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Han HJ, Ryu D, Kim JY, Jang S, Suh HS. Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study. BMC Infect Dis 2024; 24:1152. [PMID: 39396944 PMCID: PMC11472633 DOI: 10.1186/s12879-024-09971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 09/20/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease. METHODS This retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV. RESULTS Out of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 - 1,261) and full-term infants ($ 606; 95% CI: 583-630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk-shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics. CONCLUSION Our findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden.
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Affiliation(s)
- Hyun Jin Han
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Dahye Ryu
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Ju Young Kim
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Semin Jang
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea
- College of Pharmacy, The University of Texas at Austin, Austin, TX, 78712 , USA
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea.
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, 02447, Republic of Korea.
- College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea.
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Méroc E, Liang C, Iantomasi R, Onwuchekwa C, Innocenti GP, d'Angela D, Molalign S, Tran TMP, Basu S, Gessner BD, Bruyndonckx R, Polkowska-Kramek A, Begier E. A Model-Based Estimation of RSV-Attributable Incidence of Hospitalizations and Deaths in Italy Between 2015 and 2019. Infect Dis Ther 2024:10.1007/s40121-024-01041-x. [PMID: 39289329 DOI: 10.1007/s40121-024-01041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/30/2024] [Indexed: 09/19/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) incidence is known to be underestimated in adults due to its infrequent diagnostic testing and lower sensitivity of single nasal/nasopharyngeal swab PCR testing outside of the early childhood period. RSV can trigger acute cardiac events as well as cause respiratory disease. Consequently, we used a model-based study to estimate RSV-attributable hospitalization and mortality incidence among adults in Italy between 2015 and 2019. METHODS Through a database predisposed by CREA Sanità, by extracting monthly data from the Italian hospitalization collection data of the Ministry of Health and the Italian National Institute of Statistics (ISTAT) data (mortality), we estimated yearly RSV-attributable incidence of events for different cardiorespiratory outcomes. We used a quasi-Poisson regression model, which accounted for periodic and aperiodic time trends and viral activity proxies. RESULTS The yearly RSV-attributable cardiorespiratory hospitalization incidence increased with age and was highest among adults aged ≥ 75 years (1064-1527 cases per 100,000 person-years). Similarly, the RSV-attributable cardiorespiratory mortality rate was highest among persons aged ≥ 75 years (59-85 deaths per 100,000 person-years). Incidence rates for RSV-attributable hospitalizations and RSV-attributable mortality were on average 2-3 times higher for cardiorespiratory than respiratory disease alone. Incidence rate based on RSV-specific ICD codes only were 405-1729 times lower than modeled estimates accounting for untested events. CONCLUSION RSV causes a substantial disease burden among adults in Italy and contributes to both respiratory and cardiovascular conditions. Our results emphasize the need for effective RSV prevention strategies, particularly among older adults.
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Affiliation(s)
- Estelle Méroc
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Caihua Liang
- Pfizer Inc, Milan, Italy.
- Pfizer Inc, Dublin, Ireland.
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
| | - Raffaella Iantomasi
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
| | | | - Giuseppe Pietro Innocenti
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
| | - Daniela d'Angela
- Centro Per La Ricerca Economica Applicanta in Sanita, Rome, Italy
| | | | | | - Somsuvro Basu
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Bradford D Gessner
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
| | | | | | - Elizabeth Begier
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
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Boracchini R, Canova B, Ferrara P, Cantarutti L, Giaquinto C, Di Chiara C, Cantarutti A. A silent strain: the unseen burden of acute respiratory infections in children. Ital J Pediatr 2024; 50:167. [PMID: 39244583 PMCID: PMC11380415 DOI: 10.1186/s13052-024-01754-2] [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: 07/01/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024] Open
Abstract
The significant impact of acute respiratory tract infections on healthcare systems is well-documented, given their contribution to emergency department admissions, hospitalizations, and increased use of antibiotics and other medications. However, further research is needed to understand the burden of acute respiratory tract infections in pediatric community care to develop effective public health interventions and improve child health outcomes. Real-world data were retrieved from Pedianet, an Italian network of over 200 family pediatricians. Acute respiratory tract infection visits were identified and analysed using an infection-duration algorithm to extract individual cases. The number of follow-up visits per 100 cases was calculated to assess the burden on the Italian National Health Service. Comparisons were made overall and stratified by type of acute respiratory tract infections and epidemiological season. A total of 1,402,953 acute respiratory infections-related visits were recorded, with an overall rate of 12 visits per 100 cases. Upper respiratory tract infections had an average of 9 visits per 100 cases. Lower respiratory tract infections exhibited a higher burden, with 29 visits per 100 cases. Pneumonia showed a declining trend in the pre-pandemic era (62 to 48 visits) but rebounded in the post-COVID-19 years (32 to 42 visits). This study underscores the importance of monitoring and managing acute respiratory infections, especially lower respiratory tract infections, in pediatric care.
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Affiliation(s)
- Riccardo Boracchini
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Via Bicocca Degli Arcimboldi, 8, Milan, 20126, Italy.
| | - Benedetta Canova
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Via Bicocca Degli Arcimboldi, 8, Milan, 20126, Italy
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, Via Cadore 48, Monza, 20900, Italy
| | - Luigi Cantarutti
- Società Servizi Telematici (SoSeTe), Pedianet Project, Via Giacomo Medici 9/A, Padua, 35138, Italy
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, Padua, 35128, Italy
| | - Costanza Di Chiara
- Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, Padua, 35128, Italy
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Via Bicocca Degli Arcimboldi, 8, Milan, 20126, Italy
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Mitratza M, Elsobky M, Liang C, Bruyndonckx R, Polkowska-Kramek A, Ewnetu WB, Peerawaranun P, Tran TMP, Nuttens C, Grajales AG, Nzula S, Gessner BD, Begier E. Estimated Incidence of Hospitalizations Attributable to RSV Infection Among Adults in Ontario, Canada, Between 2013 and 2019. Infect Dis Ther 2024; 13:1949-1962. [PMID: 39004648 PMCID: PMC11343949 DOI: 10.1007/s40121-024-01018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Adult respiratory syncytial virus (RSV) burden is underestimated due to non-specific symptoms, limited standard-of-care and delayed testing, reduced diagnostic test sensitivity-particularly when using single diagnostic specimen-when compared to children, and variable test sensitivity based on the upper airway specimen source. We estimated RSV-attributable hospitalization incidence among adults aged ≥ 18 years in Ontario, Canada, using a retrospective time-series model-based approach. METHODS The Institute for Clinical Evaluative Sciences data repository provided weekly numbers of hospitalizations (from 2013 to 2019) for respiratory, cardiovascular, and cardiorespiratory disorders. The number of hospitalizations attributable to RSV was estimated using a quasi-Poisson regression model that considered probable overdispersion and was based on periodic and aperiodic time trends and viral activity. As proxies for viral activity, weekly counts of RSV and influenza hospitalizations in children under 2 years and adults aged 60 years and over, respectively, were employed. Models were stratified by age and risk group. RESULTS In patients ≥ 60 years, RSV-attributable incidence rates were high for cardiorespiratory hospitalizations (range [mean] in 2013-2019: 186-246 [215] per 100,000 person-years, 3‒4% of all cardiorespiratory hospitalizations), and subgroups including respiratory hospitalizations (144-192 [167] per 100,000 person-years, 5‒7% of all respiratory hospitalizations) and cardiovascular hospitalizations (95-126 [110] per 100,000 person-years, 2‒3% of all cardiovascular hospitalizations). RSV-attributable cardiorespiratory hospitalization incidence increased with age, from 14-18 [17] hospitalizations per 100,000 person-years (18-49 years) to 317-411 [362] per 100,000 person-years (≥ 75 years). CONCLUSIONS Estimated RSV-attributable respiratory hospitalization incidence among people ≥ 60 years in Ontario, Canada, is comparable to other incidence estimates from high-income countries, including model-based and pooled prospective estimates. Recently introduced RSV vaccines could have a substantial public health impact.
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Affiliation(s)
| | | | - Caihua Liang
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
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Kenmoe S, Nair H. The disease burden of respiratory syncytial virus in older adults. Curr Opin Infect Dis 2024; 37:129-136. [PMID: 38197402 PMCID: PMC10911257 DOI: 10.1097/qco.0000000000001000] [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: 01/11/2024]
Abstract
PURPOSE OF REVIEW To highlight the respiratory syncytial virus (RSV) disease burden and the current developments and challenges in RSV prevention for older adults ≥60 years through analysis of RSV epidemiology and the effectiveness of emerging vaccines. RECENT FINDINGS In industrialized countries, RSV incidence rates and hospitalization rates among older adults are estimated to be 600.7 cases per 100 000 person-years and 157 hospitalizations per 100 000 person-years, respectively. Yet, accurately determining RSV morbidity and mortality in older adults is challenging, thus resulting in substantially under-estimating the disease burden. The in-hospital fatality rates vary substantially with age and geographies, and can be as high as 9.1% in developing countries. Two promising RSV vaccines for the elderly have been approved, demonstrating efficacies of up to 94.1%, signifying considerable advancement in RSV prevention. However, concerns over potential side effects remain. SUMMARY RSV is associated with a significant burden in older adults. While the landscape of RSV prevention in older adults is promising with the licensure of vaccines from two companies, current trial data underscore the need for additional studies. Addressing the real-world effectiveness of these vaccines, understanding potential rare side effects, and ensuring broad inclusivity in future trials are crucial steps to maximize their potential benefits.
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Affiliation(s)
- Sebastien Kenmoe
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- School of Public Health, University of the Witwatersrand, South Africa
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Boattini M, Almeida A, Comini S, Bianco G, Cavallo R, Costa C. From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults. Viruses 2024; 16:531. [PMID: 38675874 PMCID: PMC11053843 DOI: 10.3390/v16040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory syncytial virus (RSV) is increasingly recognized as being implicated in acute illness in older adults, with a significant weight in hospitalizations for respiratory illness and death. By means of a best-evidence review, this paper aims to investigate whether RSV can be considered a forgotten pathogen in older patients, looking at trends in the literature volume and exploring possible epidemiological and clinical features underlying the focus given to it. We then present an assessment of its disease burden and present and future strategies for its reduction, particularly in light of the recent availability of new vaccines.
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Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - André Almeida
- Department of Internal Medicine 4, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-024 Lisbon, Portugal;
- NOVA Medical School, Universidade Nova de Lisboa, Centro Clínico Académico de Lisboa, 1169-056 Lisbon, Portugal
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, 60035 Jesi, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Department of Experimental Medicine, University of Salento, Via Provinciale Monteroni n. 165, 73100 Lecce, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
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Bouzid D, Visseaux B, Ferré VM, Peiffer-Smadja N, Le Hingrat Q, Loubet P. Respiratory syncytial virus in adults with comorbidities: an update on epidemiology, vaccines, and treatments. Clin Microbiol Infect 2023; 29:1538-1550. [PMID: 37666450 DOI: 10.1016/j.cmi.2023.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is widely known as a frequent cause of respiratory distress among adults, particularly in older people. Recent years have witnessed several improvements in respiratory virus detection, leading to more questions about therapeutic management strategies. OBJECTIVES This narrative review focuses on the RSV burden in older people and adults with risk factors and provides an update on the main recent developments regarding managing this infection. SOURCES A comprehensive PubMed search was conducted till August 2023 to identify studies on RSV among the adult population. We included observational studies, RCTs on vaccines, and different therapies. CONTENT This review should give clinicians an overview of RSV epidemiology and burden among older people and adults with pre-existing risk factors, the most recent randomized clinical trials on RSV vaccines, and the existing data on the different therapeutics existing and under development. IMPLICATIONS There is a growing body of evidence on RSV burden in adults. The landscape of preventive and curative treatments is quickly evolving.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Emergency Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Benoit Visseaux
- Laboratoire Cerba, Infectious Diseases Department, Saint Ouen l'Aumône, France
| | - Valentine Marie Ferré
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Infectious Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Virology Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Quentin Le Hingrat
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Infectious Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Paul Loubet
- Université de Montpellier, VBMI, Inserm U1047, Nîmes, France; Department of Infectious and Tropical Diseases, CHU Nîmes, Université de Montpellier, Nîmes, France.
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Njue A, Nuabor W, Lyall M, Margulis A, Mauskopf J, Curcio D, Kurosky S, Gessner BD, Begier E. Systematic Literature Review of Risk Factors for Poor Outcomes Among Adults With Respiratory Syncytial Virus Infection in High-Income Countries. Open Forum Infect Dis 2023; 10:ofad513. [PMID: 38033988 PMCID: PMC10686344 DOI: 10.1093/ofid/ofad513] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Identification of risk factors for severe respiratory syncytial virus (RSV) disease in adults could facilitate their appropriate vaccine recommendations. We conducted a systematic literature review (last 10 years in PubMed/Embase) to identify quantitative estimates of risk factors for severe RSV infection outcomes in high-income countries. Severe outcomes from RSV infection included hospitalization, excess mortality, lower respiratory tract infection, or a composite measure: severe RSV, which included these outcomes and others, such as mechanical ventilation and extended hospital stay. Among 1494 articles screened, 26 met eligibility criteria. We found strong evidence that the following increased the risk of severe outcomes: age, preexisting comorbid conditions (eg, cardiac, pulmonary, and immunocompromising diseases, as well as diabetes and kidney disease), and living conditions (socioeconomic status and nursing home residence). The frequency of severe outcomes among younger adults with comorbidities was generally similar to that experienced by older adults, suggesting that immunosenescence and chronic conditions are both contributing factors for elevated risk. Trial registration PROSPERO (CRD42022315239).
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Affiliation(s)
- Annete Njue
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Weyinmi Nuabor
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Matthew Lyall
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Andrea Margulis
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Josephine Mauskopf
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Daniel Curcio
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Samantha Kurosky
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Bradford D Gessner
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Elizabeth Begier
- Global Medical Development & Scientific Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
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Rozenbaum MH, Begier E, Kurosky SK, Whelan J, Bem D, Pouwels KB, Postma M, Bont L. Incidence of Respiratory Syncytial Virus Infection in Older Adults: Limitations of Current Data. Infect Dis Ther 2023; 12:1487-1504. [PMID: 37310617 PMCID: PMC10262134 DOI: 10.1007/s40121-023-00802-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important cause of severe respiratory illness in older adults and adults with respiratory or cardiovascular comorbidities. Published estimates of its incidence and prevalence in adult groups vary widely. This article reviews the potential limitations affecting RSV epidemiology studies and suggests points to consider when evaluating or designing them. METHODS Studies reporting the incidence or prevalence of RSV infection in adults in high-income Western countries from 2000 onwards were identified via a rapid literature review. Author-reported limitations were recorded, together with presence of other potential limitations. Data were synthesized narratively, with a focus on factors affecting incidence estimates for symptomatic infection in older adults. RESULTS A total of 71 studies met the inclusion criteria, most in populations with medically attended acute respiratory illness (ARI). Only a minority used case definitions and sampling periods tailored specifically to RSV; many used influenza-based or other criteria that are likely to result in RSV cases being missed. The great majority relied solely on polymerase chain reaction (PCR) testing of upper respiratory tract samples, which is likely to miss RSV cases compared with dual site sampling and/or addition of serology. Other common limitations were studying a single season, which has potential for bias due to seasonal variability; failure to stratify results by age, which underestimates the burden of severe disease in older adults; limited generalizability beyond a limited study setting; and absence of measures of uncertainty in the reporting of results. CONCLUSIONS A significant proportion of studies are likely to underestimate the incidence of RSV infection in older adults, although the effect size is unclear and there is also potential for overestimation. Well-designed studies, together with increased testing for RSV in patients with ARI in clinical practice, are required to accurately capture both the burden of RSV and the potential public health impact of vaccines.
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Affiliation(s)
| | | | | | | | | | | | | | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Grace M, Colosia A, Wolowacz S, Panozzo C, Ghaswalla P. Economic burden of respiratory syncytial virus infection in adults: a systematic literature review. J Med Econ 2023:1-60. [PMID: 37167068 DOI: 10.1080/13696998.2023.2213125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIMS Capture the economic and healthcare resource utilization (HCRU) burden in older adults due to respiratory syncytial virus (RSV) infection. METHODS An electronic literature search of PubMed, Embase, the Cochrane Library, PsycINFO, and EconLit was conducted for studies of the cost and HCRU outcomes of RSV infection in adult patients, with no language or country restrictions. Search dates for primary studies were January 1, 2002-May 18, 2022. The methodological quality of included studies was assessed using a modification of the Critical Appraisal Skills Programme (CASP) checklist for economic studies and the Drummond checklist. RESULTS 42 studies were identified that reported cost or HCRU data associated with RSV infections, with geographic locations across North America, South America, Europe, Asia, and Oceania. Generally, hospitalization costs were highest in the United States (US). Driving factors of increased cost included older age, comorbidities, and length of stay. US studies found that the national direct cost burden of RSV hospitalizations was $1.3 billion for all adults and $1.5-$4.0 billion for adults aged ≥60 years (estimates for other countries were not identified). Studies estimating incremental costs for RSV cases versus controls and costs pre- and post-RSV infection demonstrated higher costs for RSV cases. Hospitalizations accounted for the majority of total costs.
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Affiliation(s)
- Mei Grace
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Ann Colosia
- RTI Health Solutions, Research Triangle Park, NC, USA
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Jogie JA. Acute Upper Respiratory Infection in a Pediatric Patient During the COVID-19 Pandemic: A Case Report. Cureus 2023; 15:e39057. [PMID: 37378231 PMCID: PMC10292066 DOI: 10.7759/cureus.39057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Upper respiratory infections (URIs) are a frequent presentation of the COVID-19 pandemic, which has had a major detrimental impact on the pediatric population. In this case report, we detail the pandemic-related treatment of a five-year-old patient who had an acute upper respiratory illness. The case report begins with an overview of the COVID-19 pandemic, then discusses the difficulties in identifying and treating pediatric patients with respiratory illnesses in the current setting. In this report, we describe the case of a five-year-old child who originally displayed signs and symptoms of a viral URI that, with further investigation, proved unrelated to COVID-19. Treatment for the patient included symptom control, monitoring, and ultimately recovery. This study stresses the necessity for adequate diagnostic testing, individualized treatment plans, and ongoing surveillance for respiratory infections in pediatric patients during the COVID-19 pandemic.
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Affiliation(s)
- Joshua A Jogie
- Department of Medical Sciences, University of the West Indies, St. Augustine, TTO
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12
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Atkins KE, Hodgson D, Jit M, Davies NG. Evaluating the impact of Respiratory Syncytial Virus immunisation strategies on antibiotic use and drug resistant bacterial infections in England. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18183.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Vaccines against viruses have been proposed as a novel means to reduce antibiotic use, which would, in turn, decrease selection for antibiotic resistant bacteria. However, the impact of this intervention is poorly quantified, and likely depends on setting-specific epidemiology. Therefore, with increasing confidence in a new vaccine against respiratory syncytial virus (RSV), it is important to quantify the impact of these vaccines on antibiotic prescribing and any downstream reduction in drug resistant bacterial infections. Methods: Here we integrate results from a dynamic transmission model of RSV and a statistical attribution framework to capture the impact of RSV vaccines on the reduction in antibiotic prescribing due to averted primary care visits in England. Results: Under base case assumptions, we find that the most impactful RSV vaccine strategy targets children aged 5–14 years, resulting in an annual reduction of 10.9 (8.0–14.2) antibiotic courses per 10,000 person years across the entire population, equivalent to reducing annual all-cause primary care prescribing by 0.23%. Our results suggest that this reduction in antibiotic use would gain 130 disability-adjusted life years and avert £51,000 associated with drug resistant bacterial infections. Seasonally administering monoclonal antibodies (mAbs) to high-risk infants under 6 months is the most efficient strategy, reducing per person year antibiotic prescribing by 2.6 (1.9–3.3) antibiotic courses per 1,000 mAb courses. Conclusions: Under optimistic conditions, the cost-effectiveness of RSV vaccine strategies in England would likely not be altered by integrating the benefits of preventing drug resistant infections in addition to RSV disease prevention.
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Bylsma LC, Suh M, Movva N, Fryzek JP, Nelson CB. Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review. J Infect Dis 2022; 226:S267-S281. [PMID: 35968871 PMCID: PMC9377034 DOI: 10.1093/infdis/jiac226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background A systematic literature review was conducted to summarize the mortality (overall and by disease severity factors) of US infants and children aged <5 years with respiratory syncytial virus (RSV) or all-cause bronchiolitis (ACB). Methods Comprehensive, systematic literature searches were conducted; articles were screened using prespecified eligibility criteria. A standard risk of bias tool was used to evaluate studies. Mortality was extracted as the rate per 100 000 or the case fatality ratio (CFR; proportion of deaths among RSV/ACB cases). Results Among 42 included studies, 36 evaluated inpatient deaths; 10 used nationally representative populations updated through 2013, and only 2 included late-preterm/full-term otherwise healthy infants and children. The RSV/ACB definition varied across studies (multiple International Classification of Diseases [ICD] codes; laboratory confirmation); no study reported systematic testing for RSV. No studies reported RSV mortality rates, while 3 studies provided ACB mortality rates (0.57–9.4 per 100 000). CFRs ranged from 0% to 1.7% for RSV (n = 15) and from 0% to 0.17% for ACB (n = 6); higher CFRs were reported among premature, intensive care unit-admitted, and publicly insured infants and children. Conclusions RSV mortality reported among US infants and children is variable. Current, nationally representative estimates are needed for otherwise healthy, late-preterm to full-term infants and children.
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Affiliation(s)
- Lauren C Bylsma
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
| | - Mina Suh
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
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14
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Hartnett J, Donga P, Ispas G, Vandendijck Y, Anderson D, House S, Suner S. Risk factors and medical resource utilization in US adults hospitalized with influenza or respiratory syncytial virus in the Hospitalized Acute Respiratory Tract Infection study. Influenza Other Respir Viruses 2022; 16:906-915. [PMID: 35474419 PMCID: PMC9343339 DOI: 10.1111/irv.12994] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Influenza and respiratory syncytial virus (RSV) are associated with substantial morbidity and mortality in the United States. We assessed risk factors for severe disease and medical resource utilization (MRU) among US adults hospitalized with influenza or RSV in the Hospitalized Acute Respiratory Tract Infection (HARTI) study. Methods HARTI was a prospective global (40 centers, 12 countries) epidemiological study of adults hospitalized with acute respiratory tract infections conducted across the 2017–2019 epidemic seasons. Patients with confirmed influenza or RSV were followed up to 3 months post‐discharge. Baseline characteristics, prevalence of core risk factors (CRFs) for severe disease (age ≥65 years, chronic heart or renal disease, chronic obstructive pulmonary disease, or asthma), and MRU were summarized descriptively. Results The US cohort included 280 influenza‐positive and 120 RSV‐positive patients. RSV patients were older (mean: 63.1 vs. 59.7 years) and a higher proportion had CRFs (87.5% vs. 81.4%). Among those with CRFs (influenza, n = 153; RSV, n = 99), RSV patients required longer hospitalizations (median length of stay: 4.5 days) and a greater proportion (79.8%) required oxygen supplementation during hospitalization compared with influenza patients (4.0 days and 59.5%, respectively). At 3 months post‐discharge, a greater proportion of RSV patients with CRFs reported use of antibiotics, antitussives, bronchodilators, and inhaled and systemic steroids versus those with influenza and CRFs. Many patients with CRFs reported hospital readmission at 3 months post‐discharge (RSV: 13.4%; influenza: 11.9%). Conclusions MRU during and post‐hospitalization due to RSV in adults is similar to or greater than that of influenza. Enhanced RSV surveillance and preventive and therapeutic interventions are needed.
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Affiliation(s)
| | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | | | | | - David Anderson
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Selim Suner
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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15
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Determination of genetic characterization and circulation pattern of Respiratory Syncytial Virus (RSV) in children with a respiratory infection, Tehran, Iran, during 2018-2019. Virus Res 2021; 305:198564. [PMID: 34530047 DOI: 10.1016/j.virusres.2021.198564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/01/2021] [Accepted: 09/05/2021] [Indexed: 11/21/2022]
Abstract
The RSV-associated disease accounts for a significant health burden particularly in infants and young children who need to be hospitalized. Since continuous surveillance of circulating RSV genotypes is crucial worldwide, this study aimed to investigate the genetic diversity of RSV circulating strains causing upper or lower acute respiratory infection. Our attention was geared towards studying the cases hospitalized or outpatient in children younger than 2 years of age in Iran during 2018/2019. In this study, nasopharyngeal swabs collected from 206 children who presented with respiratory infection symptoms, were admitted to the referral pediatric ward of Bahrami children's hospital in Tehran, Iran. RSV-positive samples were detected via Nested RT-PCR. The glycoprotein gene was sequenced, and virus genotypes were confirmed through phylogenetic analysis by the MEGA X program. A total of 74 (35.92%) samples tested positive for RSV. Among them, sequencing was done in 10 specimens from 2018 (RSV-A: RSV-B=4:6) and 19 specimens from 2019 (RSV-A: RSV-B=16:3). According to phylogenetic analysis, all RSV-A strains were assigned as ON1 genotype and RSV-B strains were assigned as BA9 genotype. A new N-glycosylation site in Iranian BA9 and positive selection in ON1 genotype was observed. Phylogenetic characterization of strains in the current study revealed co-circulation of ON1 and BA9 as the only prevalent genotypes of both RSV-A and -B groups.
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16
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Zhang Y, Qiao L, Yao J, Yu N, Mu X, Huang S, Hu B, Li W, Qiu F, Zeng F, Chen C, Zhou Y, Zhang B, Cai T, Wang W, Wu X, Zhou Y, Wang G, Situ B, Lan S, Li N, Li X, Li Z, Li X, Wang C, Yang C, Feng P, Wang H, Zhu S, Xiong Y, Luo M, Shen W, Hu X, Zheng L. Epidemiological and clinical characteristics of respiratory viruses in 4403 pediatric patients from multiple hospitals in Guangdong, China. BMC Pediatr 2021; 21:284. [PMID: 34140022 PMCID: PMC8212487 DOI: 10.1186/s12887-021-02759-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background Acute respiratory infections (ARI) cause considerable morbidity and mortality worldwide, especially in children. Unfortunately, there are limited multi-center data on common viral respiratory infections in south China. Methods A total of 4403 nasal swabs were collected from children in 10 cities in Guangdong, China in 2019. Seven respiratory viruses, influenza A virus (IFA), influenza B virus (IFB), respiratory syncytial virus (RSV), adenoviruses (ADV) and parainfluenza virus types 1–3 (PIV1, PIV2 and PIV3), were detected by direct immunofluorescence antibody assay. The personal information and clinical characteristics were recorded and analyzed. Results The results showed that at least one virus was detected in 1099 (24.96 %) samples. The detection rates of RSV, IFA, ADV, PIV3, PIV1 and PIV2 were 7.13 % (314/4403), 5.31 % (234/4403), 4.02 % (177/4403), 3.04 % (134/4403), 1.70 % (75/4403) and 1.16 % (51/4403), respectively. The detection rate of RSV was highest in 0–6-month-old children at 18.18 % (106/583), while the detection rate of IFA was highest in 12–18-year-old children at 20.48 % (17/83). The total detection rates in winter and spring were 35.67 % (219/614) and 34.56 % (403/1166), higher than those in summer, 17.41 % (284/1631), and autumn, 19.46 % (193/992). Conclusions RSV and IFA were the main respiratory viruses in children. With increasing age the detection rate of RSV decreased in children, but the trends for the detection rates of IFA and IFB were the opposite. This study provided the viral etiology and epidemiology of pediatric patients with ARI in Guangdong, China. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02759-0.
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Affiliation(s)
- Yajie Zhang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lin Qiao
- Guangdong 999 Brain Hospital, Guangzhou, China
| | - Jinxiu Yao
- Yangjiang People's Hospital, Yangjiang, China
| | - Nan Yu
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoping Mu
- Guangdong Women and Children Hospital, Guangzhou, China
| | | | - Bo Hu
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weixuan Li
- The First People's Hospital of Foshan, Foshan, China
| | - Feng Qiu
- Nanhai Hospital, Southern Medical University, Foshan, China
| | - Fangyin Zeng
- The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Cong Chen
- Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Yuqiu Zhou
- Zhuhai Maternal and Child Health Hospital, Zhuhai, China
| | | | - Tian Cai
- Nanhai District People's Hospital of Foshan, Foshan, China
| | - Weijia Wang
- Zhongshan People's Hospital, Zhongshan, China
| | - Xianjin Wu
- Central People's Hospital of Huizhou, Huizhou, China
| | - Yiwen Zhou
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Guochang Wang
- School of Economics, Jinan University, Guangdong, Guangzhou, China
| | - Bo Situ
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuling Lan
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiu Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihua Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Congrong Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chao Yang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingfeng Feng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongxia Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sijing Zhu
- Nanfang College of Sun Yat-Sen University, Guangdong, Guangzhou, China
| | - Yufeng Xiong
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Luo
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenjuan Shen
- The Seventh Affiliated Hospital, Sun Yat-Sen University, Guangdong, Guangdong, China
| | - Xiumei Hu
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Treskova M, Pozo-Martin F, Scholz S, Schönfeld V, Wichmann O, Harder T. Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data. PHARMACOECONOMICS 2021; 39:287-315. [PMID: 33462760 PMCID: PMC7813556 DOI: 10.1007/s40273-020-00991-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several vaccine and antibody candidates are currently in development for the prevention of lower respiratory tract infections caused by the respiratory syncytial virus (RSV). METHODS We searched MEDLINE, Embase, and SCOPUS and included model-based evaluations of RSV vaccinations. Two reviewers performed the selection, data extraction, and quality evaluation with EVIDEM. Cost-effectiveness (CE) estimates were converted to $US purchasing power parity (PPP), year 2018 values. Potential economic and epidemiological outcomes were summarised for maternal, infant, children, and elderly vaccinations. The PROSPERO identifier is CRD42019122570. RESULTS In total, 22 model-based studies were reviewed. On average, a potential 27% reduction in RSV hospitalisations in infants was projected for maternal vaccination and 50% for direct infant immunisation. The CE of maternal vaccination was $US1766-5857 PPP 2018/disability-adjusted life-years (DALYs) for Global Alliance for Vaccines and Immunisation (Gavi)-eligible countries. For England, the maximum cost-effective price of maternal vaccination was estimated at $US81.5 PPP 2018. Infant vaccination was associated with higher CE ratios in low- and high-income settings. Vaccination of neonates born before the RSV season was the most cost effective in high-income settings. Higher values for vaccine effectiveness, duration of protection, and vaccine uptake increased the benefits. Due to indirect effects, the vaccination of school-age children and a cocooning strategy were effective alternatives to protect infants, and the vaccination of children aged < 5 years had a beneficial impact on the elderly. CONCLUSION RSV vaccines with anticipated characteristics may reduce a sizeable proportion of the RSV burden. The results are subject to uncertainty because of the limited epidemiological and clinical data. Data on RSV incidence and hospitalisation risk for granular age strata should be prioritised to facilitate the evaluation of RSV interventions and decision making.
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Affiliation(s)
- Marina Treskova
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany.
| | | | - Stefan Scholz
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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18
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Wenfang G, Yi L, Wang P, Wang B, Li M. Assessing the effects of meteorological factors on daily children's respiratory disease hospitalizations: A retrospective study. Heliyon 2020; 6:e04657. [PMID: 32817894 PMCID: PMC7424195 DOI: 10.1016/j.heliyon.2020.e04657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 01/27/2023] Open
Abstract
Respiratory disease symptoms in children are aggravated by frequent changes in meteorological conditions. The net effective temperature (NET) integrates temperature, relative humidity, and wind speed as a cooling indicator. This study aims to assess the effect of daily changes in meteorological factors and corresponding NET data on children's hospitalizations for different ages, genders and subtypes of respiratory infections in Baotou, China. Distributed lag non-linear models were constructed to simultaneously assess the exposure–response associations between daily admission counts of children with respiratory diseases and daily NET and other meteorological factors, as well as their lag dependencies. As air pollution significantly affects the respiratory tract, it was considered as confounding factor. In general, the cumulative meteorological factors had greater effects on lower respiratory tract infections than upper respiratory tract infections (RR: temperature [5.21 vs. 2.33], wind speed [4.89 vs. 3.12], and humidity [1.77 vs. 0.97]). The effects of cumulative meteorological factors on female children were greater than those on male children (RR: temperature [2.14 vs. 1.82], wind speed [5.46 vs. 1.90], and humidity [1.60 vs. 1.55]). Temperature and wind speed showed an influence on 4–7-year-old children, but these factors had no influence on other age groups; humidity only showed an influence on the 0–3-year-old group. The NET value had a large effect on lower respiratory infections, in the 4–7-year-old group and female children. In conclusion, a complex non-linear relationship exists between climate variability and children's respiratory diseases. The results of the study can be used to support the development of important meteorological information tools for early warnings of respiratory disease events in children. Concurrently, the NET values can be used for comprehensive assessments of climate change in the future, which will help the government and health authorities better minimize the impacts of children's respiratory diseases.
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Affiliation(s)
- Guo Wenfang
- Inner Mongolia Autonomous Region Academy of Traditional Medicine, Hohhot 010020, China.,Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot 010020, China
| | - Letai Yi
- Inner Mongolia Autonomous Region Academy of Traditional Medicine, Hohhot 010020, China.,Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot 010020, China
| | - Peng Wang
- The First Affiliated Hospital of Baotou Medical College, Baotou 014000, China
| | - Baojun Wang
- Inner Mongolia Baotou City Central Hospital, Baotou 014040, China
| | - Minhui Li
- Inner Mongolia Autonomous Region Academy of Traditional Medicine, Hohhot 010020, China.,Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot 010020, China.,Baotou Medical College, Baotou 014060, China
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19
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Smithgall M, Maykowski P, Zachariah P, Oberhardt M, Vargas CY, Reed C, LaRussa P, Saiman L, Stockwell MS. Epidemiology, clinical features, and resource utilization associated with respiratory syncytial virus in the community and hospital. Influenza Other Respir Viruses 2020; 14:247-256. [PMID: 32077641 PMCID: PMC7182604 DOI: 10.1111/irv.12723] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The epidemiology, clinical features, and resource utilization of respiratory syncytial virus (RSV) cases in the community and the hospital are not fully characterized. METHODS We identified individuals of all ages with laboratory-confirmed RSV from two sources, a community cohort undergoing surveillance for acute respiratory infections (ARIs) and hospitalized patients from the same geographic area of New York City between 2013 and 15. The epidemiology, clinical features, and resource utilization (antibiotic/steroid/ribavirin usage, chest X-rays, respiratory-support (continuous positive airway pressure [CPAP], mechanical ventilation or extracorporeal membrane oxygenation [ECMO]), and indicators of disease severity (respiratory-support, and/or ICU admission or death)) were compared among age groups using univariate and bivariate analyses. RESULTS In the community cohort (1777 people with 1805 ARIs), 66(3.7%) tested RSV-positive (3.8% of <1-year-olds; 3.8% of adults ≥65); 40.9% were medically attended, and 23.1% reported antibiotic usage. Among 40,461 tests performed on hospital patients, 2.7% were RSV-positive within ± 2 days of admission (37.3% <1 year old; 17.4% ≥65 years old). Among RSV-positive hospitalized adults ≥65%, 92.7%, 89.6% and 78.1% received a chest X-ray, antibiotics and/or steroids respectively, compared with 48.9%, 45.7%, and 48.7% of children <1. Severe illness occurred in 27.0% RSV-positive hospitalized <1-year-olds and 19.8% ≥65-year-olds. CONCLUSIONS Respiratory syncytial virus had a demonstrated impact in the community and hospital. Only 40% of RSV community cases were medically attended. In the hospitalized-cohort, <1- and ≥ 65-year-olds accounted for the majority of patients and had similar rates of severe illness. In addition, resource utilization was high in older adults, making both young children and older adults important potential RSV vaccine targets.
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Affiliation(s)
- Marie Smithgall
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Philip Maykowski
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Philip Zachariah
- Department of Pediatrics, Columbia University, New York, NY, USA
| | | | | | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip LaRussa
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University, New York, NY, USA
- Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, USA
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Viruses of Respiratory Tract: an Observational Retrospective Study on Hospitalized Patients in Rome, Italy. Microorganisms 2020; 8:microorganisms8040501. [PMID: 32244685 PMCID: PMC7232519 DOI: 10.3390/microorganisms8040501] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Respiratory tract infections account for high morbidity and mortality around the world. Fragile patients are at high risk of developing complications such as pneumonia and may die from it. Limited information is available on the extent of the circulation of respiratory viruses in the hospital setting. Most knowledge relates to influenza viruses (FLU) but several other viruses produce flu-like illness. The study was conducted at the University Hospital Policlinico Tor Vergata, Rome, Italy. Clinical and laboratory data from hospitalized patients with respiratory tract infections during the period October 2016-March 2019 were analysed. The retrospective analysis included 17 viral agents detected by FilmArray test and clinical data from medical records and hospital discharge sheets. Models were adjusted for relevant confounders such as clinical severity and risk of death, socio-demographic characteristics and surgical procedures. From a total of 539 specimens analysed, 180 (33.39%) were positive for one or more respiratory viruses. Among them, 83 (46.1 %) were positive for influenza viruses (FLU), 36 (20%) rhino/enteroviruses (RHV/EV), 17 (9.44%) human coronaviruses (HCOV-229E, -HKU1, -NL63, and -OC43), 17 (9.44%) respiratory syncytial virus, 15 (8.33%) human metapneumovirus (HMPV), 8 (4.44%) parainfluenza viruses (PIV) and 4 (2.22%) adenoviruses (ADV). The distribution of viral agents varied across age groups and month of detection. The positive specimens were from 168 patients [102 M, 66 F; median age (range): 64 years (19-93)]. Overall, 40% of them had a high-grade clinical severity and a 27% risk of death; 27 patients died and 22 of them (81.5%) had received a clinical diagnosis of pneumonia. Respiratory viral infections may have a severe course and a poor prognosis in hospitalized patients, due to underlying comorbidities. Monitoring the circulation of respiratory viruses in hospital settings is important to improve diagnosis, prevention and treatment.
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21
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The journey to a respiratory syncytial virus vaccine. Ann Allergy Asthma Immunol 2020; 125:36-46. [PMID: 32217187 DOI: 10.1016/j.anai.2020.03.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The high burden associated with respiratory syncytial virus (RSV) has made the development of RSV vaccine(s) a global health high priority. This review summarizes the journey to an RSV vaccine, the different strategies and challenges associated with the development of preventive strategies for RSV, and the diverse products that are undergoing clinical testing. DATA SOURCES Studies on RSV biology, immunology, epidemiology, and monoclonal antibodies (mAbs) and vaccines were searched using MEDLINE. We also searched PATH.org and ClinicalTrials.gov for updated information regarding the status of RSV vaccines and mAbs undergoing clinical trials. STUDY SELECTIONS We selected relevant studies conducted in infants and young children, pregnant women, and elderly population for the prevention of RSV infection. RESULTS Identification of a safe and immunogenic vaccine has been an important but elusive initiative for more than 60 years for different reasons, including the legacy of formalin-inactivated vaccine, our limited understanding of the immune response to RSV and how it relates to clinical disease severity, or the need for different end points according to the different vaccine platforms. Nevertheless, there are currently 39 vaccines and mAbs under development and 19 undergoing clinical trials. CONCLUSION Over the past decade, there have been significant advances in our knowledge of RSV molecular and structural biology and in understanding the human immune response to RSV. Despite the barriers, there are several promising mAbs and RSV vaccines undergoing clinical trials that hope to offer protection to the most vulnerable populations.
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