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Reicherz F, Abu-Raya B, Akinseye O, Rassekh SR, Wiens MO, Lavoie PM. Efficacy of Palivizumab Immunoprophylaxis for Reducing Severe RSV Outcomes in Children with Immunodeficiencies: A Systematic Review. J Pediatric Infect Dis Soc 2024; 13:136-143. [PMID: 38279954 DOI: 10.1093/jpids/piae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Palivizumab is recommended for prevention of severe respiratory syncytial virus (RSV) disease in immunocompromised children, despite a lack of strong supporting evidence. The recent approval of substitute RSV-neutralizing monoclonal antibodies against RSV, offers an opportunity to synthesize the most current evidence supporting the palivizumab standard of care. OBJECTIVE To evaluate the efficacy of palivizumab in preventing acute respiratory tract infection- or RSV-related hospitalization, or mortality in immunocompromised children. METHODS We searched Ovid MEDLINE and EMBASE for published clinical studies that investigated outcomes of palivizumab use in children. We included clinical trials, cohort studies, and case-control studies. The primary outcomes were RSV-related or respiratory viral infection-related hospitalizations, or RSV-related mortality. This systematic review was registered in PROSPERO (ID CRD42021248619) and is reported in accordance with the PRISMA guidelines. RESULTS From the 1993 records, six studies were eligible and included, for a total of 625 immunocompromised children with an heterogeneous composition of primary and acquired immunodeficiencies enrolled from palivizumab programs. There were no intervention studies. None of the studies included a control group. RSV hospitalizations were infrequent (0%-3.1% of children). Most children included received palivizumab, although one study (n = 56) did not specify how many received palivizumab. RSV mortality was neither observed, in three studies, nor reported, in three other studies. CONCLUSIONS The evidence supporting the use of palivizumab for prevention of severe RSV disease in immunocompromised children remains extremely limited and appears insufficient to justify prioritizing this intervention as the current standard of care over alternative interventions.
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Affiliation(s)
- Frederic Reicherz
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Bahaa Abu-Raya
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Canada
- Departments of Pediatrics, Dalhousie University, Nova Scotia, Canada
- Microbiology and Immunology, Dalhousie University, Nova Scotia, Canada
| | - Omolabake Akinseye
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shahrad Rod Rassekh
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Matthew O Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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2
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Risso-Ballester J, Rameix-Welti MA. Spatial resolution of virus replication: RSV and cytoplasmic inclusion bodies. Adv Virus Res 2023; 116:1-43. [PMID: 37524479 DOI: 10.1016/bs.aivir.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Respiratory Syncytial Virus (RSV) is a major cause of respiratory illness in young children, elderly and immunocompromised individuals worldwide representing a severe burden for health systems. The urgent development of vaccines or specific antivirals against RSV is impaired by the lack of knowledge regarding its replication mechanisms. RSV is a negative-sense single-stranded RNA (ssRNA) virus belonging to the Mononegavirales order (MNV) which includes other viruses pathogenic to humans as Rabies (RabV), Ebola (EBOV), or measles (MeV) viruses. Transcription and replication of viral genomes occur within cytoplasmatic virus-induced spherical inclusions, commonly referred as inclusion bodies (IBs). Recently IBs were shown to exhibit properties of membrane-less organelles (MLO) arising by liquid-liquid phase separation (LLPS). Compartmentalization of viral RNA synthesis steps in viral-induced MLO is indeed a common feature of MNV. Strikingly these key compartments still remain mysterious. Most of our current knowledge on IBs relies on the use of fluorescence microscopy. The ability to fluorescently label IBs in cells has been key to uncover their dynamics and nature. The generation of recombinant viruses expressing a fluorescently-labeled viral protein and the immunolabeling or the expression of viral fusion proteins known to be recruited in IBs are some of the tools used to visualize IBs in infected cells. In this chapter, microscope techniques and the most relevant studies that have shed light on RSV IBs fundamental aspects, including biogenesis, organization and dynamics are being discussed and brought to light with the investigations carried out on other MNV.
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Affiliation(s)
| | - Marie-Anne Rameix-Welti
- Institut Pasteur, Université Paris-Saclay, Université de Versailles St. Quentin, UMR 1173 (2I), INSERM, Paris, France; Assistance Publique des Hôpitaux de Paris, Hôpital Ambroise Paré, Laboratoire de Microbiologie, DMU15, Paris, France.
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3
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Gonnin L, Richard CA, Gutsche I, Chevret D, Troussier J, Vasseur JJ, Debart F, Eléouët JF, Galloux M. Importance of RNA length for in vitro encapsidation by the nucleoprotein of human Respiratory Syncytial Virus. J Biol Chem 2022; 298:102337. [PMID: 35931116 PMCID: PMC9436823 DOI: 10.1016/j.jbc.2022.102337] [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: 04/23/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Respiratory syncytial virus has a negative-sense single-stranded RNA genome constitutively encapsidated by the viral nucleoprotein N, forming a helical nucleocapsid which is the template for viral transcription and replication by the viral polymerase L. Recruitment of L onto the nucleocapsid depends on the viral phosphoprotein P, which is an essential L cofactor. A prerequisite for genome and antigenome encapsidation is the presence of the monomeric, RNA-free, neosynthesized N protein, named N0. Stabilization of N0 depends on the binding of the N-terminal residues of P to its surface, which prevents N oligomerization. However, the mechanism involved in the transition from N0-P to nucleocapsid assembly, and thus in the specificity of viral genome encapsidation, is still unknown. Furthermore, the specific role of N oligomerization and RNA in the morphogenesis of viral factories, where viral transcription and replication occur, have not been elucidated although the interaction between P and N complexed to RNA has been shown to be responsible for this process. Here, using a chimeric protein comprising N and the first 40 N-terminal residues of P, we succeeded in purifying a recombinant N0-like protein competent for RNA encapsidation in vitro. Our results showed the importance of RNA length for stable encapsidation and revealed that the nature of the 5′ end of RNA does not explain the specificity of encapsidation. Finally, we showed that RNA encapsidation is crucial for the in vitro reconstitution of pseudo-viral factories. Together, our findings provide insight into respiratory syncytial virus viral genome encapsidation specificity.
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Affiliation(s)
- Lorène Gonnin
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | - Irina Gutsche
- University of Grenoble Alpes, CEA, CNRS, IBS, Grenoble, France
| | - Didier Chevret
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Joris Troussier
- IBMM, Université de Montpellier, ENSCM, CNRS, UMR 5247, Montpellier, France
| | | | - Françoise Debart
- IBMM, Université de Montpellier, ENSCM, CNRS, UMR 5247, Montpellier, France
| | | | - Marie Galloux
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France.
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4
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Cosentino G, Marougka K, Desquesnes A, Welti N, Sitterlin D, Gault E, Rameix-Welti MA. Respiratory syncytial virus ribonucleoproteins hijack microtubule Rab11 dependent transport for intracellular trafficking. PLoS Pathog 2022; 18:e1010619. [PMID: 35797399 PMCID: PMC9262236 DOI: 10.1371/journal.ppat.1010619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/25/2022] [Indexed: 01/31/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the primary cause of severe respiratory infection in infants worldwide. Replication of RSV genomic RNA occurs in cytoplasmic inclusions generating viral ribonucleoprotein complexes (vRNPs). vRNPs then reach assembly and budding sites at the plasma membrane. However, mechanisms ensuring vRNPs transportation are unknown. We generated a recombinant RSV harboring fluorescent RNPs allowing us to visualize moving vRNPs in living infected cells and developed an automated imaging pipeline to characterize the movements of vRNPs at a high throughput. Automatic tracking of vRNPs revealed that around 10% of the RNPs exhibit fast and directed motion compatible with transport along the microtubules. Visualization of vRNPs moving along labeled microtubules and restriction of their movements by microtubule depolymerization further support microtubules involvement in vRNPs trafficking. Approximately 30% of vRNPs colocalize with Rab11a protein, a marker of the endosome recycling (ER) pathway and we observed vRNPs and Rab11-labeled vesicles moving together. Transient inhibition of Rab11a expression significantly reduces vRNPs movements demonstrating Rab11 involvement in RNPs trafficking. Finally, Rab11a is specifically immunoprecipitated with vRNPs in infected cells suggesting an interaction between Rab11 and the vRNPs. Altogether, our results strongly suggest that RSV RNPs move on microtubules by hijacking the ER pathway.
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Affiliation(s)
- Gina Cosentino
- Université Paris-Saclay, Université de Versailles St. Quentin, UMR 1173 (2I), INSERM, Versailles, France
| | - Katherine Marougka
- Université Paris-Saclay, Université de Versailles St. Quentin, UMR 1173 (2I), INSERM, Versailles, France
| | - Aurore Desquesnes
- Université Paris-Saclay, Université de Versailles St. Quentin, UMR 1173 (2I), INSERM, Versailles, France
| | - Nicolas Welti
- Université Paris-Saclay, Université de Versailles St. Quentin, UMR 1173 (2I), INSERM, Versailles, France
| | - Delphine Sitterlin
- Université Paris-Saclay, Université de Versailles St. Quentin, UMR 1173 (2I), INSERM, Versailles, France
| | - Elyanne Gault
- Université Paris-Saclay, Université de Versailles St. Quentin; UMR 1173 (2I), INSERM; Assistance Publique des Hôpitaux de Paris, Hôpital Ambroise Paré, Laboratoire de Microbiologie, DMU15; Versailles, France
| | - Marie-Anne Rameix-Welti
- Université Paris-Saclay, Université de Versailles St. Quentin; UMR 1173 (2I), INSERM; Assistance Publique des Hôpitaux de Paris, Hôpital Ambroise Paré, Laboratoire de Microbiologie, DMU15; Versailles, France
- * E-mail:
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5
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González-Granado LI, Martín-Nalda A, Alsina L, Neth O, Santamaría M, Soler-Palacín P. Infecciones por virus respiratorio sincitial que requieren hospitalización en pacientes con inmunodeficiencias primarias. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Respiratory syncytial virus infections requiring hospitalization in patients with primary immunodeficiency. An Pediatr (Barc) 2022; 96:492-500. [DOI: 10.1016/j.anpede.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
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7
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Interactions between the Nucleoprotein and the Phosphoprotein of Pneumoviruses: Structural Insight for Rational Design of Antivirals. Viruses 2021; 13:v13122449. [PMID: 34960719 PMCID: PMC8706346 DOI: 10.3390/v13122449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Pneumoviruses include pathogenic human and animal viruses, the most known and studied being the human respiratory syncytial virus (hRSV) and the metapneumovirus (hMPV), which are the major cause of severe acute respiratory tract illness in young children worldwide, and main pathogens infecting elderly and immune-compromised people. The transcription and replication of these viruses take place in specific cytoplasmic inclusions called inclusion bodies (IBs). These activities depend on viral polymerase L, associated with its cofactor phosphoprotein P, for the recognition of the viral RNA genome encapsidated by the nucleoprotein N, forming the nucleocapsid (NC). The polymerase activities rely on diverse transient protein-protein interactions orchestrated by P playing the hub role. Among these interactions, P interacts with the NC to recruit L to the genome. The P protein also plays the role of chaperone to maintain the neosynthesized N monomeric and RNA-free (called N0) before specific encapsidation of the viral genome and antigenome. This review aims at giving an overview of recent structural information obtained for hRSV and hMPV P, N, and more specifically for P-NC and N0-P complexes that pave the way for the rational design of new antivirals against those viruses.
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8
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Descamps D, Peres de Oliveira A, Gonnin L, Madrières S, Fix J, Drajac C, Marquant Q, Bouguyon E, Pietralunga V, Iha H, Morais Ventura A, Tangy F, Vidalain PO, Eléouët JF, Galloux M. Depletion of TAX1BP1 Amplifies Innate Immune Responses during Respiratory Syncytial Virus Infection. J Virol 2021; 95:e0091221. [PMID: 34431698 PMCID: PMC8549506 DOI: 10.1128/jvi.00912-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the main cause of acute respiratory infections in young children and also has a major impact on the elderly and immunocompromised people. In the absence of a vaccine or efficient treatment, a better understanding of RSV interactions with the host antiviral response during infection is needed. Previous studies revealed that cytoplasmic inclusion bodies (IBs), where viral replication and transcription occur, could play a major role in the control of innate immunity during infection by recruiting cellular proteins involved in the host antiviral response. We recently showed that the morphogenesis of IBs relies on a liquid-liquid-phase separation mechanism depending on the interaction between viral nucleoprotein (N) and phosphoprotein (P). These scaffold proteins are expected to play a central role in the recruitment of cellular proteins to IBs. Here, we performed a yeast two-hybrid screen using RSV N protein as bait and identified the cellular protein TAX1BP1 as a potential partner of this viral protein. This interaction was validated by pulldown and immunoprecipitation assays. We showed that TAX1BP1 suppression has only a limited impact on RSV infection in cell cultures. However, RSV replication is decreased in TAX1BP1-deficient (TAX1BP1 knockout [TAX1BP1KO]) mice, whereas the production of inflammatory and antiviral cytokines is enhanced. In vitro infection of wild-type or TAX1BP1KO alveolar macrophages confirmed that the innate immune response to RSV infection is enhanced in the absence of TAX1BP1. Altogether, our results suggest that RSV could hijack TAX1BP1 to restrain the host immune response during infection. IMPORTANCE Respiratory syncytial virus (RSV), which is the leading cause of lower respiratory tract illness in infants, remains a medical problem in the absence of a vaccine or efficient treatment. This virus is also recognized as a main pathogen in the elderly and immunocompromised people, and the occurrence of coinfections (with other respiratory viruses and bacteria) amplifies the risks of developing respiratory distress. In this context, a better understanding of the pathogenesis associated with viral respiratory infections, which depends on both viral replication and the host immune response, is needed. The present study reveals that the cellular protein TAX1BP1, which interacts with the RSV nucleoprotein N, participates in the control of the innate immune response during RSV infection, suggesting that the N-TAX1BP1 interaction represents a new target for the development of antivirals.
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Affiliation(s)
| | - Andressa Peres de Oliveira
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Lorène Gonnin
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Sarah Madrières
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Jenna Fix
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Carole Drajac
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Quentin Marquant
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Edwige Bouguyon
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | - Hidekatsu Iha
- Department of Infectious Diseases, Faculty of Medicine, Oita University Idaiga-oka, Hasama Yufu, Japan
| | - Armando Morais Ventura
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Frédéric Tangy
- Unité de Génomique Virale et Vaccination, Institut Pasteur, CNRS UMR-3569, Paris, France
| | - Pierre-Olivier Vidalain
- Unité de Génomique Virale et Vaccination, Institut Pasteur, CNRS UMR-3569, Paris, France
- CIRI, Centre International de Recherche en Infectiologie, Université Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | | | - Marie Galloux
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
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10
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Okada K, Mizuno M, Moriuchi H, Kusuda S, Morioka I, Mori M, Okamoto K, Okada K, Yoshihara S, Yamagishi H, Yokoyama U, Kubota T, Kudo K, Takagi M, Ito S, Kanamori Y, Sasahara Y. The Working Group for Revision of "Guidelines for the Use of Palivizumab in Japan": A Committee Report. Pediatr Int 2020; 62:1223-1229. [PMID: 33078556 DOI: 10.1111/ped.14410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Satoshi Kusuda
- Japan Society for Neonatal Health and Development, Osaka, Japan
| | - Ichiro Morioka
- Japan Society for Neonatal Health and Development, Osaka, Japan
| | - Masaaki Mori
- Japanese Society for Pediatric Infectious Diseases, Tokyo, Japan.,Pediatric Rheumatology Association of Japan, Tokyo, Japan
| | - Keisuke Okamoto
- Japanese Society for Pediatric Infectious Diseases, Tokyo, Japan
| | | | | | - Hiroyuki Yamagishi
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Utako Yokoyama
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | | | - Kazuko Kudo
- The Japanese Society of Pediatric Hematology/Oncology, Tokyo, Japan
| | - Masatoshi Takagi
- The Japanese Society of Pediatric Hematology/Oncology, Tokyo, Japan
| | - Shuichi Ito
- Japanese Society for Pediatric Nephrology, Tokyo, Japan
| | | | - Yoji Sasahara
- Japanese Society for Immunodeficiency and Autoinflammatory Diseases, Tokyo, Japan
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11
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Respiratory Syncytial Virus Prophylaxis in Immunocompromised Children: Outcomes From the Canadian RSV Evaluation Study of Palivizumab Registry Over Twelve Seasons (2005-2017). Pediatr Infect Dis J 2020; 39:539-545. [PMID: 32235248 DOI: 10.1097/inf.0000000000002665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immunocompromised children are at increased risk for respiratory syncytial virus (RSV) infection with associated morbidity and mortality. Prophylaxis is usually provided to these children on a case-by-case basis. METHODS Immunocompromised children who received ≥1 injection of palivizumab were prospectively enrolled across 32 Canadian sites, between 2005 and 2017, during the RSV season. We assessed respiratory illness hospitalization (RIH) and RSV-related hospitalization (RSVH) hazard ratios (HRs) in immunocompromised children versus infants' prophylaxed for standard indications (SI: prematurity ≤35 weeks' gestation, bronchopulmonary dysplasia, and congenital heart disease) and complex medical disorders (CMD). Data were analyzed using t-tests, χ and Cox proportional hazards adjusted for confounders. RESULTS A total of 25,003 infants were recruited; 214 immunocompromised, 4283 CMD, 20,506 SI. On average, children received 4.4 ± 1.3 injections. A total of 16,231 children were perfectly adherent (58.4% immunodeficiency, 68.9% CMD, 64.2% SI; P < 0.0005). A higher proportion of immunocompromised children were aboriginal and exposed to smoking compared with CMD and SI. Immunocompromised children also had a higher median; gestational and enrollment age and birth weight compared with CMD and SI. Immunodeficient children had a higher RIH risk compared with SI (HR = 2.4, 95% confidence interval, 1.3-4.7, P = 0.009) but were similar to CMD (HR = 1.7, 95% confidence interval, 0.9-3.4, P = 0.118). RSVH in prophylaxed, immunocompromised children was similar to CMD (HR < 0.005, P = 0.955) and SI (HR < 0.005, P = 0.953). CONCLUSIONS Immunocompromised children who received palivizumab had an increased RIH hazard compared with the SI group. Similar RSVH hazard between the 3 groups suggests that immunocompromised children may benefit from palivizumab during the RSV season.
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12
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Ye X, Iwuchukwu OP, Avadhanula V, Aideyan LO, McBride TJ, Ferlic-Stark LL, Patel KD, Piedra FA, Shah DP, Chemaly RF, Piedra PA. Antigenic Site-Specific Competitive Antibody Responses to the Fusion Protein of Respiratory Syncytial Virus Were Associated With Viral Clearance in Hematopoietic Cell Transplantation Adults. Front Immunol 2019; 10:706. [PMID: 30984206 PMCID: PMC6449644 DOI: 10.3389/fimmu.2019.00706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Recent studies of human sera showed that the majority of the respiratory syncytial virus (RSV) neutralizing antibodies are directed against pre-fusion conformation of the fusion (F) protein of RSV and revealed the importance of pre-fusion antigenic site Ø specific antibodies. However, detailed analysis of multiple antigenic site-specific competitive antibody responses to RSV F protein and their contribution to virus clearance in humans are lacking. Methods: We prospectively enrolled a cohort of RSV infected hematopoietic cell transplantation (HCT) adults (n = 40). Serum samples were collected at enrollment (acute, n = 40) and 14 to 60 days post-enrollment (convalescent, n = 40). Antigenic site-specific F protein antibodies were measured against pre-fusion site Ø, post-fusion site I, and sites II and IV present in both the pre-fusion and post-fusion F protein conformations utilizing four different competitive antibody assays developed with biotinylated monoclonal antibodies (mAb) D25, 131-2A, palivizumab, and 101F, respectively. The lower limit of detection were 7.8 and 1.0 μg/mL for the competitive antibody assays that measured site Ø specific response, as well as sites I, II, and IV specific responses, respectively. Neutralizing antibody titers to RSV A and B subgroups was determined by microneutralization assays. Results: The overall findings in RSV infected HCT adults revealed: (1) a significant increase in antigenic site-specific competitive antibodies in convalescent sera except for site Ø competitive antibody (p < 0.01); (2) comparable concentrations in the acute and convalescent serum samples of antigenic site-specific competitive antibodies between RSV/A and RSV/B infected HCT adults (p > 0.05); (3) significantly increased concentrations of the antigenic site-specific competitive antibodies in HCT adults who had genomic RSV detected in the upper respiratory tract for <14 days compared to those for ≥14 days (p < 0.01); and (4) statistically significant correlation between the antigenic site-specific competitive antibody concentrations and neutralizing antibody titers against RSV/A and RSV/B (r ranged from 0.33 to 0.83 for acute sera, and 0.50-0.88 for convalescent sera; p < 0.05). Conclusions: In RSV infected HCT adults, antigenic site-specific antibody responses were induced against multiple antigenic sites found in both the pre-fusion and post-fusion F conformations, and were associated with a more rapid viral clearance and neutralizing antibody activity. However, the association is not necessarily the cause and the consequence.
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Affiliation(s)
- Xunyan Ye
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Obinna P Iwuchukwu
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Vasanthi Avadhanula
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Letisha O Aideyan
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Trevor J McBride
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Laura L Ferlic-Stark
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Kirtida D Patel
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Felipe-Andres Piedra
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Dimpy P Shah
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Roy F Chemaly
- Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pedro A Piedra
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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13
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Science M, Akseer N, Asner S, Allen U. Risk stratification of immunocompromised children, including pediatric transplant recipients at risk of severe respiratory syncytial virus disease. Pediatr Transplant 2019; 23:e13336. [PMID: 30604582 DOI: 10.1111/petr.13336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/18/2018] [Accepted: 11/02/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection is associated with increased morbidity and mortality in immunocompromised patients. Our goal was to develop a framework for risk stratifying immunocompromised patients, including transplant patients, for RSV prophylaxis. METHODS Risk factors for severe RSV disease in immunocompromised patients were identified in the literature and by an expert panel via survey. Experts assigned a probability of developing severe disease (0 to 100 scale) to the risk factors for each immunocompromised population. The results were validated using a clinical dataset. Linear mixed models adjusted for within-expert clustering of ranks were used to estimate average scores, and differences were tested using paired t tests. Logistic regression was utilized to identify important determinants of severe RSV disease. RESULTS The survey was emailed to twenty-seven experts and thirteen responded (48%). Across all transplant groups, age <2 years (mean 77.1, 95% CI 71.7, 82.5) and day care attendance (mean 72.8, 95% CI 67.3, 78.3) were assigned the highest risk of severe disease. The highest risk groups were lung transplant recipients (mean 73.2, 95% CI 67.6, 78.8), combined lung and heart transplant recipients (mean 75.2, 95% CI 69.6, 80.7), allogeneic stem cell transplant (mean 76.0, 95% CI 70.4, 81.6), and severe combined immunodeficiency (mean 74.7, 95% CI 69.1, 80.3). CONCLUSION The results provide a logical validity to current practice and provide guidance for prioritizing patients to receive prophylactic agents to prevent severe RSV disease. The results will facilitate the development of a risk stratification tool for RSV prophylaxis for immunocompromised patients.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nadia Akseer
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sandra Asner
- Pediatric Infectious Diseases Unit, Department of Pediatrics, University Hospital Lausanne, Lausanne, Switzerland
| | - Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Vittucci AC, Zangari P, Ciarlitto C, Di Camillo C, Grandin A, Cotugno N, Marchili MR, Villani A. Active prophylaxis for respiratory syncytial virus: current knowledge and future perspectives. Minerva Pediatr 2018; 70:566-578. [PMID: 30334621 DOI: 10.23736/s0026-4946.18.05305-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common respiratory pathogen in infants and young children but represents also an important cause of morbidity in adults, particularly in the elderly and immunocompromised persons. Despite its global impact on human health, no effective treatment is available except for supportive care and no safe vaccine has been licensed yet. Vaccine development has been hindered by several factors including vaccine enhanced disease associated with formalin-inactivated RSV vaccine, ethical concerns and lack of consensus concerning the most appropriate target antigen. In this review, we analyze history of RSV vaccine and current approaches for preventing RSV including live-attenuated, vector-based, subunit, nucleic acid-based, particle-based vaccines and we debate about concerns on target population, correlates of protection and obstacles that are slowing the progress toward a successful RSV vaccination strategy.
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Affiliation(s)
- Anna C Vittucci
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy -
| | - Paola Zangari
- Congenital and Perinatal Infections Research Unit, Division of Immune and Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | | | - Chiara Di Camillo
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Annalisa Grandin
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Nicola Cotugno
- Congenital and Perinatal Infections Research Unit, Division of Immune and Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Maria R Marchili
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
| | - Alberto Villani
- Unit of Pediatric Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital (OPBG), Rome, Italy
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15
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German P, Xin Y, Chien JW, Weng W, Mackman R, Lewis SA, Meng A, Ling J, Mathias A. Phase 1 First-in-Human, Single- and Multiple-Ascending Dose, and Food Effect Studies to Assess the Safety, Tolerability, and Pharmacokinetics of Presatovir for the Treatment of Respiratory Syncytial Virus Infection. J Clin Pharmacol 2018; 58:1025-1034. [PMID: 29663420 DOI: 10.1002/jcph.1112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/31/2018] [Indexed: 12/12/2022]
Abstract
Respiratory syncytial virus (RSV)-associated respiratory tract infection is a leading cause of hospitalizations in infants for which no effective treatment exists. RSV infection is also an important cause of respiratory disease in adults and immunocompromised patients. Presatovir (GS-5806) is an orally bioavailable antiviral agent that inhibits fusion of RSV with host cell membranes. Here, results from 2 phase 1 studies that evaluated safety, tolerability, and pharmacokinetics of presatovir in healthy adults following administration of single and multiple (7 days) once- or twice-daily ascending doses (first-in-human study) and in the presence or absence of food (food effect study) are described. Presatovir exhibited favorable safety and pharmacokinetic profiles that supported once-daily dosing. Presatovir exposure increased in an approximately dose-proportional manner across the evaluated dose range (single doses 25-300 mg; multiple doses 10-75 mg once daily for 7 days). Administration of presatovir with a high-fat meal did not alter exposure, supporting administration without regard to a meal in further clinical studies. These data were subsequently used to inform presatovir dosing regimens in a phase 2a challenge study of adults experimentally infected with RSV. Collectively, results from phase 1 evaluations and a phase 2a challenge study support further clinical investigation of presatovir for the treatment of RSV infection.
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Affiliation(s)
| | - Yan Xin
- Gilead Sciences, Inc, Foster City, CA, USA
| | | | | | | | | | - Amy Meng
- Gilead Sciences, Inc, Foster City, CA, USA
| | - John Ling
- Gilead Sciences, Inc, Foster City, CA, USA
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16
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Chatzis O, Darbre S, Pasquier J, Meylan P, Manuel O, Aubert JD, Beck-Popovic M, Masouridi-Levrat S, Ansari M, Kaiser L, Posfay-Barbe KM, Asner SA. Burden of severe RSV disease among immunocompromised children and adults: a 10 year retrospective study. BMC Infect Dis 2018; 18:111. [PMID: 29510663 PMCID: PMC5838875 DOI: 10.1186/s12879-018-3002-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) recipients, with less known about other immunocompromised patients. Methods Ten-year retrospective cohort study of immunocompromised patients presenting with RSV disease documented at University Hospitals of Lausanne and Geneva. Severe RSV-related outcomes referred to RSV documented respiratory conditions requiring hospital admission, presenting as lower respiratory tract infection (LRTI) or pneumonia. We used multivariable logistic regression to assess clinical and laboratory correlates of severe RSV disease. Results From 239 RSV-positive immunocompromised in and out-patients 175 were adults and 64 children of whom 111 (47.8%) presented with LRTI, which resulted in a 38% (89/239) admission rate to hospital. While immunocompromised children were more likely to be admitted to hospital compared to adults (75% vs 62.9%, p = 0.090), inpatients admitted to the intensive care unit (17/19) or those who died (11/11) were mainly adults. From multivariable analyses, adults with solid tumors (OR 5.2; 95% CI: 1.4–20.9 P = 0.015) or those requiring chronic immunosuppressive treatments mainly for rheumatologic conditions (OR 4.1; 95% CI: 1.1–16.0; P = 0.034) were significantly more likely to be admitted to hospital compared to hematopoietic stem cell (HSCT) recipients. Bacterial co-infection was significantly and consistently associated with viral LRTI and pneumonia. Conclusions From our findings, RSV-related disease results in a significant burden among adults requiring chronic immunosuppressive treatments for rheumatological conditions and those with solid tumors. As such, systematic screening for respiratory viruses, should be extended to other immunocompromised populations than HSCT recipients. Electronic supplementary material The online version of this article (10.1186/s12879-018-3002-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Chatzis
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephanie Darbre
- Department of Paediatrics, Paediatric Infectious Disease Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
| | - Pascal Meylan
- Department of Laboratories, Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Department of Medicine, Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Surgery, Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - John David Aubert
- Unit of Pulmonary transplantation, Pulmonology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Department of Pediatrics, Paediatric Hematology and Oncology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Marc Ansari
- Paediatric Hematology and Oncology Unit, Division of General Pediatrics, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Department of Medicine, Infectious Diseases Service, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Genetical and Laboratory Medicine, Virology Laboratory, Laboratory Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandra A Asner
- Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Medicine, Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland. .,Department of Pediatrics, Pediatric Infectious Disease Unit, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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17
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Manzoni P, Figueras-Aloy J, Simões EAF, Checchia PA, Fauroux B, Bont L, Paes B, Carbonell-Estrany X. Defining the Incidence and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Children with Chronic Diseases. Infect Dis Ther 2017; 6:383-411. [PMID: 28653300 PMCID: PMC5595774 DOI: 10.1007/s40121-017-0160-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION REGAL (RSV Evidence-a Geographical Archive of the Literature) has provided a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This review covers the risk and burden of RSV infection in children with underlying medical conditions or chronic diseases (excluding prematurity and congenital heart disease). METHODS A systematic review of publications between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov was supplemented by papers identified by the authors through March 2017. Studies reporting data for hospital visits/admissions for RSV infection as well as studies reporting RSV-associated morbidity and mortality were included. Study quality and strength of evidence (SOE) were graded. RESULTS A total of 2703 studies were identified and 58 were included. Down syndrome, irrespective of prematurity and congenital heart disease (moderate SOE), immunocompromised children (low SOE), cystic fibrosis (low SOE), and neurologic conditions (low SOE) were associated with a significantly increased risk of RSV hospitalization. A number of other congenital malformations and chronic conditions were also associated with severe RSV disease (low SOE). In general, pre-existing disease was also a predisposing factor for RSV-related mortality (low SOE). CONCLUSION Severe RSV infection in infants and young children with underlying medical conditions or chronic diseases poses a significant health burden. Further studies are needed to fully quantify the epidemiology, burden and outcomes in these populations, in particular RSV-attributable mortality.
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Affiliation(s)
- Paolo Manzoni
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
- ReSViNET (Respiratory Syncytial Virus Network), Málaga, Spain
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Eric A F Simões
- Center for Global Health, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Louis Bont
- ReSViNET (Respiratory Syncytial Virus Network), Málaga, Spain
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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18
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Nanishi E, Hoshina T, Takada H, Ishimura M, Nishio H, Uehara T, Mizuno Y, Hasegawa S, Ohga S, Nagao M, Igarashi M, Yajima S, Kusumoto Y, Onishi N, Sasahara Y, Yasumi T, Heike T, Hara T. A nationwide survey of common viral infections in childhood among patients with primary immunodeficiency diseases. J Infect 2016; 73:358-68. [PMID: 27498293 DOI: 10.1016/j.jinf.2016.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients with primary immunodeficiency diseases (PID) are highly susceptible to various microorganisms. However, no population-based studies have been performed among common viral pathogens, such as respiratory syncytial virus (RSV), rotavirus (RV), varicella-zoster virus (VZV) and influenza virus (IV). The objective of this study was to reveal the clinical burden of these four infections among PID patients in Japan. METHODS We conducted a nationwide survey by sending questionnaires to 898 hospitals with pediatric departments throughout Japan. RESULTS Nine hundred ten PID patients from 621 hospitals were registered (response rate: 69.2%). Fifty-four of the patients were hospitalized due to these viral infections. The durations of hospitalization due to RSV and RV infections differed significantly in the PID patients with and without cellular immunodeficiency (12.0 vs 6.5 days, p = 0.041; and 14.0 vs 6.0 days, p = 0.031, respectively). There was no significant difference in the duration of hospitalization in PID patients with and without cellular immunodeficiency who were hospitalized with IV infections (7.3 vs 6.1 days, p = 0.53). CONCLUSIONS Special attention should be paid to PID patients with compromised cellular immunity who present with RSV and RV infection due to their high risk for severe disease.
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Affiliation(s)
- Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takayuki Hoshina
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Uehara
- Department of Pediatrics, Kameda Medical Center, Kamogawa, Japan
| | - Yumi Mizuno
- Department of Pediatric Infectious Disease, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatrics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Masayoshi Nagao
- Department of Pediatrics and Clinical Research, NHO Hokkaido Medical Center, Sapporo, Japan
| | - Maiko Igarashi
- Department of Pediatrics, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Shuhei Yajima
- Department of Pediatrics, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Yoshio Kusumoto
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Noriko Onishi
- Department of Pediatrics, Fujita General Hospital, Fukushima, Japan
| | - Yoji Sasahara
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Yasumi
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Heike
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiro Hara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Fukuoka Children's Hospital, Fukuoka, Japan
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19
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Lighter-Fisher J, Stanley K, Phillips M, Pham V, Klejmont LM. Preventing Infections in Children with Cancer. Pediatr Rev 2016; 37:247-58. [PMID: 27252180 DOI: 10.1542/pir.2015-0059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Kaitlin Stanley
- Department of Pediatrics, New York University Langone Medical Center, New York, NY
| | - Michael Phillips
- Department of Medicine, New York University Langone Medical Center, New York, NY
| | - Vinh Pham
- Department of Medicine, New York University Langone Medical Center, New York, NY
| | - Liana M Klejmont
- Department of Pharmacy, New York University Langone Medical Center, New York, NY
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20
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Chu HY, Chin J, Pollard J, Zerr DM, Englund JA. Clinical outcomes in outpatient respiratory syncytial virus infection in immunocompromised children. Influenza Other Respir Viruses 2016; 10:205-10. [PMID: 26859306 PMCID: PMC4814860 DOI: 10.1111/irv.12375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/27/2022] Open
Abstract
Background Immunocompromised patients are at high risk for morbidity and mortality due to respiratory syncytial virus (RSV) infection. Increasingly, pediatric patients with malignancy or undergoing transplantation are managed primarily as outpatients. Data regarding the clinical presentation and outcomes of RSV in the outpatient pediatric immunocompromised population are limited. Methods We performed a retrospective cohort study of children with hematologic malignancy or hematopoietic or solid organ transplant with laboratory‐confirmed RSV infection diagnosed as outpatients at an academic medical center between 2008 and 2013. Results Of 54 patients with RSV detected while outpatients, 15 (28%) were hospitalized, 7 (13%) received ribavirin, and one (2%) received intravenous immunoglobulin. One (2%) patient was critically ill, but there were no deaths due to RSV infection. Fever (P < 0·01) was associated with increased risk of hospitalization. Conclusions Most immunocompromised children with RSV detected while outpatients did not require hospitalization or receive antiviral treatment. Potential studies of RSV therapies should consider inclusion of patients in an ambulatory setting.
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Affiliation(s)
- Helen Y Chu
- Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Jennifer Chin
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
| | - Jessica Pollard
- Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, WA, USA
| | - Danielle M Zerr
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
| | - Janet A Englund
- Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA.,Division of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
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21
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Boukhvalova M, Blanco JCG, Falsey AR, Mond J. Treatment with novel RSV Ig RI-002 controls viral replication and reduces pulmonary damage in immunocompromised Sigmodon hispidus. Bone Marrow Transplant 2016; 51:119-26. [PMID: 26367224 PMCID: PMC7091900 DOI: 10.1038/bmt.2015.212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/22/2015] [Accepted: 07/25/2015] [Indexed: 01/08/2023]
Abstract
Respiratory syncytial virus (RSV) is a significant cause of bronchiolitis and pneumonia in several high health risk populations, including infants, elderly and immunocompromised individuals. Mortality in hematopoietic stem cell transplant recipients with lower respiratory tract RSV infection can exceed 80%. It has been shown that RSV replication in immunosuppressed individuals is significantly prolonged, but the contribution of pulmonary damage, if any, to the pathogenesis of RSV disease in this susceptible population is not known. In this work, we tested RI-002, a novel standardized Ig formulation containing a high level of RSV-neutralizing Ab, for its ability to control RSV infection in immunocompromised cotton rats Sigmodon hispidus. Animals immunosuppressed by repeat cyclophosphamide injections were infected with RSV and treated with RI-002. Prolonged RSV replication, characteristic of immunosuppressed cotton rats, was inhibited by RI-002 administration. Ab treatment reduced detection of systemic dissemination of viral RNA. Importantly, pulmonary interstitial inflammation and epithelial hyperplasia that were significantly elevated in immunosuppressed animals were reduced by RI-002 administration. These results indicate the potential of RI-002 to improve outcome of RSV infection in immunocompromised subjects not only by controlling viral replication, but also by reducing damage to lung parenchyma and epithelial airway lining, but further studies are needed.
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Affiliation(s)
- M Boukhvalova
- Department of Molecular Biology/Virology, Sigmovir Biosystems, Inc., Rockville, MD USA
| | - J C G Blanco
- Department of Molecular Biology/Virology, Sigmovir Biosystems, Inc., Rockville, MD USA
| | - A R Falsey
- Infectious Diseases Unit, Rochester General Hospital, University of Rochester Medical Center, Rochester, NY USA
| | - J Mond
- ADMA Biologics, Ramsey, NJ USA
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22
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Weinberger DM, Warren JL, Steiner CA, Charu V, Viboud C, Pitzer VE. Reduced-Dose Schedule of Prophylaxis Based on Local Data Provides Near-Optimal Protection Against Respiratory Syncytial Virus. Clin Infect Dis 2015; 61:506-14. [PMID: 25904370 PMCID: PMC4542596 DOI: 10.1093/cid/civ331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/21/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of respiratory infections among young children and can lead to severe disease among some infants. Infants at high risk for severe RSV infection receive monthly injections of a prophylactic monoclonal antibody during the RSV season based on national guidelines. We considered whether a reduced-dose schedule tailored to the local RSV season in the continental United States would provide adequate protection. METHODS Hospitalization data for 1942 counties across 38 states from 1997 to 2009 were obtained from the State Inpatient Databases (Agency for Healthcare Research and Quality). We assessed the timing of RSV epidemics at the county and state levels using a 2-stage hierarchical Bayesian change point model. We used a simple summation approach to estimate the fraction of RSV cases that occur during the window of protection provided by initiating RSV prophylaxis during different weeks of the year. RESULTS The timing of RSV epidemic onset varied significantly at the local level. Nevertheless, the national recommendations for initiation of prophylaxis provided near-optimal coverage of the RSV season in most of the continental United States. Reducing from 5 to 4 monthly doses (with a later initiation) provides near-optimal coverage (<5% decrease in coverage) in most settings. Earlier optimal dates for initiating 4 doses of prophylaxis were associated with being farther south and east, higher population density, and having a higher percentage of the population that was black or Hispanic. CONCLUSIONS A 4-dose schedule of prophylactic injections timed with local RSV epidemics could provide protection comparable to 5 doses and could be considered as a way to improve the cost-effectiveness of prophylaxis.
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Affiliation(s)
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Claudia A. Steiner
- Department of Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets Agency for Healthcare Research and Quality, Rockville
| | - Vivek Charu
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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23
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Domínguez-Pinilla N, Belda Hofheinz S, Vivanco Martinez J, Baro-Fernández M, Ruiz-Contreras J, González-Granado L. Respiratory syncytial virus in immunocompromised patients in a paediatric hospital: 5 years’ experience. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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24
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Domínguez-Pinilla N, Belda Hofheinz S, Vivanco Martinez J, Baro-Fernández M, Ruiz-Contreras J, González-Granado L. Infección por virus respiratorio sincitial en los pacientes inmunodeprimidos en un hospital pediátrico: experiencia de 5 años. An Pediatr (Barc) 2015; 82:35-40. [DOI: 10.1016/j.anpedi.2014.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/13/2014] [Accepted: 04/15/2014] [Indexed: 01/04/2023] Open
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25
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Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134:e620-38. [PMID: 25070304 DOI: 10.1542/peds.2014-1666] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Guidance from the American Academy of Pediatrics (AAP) for the use of palivizumab prophylaxis against respiratory syncytial virus (RSV) was first published in a policy statement in 1998. Guidance initially was based on the result from a single randomized, placebo-controlled clinical trial conducted in 1996-1997 describing an overall reduction in RSV hospitalization rate from 10.6% among placebo recipients to 4.8% among children who received prophylaxis. The results of a second randomized, placebo-controlled trial of children with hemodynamically significant heart disease were published in 2003 and revealed a reduction in RSV hospitalization rate from 9.7% in control subjects to 5.3% among prophylaxis recipients. Because no additional controlled trials regarding efficacy were published, AAP guidance has been updated periodically to reflect the most recent literature regarding children at greatest risk of severe disease. Since the last update in 2012, new data have become available regarding the seasonality of RSV circulation, palivizumab pharmacokinetics, the changing incidence of bronchiolitis hospitalizations, the effects of gestational age and other risk factors on RSV hospitalization rates, the mortality of children hospitalized with RSV infection, and the effect of prophylaxis on wheezing and palivizumab-resistant RSV isolates. These data enable further refinement of AAP guidance to most clearly focus on those children at greatest risk.
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antiviral Agents/administration & dosage
- Antiviral Agents/pharmacokinetics
- Antiviral Agents/therapeutic use
- Child, Preschool
- Comorbidity
- Cystic Fibrosis/epidemiology
- Down Syndrome/epidemiology
- Gestational Age
- Hospitalization/statistics & numerical data
- Humans
- Immunocompromised Host
- Indians, North American/statistics & numerical data
- Infant
- Infant, Premature
- Injections, Intramuscular
- Neuromuscular Diseases/epidemiology
- Palivizumab
- Respiratory Sounds
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Virus Infections/ethnology
- Respiratory Syncytial Virus Infections/prevention & control
- Risk Factors
- Seasons
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Resch B. Respiratory Syncytial Virus Infection in High-risk Infants - an Update on Palivizumab Prophylaxis. Open Microbiol J 2014; 8:71-7. [PMID: 25132870 PMCID: PMC4133922 DOI: 10.2174/1874285801408010071] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 11/22/2022] Open
Abstract
Morbidity due to respiratory syncytial virus (RSV) disease is still high in infants and children worldwide during the first two to five years of life. Certain categories of high-risk infants with increased morbidity and mortality attributed to RSV disease have been identified and are included in national recommendations for prophylaxis with the monoclonal RSV antibody palivizumab. Most guidelines recommend palivizumab for preterm infants born less than or equal to 32 weeks gestational age with or without bronchopulmonary dysplasia, those born between 33 and 35 weeks gestational age with additional risk factors, and infants and children with hemodynamically significant congenital heart disease. Over the last years several rare diseases have been identified demonstrating high morbidity associated with RSV disease, thus, extension of guidelines for the prophylaxis with palivizumab for these patients with rare diseases including children with malignancy, congenital and acquired immune deficiency, Down syndrome, neuromuscular impairment, cystic fibrosis, congenital diaphragmatic hernia and other severe respiratory disease is increasingly discussed. Efficacy of palivizumab prophylaxis is documented by meta-analysis, and different economic analyses demonstrate cost-effectiveness of palivizumab for the most common indications during the first RSV season.
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Affiliation(s)
- Bernhard Resch
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Austria
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Lanari M, Vandini S, Capretti MG, Lazzarotto T, Faldella G. Respiratory syncytial virus infections in infants affected by primary immunodeficiency. J Immunol Res 2014; 2014:850831. [PMID: 25089282 PMCID: PMC4095650 DOI: 10.1155/2014/850831] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 12/30/2022] Open
Abstract
Primary immunodeficiencies are rare inherited disorders that may lead to frequent and often severe acute respiratory infections. Respiratory syncytial virus (RSV) is one of the most frequent pathogens during early infancy and the infection is more severe in immunocompromised infants than in healthy infants, as a result of impaired T- and B-cell immune response unable to efficaciously neutralize viral replication, with subsequent increased viral shedding and potentially lethal lower respiratory tract infection. Several authors have reported a severe clinical course after RSV infections in infants and children with primary and acquired immunodeficiencies. Environmental prophylaxis is essential in order to reduce the infection during the epidemic season in hospitalized immunocompromised infants. Prophylaxis with palivizumab, a humanized monoclonal antibody against the RSV F protein, is currently recommended in high-risk infants born prematurely, with chronic lung disease or congenital heart disease. Currently however the prophylaxis is not routinely recommended in infants with primary immunodeficiency, although some authors propose the extension of prophylaxis to this high risk population.
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Affiliation(s)
- Marcello Lanari
- Pediatrics and Neonatology Unit, Imola Hospital, Via Montericco 4, 40026 Imola, Italy
| | - Silvia Vandini
- DIMEC, Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Via Massarenti 11, University of Bologna, 40138 Bologna, Italy
| | - Maria Grazia Capretti
- DIMEC, Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Via Massarenti 11, University of Bologna, 40138 Bologna, Italy
| | - Tiziana Lazzarotto
- DIMES, Clinical Microbiology Unit, Laboratory of Virology, St. Orsola-Malpighi Hospital, Via Massarenti 9, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- DIMEC, Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Via Massarenti 11, University of Bologna, 40138 Bologna, Italy
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28
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Abstract
Respiratory viruses are important pediatric pathogens with pronounced seasonal patterns of circulation. Various hypotheses have been put forth to explain the seasonality of these infections, many involving environmental factors. This review summarizes the effect of temperature on the epidemicity of respiratory viruses, with an emphasis on epidemiological findings from large-scale metanalyses, laboratory-derived data using animal models and possible mechanisms to account for viral seasonality.
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