provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years. RSV vaccines have demonstrated moderate to high efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults; postmarketing surveillance will direct future guidance.
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43
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Theodore DA, Branche AR, Zhang L, Graciaa DS, Choudhary M, Hatlen TJ, Osman R, Babu TM, Robinson ST, Gilbert PB, Follmann D, Janes H, Kublin JG, Baden LR, Goepfert P, Gray GE, Grinsztejn B, Kotloff KL, Gay CL, Leav B, Miller J, Hirsch I, Sadoff J, Dunkle LM, Neuzil KM, Corey L, Falsey AR, El Sahly HM, Sobieszczyk ME, Huang Y. Clinical and Demographic Factors Associated With COVID-19, Severe COVID-19, and SARS-CoV-2 Infection in Adults: A Secondary Cross-Protocol Analysis of 4 Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2323349. [PMID: 37440227 PMCID: PMC10346130 DOI: 10.1001/jamanetworkopen.2023.23349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/15/2023] [Indexed: 07/14/2023] Open
Abstract
Importance Current data identifying COVID-19 risk factors lack standardized outcomes and insufficiently control for confounders. Objective To identify risk factors associated with COVID-19, severe COVID-19, and SARS-CoV-2 infection. Design, Setting, and Participants This secondary cross-protocol analysis included 4 multicenter, international, randomized, blinded, placebo-controlled, COVID-19 vaccine efficacy trials with harmonized protocols established by the COVID-19 Prevention Network. Individual-level data from participants randomized to receive placebo within each trial were combined and analyzed. Enrollment began July 2020 and the last data cutoff was in July 2021. Participants included adults in stable health, at risk for SARS-CoV-2, and assigned to the placebo group within each vaccine trial. Data were analyzed from April 2022 to February 2023. Exposures Comorbid conditions, demographic factors, and SARS-CoV-2 exposure risk at the time of enrollment. Main Outcomes and Measures Coprimary outcomes were COVID-19 and severe COVID-19. Multivariate Cox proportional regression models estimated adjusted hazard ratios (aHRs) and 95% CIs for baseline covariates, accounting for trial, region, and calendar time. Secondary outcomes included severe COVID-19 among people with COVID-19, subclinical SARS-CoV-2 infection, and SARS-CoV-2 infection. Results A total of 57 692 participants (median [range] age, 51 [18-95] years; 11 720 participants [20.3%] aged ≥65 years; 31 058 participants [53.8%] assigned male at birth) were included. The analysis population included 3270 American Indian or Alaska Native participants (5.7%), 7849 Black or African American participants (13.6%), 17 678 Hispanic or Latino participants (30.6%), and 40 745 White participants (70.6%). Annualized incidence was 13.9% (95% CI, 13.3%-14.4%) for COVID-19 and 2.0% (95% CI, 1.8%-2.2%) for severe COVID-19. Factors associated with increased rates of COVID-19 included workplace exposure (high vs low: aHR, 1.35 [95% CI, 1.16-1.58]; medium vs low: aHR, 1.41 [95% CI, 1.21-1.65]; P < .001) and living condition risk (very high vs low risk: aHR, 1.41 [95% CI, 1.21-1.66]; medium vs low risk: aHR, 1.19 [95% CI, 1.08-1.32]; P < .001). Factors associated with decreased rates of COVID-19 included previous SARS-CoV-2 infection (aHR, 0.13 [95% CI, 0.09-0.19]; P < .001), age 65 years or older (aHR vs age <65 years, 0.57 [95% CI, 0.50-0.64]; P < .001) and Black or African American race (aHR vs White race, 0.78 [95% CI, 0.67-0.91]; P = .002). Factors associated with increased rates of severe COVID-19 included race (American Indian or Alaska Native vs White: aHR, 2.61 [95% CI, 1.85-3.69]; multiracial vs White: aHR, 2.19 [95% CI, 1.50-3.20]; P < .001), diabetes (aHR, 1.54 [95% CI, 1.14-2.08]; P = .005) and at least 2 comorbidities (aHR vs none, 1.39 [95% CI, 1.09-1.76]; P = .008). In analyses restricted to participants who contracted COVID-19, increased severe COVID-19 rates were associated with age 65 years or older (aHR vs <65 years, 1.75 [95% CI, 1.32-2.31]; P < .001), race (American Indian or Alaska Native vs White: aHR, 1.98 [95% CI, 1.38-2.83]; Black or African American vs White: aHR, 1.49 [95% CI, 1.03-2.14]; multiracial: aHR, 1.81 [95% CI, 1.21-2.69]; overall P = .001), body mass index (aHR per 1-unit increase, 1.03 [95% CI, 1.01-1.04]; P = .001), and diabetes (aHR, 1.85 [95% CI, 1.37-2.49]; P < .001). Previous SARS-CoV-2 infection was associated with decreased severe COVID-19 rates (aHR, 0.04 [95% CI, 0.01-0.14]; P < .001). Conclusions and Relevance In this secondary cross-protocol analysis of 4 randomized clinical trials, exposure and demographic factors had the strongest associations with outcomes; results could inform mitigation strategies for SARS-CoV-2 and viruses with comparable epidemiological characteristics.
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Affiliation(s)
- Deborah A. Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Angela R. Branche
- Department of Medicine, Infectious Disease Division, University of Rochester, Rochester, New York
| | - Lily Zhang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Daniel S. Graciaa
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Madhu Choudhary
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Raadhiya Osman
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Tara M. Babu
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle
| | - Samuel T. Robinson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Peter B. Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | - Dean Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | - James G. Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Paul Goepfert
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Karen L. Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Cynthia L. Gay
- Department of Medicine, Division of Infectious Diseases, UNC HIV Cure Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | | | | | - Ian Hirsch
- AstraZeneca BioPharmaceuticals, Cambridge, United Kingdom
| | - Jerald Sadoff
- Janssen Vaccines and Prevention, Leiden, the Netherlands
| | | | - Kathleen M. Neuzil
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Ann R. Falsey
- Department of Medicine, Infectious Disease Division, University of Rochester, Rochester, New York
| | - Hana M. El Sahly
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Global Health, University of Washington, Seattle
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ElSherif M, Andrew MK, Ye L, Ambrose A, Boivin G, Bowie W, David MP, Gruselle O, Halperin SA, Hatchette TF, Johnstone J, Katz K, Langley JM, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Pirçon JY, Powis J, Richardson D, Semret M, Smith S, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA, LeBlanc JJ. Leveraging Influenza Virus Surveillance From 2012 to 2015 to Characterize the Burden of Respiratory Syncytial Virus Disease in Canadian Adults ≥50 Years of Age Hospitalized With Acute Respiratory Illness. Open Forum Infect Dis 2023; 10:ofad315. [PMID: 37441353 PMCID: PMC10334379 DOI: 10.1093/ofid/ofad315] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Methods Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012-2013, 2013-2014, and 2014-2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Results Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8-12 per 100 000 population in adults aged 50-59 years to 174-487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. Conclusions This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.
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Affiliation(s)
- May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Andre Poirier
- Centre intégré universitaire de santé et services sociaux de la Mauricie et du Centre du Québec, Québec City, Québec, Canada
| | | | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Sylvie Trottier
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | | | - Duncan Webster
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
| | - Jason J LeBlanc
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
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45
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Ramilo O, Rodriguez-Fernandez R, Mejias A. Respiratory Syncytial Virus Infection: Old Challenges and New Approaches. J Infect Dis 2023; 228:4-7. [PMID: 36715631 PMCID: PMC10474936 DOI: 10.1093/infdis/jiad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Octavio Ramilo
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Rosa Rodriguez-Fernandez
- Department of Pediatrics, Hospital Infantil Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Asuncion Mejias
- Center for Vaccines and Immunity, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
- Division of Infectious Diseases at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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46
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Ramirez J, Carrico R, Wilde A, Junkins A, Furmanek S, Chandler T, Schulz P, Hubler R, Peyrani P, Liu Q, Trivedi S, Uppal S, Kalina WV, Falsey AR, Walsh EE, Yacisin K, Jodar L, Gessner BD, Begier E. Diagnosis of Respiratory Syncytial Virus in Adults Substantially Increases When Adding Sputum, Saliva, and Serology Testing to Nasopharyngeal Swab RT-PCR. Infect Dis Ther 2023:10.1007/s40121-023-00805-1. [PMID: 37148463 PMCID: PMC10163290 DOI: 10.1007/s40121-023-00805-1] [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: 01/18/2023] [Accepted: 04/06/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Nearly all existing respiratory syncytial virus (RSV) incidence estimates are based on real-time polymerase chain reaction (RT-PCR) testing of nasal or nasopharyngeal (NP) swabs. Adding testing of additional specimen types to NP swab RT-PCR increases RSV detection. However, prior studies only made pairwise comparisons and the synergistic effect of adding multiple specimen types has not been quantified. We compared RSV diagnosis by NP swab RT-PCR alone versus NP swab plus saliva, sputum, and serology. METHODS This was a prospective cohort study over two study periods (27 December 2021 to 1 April 2022 and 22 August 2022 to 11 November 2022) of patients aged ≥ 40 years hospitalized for acute respiratory illness (ARI) in Louisville, KY. NP swab, saliva, and sputum specimens were collected at enrollment and PCR tested (Luminex ARIES platform). Serology specimens were obtained at acute and convalescent timepoints (enrollment and 30-60-day visit). RSV detection rate was calculated for NP swab alone and for NP swab plus all other specimen type/test. RESULTS Among 1766 patients enrolled, 100% had NP swab, 99% saliva, 34% sputum, and 21% paired serology specimens. RSV was diagnosed in 56 (3.2%) patients by NP swab alone, and in 109 (6.2%) patients by NP swab plus additional specimens, corresponding to a 1.95 times higher rate [95% confidence interval (CI) 1.62, 2.34]. Limiting the comparison to the 150 subjects with all four specimen types available (i.e., NP swab, saliva, sputum, and serology), there was a 2.60-fold increase (95% CI 1.31, 5.17) compared to NP swab alone (3.3% versus 8.7%). Sensitivities by specimen type were: NP swab 51%, saliva 70%, sputum 72%, and serology 79%. CONCLUSIONS Diagnosis of RSV in adults was several-fold greater when additional specimen types were added to NP swab, even with a relatively low percentage of subjects with sputum and serology results available. Hospitalized RSV ARI burden estimates in adults based solely on NP swab RT-PCR should be adjusted for underestimation.
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Affiliation(s)
- Julio Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA.
| | - Ruth Carrico
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Ashley Wilde
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Alan Junkins
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Paul Schulz
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | | | | | - Qing Liu
- Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - Ann R Falsey
- Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Edward E Walsh
- Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Zhu Y, Chang D. Interactions between the lung microbiome and host immunity in chronic obstructive pulmonary disease. Chronic Dis Transl Med 2023. [DOI: 10.1002/cdt3.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Yixing Zhu
- Graduate School of The PLA General Hospital Beijing China
| | - De Chang
- Department of Respiratory and Critical Care Medicine, Eighth Medical Center, Department of Respiratory and Critical Care Seventh Medical Center Chinese PLA General Hospital Beijing China
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48
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Li Y, Kulkarni D, Begier E, Wahi-Singh P, Wahi-Singh B, Gessner B, Nair H. Adjusting for Case Under-Ascertainment in Estimating RSV Hospitalisation Burden of Older Adults in High-Income Countries: a Systematic Review and Modelling Study. Infect Dis Ther 2023; 12:1137-1149. [PMID: 36941483 PMCID: PMC10027261 DOI: 10.1007/s40121-023-00792-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Previous studies suggest diagnostic testing characteristics (i.e. variations in clinical specimens and diagnostic tests) can contribute to underestimation of RSV disease burden. We aimed to improve the understanding of RSV hospitalisation burden in older adults (aged ≥ 65 years) in high-income countries through adjusting for case under-ascertainment. METHODS We conducted a systematic review to include data on RSV-associated acute respiratory infection (ARI) hospitalisation burden in older adults in high-income countries. To adjust for case under-ascertainment, we developed a two-step framework that incorporated empirical data on the RSV detection proportion of different clinical specimens and testing approaches as well as their statistical uncertainty. We estimated the unadjusted and adjusted RSV-associated hospitalisation burden through multilevel random-effects meta-analysis. We further explored RSV-associated in-hospital mortality burden. RESULTS We included 12 studies with eligible RSV hospitalisation burden data. We estimated that pooled unadjusted hospitalisation rate was 157 per 100,000 (95% CI 98-252) for adults aged ≥ 65 years; the rate was adjusted to 347 per 100,000 (203-595) after accounting for under-ascertainment. The adjusted rate could be translated into 787,000 (460,000-1,347,000) RSV-associated hospitalisations in high-income countries in 2019, which was about 2.2 times the unadjusted estimate. Stratified analysis by age group showed that the adjusted rate increased with age, from 231 per 100,000 in adults aged 65-74 years to 692 per 100,000 in adults aged > 85 years. The in-hospital case fatality ratio of RSV was 6.1% (3.3-11.0) and the total RSV-associated in-hospital deaths in high-income countries in 2019 could be between 22,000 and 47,000. CONCLUSION This study improves the understanding of RSV-associated hospitalisation burden in older adults and shows that the true RSV-associated hospitalisation burden could be 2.2 times what was reported in existing studies. This study has implications for calculating the benefit of interventions to treat and prevent RSV-associated disease.
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Affiliation(s)
- You Li
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, China.
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Durga Kulkarni
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Dublin, Ireland
| | - Pia Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bhanu Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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49
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Clinical impact of healthcare-associated respiratory syncytial virus in hospitalized adults. Infect Control Hosp Epidemiol 2023; 44:433-439. [PMID: 36372395 PMCID: PMC10015267 DOI: 10.1017/ice.2022.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the clinical impact of healthcare-associated (HA) respiratory syncytial virus (RSV) in hospitalized adults. DESIGN Retrospective cohort study within a prospective, population-based, surveillance study of RSV-infected hospitalized adults during 3 respiratory seasons: October 2017-April 2018, October 2018-April 2019, and October 2019-March 2020. SETTING The study was conducted in 2 academically affiliated medical centers. PATIENTS Each HA-RSV patient (in whom RSV was detected by PCR test ≥4 days after hospital admission) was matched (age, sex, season) with 2 community-onset (CO) RSV patients (in whom RSV was detected ≤3 days of admission). METHODS Risk factors and outcomes were compared among HA-RSV versus CO-RSV patients using conditional logistic regression. Escalation of respiratory support associated with RSV detection (day 0) from day -2 to day +4 was explored among HA-RSV patients. RESULTS In total, 84 HA-RSV patients were matched to 160 CO-RSV patients. In HA-RSV patients, chronic kidney disease was more common, while chronic respiratory conditions and obesity were less common. HA-RSV patients were not more likely to be admitted to an ICU or require mechanical ventilation, but they more often required a higher level of care at discharge compared with CO-RSV patients (44% vs 14%, respectively). Also, 29% of evaluable HA-RSV patients required respiratory support escalation; these patients were older and more likely to have respiratory comorbidities, to have been admitted to intensive care, and to die during hospitalization. CONCLUSIONS HA-RSV in adults may be associated with escalation in respiratory support and an increased level of support in living situation at discharge. Infection prevention and control strategies and RSV vaccination of high-risk adults could mitigate the risk of HA-RSV.
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50
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Papi A, Ison MG, Langley JM, Lee DG, Leroux-Roels I, Martinon-Torres F, Schwarz TF, van Zyl-Smit RN, Campora L, Dezutter N, de Schrevel N, Fissette L, David MP, Van der Wielen M, Kostanyan L, Hulstrøm V. Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults. N Engl J Med 2023; 388:595-608. [PMID: 36791160 DOI: 10.1056/nejmoa2209604] [Citation(s) in RCA: 198] [Impact Index Per Article: 198.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important cause of acute respiratory infection, lower respiratory tract disease, clinical complications, and death in older adults. There is currently no licensed vaccine against RSV infection. METHODS In an ongoing, international, placebo-controlled, phase 3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive a single dose of an AS01E-adjuvanted RSV prefusion F protein-based candidate vaccine (RSVPreF3 OA) or placebo before the RSV season. The primary objective was to show vaccine efficacy of one dose of the RSVPreF3 OA vaccine against RSV-related lower respiratory tract disease, confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), during one RSV season. The criterion for meeting the primary objective was a lower limit of the confidence interval around the efficacy estimate of more than 20%. Efficacy against severe RSV-related lower respiratory tract disease and RSV-related acute respiratory infection was assessed, and analyses according to RSV subtype (A and B) were performed. Safety was evaluated. RESULTS A total of 24,966 participants received one dose of the RSVPreF3 OA vaccine (12,467 participants) or placebo (12,499). Over a median follow-up of 6.7 months, vaccine efficacy against RT-PCR-confirmed RSV-related lower respiratory tract disease was 82.6% (96.95% confidence interval [CI], 57.9 to 94.1), with 7 cases (1.0 per 1000 participant-years) in the vaccine group and 40 cases (5.8 per 1000 participant-years) in the placebo group. Vaccine efficacy was 94.1% (95% CI, 62.4 to 99.9) against severe RSV-related lower respiratory tract disease (assessed on the basis of clinical signs or by the investigator) and 71.7% (95% CI, 56.2 to 82.3) against RSV-related acute respiratory infection. Vaccine efficacy was similar against the RSV A and B subtypes (for RSV-related lower respiratory tract disease: 84.6% and 80.9%, respectively; for RSV-related acute respiratory infection: 71.9% and 70.6%, respectively). High vaccine efficacy was observed in various age groups and in participants with coexisting conditions. The RSVPreF3 OA vaccine was more reactogenic than placebo, but most adverse events for which reports were solicited were transient, with mild-to-moderate severity. The incidences of serious adverse events and potential immune-mediated diseases were similar in the two groups. CONCLUSIONS A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related acute respiratory infection and lower respiratory tract disease and severe RSV-related lower respiratory tract disease in adults 60 years of age or older, regardless of RSV subtype and the presence of underlying coexisting conditions. (Funded by GlaxoSmithKline Biologicals; AReSVi-006 ClinicalTrials.gov number, NCT04886596.).
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Affiliation(s)
- Alberto Papi
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Michael G Ison
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Joanne M Langley
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Dong-Gun Lee
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Isabel Leroux-Roels
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Federico Martinon-Torres
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Tino F Schwarz
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Richard N van Zyl-Smit
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Laura Campora
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Nancy Dezutter
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Nathalie de Schrevel
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Laurence Fissette
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Marie-Pierre David
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Marie Van der Wielen
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Lusine Kostanyan
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Veronica Hulstrøm
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
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