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Lassoued Y, Levy C, Werner A, Assad Z, Bechet S, Frandji B, Batard C, Sellam A, Cahn-Sellem F, Fafi I, Lenglart L, Aupiais C, Basmaci R, Cohen R, Ouldali N. Effectiveness of nirsevimab against RSV-bronchiolitis in paediatric ambulatory care: a test-negative case-control study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 44:101007. [PMID: 39139197 PMCID: PMC11321316 DOI: 10.1016/j.lanepe.2024.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024]
Abstract
Background Respiratory syncytial virus (RSV) is the leading cause of lower-respiratory-tract infection in children. Nirsevimab, a monoclonal antibody against RSV, was implemented in a few countries in September 2023. However, its post-license effectiveness in ambulatory care settings is unknown. We aimed to assess the effectiveness of nirsevimab against RSV-bronchiolitis in outpatients aged <12 months. Methods We conducted a test-negative case-control study based on a national ambulatory surveillance system. We included all infants aged <12 months who had bronchiolitis and results of an RSV rapid antigen test performed, visiting a network of 107 ambulatory paediatricians from September 15, 2023, to February 1, 2024. Case patients were infants with bronchiolitis and a rapid antigen test positive for RSV. Control patients were infants with bronchiolitis and a rapid antigen test negative for RSV. Effectiveness was assessed by a logistic regression model adjusted for potential confounders. A range of sensitivity analyses were conducted to assess the robustness of the findings. Findings We included 883 outpatients who had bronchiolitis and results of an RSV rapid antigen test (453 were case patients, and 430 were control patients). Overall, 62/453 (13.7%) case patients and 177/430 (41.2%) control patients had been previously immunised for nirsevimab. The adjusted effectiveness of nirsevimab against RSV-bronchiolitis was 79.7% (95% CI 67.7-87.3). Sensitivity analyses gave similar results. Interpretation This post-license study indicates that nirsevimab was effective in preventing RSV-bronchiolitis in ambulatory care settings. Funding The study was supported by Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), French Pediatrician Ambulatory Association (AFPA) and unrestricted grants from GSK, MSD, Pfizer and Sanofi.
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Affiliation(s)
- Yannis Lassoued
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
- Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM UMR 1137, Paris Cité University, 75018, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Andreas Werner
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
| | - Zein Assad
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
- Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM UMR 1137, Paris Cité University, 75018, Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
| | - Stephane Bechet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
| | | | - Christophe Batard
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
| | - Aurélie Sellam
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
- General Paediatrics, Paediatric Emergency and Neonatal Intensive Care, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, 93140, Bondy, France
| | | | - Inès Fafi
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Léa Lenglart
- Paediatric Emergency Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Camile Aupiais
- General Paediatrics, Paediatric Emergency and Neonatal Intensive Care, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, 93140, Bondy, France
- ECEVE, Inserm UMR 1123, Paris Cité University, 75010, Paris, France
| | - Romain Basmaci
- Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM UMR 1137, Paris Cité University, 75018, Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
- General Paediatrics, Paediatric Emergency, Louis Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, 92700, Colombes, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Naim Ouldali
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
- Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM UMR 1137, Paris Cité University, 75018, Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Créteil, France
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Alharbi AS, Al-Hindi MY, Alqwaiee M, Al-Shamrani A, Alharbi S, Yousef A, Alshammary A, Miqdad A, Said Y, Alnemri A, Alahmadi T, Almudeer AH. Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention 2024 updated consensus on the prevention of respiratory syncytial virus. Ann Thorac Med 2024; 19:190-200. [PMID: 39144535 PMCID: PMC11321529 DOI: 10.4103/atm.atm_69_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 08/16/2024] Open
Abstract
Respiratory syncytial virus (RSV) is the major cause of bronchiolitis among children under 5 years of age worldwide, accounting for a prevalence of 25%-88% in Saudi Arabia. Although no effective treatment for the virus exists, passive immunoprophylaxis reduced RSV hospitalizations in high-risk children. With recent advances in immunization, the Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention panel screened recent relevant international guidelines, locally published data, and expert consensus to update guidelines for RSV prevention, taking into consideration the resources, timing, varying health profiles, and RSV burden in Saudi Arabia. The panel updated its recommendations to include immunization of infants, mothers, and older adults. Practical guidelines were prepared to facilitate the administration of the short-acting and newly developed long-acting RSV monoclonal antibodies (mAb) during the regular follow-ups of high-risk infants in specialized clinics. In addition, long-acting mAb was highlighted as all-infant protection in the routine immunization calendar.
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Affiliation(s)
- Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Mohammed Y Al-Hindi
- Department of Pediatric, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- Research and Development, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mansour Alqwaiee
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Abdullah Al-Shamrani
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Saleh Alharbi
- Department of Pediatrics, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdullah Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Aisha Alshammary
- Department of Pediatrics, Alyammamah Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Abeer Miqdad
- Department of Pediatrics, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Yazan Said
- Department of Pediatrics, King Fahad Specialist Hospital, Ministry of Health, Dammam, Saudi Arabia
| | - Abdulrahman Alnemri
- Department of Pediatrics, College of Medicine, Pediatrics Department, King Saud University, Riyadh, Saudi Arabia
| | - Turki Alahmadi
- Department of Pediatrics, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ali Husein Almudeer
- Department of Pediatrics, College of Medicine, Pediatrics Department, King Saud University, Riyadh, Saudi Arabia
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3
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Walsh R, Costello L, DiCosimo A, Doyle AM, Kehoe L, Mulhall C, O'Hara S, Elnazir B, Meehan J, Isweisi E, Semova G, Branagan A, Roche E, Molloy E. Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting. Pediatr Res 2024:10.1038/s41390-024-03340-y. [PMID: 38902454 DOI: 10.1038/s41390-024-03340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/13/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024]
Abstract
AIM Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge. METHODS This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included. RESULTS There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use. CONCLUSIONS Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting. IMPACT Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.
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Affiliation(s)
- Ruth Walsh
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland.
| | - Liam Costello
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
| | - Alexandria DiCosimo
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
| | - Anne-Marie Doyle
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
| | - Laura Kehoe
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
| | - Cormac Mulhall
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
| | - Sean O'Hara
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
| | - Basil Elnazir
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Respiratory Medicine, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, 24, Ireland
| | - Judith Meehan
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
| | - Eman Isweisi
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
| | - Gergana Semova
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
| | - Aoife Branagan
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Paediatrics, The Coombe Hospital, Dublin, 8, Ireland
| | - Edna Roche
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, 24, Ireland
| | - Eleanor Molloy
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Paediatrics, The Coombe Hospital, Dublin, 8, Ireland
- Neurodisability Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, 24, Ireland
- Neonatology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
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Levin JC, Beam AL, Fox KP, Hayden LP. Cost Savings Without Increased Risk of Respiratory Hospitalization for Preterm Children after the 2014 Palivizumab Policy Update. Am J Perinatol 2024; 41:e133-e141. [PMID: 35523410 PMCID: PMC9969323 DOI: 10.1055/a-1845-2184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Our objective was to compare rates of hospitalizations for respiratory illnesses in preterm and full-term (FT) children for 4 years before and after the 2014 update to the American Academy of Pediatrics (AAP) respiratory syncytial virus (RSV) immunoprophylaxis guidance, which restricted eligibility among infants born at 29 to 34 weeks in the first winter and all preterm infants in the second winter after neonatal discharge. STUDY DESIGN We conducted pre-post and interrupted time series analyses on claims data from a commercial national managed care plan. We compared the number of RSV and all respiratory hospital admissions in the first and second RSV seasons after neonatal discharge among a cohort of preterm children, regardless of palivizumab status, in the 4 years before and after the implementation of the 2014 palivizumab eligibility change. A FT group was included for reference. RESULTS The cohort included 821 early preterm (EP, <29 weeks), 4,790 moderate preterm (MP, 29-34 weeks), and 130,782 FT children. Palivizumab use after the policy update decreased among MP children in the first and second RSV seasons after neonatal discharge, without any change in the odds of hospitalization with RSV or respiratory illness. For the EP group, there was no change in the rate of palivizumab or the odds of hospitalization with RSV or respiratory illness after the policy update. For the FT group, there was a slight decrease in odds of hospitalization post-2014 after the policy update. The interrupted time series did not reveal any secular trends over time in hospitalization rates among preterm children. Following the policy change, there were cost savings for MP children in the first and second RSV seasons, when accounting for the cost of hospitalizations and the cost of palivizumab. CONCLUSION Hospitalizations for RSV or respiratory illness did not increase, and cost savings were obtained after the implementation of the 2014 AAP palivizumab prophylaxis policy. KEY POINTS · Palivizumab use decreased among children born moderate preterm (29 to34 weeks) after the 2014 palivizuamb policy update.. · There was no change in odds of hospitalization with respiratory syncitial virus or respiratory illness among preterm infants after the policy update when compared to before.. · There were cost savings, when accounting for the cost of hospitalizations and the cost of palivizumab, after the policy update among children born moderate preterm..
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Affiliation(s)
- Jonathan C. Levin
- Division of Newborn Medicine, Boston Children’s
Hospital, Boston MA
- Division of Pulmonary Medicine, Boston Children’s
Hospital, Boston MA
| | - Andrew L. Beam
- Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston MA
| | - Kathe P. Fox
- Department of Biomedical Informatics, Harvard Medical
School, Boston, MA
| | - Lystra P. Hayden
- Division of Pulmonary Medicine, Boston Children’s
Hospital, Boston MA
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA
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Altawalah H, Alfouzan W, Al-Fadalah T, Zalzala MA, Ezzikouri S. Viral etiology of severe lower respiratory tract infections in SARS-CoV-2 negative hospitalized patients during the COVID-19 pandemic in Kuwait. Heliyon 2024; 10:e29855. [PMID: 38681623 PMCID: PMC11046192 DOI: 10.1016/j.heliyon.2024.e29855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
Background The prevalence of respiratory infections is largely underexplored in Kuwait. The aim of our study is to determine the etiology of infections from patients who are SARS-CoV-2 negative hospitalized with severe lower respiratory tract infections (LRTIs) in Kuwait during the coronavirus disease 2019 (COVID-19) pandemic. Methods We conducted an observational cross-sectional study among severe LRTI patients between September 2021 and March 2022. Respiratory samples from 545 non-COVID-19 severe LRTIs patients were prospectively evaluated with FTD Respiratory 21 Plus® real-time PCR, targeting 20 different viruses and 1 atypical bacterial pathogen. Results Among all 545 hospitalized cases, 411 (75.4 %) tested positive for at least one respiratory pathogen. The most common were rhinovirus (HRV) (32.7 %), respiratory syncytial virus (RSV) (20.9 %), metapneumovirus (HMPV) (14.1 %), bocavirus (13.2 %), and influenza A (12.7 %). The proportion of pathogens detected was highest in the under-5 age group, while HKU1 (44.4 %) predominated in the elderly (>50 years). Conclusion Our study reveals a high prevalence of respiratory viruses in severe acute lower respiratory tract infections among non-COVID-19 hospitalized patients in Kuwait. HRV remains the main etiology affecting the country, particularly in infants. These results underscore the necessity of employing multiplex PCR for accurate diagnosis and describing the epidemiology of infections among severe lower respiratory tract infections. This will facilitate the use of specific antiviral therapy and help avoid excessive or inappropriate antibiotic therapy.
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Affiliation(s)
- Haya Altawalah
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, 24923, Kuwait
- Virology Unit, Yacoub Behbehani Center, Sabah Hospital, Ministry of Health, Kuwait, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, 24923, Kuwait
- Laboratory Medicine, Farwania Hospital, Ministry of Health, Farwania, Kuwait
| | - Talal Al-Fadalah
- Qualities and Accreditation Directorate, Ministry of Health, Kuwait, Kuwait
| | - Mariam Ali Zalzala
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, 24923, Kuwait
| | - Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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Xu X, Qiao D, Brasier AR. Cooperative interaction of interferon regulatory factor -1 and bromodomain-containing protein 4 on RNA polymerase activation for intrinsic innate immunity. Front Immunol 2024; 15:1366235. [PMID: 38601157 PMCID: PMC11004252 DOI: 10.3389/fimmu.2024.1366235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The human orthopneumovirus, Respiratory Syncytial Virus (RSV), is the causative agent of severe lower respiratory tract infections (LRTI) and exacerbations of chronic lung diseases. In immune competent hosts, RSV productively infects highly differentiated epithelial cells, where it elicits robust anti-viral, cytokine and remodeling programs. By contrast, basal cells are relatively resistant to RSV infection, in part, because of constitutive expression of an intrinsic innate immune response (IIR) consisting of a subgroup of interferon (IFN) responsive genes. The mechanisms controlling the intrinsic IIR are not known. Methods Here, we use human small airway epithelial cell hSAECs as a multipotent airway stem cell model to examine regulatory control of an intrinsic IIR pathway. Results We find hSAECs express patterns of intrinsic IIRs, highly conserved with pluri- and multi-potent stem cells. We demonstrate a core intrinsic IIR network consisting of Bone Marrow Stromal Cell Antigen 2 (Bst2), Interferon Induced Transmembrane Protein 1 (IFITM1) and Toll-like receptor (TLR3) expression are directly under IRF1 control. Moreover, expression of this intrinsic core is rate-limited by ambient IRF1• phospho-Ser 2 CTD RNA Polymerase II (pSer2 Pol II) complexes binding to their proximal promoters. In response to RSV infection, the abundance of IRF1 and pSer2 Pol II binding is dramatically increased, with IRF1 complexing to the BRD4 chromatin remodeling complex (CRC). Using chromatin immunoprecipitation in IRF1 KD cells, we find that the binding of BRD4 is IRF1 independent. Using a small molecule inhibitor of the BRD4 acetyl lysine binding bromodomain (BRD4i), we further find that BRD4 bromodomain interactions are required for stable BRD4 promoter binding to the intrinsic IIR core promoters, as well as for RSV-inducible pSer2 Pol II recruitment. Surprisingly, BRD4i does not disrupt IRF1-BRD4 interactions, but disrupts both RSV-induced BRD4 and IRF1 interactions with pSer2 Pol II. Conclusions We conclude that the IRF1 functions in two modes- in absence of infection, ambient IRF1 mediates constitutive expression of the intrinsic IIR, whereas in response to RSV infection, the BRD4 CRC independently activates pSer2 Pol II to mediates robust expression of the intrinsic IIR. These data provide insight into molecular control of anti-viral defenses of airway basal cells.
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Affiliation(s)
- Xiaofang Xu
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
| | - Dianhua Qiao
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
| | - Allan R. Brasier
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, United States
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7
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Servadio M, Finocchietti M, Vassallo C, Cipelli R, Heiman F, Di Lucchio G, Oresta B, Addis A, Belleudi V. An epidemiological investigation of high-risk infants for Respiratory Syncytial Virus infections: a retrospective cohort study. Ital J Pediatr 2024; 50:56. [PMID: 38528568 DOI: 10.1186/s13052-024-01627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Respiratory Syncytial Virus (RSV) infections may lead to severe consequences in infants born preterm with breathing problems (such as bronchopulmonary dysplasia (BPD) and respiratory distress syndrome (RDS)) or congenital heart diseases (CHD). Since studies investigating the influence of different gestational age (WGA) and concomitant specific comorbidities on the burden of RSV infections are scarce, the present study aimed to better characterize these high-risk populations in the Italian context. METHODS This retrospective, longitudinal and record-linkage cohort study involved infants born between 2017 and 2019 in Lazio Region (Italy) and is based on data extracted from administrative databases. Each infant was exclusively included in one of the following cohorts: (1) BPD-RDS (WGA ≤35 with or without CHD) or (2) CHD (without BPD and/or RDS) or (3) Preterm (WGA ≤35 without BPD (and/or RDS) or CHD). Each cohort was followed for 12 months from birth. Information related to sociodemographic at birth, and RSV and Undetermined Respiratory Agents (URA) hospitalizations and drug consumption at follow-up were retrieved and described. RESULTS A total of 8,196 infants were selected and classified as 1,084 BPD-RDS, 3,286 CHD and 3,826 Preterm. More than 30% of the BPD-RDS cohort was composed by early preterm infants (WGA ≤ 29) in contrast to the Preterm cohort predominantly constitute by moderate preterm infants (98.2%), while CHD infants were primarily born at term (83.9%). At follow-up, despite the cohorts showed similar proportions of RSV hospitalizations, in BPD-RDS cohort hospitalizations were more frequently severe compared to those occurred in the Preterm cohort (p<0.01), in the BPD-RDS cohort was also found the highest proportion of URA hospitalizations (p<0.0001). In addition, BPD-RDS infants, compared to those of the remaining cohorts, received more frequently prophylaxis with palivizumab (p<0.0001) and were more frequently treated with adrenergics inhalants, and glucocorticoids for systemic use. CONCLUSIONS The assessment of the study clinical outcomes highlighted that, the demographic and clinical characteristics at birth of the study cohorts influence their level of vulnerability to RSV and URA infections. As such, continuous monitoring of these populations is necessary in order to ensure a timely organization of health care system able to respond to their needs in the future.
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Affiliation(s)
- Michela Servadio
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
- IQVIA Solutions Italy S.r.l., Milan, Italy
| | - Marco Finocchietti
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
| | | | | | | | | | - Bianca Oresta
- AstraZeneca S.p.A. - Medical Department, Milan, Italy
| | - Antonio Addis
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy.
| | - Valeria Belleudi
- Department of Epidemiology of the Regional Health Service Lazio, Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
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8
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Dovizio M, Veronesi C, Bartolini F, Cavaliere A, Grego S, Pagliaro R, Procacci C, Ubertazzo L, Bertizzolo L, Muzii B, Parisi S, Perrone V, Baraldi E, Bozzola E, Mosca F, Esposti LD. Clinical and economic burden of respiratory syncytial virus in children aged 0-5 years in Italy. Ital J Pediatr 2024; 50:57. [PMID: 38528616 DOI: 10.1186/s13052-024-01628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is among the leading causes of hospitalization due to lower respiratory tract infections (LRTIs) in children younger than 5 years worldwide and the second cause of infant death after malaria. RSV infection occurs in almost all the infants before the second year of life with variable clinical severity, often requiring medical assistance. This analysis investigated patients aged 0-5 years with RSV infection focusing on epidemiology, clinical features, and economic burden of RSV-associated hospitalizations in a setting of Italian real clinical practice. METHODS An observational retrospective analysis was conducted on administrative databases of healthcare entities covering around 2.6 million residents of whom 120,000 health-assisted infants aged < 5 years. From 2010 to 2018, pediatric patients were included in the presence of hospitalization discharge diagnosis for RSV infections, and RSV-related acute bronchiolitis or pneumonia. Epidemiology, demographics, clinical picture and costs were evaluated in RSV-infected patients, overall and stratified by age ranges (0-1, 1-2, 2-5 years) and compared with an age-matched general population. RESULTS Overall 1378 RSV-infected children aged 0-5 years were included. Among them, the annual incidence rate of RSV-related hospitalizations was 175-195/100,000 people, with a peak in neonates aged < 1 year (689-806/100,000). While nearly 85% of infected infants were healthy, the remaining 15% presented previous hospitalization for known RSV risk factors, like preterm birth, or congenital heart, lung, and immune diseases. The economic analysis revealed that direct healthcare costs per patient/year were markedly higher in RSV patients than in the general population (3605€ vs 344€). CONCLUSIONS These findings derived from the real clinical practice in Italy confirmed that RSV has an important epidemiological, clinical, and economic burden among children aged 0-5 years. While the complex management of at-risk infants was confirmed, our data also highlighted the significant impact of RSV infection in infants born at term or otherwise healthy, demonstrating that all infants need protection against RSV disease, reducing then the risk of medium and long-term complications, such as wheezing and asthma.
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Affiliation(s)
- Melania Dovizio
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | - Chiara Veronesi
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | | | | | - Stefano Grego
- Dipartimento Tecnico-Amministrativo, ASL 3 Genovese, Genova, Italy
| | - Romina Pagliaro
- UOC Farmaceutica Territoriale, Azienda Sanitaria Locale Roma 5, Rome, Italy
| | - Cataldo Procacci
- Dipartimento Farmaceutico, ASL BAT (Barletta-Trani-Andria), Trani, Italy
| | | | | | | | | | - Valentina Perrone
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padova, Italy
| | - Elena Bozzola
- Pediatric Disease Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Degli Esposti
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy.
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9
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Lee YZ, Han J, Zhang YN, Ward G, Gomes KB, Auclair S, Stanfield RL, He L, Wilson IA, Zhu J. A tale of two fusion proteins: understanding the metastability of human respiratory syncytial virus and metapneumovirus and implications for rational design of uncleaved prefusion-closed trimers. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.07.583986. [PMID: 38496645 PMCID: PMC10942449 DOI: 10.1101/2024.03.07.583986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) cause human respiratory diseases and are major targets for vaccine development. In this study, we designed uncleaved prefusion-closed (UFC) trimers for the fusion (F) proteins of both viruses by examining mutations critical to F metastability. For RSV, we assessed four previous prefusion F designs, including the first and second generations of DS-Cav1, SC-TM, and 847A. We then identified key mutations that can maintain prefusion F in a native-like, closed trimeric form (up to 76%) without introducing any interprotomer disulfide bond. For hMPV, we developed a stable UFC trimer with a truncated F2-F1 linkage and an interprotomer disulfide bond. Tens of UFC constructs were characterized by negative-stain electron microscopy (nsEM), x-ray crystallography (11 RSV-F and one hMPV-F structures), and antigenic profiling. Using an optimized RSV-F UFC trimer as bait, we identified three potent RSV neutralizing antibodies (NAbs) from a phage-displayed human antibody library, with a public NAb lineage targeting sites Ø and V and two cross-pneumovirus NAbs recognizing site III. In mouse immunization, rationally designed RSV-F and hMPV-F UFC trimers induced robust antibody responses with high neutralizing titers. Our study provides a foundation for future prefusion F-based RSV and hMPV vaccine development.
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Affiliation(s)
- Yi-Zong Lee
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Jerome Han
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Yi-Nan Zhang
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Garrett Ward
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Keegan Braz Gomes
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Sarah Auclair
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Robyn L Stanfield
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Linling He
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Ian A Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
- Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Jiang Zhu
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California 92037, USA
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California 92037, USA
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10
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Milucky J, Patel K, Patton ME, Kirley PD, Austin E, Meek J, Anderson EJ, Brooks A, Brown C, Mumm E, Salazar-Sanchez Y, Barney G, Popham K, Sutton M, Talbot HK, Crossland MT, Havers FP. Characteristics and Outcomes of Pregnant Women Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Before and During the COVID-19 Pandemic. Open Forum Infect Dis 2024; 11:ofae042. [PMID: 38524226 PMCID: PMC10960599 DOI: 10.1093/ofid/ofae042] [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: 12/27/2023] [Accepted: 01/25/2024] [Indexed: 03/26/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause severe disease among infants and older adults. Less is known about RSV among pregnant women. Methods To analyze hospitalizations with laboratory-confirmed RSV among women aged 18 to 49 years, we used data from the RSV Hospitalization Surveillance Network (RSV-NET), a multistate population-based surveillance system. Specifically, we compared characteristics and outcomes among (1) pregnant and nonpregnant women during the pre-COVID-19 pandemic period (2014-2018), (2) pregnant women with respiratory symptoms during the prepandemic and pandemic periods (2021-2023), and (3) pregnant women with and without respiratory symptoms in the pandemic period. Using multivariable logistic regression, we examined whether pregnancy was a risk factor for severe outcomes (intensive care unit admission or in-hospital death) among women aged 18 to 49 years who were hospitalized with RSV prepandemic. Results Prepandemic, 387 women aged 18 to 49 years were hospitalized with RSV. Of those, 350 (90.4%) had respiratory symptoms, among whom 33 (9.4%) were pregnant. Five (15.2%) pregnant women and 74 (23.3%) nonpregnant women were admitted to the intensive care unit; no pregnant women and 5 (1.6%) nonpregnant women died. Among 279 hospitalized pregnant women, 41 were identified prepandemic and 238 during the pandemic: 80.5% and 35.3% had respiratory symptoms, respectively (P < .001). Pregnant women were more likely to deliver during their RSV-associated hospitalization during the pandemic vs the prepandemic period (73.1% vs 43.9%, P < .001). Conclusions Few pregnant women had severe RSV disease, and pregnancy was not a risk factor for a severe outcome. More asymptomatic pregnant women were identified during the pandemic, likely due to changes in testing practices for RSV.
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Affiliation(s)
- Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica E Patton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Elizabeth Austin
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Departments of Medicine and Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Alicia Brooks
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Erica Mumm
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fiona P Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Uusitupa E, Waris M, Vuorinen T, Heikkinen T. Respiratory Syncytial Virus-Associated Hospitalizations in Children: A 10-Year Population-Based Analysis in Finland, 2008-2018. Influenza Other Respir Viruses 2024; 18:e13268. [PMID: 38477388 DOI: 10.1111/irv.13268] [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: 09/15/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The risk of respiratory syncytial virus (RSV) hospitalization is highest during the first months of life, but few studies have assessed the population-based rates of hospitalization in monthly age groups of infants. METHODS We determined the average population-based rates of hospitalization with virologically confirmed RSV infections in children ≤15 years of age admitted during the 10-year period of 2008-2018. Testing for RSV was routine in all children hospitalized with respiratory infections, and all RSV-positive children admitted at any time during the study period were included in the analyses. RESULTS The annual population-based rate of RSV hospitalization was highest in infants 1 month of age (52.0 per 1000 children; 95% CI, 45.2-59.7), followed by infants <1 month of age (34.8 per 1000; 95% CI, 29.2-41.1) and those 2 months of age (32.2 per 1000; 95% CI, 26.9-38.4). In cumulative age groups, the rate of hospitalization was 39.7 per 1000 (95% CI, 36.2-43.4) among infants <3 months of age, 26.8 per 1000 (95% CI, 24.8-29.0) in infants aged <6 months, and 15.8 per 1000 (95% CI, 14.7-17.0) in those <12 months of age. CONCLUSION In monthly age groups of infants, the incidence rates of virologically confirmed RSV hospitalization in all infants up to 3 months of age were substantially higher than those reported in earlier studies. These data may be important for improving the estimates of the cost-effectiveness of various interventions to reduce the burden of RSV in young infants.
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Affiliation(s)
- Erika Uusitupa
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Matti Waris
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
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12
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Curns AT, Rha B, Lively JY, Sahni LC, Englund JA, Weinberg GA, Halasa NB, Staat MA, Selvarangan R, Michaels M, Moline H, Zhou Y, Perez A, Rohlfs C, Hickey R, Lacombe K, McHenry R, Whitaker B, Schuster J, Pulido CG, Strelitz B, Quigley C, Dnp GW, Avadhanula V, Harrison CJ, Stewart LS, Schlaudecker E, Szilagyi PG, Klein EJ, Boom J, Williams JV, Langley G, Gerber SI, Hall AJ, McMorrow ML. Respiratory Syncytial Virus-Associated Hospitalizations Among Children <5 Years Old: 2016 to 2020. Pediatrics 2024; 153:e2023062574. [PMID: 38298053 DOI: 10.1542/peds.2023-062574] [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] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. METHODS We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. RESULTS Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). CONCLUSIONS Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants.
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Affiliation(s)
- Aaron T Curns
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joana Y Lively
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leila C Sahni
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Mary A Staat
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Marian Michaels
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heidi Moline
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yingtao Zhou
- Centers for Disease Control and Prevention, Atlanta, Georgia
- TDB Communications, Inc, Atlanta, Georgia
| | - Ariana Perez
- Centers for Disease Control and Prevention, Atlanta, Georgia
- GDIT, Atlanta, Georgia
| | - Chelsea Rohlfs
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert Hickey
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rendie McHenry
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brett Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Christina Quigley
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Vasanthi Avadhanula
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | - Elizabeth Schlaudecker
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Peter G Szilagyi
- UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | | | - Julie Boom
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - John V Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gayle Langley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aron J Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Anderson LJ, Jadhao SJ, Hussaini L, Ha B, McCracken CE, Gibson T, Yildirim I, Yi J, Stephens K, Korski C, Kao C, Sun H, Lee CY, Jaunarajs A, Rostad CA, Anderson EJ. Development and comparison of immunologic assays to detect primary RSV infections in infants. Front Immunol 2024; 14:1332772. [PMID: 38283339 PMCID: PMC10811012 DOI: 10.3389/fimmu.2023.1332772] [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: 11/03/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Effective respiratory syncytial virus (RSV) vaccines have been developed and licensed for elderly adults and pregnant women but not yet for infants and young children. The RSV immune state of the young child, i.e., previously RSV infected or not, is important to the conduct and interpretation of epidemiology studies and vaccine clinical trials. To address the need for sensitive assays to detect immunologic evidence of past infection, we developed, characterized, and evaluated 7 assays including 4 IgG antibody enzyme immunoassays (EIAs), two neutralizing antibody assays, and an IFN-γ EliSpot (EliSpot) assay. The four IgG EIAs used a subgroup A plus subgroup B RSV-infected Hep-2 cell lysate antigen (Lysate), an expressed RSV F protein antigen (F), an expressed subgroup A G protein antigen (Ga), or an expressed subgroup B G protein (Gb) antigen. The two neutralizing antibody assays used either a subgroup A or a subgroup B RSV strain. The EliSpot assay used a sucrose cushion purified combination of subgroup A and subgroup B infected cell lysate. All seven assays had acceptable repeatability, signal against control antigen, lower limit of detection, and, for the antibody assays, effect of red cell lysis, lipemia and anticoagulation of sample on results. In 44 sera collected from children >6 months after an RSV positive illness, the lysate, F, Ga and Gb IgG EIAs, and the subgroup A and B neutralizing antibody assays, and the EliSpot assays were positive in 100%, 100%, 86%, 95%, 43%, and 57%, respectively. The Lysate and F EIAs were most sensitive for detecting RSV antibody in young children with a documented RSV infection. Unexpectedly, the EliSpot assay was positive in 9/15 (60%) of PBMC specimens from infants not exposed to an RSV season, possibly from maternal microchimerism. The Lysate and F EIAs provide good options to reliably detect RSV antibodies in young children for epidemiologic studies and vaccine trials.
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Affiliation(s)
- Larry J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Samadhan J Jadhao
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Laila Hussaini
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Binh Ha
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Theda Gibson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Inci Yildirim
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jumi Yi
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kathy Stephens
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Chelsea Korski
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Carol Kao
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Heying Sun
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Chun Yi Lee
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | - Christina A Rostad
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Evan J Anderson
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA, United States
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
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14
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Chen F, Park HR, Ji HJ, Kwon Y, Kim MK, Song JY, Ahn KB, Seo HS. Gamma Irradiation-Inactivated Respiratory Syncytial Virus Vaccine Provides Protection but Exacerbates Pulmonary Inflammation by Switching from Prefusion to Postfusion F Protein. Microbiol Spectr 2023; 11:e0135823. [PMID: 37272801 PMCID: PMC10434263 DOI: 10.1128/spectrum.01358-23] [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: 04/22/2023] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a common respiratory pathogen that causes lower respiratory diseases among infants and elderly people. Moreover, formalin-inactivated RSV (FI-RSV) vaccine induces serious enhanced respiratory disease (ERD). Radiation has been investigated as an alternative approach for producing inactivated or live-attenuated vaccines, which enhance the antigenicity and heterogeneous protective effects of vaccines compared with conventional formalin inactivation. In this study, we developed an RSV vaccine using gamma irradiation and analyzed its efficacy against RSV vaccine-induced ERD in a mouse model. Although gamma irradiation-inactivated RSV (RI-RSV) carbonylation was lower than FI-RSV carbonylation and RI-RSV showed a significant antibody production and viral clearance, RI-RSV caused more obvious body weight loss, pulmonary eosinophil infiltration, and pulmonary mucus secretion. Further, the conversion of prefusion F (pre-F) to postfusion F (post-F) was significant for both RI-RSV and FI-RSV, while that of RI-RSV was significantly higher than that of FI-RSV. We found that the conversion from pre- to post-F during radiation was caused by radiation-induced reactive oxygen species. Although we could not propose an effective RSV vaccine manufacturing method, we found that ERD was induced by RSV vaccine by various biochemical effects that affect antigen modification during RSV vaccine manufacturing, rather than simply by the combination of formalin and alum. Therefore, these biochemical actions should be considered in future developments of RSV vaccine. IMPORTANCE Radiation inactivation for viral vaccine production has been known to elicit a better immune response than other inactivation methods due to less surface protein damage. However, we found in this study that radiation-inactivated RSV (RI-RSV) vaccine induced a level of immune response similar to that induced by formalin-inactivated RSV (FI-RSV). Although RI-RSV vaccine showed less carbonylation than FI-RSV, it induced more conformational changes from pre-F to post-F due to the gamma radiation-induced reactive oxygen species response, which may be a key factor in RI-RSV-induced ERD. Therefore, ERD induced by RSV vaccine may be due to pre-F to post-F denaturation by random protein modifications caused by external stress. Our findings provide new ideas for inactivated vaccines for RSV and other viruses and confirm the importance of pre-F in RSV vaccines.
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Affiliation(s)
- Fengjia Chen
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Hae-Ran Park
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Hyun Jung Ji
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Yeongkag Kwon
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Min-Kyu Kim
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki Bum Ahn
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Animal Production and Health Laboratory, Joint FAO/IAEA Centre for Nuclear Applications in Food and Agriculture, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Seibersdorf, Austria
| | - Ho Seong Seo
- Accelerator Radioisotope Research Section, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Radiation Science, University of Science and Technology, Daejeon, Republic of Korea
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15
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Reyes MA, Etinger V, Hronek C, Hall M, Davidson A, Mangione-Smith R, Kaiser SV, Parikh K. Pediatric Respiratory Illnesses: An Update on Achievable Benchmarks of Care. Pediatrics 2023; 152:e2022058389. [PMID: 37403624 DOI: 10.1542/peds.2022-058389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric respiratory illnesses (PRI): asthma, bronchiolitis, pneumonia, croup, and influenza are leading causes of pediatric hospitalizations, and emergency department (ED) visits in the United States. There is a lack of standardized measures to assess the quality of hospital care delivered for these conditions. We aimed to develop a measure set for automated data extraction from administrative data sets and evaluate its performance including updated achievable benchmarks of care (ABC). METHODS A multidisciplinary subject-matter experts team selected quality measures from multiple sources. The measure set was applied to the Public Health Information System database (Children's Hospital Association, Lenexa, KS) to cohorts of ED visits and hospitalizations from 2017 to 2019. ABC for pertinent measures and performance gaps of mean values from the ABC were estimated. ABC were compared with previous reports. RESULTS The measure set: PRI report includes a total of 94 quality measures. The study cohort included 984 337 episodes of care, and 82.3% were discharged from the ED. Measures with low performance included bronchodilators (19.7%) and chest x-rays (14.4%) for bronchiolitis in the ED. These indicators were (34.6%) and (29.5%) in the hospitalized cohort. In pneumonia, there was a 57.3% use of narrow spectrum antibiotics. In general, compared with previous reports, there was improvement toward optimal performance for the ABCs. CONCLUSIONS The PRI report provides performance data including ABC and identifies performance gaps in the quality of care for common respiratory illnesses. Future directions include examining health inequities, and understanding and addressing the effects of the coronavirus disease 2019 pandemic on care quality.
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Affiliation(s)
- Mario A Reyes
- Division of Hospital Medicine, Department of Pediatrics, Nicklaus Children's Hospital, Florida International University, Herbert Wertheim College of Medicine
| | - Veronica Etinger
- Division of Hospital Medicine, Department of Pediatrics, Nicklaus Children's Hospital, Florida International University, Herbert Wertheim College of Medicine
| | | | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | | | - Sunitha V Kaiser
- Department of Pediatrics, University of California, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
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16
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Qiao D, Xu X, Zhang Y, Yang J, Brasier AR. RSV replication modifies the XBP1s binding complex on the IRF1 upstream enhancer to potentiate the mucosal anti-viral response. Front Immunol 2023; 14:1197356. [PMID: 37564646 PMCID: PMC10411192 DOI: 10.3389/fimmu.2023.1197356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction The unfolded protein response (UPR) has emerged as an important signaling pathway mediating anti-viral defenses to Respiratory Syncytial Virus (RSV) infection. Earlier we found that RSV replication predominantly activates the evolutionarily conserved Inositol Requiring Enzyme 1α (IRE1α)-X-Box Binding Protein 1 spliced (XBP1s) arm of the Unfolded Protein Response (UPR) producing inflammation, metabolic adaptation and cellular plasticity, yet the mechanisms how the UPR potentiates inflammation are not well understood. Methods To understand this process better, we examined the genomic response integrating RNA-seq and Cleavage Under Targets and Release Using Nuclease (CUT&RUN) analyses. These data were integrated with an RNA-seq analysis conducted on RSV-infected small airway cells ± an IRE1α RNAse inhibitor. Results We identified RSV induced expression changes in ~3.2K genes; of these, 279 required IRE1α and were enriched in IL-10/cytokine signaling pathways. From this data set, we identify those genes directly under XBP1s control by CUT&RUN. Although XBP1s binds to ~4.2 K high-confidence genomic binding sites, surprisingly only a small subset of IL10/cytokine signaling genes are directly bound. We further apply CUT&RUN to find that RSV infection enhances XBP1s loading on 786 genomic sites enriched in AP1/Fra-1, RELA and SP1 binding sites. These control a subset of cytokine regulatory factor genes including IFN response factor 1 (IRF1), CSF2, NFKB1A and DUSP10. Focusing on the downstream role of IRF1, selective knockdown (KD) and overexpression experiments demonstrate IRF1 induction controls type I and -III interferon (IFN) and IFN-stimulated gene (ISG) expression, demonstrating that ISG are indirectly regulated by XBP1 through IRF1 transactivation. Examining the mechanism of IRF1 activation, we observe that XBP1s directly binds a 5' enhancer sequence whose XBP1s loading is increased by RSV. The functional requirement for the enhancer is demonstrated by targeting a dCas9-KRAB silencer, reducing IRF1 activation. Chromatin immunoprecipitation shows that XBP1 is required, but not sufficient, for RSV-induced recruitment of activated phospho-Ser2 Pol II to the enhancer. Discussion We conclude that XBP1s is a direct activator of a core subset of IFN and cytokine regulatory genes in response to RSV. Of these IRF1 is upstream of the type III IFN and ISG response. We find that RSV modulates the XBP1s binding complex on the IRF1 5' enhancer whose activation is required for IRF1 expression. These findings provide novel insight into how the IRE1α-XBP1s pathway potentiates airway mucosal anti-viral responses.
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Affiliation(s)
- Dianhua Qiao
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
| | - Xiaofang Xu
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
| | - Yueqing Zhang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Jun Yang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Allan R. Brasier
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
- Institute for Clinical and Translational Research (ICTR), University of Wisconsin-Madison, Madison, WI, United States
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17
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Huang Y, Zhu X, Guo X, Zhou Y, Liu D, Mao J, Xiong Y, Deng Y, Gao X. Advances in mRNA vaccines for viral diseases. J Med Virol 2023; 95:e28924. [PMID: 37417396 DOI: 10.1002/jmv.28924] [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: 02/21/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
Since the onset of the pandemic caused by severe acute respiratory syndrome coronavirus 2, messenger RNA (mRNA) vaccines have demonstrated outstanding performance. mRNA vaccines offer significant advantages over conventional vaccines in production speed and cost-effectiveness, making them an attractive option against other viral diseases. This article reviewed recent advances in viral mRNA vaccines and their delivery systems to provide references and guidance for developing mRNA vaccines for new viral diseases.
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Affiliation(s)
- Yukai Huang
- Department of Microbiology, School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xuerui Zhu
- Department of Microbiology, School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiao Guo
- Department of Microbiology, School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yuancheng Zhou
- Livestock and Poultry Biological Products Key Laboratory of Sichuan Province, Sichuan Animal Science Academy, Chengdu, China
| | - Dongying Liu
- Department of Microbiology, School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jingrui Mao
- Department of Microbiology, School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yongai Xiong
- Department of Pharmaceutics, School of Pharmacy, Zunyi Medical University, Zunyi, Guizhou, China
| | - Youcai Deng
- Department of Hematology, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xinghong Gao
- Department of Microbiology, School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
- Provincial Department of Education, Key Laboratory of Infectious Disease & Bio-Safety, Zunyi Medical University, Zunyi, Guizhou, China
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18
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Abbate F, Depietri G, Tinelli C, Massimetti G, Picariello S, Peroni D, Di Cicco M. Impact of the publication of the Italian guidelines for bronchiolitis on the management of hospitalized children in Pisa, Italy. Pediatr Pulmonol 2023. [PMID: 37154513 DOI: 10.1002/ppul.26460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
Bronchiolitis represents one of the major causes of hospitalization and mortality in children younger than 1 year, but its management continues to be heterogenous both in those who are hospitalized and in those who are not. To assess the impact of the publication of the Italian guidelines on bronchiolitis in October 2014, we analyzed data from children aged ≤12 months admitted for bronchiolitis at the University Hospital of Pisa from January 2010 to December 2019, dividing them into two groups based on whether admission was either preceding (Group 1) or following (Group 2) the publication of the guidelines. 346 patients (mean age 4.1 ± 2.8 months, 55% males) were admitted in the study period; 43.3%, 49.4%, and 7.3% of patients had mild, moderate or severe bronchiolitis, respectively. The mean length of hospital stay was 6.7 ± 2.9 days; 90.5% of the patients underwent nasal swab and 200 patients tested positive for RSV (in mono or coinfection with other viruses). We found no difference in RSV prevalence and severity distribution between the two groups, while we observed a significant reduction in the use of both chest X-rays (66.9% vs. 34.8%, p < 0.001), blood testing (93.4% vs. 58.2%, p < 0.001) and inhaled or systemic corticosteroids (93.1% vs. 47.8%, p < 0.001) in Group 2. No significant reduction in the use of antibiotics and of inhaled β2 agonists was found. Our data suggest that the publication of the Italian guidelines for bronchiolitis has contributed to improving the management of patients admitted for bronchiolitis in our Unit.
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Affiliation(s)
- Federica Abbate
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Greta Depietri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Camilla Tinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Picariello
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Maria Di Cicco
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
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19
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Osman S, Alaa Adeen A, Hetta O, Alsiraihi A, Bader M, Aloufi A, Abushouk A, Al-Hindi MY. Epidemiology and Risk Factor Analysis of Children with Bronchiolitis Admitted to the Intensive Care Unit at a Tertiary Care Center in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040646. [PMID: 37189894 DOI: 10.3390/children10040646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
Bronchiolitis is a leading cause of hospitalization worldwide for children aged ≤2 years. Few studies have compared general ward and pediatric intensive care unit (PICU) admissions, particularly in Saudi Arabia. This retrospective cohort study aimed to compare the demographic and clinical characteristics of children with bronchiolitis admitted to the general ward with those admitted to the PICU. Children (≤6 years) previously diagnosed with bronchiolitis and admitted to the PICU or general ward at a tertiary center in Saudi Arabia between May 2016 and May 2021 were included. Multiplex polymerase chain reaction was used to identify respiratory viruses. Of the 417 patients enrolled, 67 (16.06%) were admitted to the PICU. The PICU group was younger (median, 2 months; interquartile range [IQR], 1-5 months) vs. (6 months; IQR, 2.65-13.25 months). There was a dramatic reduction in bronchiolitis admissions during the COVID-19 pandemic. The most common causative virus was respiratory syncytial virus (RSV) (54.9%). In the multivariate regression analysis, hypoxia, hyperinflation on X-ray, and non-RSV bronchiolitis were independently associated with PICU admission. However, a higher chronological age and cough were protective. Children with Down syndrome, immunodeficiency, or neuromuscular disorders, and intermediate preterm infants (29-33 weeks of gestation) are at a high risk of PICU admission (adjusted odds ratio: 2.4, 7.1, 2.9, and 2.9; p = 0.037, 0.046, 0.033, and 0.029, respectively). Bronchiolitis is still one of the leading causes of PICU admission. Particular attention should be paid to preventive measures, especially in the post-COVID-19 era, targeting high-risk groups.
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Affiliation(s)
- Sara Osman
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
| | - Abdulqader Alaa Adeen
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah 22384, Saudi Arabia
| | - Omar Hetta
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah 22384, Saudi Arabia
| | - Abdulaziz Alsiraihi
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah 22384, Saudi Arabia
| | - Mahmoud Bader
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah 22384, Saudi Arabia
| | - Alwaleed Aloufi
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah 22384, Saudi Arabia
| | - Amir Abushouk
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Mohammed Yasir Al-Hindi
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
- Research Office, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah 22384, Saudi Arabia
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20
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Saeland E, van der Fits L, Bolder R, Heemskerk-van der Meer M, Drijver J, van Polanen Y, Vaneman C, Tettero L, Cox F, Serroyen J, Jorgensen MJ, Langedijk JPM, Schuitemaker H, Callendret B, Zahn RC. Combination Ad26.RSV.preF/preF protein vaccine induces superior protective immunity compared with individual vaccine components in preclinical models. NPJ Vaccines 2023; 8:45. [PMID: 36949051 PMCID: PMC10033289 DOI: 10.1038/s41541-023-00637-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of severe respiratory disease for which no licensed vaccine is available. We have previously shown that a prefusion (preF) conformation-stabilized RSV F protein antigen and an adenoviral vector encoding RSV preF protein (Ad26.RSV.preF) are immunogenic and protective in animals when administered as single components. Here, we evaluated a combination of the 2 components, administered as a single injection. Strong induction of both humoral and cellular responses was shown in RSV-naïve and pre-exposed mice and pre-exposed African green monkeys (AGMs). Both components of the combination vaccine contributed to humoral immune responses, while the Ad26.RSV.preF component was the main contributor to cellular immune responses in both mice and AGMs. Immunization with the combination elicited superior protection against RSV A2 challenge in cotton rats. These results demonstrate the advantage of a combination vaccine and support further clinical development.
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Affiliation(s)
- Eirikur Saeland
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands.
| | | | - Renske Bolder
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | - Joke Drijver
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | | | | | - Freek Cox
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Jan Serroyen
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Matthew J Jorgensen
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Roland C Zahn
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
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21
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Rodriguez-Martinez CE, Sossa-Briceño MP, Nino G. Oxygen saturation thresholds for bronchiolitis at high altitudes: a cost-effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2023; 23:527-533. [PMID: 36922366 DOI: 10.1080/14737167.2023.2192482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is evidence suggesting that exaggerated reliance on pulse oximetry (SpO2) and the use of arbitrary/inadequate thresholds of SpO2 might drive unnecessary hospitalizations for viral bronchiolitis, especially among high-altitude residents. The aim of the present study was to compare the cost-effectiveness of two oxygen SpO2 thresholds for deciding whether infants with viral bronchiolitis living at high altitudes need hospital admission or can be discharged home. METHODS A cost-effectiveness study was performed to compare the cost and clinical outcomes of two oxygen SpO2 thresholds, adjusted or not, to an altitude above the sea level of Bogota, Colombia (2640 m), for deciding whether infants with viral bronchiolitis need hospitalization or can be discharged home. The principal outcome was avoidance of hospital admission. RESULTS Compared to the use of an SpO2 threshold of 90%, using an SpO2 threshold of 85% in infants with viral bronchiolitis was associated with lower overall costs (US$130.4 vs. US$194.0 average cost per patient) and a higher probability of hospitalization avoided (0.7500 vs. 0.5900), thus leading to dominance. CONCLUSIONS The use of an SpO2 threshold below 90% for deciding on hospitalization in infants with viral bronchiolitis living at high altitudes appears to be logical, secure, and cost-effective.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Gustavo Nino
- Division of Pediatric Pulmonary, Sleep Medicine and Integrative Systems Biology. Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, United States
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22
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Wang YC, Hsueh JC, Chu DM, Chang FY. Respiratory syncytial virus and Streptococcus pneumoniae Co-infection in an elderly individual within a familial cluster. JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/jmedsci.jmedsci_318_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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23
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Manzoni P, Baraldi E, Luna MS, Tzialla C. Real-World Studies of Respiratory Syncytial Virus Hospitalizations among Moderate/Late Preterm Infants Exposed to Passive Immunoprophylaxis with Palivizumab. Am J Perinatol 2022; 39:S7-S13. [PMID: 36307092 DOI: 10.1055/s-0042-1757279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article aims to assess the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-associated hospitalization (RSVH) rates in otherwise healthy moderate/late preterm infants and discuss the role of palivizumab in preventing acute and long-term outcomes. We identified studies in the PubMed and Embase databases that reported patient-level data on (1) exposure to palivizumab in preterm infants born between 29 and 35 weeks of gestational age (or subsets within this range) ≤ 2 years of chronological age, and (2) the outcome of RSVH. Six studies assessed RSVH in infants this gestational age who had been exposed or not to palivizumab and reported patient-level data. Exposure was associated with a reduction in RSVH rates that was comparable to the reduction seen in controlled clinical trials (weighed mean 4.0-fold reduction). RSV immunoprophylaxis in preterm infants within 29 to 35 weeks of gestational age is associated with a considerably lower burden of RSVH. KEY POINTS: · RSV is the leading cause of lower respiratory tract infection hospitalization in infants.. · Palivizumab prevents RSVH in a real-world scenario.. · Immunoprophylaxis should be used in high-risk infants..
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Affiliation(s)
- Paolo Manzoni
- Department of Maternal Infant Medicine, Degli Infermi Hospital, Biella, Italy.,University of Torino, Turin, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuel Sánchez Luna
- Neonatology Division and NICU, University Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Italy
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Lamichhane P, Terhüja M, Snider TA, Oomens AGP. Enhancing Anti-G Antibody Induction by a Live Single-Cycle Prefusion F-Expressing RSV Vaccine Improves In Vitro and In Vivo Efficacy. Viruses 2022; 14:2474. [PMID: 36366572 PMCID: PMC9697216 DOI: 10.3390/v14112474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
The human respiratory syncytial virus (RSV) is a major cause of severe respiratory tract disease, and a vaccine is not available. We previously reported a novel live vaccine expressing prefusion-stabilized fusion protein (preF) in place of the native F protein (RSV-preFΔCT). As preF is non-functional, RSV-preFΔCT was amplified in a production line expressing a functional substitute, and exhibited a single-cycle replication phenotype, which holds several unique potential advantages. RSV-preFΔCT prevented shedding and lung pathology after viral challenge in mice, but induced low levels of anti-attachment protein (G) antibodies (Abs). Given the significant contributions of anti-G Abs toward disease prevention, we generated modifications to RSV-preFΔCT in an effort to induce higher anti-G Ab levels. The Ab levels were monitored after the prime-boost vaccination of mice with modified vaccines. The most successful modification for enhancing induced anti-G Abs was seen with the placement of G in the first genome position. This vaccine also reduced the pathology after challenge with a high dose of wt RSV, and outperformed the sera from wt RSV-vaccinated mice in in vitro neutralization. Thus, raising the anti-G Ab levels induced by RSV-preFΔCT enhanced efficacy in vitro and in vivo, and constitutes an important next step in developing a live, single-cycle, efficacious vaccine for the human population.
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Affiliation(s)
| | | | | | - Antonius G. P. Oomens
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA
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25
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Receveur M, Ottmann M, Reynes J, Eleouet J, Galloux M, Receveur A, Ploin D, Fiorini S, Rivat N, Valette M, Lina B, Casalegno J. Level of maternal antibodies against respiratory syncytial virus (RSV) nucleoprotein at birth and risk of RSV very severe lower respiratory tract infection. Influenza Other Respir Viruses 2022; 17:e13025. [PMID: 36251946 PMCID: PMC9835445 DOI: 10.1111/irv.13025] [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: 03/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The nucleoprotein (N protein) of respiratory syncytial virus (RSV) is a candidate antigen for new RSV vaccine development. The aim of the present study was to investigate the association between maternal antibody titers against the RSV N protein at birth and the newborns' risk of developing very severe lower respiratory tract infection (VS-LRTI). METHODS In this single-center prospective cohort study, 578 infants born during the RSV epidemic season in France were included. Among these, 36 were hospitalized for RSV VS-LRTI. A generalized linear model was used to test the occurrence of a VS-LRTI in function of sex, mode of delivery, parity of the mother, type of pregnancy, date of birth in relation to the peak of the epidemic, and antibody titer against N protein. RESULTS All cord blood samples had detectable antibodies against N protein. The mean titers were significantly lower in newborns with risk factors for RSV severe LRTI (preterm infants, birth before the peak epidemic, multiparous mother). There was no association between antibody titer against the N protein and a protection against VS-LRTI. CONCLUSIONS Further studies are needed to support the hypothesis that transfer of maternal antibodies against the RSV N protein can provide a significant immune protection early in infancy and that N protein candidate vaccine may be a suitable target for maternal vaccine.
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Affiliation(s)
- Matthieu Receveur
- Hospices Civils de Lyon, Hôpital Femme Mère EnfantService de Réanimation Pédiatrique et d'Accueil des UrgencesBronFrance,Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon EstLyonFrance
| | - Michèle Ottmann
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Jean‐Marc Reynes
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance,Unité Environnement et Risques InfectieuxInstitut Pasteur, Université Paris CitéParisFrance
| | - Jean‐François Eleouet
- Université Paris‐Saclay, INRAE, Unité de Virologie et Immunologie MoléculairesJouy‐en‐JosasFrance
| | - Marie Galloux
- Université Paris‐Saclay, INRAE, Unité de Virologie et Immunologie MoléculairesJouy‐en‐JosasFrance
| | - Aurore Receveur
- OFP/FEMAPacific Community, SPCNoumeaNew Caledonia,ENTROPIEUniversité de la Réunion, IRD, CNRS, UMR9220, Université de La Nouvelle‐Calédonie, IfremerNoumeaNew Caledonia
| | - Dominique Ploin
- Hospices Civils de Lyon, Hôpital Femme Mère EnfantService de Réanimation Pédiatrique et d'Accueil des UrgencesBronFrance,Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Sylvie Fiorini
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Nathalie Rivat
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Martine Valette
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Hospices Civils de Lyon, Hôpital de la Croix‐Rousse, Institut des Agents Infectieux (IAI), Laboratoire de Virologie, Centre National de Référence des virus des infections respiratoiresLyonFrance
| | - Bruno Lina
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon EstLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance,Hospices Civils de Lyon, Hôpital de la Croix‐Rousse, Institut des Agents Infectieux (IAI), Laboratoire de Virologie, Centre National de Référence des virus des infections respiratoiresLyonFrance
| | - Jean‐Sebastien Casalegno
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon EstLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance,Hospices Civils de Lyon, Hôpital de la Croix‐Rousse, Institut des Agents Infectieux (IAI), Laboratoire de Virologie, Centre National de Référence des virus des infections respiratoiresLyonFrance
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Motelow JE, Lippa NC, Hostyk J, Feldman E, Nelligan M, Ren Z, Alkelai A, Milner JD, Gharavi AG, Tang Y, Goldstein DB, Kernie SG. Risk Variants in the Exomes of Children With Critical Illness. JAMA Netw Open 2022; 5:e2239122. [PMID: 36306130 PMCID: PMC9617179 DOI: 10.1001/jamanetworkopen.2022.39122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Diagnostic genetic testing can lead to changes in management in the pediatric intensive care unit. Genetic risk in children with critical illness but nondiagnostic exome sequencing (ES) has not been explored. OBJECTIVE To assess the association between loss-of-function (LOF) variants and pediatric critical illness. DESIGN, SETTING, AND PARTICIPANTS This genetic association study examined ES first screened for causative variants among 267 children at the Morgan Stanley Children's Hospital of NewYork-Presbyterian, of whom 22 were otherwise healthy with viral respiratory failure; 18 deceased children with bronchiolitis from the Office of the Chief Medical Examiner of New York City, of whom 14 were previously healthy; and 9990 controls from the Institute for Genomic Medicine at Columbia University Irving Medical Center. The ES data were generated between January 1, 2015, and December 31, 2020, and analyzed between January 1, 2017, and September 2, 2022. EXPOSURE Critical illness. MAIN OUTCOMES AND MEASURES Odds ratios and P values for genes and gene-sets enriched for rare LOF variants and the loss-of-function observed/expected upper bound fraction (LOEUF) score at which cases have a significant enrichment. RESULTS This study included 285 children with critical illness (median [range] age, 4.1 [0-18.9] years; 148 [52%] male) and 9990 controls. A total of 228 children (80%) did not receive a genetic diagnosis. After quality control (QC), 231 children harbored excess rare LOF variants in genes with a LOEUF score of 0.680 or less (intolerant genes) (P = 1.0 × 10-5). After QC, 176 children without a diagnosis harbored excess ultrarare LOF variants in intolerant genes but only in those without a known disease association (odds ratio, 1.8; 95% CI, 1.3-2.5). After QC, 25 children with viral respiratory failure harbored excess ultrarare LOF variants in intolerant genes but only in those without a known disease association (odds ratio, 2.8; 95% CI, 1.1-6.6). A total of 114 undiagnosed children were enriched for de novo LOF variants in genes without a known disease association (observed, 14; expected, 6.8; enrichment, 2.05). CONCLUSIONS AND RELEVANCE In this genetic association study, excess LOF variants were observed among critically ill children despite nondiagnostic ES. Variants lay in genes without a known disease association, suggesting future investigation may connect phenotypes to causative genes.
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Affiliation(s)
- Joshua E. Motelow
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Natalie C. Lippa
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Joseph Hostyk
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Evin Feldman
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Matthew Nelligan
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Zhong Ren
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Anna Alkelai
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Tarrytown, New York
| | | | - Ali G. Gharavi
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian, New York, New York
| | - Yingying Tang
- Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner, New York, New York
| | - David B. Goldstein
- Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Steven G. Kernie
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
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Kieffer A, Beuvelet M, Sardesai A, Musci R, Milev S, Roiz J, Lee JKH. Expected Impact of Universal Immunization With Nirsevimab Against RSV-Related Outcomes and Costs Among All US Infants in Their First RSV Season: A Static Model. J Infect Dis 2022; 226:S282-S292. [PMID: 35968866 PMCID: PMC9377043 DOI: 10.1093/infdis/jiac216] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is associated with substantial morbidity in the United States, especially among infants. Nirsevimab, an investigational long-acting monoclonal antibody, was evaluated as an immunoprophylactic strategy for infants in their first RSV season and for its potential impact on RSV-associated, medically attended lower respiratory tract illness (RSV-MALRTI) and associated costs. METHODS A static decision-analytic model of the US birth cohort during its first RSV season was developed to estimate nirsevimab's impact on RSV-related health events and costs; model inputs included US-specific costs and epidemiological data. Modelled RSV-related outcomes included primary care and emergency room visits, hospitalizations including intensive care unit admission and mechanical ventilations, and RSV-related mortality. RESULTS Under current standard of care, RSV caused 529 915 RSV-MALRTIs and 47 281 hospitalizations annually, representing $1.2 billion (2021 US dollars [USD]) in costs. Universal immunization of all infants with nirsevimab is expected to reduce 290 174 RSV-MALRTI, 24 986 hospitalizations, and expenditures of $612 million 2021 USD. CONCLUSIONS An all-infant immunization strategy with nirsevimab could substantially reduce the health and economic burden for US infants during their first RSV season. While this reduction is driven by term infants, all infants, including palivizumab-eligible and preterm infants, would benefit from this strategy.
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The IRE1α-XBP1s Arm of the Unfolded Protein Response Activates N-Glycosylation to Remodel the Subepithelial Basement Membrane in Paramyxovirus Infection. Int J Mol Sci 2022; 23:ijms23169000. [PMID: 36012265 PMCID: PMC9408905 DOI: 10.3390/ijms23169000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Respiratory syncytial virus (RSV) causes severe lower respiratory tract infections (LRTI) associated with decreased pulmonary function, asthma, and allergy. Recently, we demonstrated that RSV induces the hexosamine biosynthetic pathway via the unfolded protein response (UPR), which is a pathway controlling protein glycosylation and secretion of the extracellular matrix (ECM). Because the presence of matrix metalloproteinases and matricellular growth factors (TGF) is associated with severe LRTI, we studied the effect of RSV on ECM remodeling and found that RSV enhances the deposition of fibronectin-rich ECM by small airway epithelial cells in a manner highly dependent on the inositol requiring kinase (IRE1α)–XBP1 arm of the UPR. To understand this effect comprehensively, we applied pharmacoproteomics to understand the effect of the UPR on N-glycosylation and ECM secretion in RSV infection. We observe that RSV induces N-glycosylation and the secretion of proteins related to ECM organization, secretion, or proteins integral to plasma membranes, such as integrins, laminins, collagens, and ECM-modifying enzymes, in an IRE1α–XBP1 dependent manner. Using a murine paramyxovirus model that activates the UPR in vivo, we validate the IRE1α–XBP1-dependent secretion of ECM to alveolar space. This study extends understanding of the IRE1α–XBP1 pathway in regulating N-glycosylation coupled to structural remodeling of the epithelial basement membrane in RSV infection.
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RELA∙8-Oxoguanine DNA Glycosylase1 Is an Epigenetic Regulatory Complex Coordinating the Hexosamine Biosynthetic Pathway in RSV Infection. Cells 2022; 11:cells11142210. [PMID: 35883652 PMCID: PMC9319012 DOI: 10.3390/cells11142210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Respiratory syncytial virus (RSV), or human orthopneumovirus, is a negative-sense RNA virus that is the causative agent of severe lower respiratory tract infections in children and is associated with exacerbations of adult lung disease. The mechanisms how severe and/or repetitive virus infections cause declines in pulmonary capacity are not fully understood. We have recently discovered that viral replication triggers epithelial plasticity and metabolic reprogramming involving the hexosamine biosynthetic pathway (HBP). In this study, we examine the relationship between viral induced innate inflammation and the activation of hexosamine biosynthesis in small airway epithelial cells. We observe that RSV induces ~2-fold accumulation of intracellular UDP-GlcNAc, the end-product of the HBP and the obligate substrate of N glycosylation. Using two different silencing approaches, we observe that RSV replication activates the HBP pathway in a manner dependent on the RELA proto-oncogene (65 kDa subunit). To better understand the effect of RSV on the cellular N glycoproteome, and its RELA dependence, we conduct affinity enriched LC-MS profiling in wild-type and RELA-silenced cells. We find that RSV induces the accumulation of 171 N glycosylated peptides in a RELA-dependent manner; these proteins are functionally enriched in integrins and basal lamina formation. To elaborate this mechanism of HBP expression, we demonstrate that RSV infection coordinately induces the HBP pathway enzymes in a manner requiring RELA; these genes include Glutamine-Fructose-6-Phosphate Transaminase 1 (GFPT)-1/2, Glucosamine-Phosphate N-Acetyltransferase (GNPNAT)-1, phosphoglucomutase (PGM)-3 and UDP-N-Acetylglucosamine Pyrophosphorylase (UAP)-1. Using small-molecule inhibitor(s) of 8-oxoguanine DNA glycosylase1 (OGG1), we observe that OGG1 is also required for the expression of HBP pathway. In proximity ligation assays, RSV induces the formation of a nuclear and mitochondrial RELA∙OGG1 complex. In co-immunoprecipitaton (IP) experiments, we discover that RSV induces Ser 536-phosphorylated RELA to complex with OGG1. Chromatin IP experiments demonstrate a major role of OGG1 in supporting the recruitment of RELA and phosphorylated RNA Pol II to the HBP pathway genes. We conclude that the RELA∙OGG1 complex is an epigenetic regulator mediating metabolic reprogramming and N glycoprotein modifications of integrins in response to RSV. These findings have implications for viral-induced adaptive epithelial responses.
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Eşki A, Öztürk GK, Turan C, Özgül S, Gülen F, Demir E. High-flow nasal cannula oxygen in children with bronchiolitis: A randomized controlled trial. Pediatr Pulmonol 2022; 57:1527-1534. [PMID: 35293153 DOI: 10.1002/ppul.25893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether high-flow nasal cannula oxygen (HFNCO) provided enhanced respiratory support in bronchiolitis than low-flow oxygen (LFO). METHODS We conducted a prospective, randomized controlled trial in children between 1 and 24 months diagnosed with moderate-to-severe bronchiolitis requiring oxygen therapy. Participants received LFO via face mask (6-10 L/min) or HFNCO (2 L/kg/min). Primary outcomes were the time that heart rate (HR) and respiratory rate (RR) return to their normal range for age and the time that baseline clinical respiratory score (CRS) regress to a lower severity score. Secondary outcomes were changes in HR, RR, and CRS over time, length of stay (LOS), duration of oxygen requirement, treatment failure, and adverse event (AE). RESULTS Eighty-seven children were enrolled (48 in LFO; 39 in HFNCO). The time that HR and RR baseline values reached their normal range for age was shorter in HFNCO therapy (2.0 h [1.0-4.0] vs. 12.0 h [2.0-24.0], and 4.0 h [2.0-12.0] vs. 24.0 h [4.0-48.0], respectively; p < 0.001); additionally, the improvement in CRS emerged more quickly in children treated with HFNCO (2.0 h [1.0-4.0] vs. 4.0 h [2.0-24.0]; p = 0.003). While the duration of oxygen requirement (19.0 h [4.0-30.0] vs. 29.5 h [14.0-45.7]; p = 0.009) and treatment failure (3% vs. 21%) was statistically lower in children who received HFNCO, there were no differences in LOS and AE between groups. CONCLUSION HFNCO may provide enhanced respiratory support with a notable improvement in HR, RR, and CRS than LFO. Comprehensive studies are needed to assess the clinical efficacy of HFNCO therapy.
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Affiliation(s)
- Aykut Eşki
- Division of Pediatric Pulmonology, Department of Pediatrics, Gazi Yaşargil Gynecology, Child Health, and Diseases Training and Research Hospital, University of Health Sciences, Diyarbakır, Turkey
| | - Gökçen Kartal Öztürk
- Division of Pediatric Pulmonology, Department of Pediatrics, Ege University Medical Faculty, Ege University Children Hospital, Izmir, Turkey
| | - Caner Turan
- Division of Emergency Medicine, Department of Pediatrics, Ege University Medical Faculty, Ege University Children Hospital, Izmir, Turkey
| | - Semiha Özgül
- Department of Medical Informatics, School of Medicine, Ege University, Izmir, Turkey
| | - Figen Gülen
- Division of Pediatric Pulmonology, Department of Pediatrics, Ege University Medical Faculty, Ege University Children Hospital, Izmir, Turkey
| | - Esen Demir
- Division of Pediatric Pulmonology, Department of Pediatrics, Ege University Medical Faculty, Ege University Children Hospital, Izmir, Turkey
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31
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Rafferty E, Paulden M, Buchan SA, Robinson JL, Bettinger JA, Kumar M, Svenson LW, MacDonald SE. Evaluating the Individual Healthcare Costs and Burden of Disease Associated with RSV Across Age Groups. PHARMACOECONOMICS 2022; 40:633-645. [PMID: 35553028 PMCID: PMC9130187 DOI: 10.1007/s40273-022-01142-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI), with high morbidity and mortality worldwide. RSV costing and burden estimates can highlight the potential benefits of future vaccination programs and are essential for economic evaluations. OBJECTIVE We aimed to determine RSV healthcare costs across age groups and the overall disease burden of medically attended RSV in Canada. METHODS We conducted a retrospective case-control study to estimate the attributable healthcare costs per RSV case in Alberta. We used two case definitions to capture diversity in case severity: laboratory-confirmed RSV and ARI attributable to RSV. Matching occurred on five criteria: (1) age, (2) urban/rural status, (3) sex, (4) prematurity and (5) Charlson Comorbidity Index score. We calculated the age-specific burden of medically attended RSV in Canada from 2010 to 2019 by multiplying the weekly age-specific incidence of medically attended ARI with the RSV positivity rate. RESULTS Costs per laboratory-confirmed RSV case were (in Canadian dollars [CAD], year 2020 values) $CAD12,713 and 40,028 in the first 30 and 365 days following diagnosis, respectively, whereas a case of ARI potentially attributable to RSV cost $CAD316 and 915, in 30 and 365 days, respectively. Older (aged ≥ 65 years) and younger (aged < 90 days) age groups had the highest case costs. The average medically attended RSV incidence rate across nine seasons was 1743 cases per 100,000 people per year. CONCLUSIONS RSV is a common and expensive infection at the extremes of life, and the development of immunization programs targeting older and younger ages may be important for the reduction of RSV burden and cost.
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Affiliation(s)
- Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
- Institute of Health Economics, #1200, 10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada.
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Letafati A, Aghamirmohammadali FS, Rahimi-Foroushani A, Hasani SA, Mokhtari-Azad T, Yavarian J. No Human Respiratory Syncytial Virus but SARS-CoV-2 in children under 5 years old referred to Children Medical Center in 2021, Tehran, Iran. J Med Virol 2022; 94:3096-3100. [PMID: 35229318 PMCID: PMC9088699 DOI: 10.1002/jmv.27685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/06/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022]
Abstract
Acute respiratory infections (ARIs) are one of the leading causes of illness and death among community members worldwide. Viral infections are the most common agents estimated to be involved in these patients. This study aimed to investigate the prevalence of human respiratory syncytial virus (hRSV) and severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) among children with ARIs. This study evaluated the presence of SARS‐CoV‐2 and hRSV in 168 throat and nasopharyngeal swab samples using real‐time RT‐PCR. All samples were collected from children under 5 years old with ARIs who attended Children's Medical Center, Tehran, Iran, and sent to the Iranian National Influenza Center with appropriate conditions in 2021. Chi‐square and Fisher's exact tests were used for comparison of the data of the prevalence of hRSV and SARS‐CoV‐2 infections among children. Of 168 patients examined, 95 (57%) were male and 73 (43%) female. Out of them, 47 (28%) cases were younger than 1 year old and 121 cases (72%) were 1–5 years old. The most common clinical manifestations of patients were cough (78%), nausea (31%), diarrhea (27%), and fever (18%). Among 168 patients, no hRSV was detected, while the SARS‐CoV‐2 genome was identified in 16 (9.5%) patients. Among 16 positive cases of SARS‐CoV‐2, 8 (50%) were under 1 year old and 8 positive cases were 1–5 years old. This study was performed at cold months of the year but due to the coronavirus disease 2019 pandemic and adherence to health protocols, school closures, and virtual classes, no cases of hRSV infections were identified.
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Affiliation(s)
- Arash Letafati
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Rahimi-Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Hasani
- Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Incidence and risk factors of hospitalisations for respiratory syncytial virus among children aged less than two years. Epidemiol Infect 2022; 150:e45. [PMID: 35105415 PMCID: PMC8895720 DOI: 10.1017/s0950268822000152] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The study aim was to examine the incidence and risk factors of respiratory syncytial virus (RSV) bronchiolitis hospitalisations and disease severity among infants. We compared demographic and health characteristics of children aged 0–23 hospitalised for RSV bronchiolitis (cases, n = 1227) during 2008–2018 and control children (n = 554) of the same age admitted for non-respiratory disease. RSV antigen was detected in nasal swabs by immunochromatography. Multiple logistic regression models were applied. The average annual incidence of hospitalisation for RSV bronchiolitis was 12.6 per 1000 and 1.7 per 1000 (P < 0.001) among infants and toddlers, respectively, with winter seasonality (November–March). The risk of hospitalisation for RSV bronchiolitis increased among children aged 0–5 months (OR 7.66; 95% CI 5.61–10.45) and 6–11 months (OR 12.88, 95% CI 8.48–19.55), compared to those aged 12–23 months. Additional risk factors were living in low vs. higher socio-economic status towns (OR 1.49; 95% CI 1.14–1.95), having chronic medical conditions (OR 2.75; 95% CI 1.61–4.70), birth month (October–January vs. June–September) (OR 2.19; 95% CI 1.60–2.99) and history of stay in neonatal intensive care unit at birth (OR 2.37; 95% CI 1.27–4.41). Male children and those who had pneumonia were more likely to have severe RSV bronchiolitis. In conclusion, the burden of hospitalisations for RSV bronchiolitis is high, especially in young infants. Effective preventive measures such as RSV active vaccines can reduce the risk of hospitalisations for RSV bronchiolitis among these vulnerable groups.
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Voirin N, Virlogeux V, Demont C, Kieffer A. Potential Impact of Nirsevimab on RSV Transmission and Medically Attended Lower Respiratory Tract Illness Caused by RSV: A Disease Transmission Model. Infect Dis Ther 2022; 11:277-292. [PMID: 34813073 PMCID: PMC8847469 DOI: 10.1007/s40121-021-00566-9] [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: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is associated with significant morbidity worldwide, especially among infants. We evaluated the potential impact of prophylactic nirsevimab, a monoclonal antibody, in infants experiencing their first RSV season, and the number of medically-attended lower respiratory tract infection episodes caused by RSV (RSV-MALRTI) in the USA. METHODS We developed an age-structured, dynamic, deterministic compartmental model reflecting RSV natural history, incorporating USA demographic data and an age-specific contact matrix. We assumed either no effect of nirsevimab on transmission (scenario 1) or a 50% reduction of viral shedding (scenario 2). Model outcomes were RSV-MALRTIs, ICD-9 coded in the Marketscan® database by month. We focused on age groups corresponding to the first 2 years of life, during seven RSV seasons (2008-2015). RESULTS Scenario 1 illustrated the direct individual benefit when a universal immunization strategy is applied to all infants. In scenario 2, herd protection was observed across age groups, with 15.5% of all avoided cases due to reduced transmission; the greatest impact was in the youngest age group and a benefit was observed in those aged 65+ years. CONCLUSION These preliminary data suggest that single-dose nirsevimab will benefit infants experiencing their first RSV season, with a potential increase in effectiveness dependent on nirsevimab's mechanism of action.
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Affiliation(s)
- Nicolas Voirin
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Lent, France
| | - Victor Virlogeux
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Lent, France
- Hospices Civils de Lyon, Lyon, France
| | - Clarisse Demont
- Vaccine and Epidemiology Modelling, Sanofi Pasteur, Lyon, France
| | - Alexia Kieffer
- Health Economics and Value Assessment, Sanofi Pasteur, Siège Mondial, 14 Espace Henry Vallée, 69007, Lyon, France.
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35
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Affiliation(s)
- Mina Suh
- Correspondence: Mina Suh, MPH, EpidStrategies, A Division of ToxStrategies, Inc. 27001 La Paz Road, Suite 260 Mission Viejo, CA 92691 ()
| | - Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
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Brasier AR, Qiao D, Zhao Y. The Hexosamine Biosynthetic Pathway Links Innate Inflammation With Epithelial-Mesenchymal Plasticity in Airway Remodeling. Front Pharmacol 2021; 12:808735. [PMID: 35002741 PMCID: PMC8727908 DOI: 10.3389/fphar.2021.808735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
Disruption of the lower airway epithelial barrier plays a major role in the initiation and progression of chronic lung disease. Here, repetitive environmental insults produced by viral and allergens triggers metabolic adaptations, epithelial-mesenchymal plasticity (EMP) and airway remodeling. Epithelial plasticity disrupts epithelial barrier function, stimulates release of fibroblastic growth factors, and remodels the extracellular matrix (ECM). This review will focus on recent work demonstrating how the hexosamine biosynthetic pathway (HBP) links innate inflammation to airway remodeling. The HBP is a core metabolic pathway of the unfolded protein response (UPR) responsible for protein N-glycosylation, relief of proteotoxic stress and secretion of ECM modifiers. We will overview findings that the IκB kinase (IKK)-NFκB pathway directly activates expression of the SNAI-ZEB1 mesenchymal transcription factor module through regulation of the Bromodomain Containing Protein 4 (BRD4) chromatin modifier. BRD4 mediates transcriptional elongation of SNAI1-ZEB as well as enhancing chromatin accessibility and transcription of fibroblast growth factors, ECM and matrix metalloproteinases (MMPs). In addition, recent exciting findings that IKK cross-talks with the UPR by controlling phosphorylation and nuclear translocation of the autoregulatory XBP1s transcription factor are presented. HBP is required for N glycosylation and secretion of ECM components that play an important signaling role in airway remodeling. This interplay between innate inflammation, metabolic reprogramming and lower airway plasticity expands a population of subepithelial myofibroblasts by secreting fibroblastic growth factors, producing changes in ECM tensile strength, and fibroblast stimulation by MMP binding. Through these actions on myofibroblasts, EMP in lower airway cells produces expansion of the lamina reticularis and promotes airway remodeling. In this manner, metabolic reprogramming by the HBP mediates environmental insult-induced inflammation with remodeling in chronic airway diseases.
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Affiliation(s)
- Allan R. Brasier
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
- Institute for Clinical and Translational Research (ICTR), University of Wisconsin-Madison, Madison, WI, United States
| | - Dianhua Qiao
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, United States
| | - Yingxin Zhao
- Department of Internal Medicine, University of Texas Medical Branch Galveston, Galveston, TX, United States
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Mira-Iglesias A, Demont C, López-Labrador FX, Mengual-Chuliá B, García-Rubio J, Carballido-Fernández M, Tortajada-Girbés M, Mollar-Maseres J, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J. Role of age and birth month in infants hospitalized with RSV-confirmed disease in the Valencia Region, Spain. Influenza Other Respir Viruses 2021; 16:328-339. [PMID: 34821055 PMCID: PMC8818825 DOI: 10.1111/irv.12937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background RSV is the leading cause of hospital admissions in infants and the principal cause of bronchiolitis in young children. There is a lack of granular data on RSV‐associated hospitalization per season using laboratory confirmed results. Our current study addresses this issue and intends to fill this gap. Methods The study was conducted from 2014 through 2018, in 4 to 10 hospitals in the Valencia Region, Spain. Infants included in this study were admitted in hospital through the Emergency Department with a respiratory complaint and tested by RT‐PCR for RSV in a central laboratory. Results Incidence rates of RSV‐associated hospitalization varied by season and hospital. Overall, the highest incidence rates were observed in 2017/2018. RSV‐associated hospitalization was highest in infants below 3 months of age and in those born before or at the beginning of the RSV season. Almost 54% of total infants hospitalized with laboratory confirmed RSV were found to be born outside the season, from April to October. The RSV positivity rate by ICD‐10 discharged codes varied by season and age with results from 48% to 57% among LRI (J09‐J22). Conclusion The study was instrumental in bringing forth the time unpredictability of RSV epidemics, the critical impact of age, and the comparable distribution of RSV‐associated hospitalization in infants born on either side of the RSV season. These data could help in better characterization of the population that drives the healthcare burden and is crucial for the development of future immunization strategies, especially with upcoming vaccines in against RSV.
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Affiliation(s)
- Ainara Mira-Iglesias
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Clarisse Demont
- RSV Medical Evidence Generation, Sanofi Pasteur, Lyon, France
| | - F Xavier López-Labrador
- Laboratorio de Virología, Área de Genómica y Salud. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain.,Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Mengual-Chuliá
- Laboratorio de Virología, Área de Genómica y Salud. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier García-Rubio
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Mario Carballido-Fernández
- Preventive Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Spain.,Medicine Department, Universidad CEU Cardenal Herrera, Castellón de la Plana, Spain
| | | | - Juan Mollar-Maseres
- Preventive Medicine, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Germán Schwarz-Chavarri
- Out-of-Hospital Family and Community Medicine, Hospital General Universitario de Alicante, Alicante, Spain
| | - Joan Puig-Barberà
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis. CHILDREN 2021; 8:children8111035. [PMID: 34828749 PMCID: PMC8618830 DOI: 10.3390/children8111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.
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Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, Jayashree M. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021; 25:1301-1307. [PMID: 34866830 PMCID: PMC8608649 DOI: 10.5005/jp-journals-10071-24016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB). METHODOLOGY In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission. RESULTS Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes. CONCLUSION Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission. HOW TO CITE THIS ARTICLE Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, et al. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021;25(11):1301-1307.
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Affiliation(s)
| | - Lalit Takia
- Department of Pediatrics, PGIMER, Chandigarh, India
| | | | | | - Ishani Bora
- Department of Virology, PGIMER, Chandigarh, India
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Elkashif A, Alhashimi M, Sayedahmed EE, Sambhara S, Mittal SK. Adenoviral vector-based platforms for developing effective vaccines to combat respiratory viral infections. Clin Transl Immunology 2021; 10:e1345. [PMID: 34667600 PMCID: PMC8510854 DOI: 10.1002/cti2.1345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023] Open
Abstract
Since the development of the first vaccine against smallpox over two centuries ago, vaccination strategies have been at the forefront of significantly impacting the incidences of infectious diseases globally. However, the increase in the human population, deforestation and climate change, and the rise in worldwide travel have favored the emergence of new viruses with the potential to cause pandemics. The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a cruel reminder of the impact of novel pathogens and the suboptimal capabilities of conventional vaccines. Therefore, there is an urgent need to develop new vaccine strategies that allow the production of billions of doses in a short duration and are broadly protective against emerging and re-emerging infectious diseases. Extensive knowledge of the molecular biology and immunology of adenoviruses (Ad) has favored Ad vectors as platforms for vaccine design. The Ad-based vaccine platform represents an attractive strategy as it induces robust humoral and cell-mediated immune responses and can meet the global demand in a pandemic situation. This review describes the status of Ad vector-based vaccines in preclinical and clinical studies for current and emerging respiratory viruses, particularly coronaviruses, influenza viruses and respiratory syncytial viruses.
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Affiliation(s)
- Ahmed Elkashif
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
| | - Marwa Alhashimi
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
| | - Ekramy E Sayedahmed
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
| | | | - Suresh K Mittal
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
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Tong S, Amand C, Kieffer A, Kyaw MH. Incidence of respiratory syncytial virus related health care utilization in the United States. J Glob Health 2021; 10:020422. [PMID: 33110581 PMCID: PMC7568930 DOI: 10.7189/jogh.10.020422] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Respiratory Syncytial Virus (RSV) is one of the most frequent causes of acute respiratory infection worldwide. Understanding age-specific health care utilization is necessary to guide effective prevention strategies. This retrospective database analysis assessed the incidence rates of RSV-related health care utilization in the USA over a 7-year period. Methods Episodes of RSV were identified in the Truven Health MarketScan® Commercial Claims and Encounters database between 2008 and 2014 using ICD-9-CM codes for pneumonia, bronchiolitis and RSV (480-486, 487.0, 466.1, 491.2, 079.6). Annual RSV-related health care utilization was calculated for the total population, by age group (<1, 1, 2-4, 5-17, 18-49, 50-64, 65-74, 75-84 and ≥85 years) and the proportion of cases for each setting (hospitalization, outpatient, or emergency department [ED] / urgent care [UC]). Results Over the 7-year study period, the mean rate of all RSV-associated health care utilization was 2.4 per 1000 person-years, with mean rates ranging from 2.0 to 2.6). The highest rate was seen in infants aged <1 year (mean 79.0 per 1000 over the 7-year period), which decreased with increasing age in the range 2-49 years before increasing with age in older adults (mean rate 8.1 per 1000 over the 7-year period in those ≥85 years). Of all RSV cases, 82% were reported in an outpatient setting, 11% in the ED/UC and 7% were hospitalized. Conclusions The annual RSV-related healthcare utilization rates were substantial, especially in infants and young children. These results underscore the need to accelerate the development of RSV prevention strategies to reduce the healthcare burden of RSV.
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Affiliation(s)
| | | | | | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA
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42
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Qiao D, Skibba M, Xu X, Garofalo RP, Zhao Y, Brasier AR. Paramyxovirus replication induces the hexosamine biosynthetic pathway and mesenchymal transition via the IRE1α-XBP1s arm of the unfolded protein response. Am J Physiol Lung Cell Mol Physiol 2021; 321:L576-L594. [PMID: 34318710 PMCID: PMC8461800 DOI: 10.1152/ajplung.00127.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The paramyxoviridae, respiratory syncytial virus (RSV), and murine respirovirus are enveloped, negative-sense RNA viruses that are the etiological agents of vertebrate lower respiratory tract infections (LRTIs). We observed that RSV infection in human small airway epithelial cells induced accumulation of glycosylated proteins within the endoplasmic reticulum (ER), increased glutamine-fructose-6-phosphate transaminases (GFPT1/2) and accumulation of uridine diphosphate (UDP)-N-acetylglucosamine, indicating activation of the hexosamine biosynthetic pathway (HBP). RSV infection induces rapid formation of spliced X-box binding protein 1 (XBP1s) and processing of activating transcription factor 6 (ATF6). Using pathway selective inhibitors and shRNA silencing, we find that the inositol-requiring enzyme (IRE1α)-XBP1 arm of the unfolded protein response (UPR) is required not only for activation of the HBP, but also for expression of mesenchymal transition (EMT) through the Snail family transcriptional repressor 1 (SNAI1), extracellular matrix (ECM)-remodeling proteins fibronectin (FN1), and matrix metalloproteinase 9 (MMP9). Probing RSV-induced open chromatin domains by ChIP, we find XBP1 binds and recruits RNA polymerase II to the IL6, SNAI1, and MMP9 promoters and the intragenic superenhancer of glutamine-fructose-6-phosphate transaminase 2 (GFPT2). The UPR is sustained through RSV by an autoregulatory loop where XBP1 enhances Pol II binding to its own promoter. Similarly, we investigated the effects of murine respirovirus infection on its natural host (mouse). Murine respirovirus induces mucosal growth factor response, EMT, and the indicators of ECM remodeling in an IRE1α-dependent manner, which persists after viral clearance. These data suggest that IRE1α-XBP1s arm of the UPR pathway is responsible for paramyxovirus-induced metabolic adaptation and mucosal remodeling via EMT and ECM secretion.
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Affiliation(s)
- Dianhua Qiao
- Department of Internal Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Melissa Skibba
- Department of Internal Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Xiaofang Xu
- Department of Internal Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Roberto P Garofalo
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Yingxin Zhao
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Allan R Brasier
- Department of Internal Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, Wisconsin
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Whaley KJ, Zeitlin L. Emerging antibody-based products for infectious diseases: Planning for metric ton manufacturing. Hum Vaccin Immunother 2021; 18:1930847. [PMID: 34259613 PMCID: PMC9103258 DOI: 10.1080/21645515.2021.1930847] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This review focuses on the emerging monoclonal antibody market for infectious diseases and the metric ton scale manufacturing requirements to meet global demand. Increasing access to existing antibody-based products coupled with the unmet need in infectious disease will likely exceed the current existing global manufacturing capacity. Further, the large numbers of individuals infected during epidemics such as the ongoing COVID-19 pandemic emphasizes the need to plan for metric ton manufacturing of monoclonal antibodies by expanding infrastructure and exploring alternative production systems.
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Affiliation(s)
- Kevin J Whaley
- Mapp Biopharmaceutical, San Diego, CA, USA.,ZabBio, San Diego, CA, USA
| | - Larry Zeitlin
- Mapp Biopharmaceutical, San Diego, CA, USA.,ZabBio, San Diego, CA, USA
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Anderson LJ, Jadhao SJ, Paden CR, Tong S. Functional Features of the Respiratory Syncytial Virus G Protein. Viruses 2021; 13:1214. [PMID: 34372490 PMCID: PMC8310105 DOI: 10.3390/v13071214] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/28/2021] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of serious lower respiratory tract infections in children <5 years of age worldwide and repeated infections throughout life leading to serious disease in the elderly and persons with compromised immune, cardiac, and pulmonary systems. The disease burden has made it a high priority for vaccine and antiviral drug development but without success except for immune prophylaxis for certain young infants. Two RSV proteins are associated with protection, F and G, and F is most often pursued for vaccine and antiviral drug development. Several features of the G protein suggest it could also be an important to vaccine or antiviral drug target design. We review features of G that effect biology of infection, the host immune response, and disease associated with infection. Though it is not clear how to fit these together into an integrated picture, it is clear that G mediates cell surface binding and facilitates cellular infection, modulates host responses that affect both immunity and disease, and its CX3C aa motif contributes to many of these effects. These features of G and the ability to block the effects with antibody, suggest G has substantial potential in vaccine and antiviral drug design.
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Affiliation(s)
- Larry J. Anderson
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA;
| | - Samadhan J. Jadhao
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA;
| | - Clinton R. Paden
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA; (C.R.P.); (S.T.)
| | - Suxiang Tong
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA; (C.R.P.); (S.T.)
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Burden of Respiratory Syncytial Virus Associated Severe Pneumonia in Hospitalized Children. Int J Pediatr 2021; 2021:8269400. [PMID: 34306103 PMCID: PMC8266452 DOI: 10.1155/2021/8269400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of severe respiratory infections. We examined the burden of RSV-associated severe community-acquired pneumonia among hospitalized children and factors that predict RSV etiology. A hospital-based prospective study examined children below five years of age admitted with radiologically confirmed severe or very severe pneumonia in two tertiary care centers in Sri Lanka. Nasopharyngeal secretions (NPS) were tested for 19 viruses by multiplex RT-PCR. Univariate and multivariate analysis was performed to determine whether RSV etiology could be predicted based on clinical, sociodemographic, environmental, radiological, and laboratory parameters. A total of 108 children with severe or very severe were included in the study. At least one virus was found in NPS in 92.5% of children. Forty-six children had RSV (+) pneumonia. Mean RSV proportion was 42.6% (95% CI: 33.1-52.5%, p value = 0.149). RSV as a single virus was found in 41.3% (19/46). The children with RSV (+) pneumonia were younger (p = 0.026) and had lower C-reactive protein (p = 0.003) and household crowding (p = 0.012) than the RSV (-) group, after controlling for confounding covariates. In conclusion, the present study demonstrated that respiratory syncytial virus was the commonest virus associated with CAP in children under five years. Younger age, crowded housing, and lower C-reactive protein levels were predictors of severe RSV-associated pneumonia.
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Heinonen S, Velazquez VM, Ye F, Mertz S, Acero-Bedoya S, Smith B, Bunsow E, Garcia-Mauriño C, Oliva S, Cohen DM, Moore-Clingenpeel M, Peeples ME, Ramilo O, Mejias A. Immune profiles provide insights into respiratory syncytial virus disease severity in young children. Sci Transl Med 2021; 12:12/540/eaaw0268. [PMID: 32321862 DOI: 10.1126/scitranslmed.aaw0268] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 11/21/2019] [Accepted: 03/05/2020] [Indexed: 12/29/2022]
Abstract
Respiratory syncytial virus (RSV) is associated with major morbidity in infants, although most cases result in mild disease. The pathogenesis of the disease is incompletely understood, especially the determining factors of disease severity. A better characterization of these factors may help with development of RSV vaccines and antivirals. Hence, identification of a "safe and protective" immunoprofile induced by natural RSV infection could be used as a as a surrogate of ideal vaccine-elicited responses in future clinical trials. In this study, we integrated blood transcriptional and cell immune profiling, RSV loads, and clinical data to identify factors associated with a mild disease phenotype in a cohort of 190 children <2 years of age. Children with mild disease (outpatients) showed higher RSV loads, greater induction of interferon (IFN) and plasma cell genes, and decreased expression of inflammation and neutrophil genes versus children with severe disease (inpatients). Additionally, only infants with severe disease had increased numbers of HLA-DRlow monocytes, not present in outpatients. Multivariable analyses confirmed that IFN overexpression was associated with decreased odds of hospitalization, whereas increased numbers of HLA-DRlow monocytes were associated with increased risk of hospitalization. These findings suggest that robust innate immune responses are associated with mild RSV infection in infants.
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Affiliation(s)
- Santtu Heinonen
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Victoria M Velazquez
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Fang Ye
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Sara Mertz
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Santiago Acero-Bedoya
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Bennett Smith
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Eleonora Bunsow
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Cristina Garcia-Mauriño
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Silvia Oliva
- Division of Pediatric Emergency Medicine and Critical Care, Hospital Regional Universitario de Málaga, Málaga 29001, Spain.,Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Málaga 29071, Spain
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, The Research Institute at Nationwide Children's Hospital Columbus, OH 43205, USA
| | - Mark E Peeples
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. .,Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. .,Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Málaga 29071, Spain.,Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH 43205, USA
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47
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Jadhao SJ, Ha B, McCracken C, Gebretsadik T, Rosas-Salazar C, Chappell J, Das S, Hartert T, Anderson LJ. Performance evaluation of antibody tests for detecting infant respiratory syncytial virus infection. J Med Virol 2021; 93:3439-3445. [PMID: 33325064 PMCID: PMC8046717 DOI: 10.1002/jmv.26736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/20/2020] [Accepted: 12/12/2020] [Indexed: 11/12/2022]
Abstract
Respiratory syncytial virus (RSV) infection is a major cause of respiratory tract disease in young children and throughout life. Infant infection is also associated with later respiratory morbidity including asthma. With a prospective birth cohort study of RSV and asthma, we evaluated the performance of an RSV antibody enzyme-linked immunoassay (EIA) for detecting prior infant RSV infection. Infant RSV infection was determined by biweekly respiratory illness surveillance plus RSV polymerase chain reaction (PCR) testing in their first RSV season and serum RSV antibodies after the season at approximately 1 year of age. RSV antibodies were detected by RSV A and B lysate EIA. Antibody and PCR results on 1707 children included 327 RSV PCR positive (PCR+) and 1380 not RSV+. Of 327 PCR+ children, 314 (96%) were lysate EIA positive and 583 out of 1380 (42%) children not PCR+ were positive. We compared the lysate EIA to RSV F, group A G (Ga), and group B G (Gb) protein antibody EIAs in a subset of 226 sera, 118 PCR+ children (97 group A and 21 group B) and 108 not PCR+. In this subset, 117 out of 118 (99%) RSV PCR+ children were positive by both the F and lysate EIAs and 103 out of 118 (87%) were positive by the Ga and/or Gb EIAs. Comparison of the two G EIAs indicated the infecting group correctly in 100 out of 118 (86%) and incorrectly in 1 out of 118 (1%). The lysate and F EIAs are sensitive for detecting infant infection and the two G EIAs can indicate the group of an earlier primary infection.
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Affiliation(s)
- Samadhan J. Jadhao
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Binh Ha
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Courtney McCracken
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Tebeb Gebretsadik
- Department of Medicine, Biostatistics and Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Christian Rosas-Salazar
- Department of Medicine, Biostatistics and Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James Chappell
- Department of Medicine, Biostatistics and Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Suman Das
- Department of Medicine, Biostatistics and Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Tina Hartert
- Department of Medicine, Biostatistics and Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Larry J. Anderson
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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48
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Grier A, Gill AL, Kessler HA, Corbett A, Bandyopadhyay S, Java J, Holden-Wiltse J, Falsey AR, Topham DJ, Mariani TJ, Caserta MT, Walsh EE, Gill SR. Temporal Dysbiosis of Infant Nasal Microbiota Relative to Respiratory Syncytial Virus Infection. J Infect Dis 2021; 223:1650-1658. [PMID: 32926147 PMCID: PMC8136976 DOI: 10.1093/infdis/jiaa577] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of infant respiratory disease. Infant airway microbiota has been associated with respiratory disease risk and severity. The extent to which interactions between RSV and microbiota occur in the airway, and their impact on respiratory disease susceptibility and severity, are unknown. METHODS We carried out 16S rRNA microbiota profiling of infants in the first year of life from (1) a cross-sectional cohort of 89 RSV-infected infants sampled during illness and 102 matched healthy controls, and (2) a matched longitudinal cohort of 12 infants who developed RSV infection and 12 who did not, sampled before, during, and after infection. RESULTS We identified 12 taxa significantly associated with RSV infection. All 12 taxa were differentially abundant during infection, with 8 associated with disease severity. Nasal microbiota composition was more discriminative of healthy vs infected than of disease severity. CONCLUSIONS Our findings elucidate the chronology of nasal microbiota dysbiosis and suggest an altered developmental trajectory associated with RSV infection. Microbial temporal dynamics reveal indicators of disease risk, correlates of illness and severity, and impact of RSV infection on microbiota composition.
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Affiliation(s)
- Alex Grier
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Genomics Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ann L Gill
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Haeja A Kessler
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Anthony Corbett
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sanjukta Bandyopadhyay
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - James Java
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jeanne Holden-Wiltse
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ann R Falsey
- Department of Medicine, Rochester General Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David J Topham
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Thomas J Mariani
- Division of Neonatology and Pediatric Molecular and Personalized Medicine Program, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mary T Caserta
- Division of Pediatric Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Edward E Walsh
- Department of Medicine, Rochester General Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Steven R Gill
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Genomics Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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49
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Toptan T, Ciesek S, Hoehl S. Pediatrics and COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:197-208. [PMID: 33973180 DOI: 10.1007/978-3-030-63761-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Viral respiratory tract infections are prevalent in children. They have substantial effects on childhood morbidity throughout the world, especially in developing countries. In this chapter, we describe the preliminary characteristics of pediatric COVID-19 and discover that severe and critical disease in children is rare. Many children remain asymptomatic. The reason why severity increases with progressing age and largely spares children is not yet known. In the search for possible explanations, we explore key differences between the pediatric and adult immune responses to new pathogens, and in host factors, such as ACE2 abundance.
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Affiliation(s)
- Tuna Toptan
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Sandra Ciesek
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Sebastian Hoehl
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
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50
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Barbieri E, Rossin S, Giaquinto C, Da Dalt L, Dona’ D. A Procalcitonin and C-Reactive Protein-Guided Clinical Pathway for Reducing Antibiotic Use in Children Hospitalized with Bronchiolitis. CHILDREN (BASEL, SWITZERLAND) 2021; 8:351. [PMID: 33925182 PMCID: PMC8146464 DOI: 10.3390/children8050351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
Despite the lack of evidence that bronchodilators, corticosteroids, and antibiotics are useful in treating bronchiolitis, their use is still widespread. This study aimed to determine the consumption of antibiotics for bronchiolitis before and after a procalcitonin-guided clinical pathway (CP) implementation. In December 2019, a CP for lower respiratory tract infection management was implemented at the Department of Women's and Children's Health at Padua University Hospital. This was a pre-post, quasi-experimental study that assessed the changes in the treatment of bronchiolitis during two bimesters preceding the CP implementation (pre-period: January 2018-February 2018 and January 2019-February 2019) and during the bimester after CP implementation (post-period January 2020-February 2020). After the CP implementation, there was a significant reduction in antibiotic prescriptions from 36.2% to 12.5% (p = 0.036) in patients hospitalized for bronchiolitis. Co-amoxiclav treatment, the antibiotic most commonly administered, decreased from 66.6% to 33.3%. Among outpatients' bronchiolitis episodes, a statistically significant decrease in beta2-agonists' use (from 18.0% to 4.4%, pre and post periods) and a quasi-significant decrease in corticosteroid use (from 8.0% to 0% pre and post periods) were observed. An evidence-based CP supported by educational lectures was associated with significant changes in the physicians' prescribing habits.
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Affiliation(s)
- Elisa Barbieri
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35100 Padova, Italy; (C.G.); (D.D.)
| | - Sara Rossin
- Pediatric Emergency Department, Department of Women’s and Children’s Health, University Hospital of Padova, 35100 Padova, Italy; (S.R.); (L.D.D.)
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35100 Padova, Italy; (C.G.); (D.D.)
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Women’s and Children’s Health, University Hospital of Padova, 35100 Padova, Italy; (S.R.); (L.D.D.)
| | - Daniele Dona’
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35100 Padova, Italy; (C.G.); (D.D.)
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