1
|
Kaiga C, Miyamoto M, Matsushita T, Kuramochi Y, Tadaki H, Enseki M, Hirai K, Yoshihara S, Furuya H, Niimura F, Kato M, Mochizuki H. Effects of COVID-19 pandemic-associated reduction in respiratory infections on infantile asthma development. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100256. [PMID: 38745864 PMCID: PMC11090864 DOI: 10.1016/j.jacig.2024.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 05/16/2024]
Abstract
Background It is speculated that the coronavirus disease 2019 (COVID-19) pandemic-associated reduction in the prevalence of respiratory tract infections has influenced the incidence of asthma in young children. Objectives We investigated an association between the reduction in viral infections and the reduction in asthma in young children. Methods The subjects were infants born in the early stages of the COVID-19 pandemic in Japan, which began in February 2020. A questionnaire survey related to asthma and allergy was conducted at 18 months and 3 years of age. These results were compared to those of age-matched infants during the nonpandemic period. Results There were no epidemics of viral infectious diseases until the target child was 18 months old. At 18 months, the incidence of asthma/asthmatic bronchitis diagnosed by physicians in pandemic children was significantly lower than that in nonpandemic children. In 3-year-olds, no marked difference was observed between nonpandemic infants and pandemic children, except for an increase in respiratory syncytial virus infection in pandemic children. In a comparative study of the same children at ages 18 months and 3 years, an increased prevalence of asthma/asthmatic bronchitis was observed in pandemic children. Furthermore, the incidence of asthma after respiratory syncytial virus infection in pandemic infants was significantly lower than that in nonpandemic children. Conclusion The COVID-19 pandemic-associated reduction in respiratory tract infections may have reduced the incidence of asthma in early childhood, and respiratory syncytial virus infection after 18 months of age had little effect on the onset of asthma. These results indicate the importance of preventing respiratory tract infections in early infancy.
Collapse
Affiliation(s)
- Chinami Kaiga
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Manabu Miyamoto
- Department of Pediatrics, Dokkyo Medical University, Mibu, Japan
| | - Takashi Matsushita
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Yu Kuramochi
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Hiromi Tadaki
- Division of Pediatrics, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Mayumi Enseki
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Kota Hirai
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | | | - Hiroyuki Furuya
- Department of Basic Clinical Science and Public Health, Tokai University School of Medicine, Isehara, Japan
| | - Fumio Niimura
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Kato
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| |
Collapse
|
2
|
Verwey C, Dangor Z, Madhi SA. Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children: Rationale and Progress to Date. Paediatr Drugs 2024; 26:101-112. [PMID: 38032456 PMCID: PMC10891269 DOI: 10.1007/s40272-023-00606-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in children, and is associated with long-term pulmonary sequelae for up to 30 years after infection. The mainstay of RSV management is supportive therapy such as supplemental oxygen. Palivizumab (Synagis™-AstraZeneca), a monoclonal antibody targeting the RSV F protein site II, has been licensed for the prevention of RSV in high-risk groups since 1998. There has been recent promising progress in preventative strategies that include vaccines and long-acting, high-potency monoclonal antibodies. Nirsevimab (Beyfortus™-AstraZeneca/Sanofi), a monoclonal antibody with an extended half-life, has recently been registered in the European Union and granted licensure by the US Food and Drug Administration. Furthermore, a pre-fusion sub-unit protein vaccine has been granted licensure for pregnant women, aimed at protecting their young infants, following established safety and efficacy in clinical trials (Abrysvo™-Pfizer). Also, multiple novel antiviral therapeutic options are in early phase clinical trials. The next few years have the potential to change the landscape of LRTI through improvements in the prevention and management of RSV LRTI. Here, we discuss these new approaches, current research, and clinical trials in novel therapeutics, monoclonal antibodies, and vaccines against RSV infection in infants and children.
Collapse
Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Flor LS, Anderson JA, Ahmad N, Aravkin A, Carr S, Dai X, Gil GF, Hay SI, Malloy MJ, McLaughlin SA, Mullany EC, Murray CJL, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Zheng P, Gakidou E. Health effects associated with exposure to secondhand smoke: a Burden of Proof study. Nat Med 2024; 30:149-167. [PMID: 38195750 PMCID: PMC10803272 DOI: 10.1038/s41591-023-02743-4] [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: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.
Collapse
Affiliation(s)
- Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Noah Ahmad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
4
|
Bakakos A, Sotiropoulou Z, Vontetsianos A, Zaneli S, Papaioannou AI, Bakakos P. Epidemiology and Immunopathogenesis of Virus Associated Asthma Exacerbations. J Asthma Allergy 2023; 16:1025-1040. [PMID: 37791040 PMCID: PMC10543746 DOI: 10.2147/jaa.s277455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023] Open
Abstract
Asthma is a common airway disease, affecting millions of people worldwide. Although most asthma patients experience mild symptoms, it is characterized by variable airflow limitation, which can occasionally become life threatening in the case of a severe exacerbation. The commonest triggers of asthma exacerbations in both children and adults are viral infections. In this review article, we will try to investigate the most common viruses triggering asthma exacerbations and their role in asthma immunopathogenesis, since viral infections in young adults are thought to trigger the development of asthma either right away after the infection or at a later stage of their life. The commonest viral pathogens associated with asthma include the respiratory syncytial virus, rhinoviruses, influenza and parainfluenza virus, metapneumovirus and coronaviruses. All these viruses exploit different molecular pathways to infiltrate the host. Asthmatics are more prone to severe viral infections due to their unique inflammatory response, which is mostly characterized by T2 cytokines. Unlike the normal T1 high response to viral infection, asthmatics with T2 high inflammation are less potent in containing a viral infection. Inhaled and/or systematic corticosteroids and bronchodilators remain the cornerstone of asthma exacerbation treatment, and although many targeted therapies which block molecules that viruses use to infect the host have been used in a laboratory level, none has been yet approved for clinical use. Nevertheless, further understanding of the unique pathway that each virus follows to infect an individual may be crucial in the development of targeted therapies for the commonest viral pathogens to effectively prevent asthma exacerbations. Finally, biologic therapies resulted in a complete change of scenery in the treatment of severe asthma, especially with a T2 high phenotype. All available data suggest that monoclonal antibodies are safe and able to drastically reduce the rate of viral asthma exacerbations.
Collapse
Affiliation(s)
- Agamemnon Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Zoi Sotiropoulou
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Angelos Vontetsianos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Stavroula Zaneli
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Andriana I Papaioannou
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Petros Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| |
Collapse
|
5
|
Atwell J, Chico M, Vaca M, Arévalo‐Cortes A, Karron R, Cooper PJ. Effect of infant viral respiratory disease on childhood asthma in a non-industrialized setting. Clin Transl Allergy 2023; 13:e12291. [PMID: 37632244 PMCID: PMC10408584 DOI: 10.1002/clt2.12291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND There are limited data from non-industrialized settings on the effects of early life viral respiratory disease on childhood respiratory illness. We followed a birth cohort in tropical Ecuador to understand how early viral respiratory disease, in the context of exposures affecting airway inflammation including ascariasis, affect wheezing illness, asthma, and rhinoconjunctivitis in later childhood. METHODS A surveillance cohort nested within a birth cohort was monitored for respiratory infections during the first 2 years in rural Ecuador and followed for 8 years for the development of wheeze and rhinoconjunctivitis. Nasal swabs were examined for viruses by polymerase chain reaction and respiratory symptom data on recent wheeze and rhinoconjunctivitis were collected by periodic questionnaires at 3, 5, and 8 years. Stools from pregnant mothers and periodically from children aged 2 years were examined microscopically for soil-transmitted helminths. Atopy was measured by allergen skin prick testing at 2 years. Spirometry, fractional exhaled nitric oxide measurement, and nasal washes were performed at 8 years. Associations between clinically significant respiratory disease (CSRD) and wheezing or rhinoconjunctivitis at 3, 5, and 8 years were estimated using multivariable logistic regression. RESULTS Four hundred and twenty six children were followed of which 67.7% had at least one CSRD episode; 12% had respiratory syncytial virus (RSV)+CSRD and 36% had rhinovirus (RHV)+CSRD. All-cause CSRD was associated with increased wheeze at 3 (OR 2.33 [95% confidence intervals (CI) 1.23-4.40]) and 5 (OR: 2.12 [95% CI 1.12-4.01]) years. RHV+CSRD was more strongly associated with wheeze at 3 years in STH-infected (STH-infected [OR 13.41, 95% CI 1.56-115.64] vs. uninfected [OR 1.68, 95% CI 0.73-3.84]) and SPT+ (SPT+ [OR 9.42, 95% CI 1.88-47.15] versus SPT- [OR 1.92, 95% CI 0.84-4.38]) children. No associations were observed between CSRD and rhinoconjunctivitis. DISCUSSION CSRD was significantly associated with childhood wheeze with stronger associations observed for RHV+CSRD in SPT+ and STH-infected children.
Collapse
Affiliation(s)
- Jessica Atwell
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Martha Chico
- Fundacion Ecuatoriana Para la Investigacion en SaludQuitoEcuador
| | - Maritza Vaca
- Fundacion Ecuatoriana Para la Investigacion en SaludQuitoEcuador
| | | | - Ruth Karron
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Philip J. Cooper
- Fundacion Ecuatoriana Para la Investigacion en SaludQuitoEcuador
- Escuela de MedicinaUniversidad Internacional del EcuadorQuitoEcuador
- Institute of Infection and ImmunitySt George's University of LondonLondonUK
| |
Collapse
|
6
|
Verwey C, Madhi SA. Review and Update of Active and Passive Immunization Against Respiratory Syncytial Virus. BioDrugs 2023; 37:295-309. [PMID: 37097594 PMCID: PMC10127166 DOI: 10.1007/s40259-023-00596-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/26/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in children, causing approximately 3.6 million hospitalizations per year, and has been associated with long-term pulmonary sequelae for up to 30 years after infection, yet preventative strategies and active treatment options remain elusive. The associated morbidity and healthcare related costs could be decreased substantially with the development of these much-needed medications. After an initial false start in the development of an RSV vaccine, gradual progress is now being made with the development of multiple vaccine candidates using numerous different mechanisms of action. Furthermore, nirsevimab, a new monoclonal antibody for the prevention of RSV, has recently been registered in the European Union. New novel treatments for RSV infection are also in the pipeline, which would provide the clinician with much needed ammunition in the management of the acute disease. The next few years have the potential to change the landscape of LRTI forever through the prevention and management of RSV LRTI and thereby decrease the mortality and morbidity associated with it. In this review, we discuss these new approaches, current research, and clinical trials in monoclonal antibody and vaccine development against RSV.
Collapse
Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise (ALIVE), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
7
|
Kenmoe S, Atenguena Okobalemba E, Takuissu GR, Ebogo-Belobo JT, Oyono MG, Magoudjou-Pekam JN, Kame-Ngasse GI, Taya-Fokou JB, Mbongue Mikangue CA, Kenfack-Momo R, Mbaga DS, Bowo-Ngandji A, Kengne-Ndé C, Esemu SN, Njouom R, Ndip L. Association between early viral lower respiratory tract infections and subsequent asthma development. World J Crit Care Med 2022; 11:298-310. [PMID: 36051944 PMCID: PMC9305678 DOI: 10.5492/wjccm.v11.i4.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/25/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The association between hospitalization for human respiratory syncytial virus (HRSV) bronchiolitis in early childhood and subsequent asthma is well established. The long-term prognosis for non-bronchiolitis lower respiratory tract infections (LRTI) caused by viruses different from HRSV and rhinovirus, on the other hand, has received less interest.
AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.
METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review. We included cohort studies comparing the incidence of asthma between patients with and without LRTI at ≤ 2 years regardless of the virus responsible. The meta-analysis was performed using the random effects model. Sources of heterogeneity were assessed by stratified analyses.
RESULTS This review included 15 articles (18 unique studies) that met the inclusion criteria. LRTIs at ≤ 2 years were associated with an increased risk of subsequent asthma up to 20 years [odds ratio (OR) = 5.0, 95%CI: 3.3-7.5], with doctor-diagnosed asthma (OR = 5.3, 95%CI: 3.3-8.6), current asthma (OR = 5.4, 95%CI: 2.7-10.6), and current medication for asthma (OR = 1.2, 95%CI: 0.7-3.9). Our overall estimates were not affected by publication bias (P = 0.671), but there was significant heterogeneity [I2 = 58.8% (30.6-75.5)]. Compared to studies with hospitalized controls without LRTI, those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma. The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview. The sensitivity analyses including only studies with similar proportions of confounding factors (gender, age at LRTI development, age at interview, gestational age, birth weight, weight, height, smoking exposure, crowding, family history of atopy, and family history of asthma) between cases and controls did not alter the overall estimates.
CONCLUSION Regardless of the causative virus and confounding factors, viral LRTIs in children < 2 years are associated with an increased risk of developing a subsequent asthma. Parents and pediatricians should be informed of this risk.
Collapse
Affiliation(s)
- Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
- Department of Virology, Centre Pasteur of Cameroon, Yaounde 00237, Cameroon
| | | | - Guy Roussel Takuissu
- Centre of Research in Food, Food Security and Nutrition, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Martin Gael Oyono
- Laboratory of Parasitology and Ecology, The University of Yaounde I, Yaounde 00237, Cameroon
| | | | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National Aids Control Committee, Douala 00237, Cameroon
| | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaounde 00237, Cameroon
| | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| |
Collapse
|
8
|
Rusconi F, Lombardi E, Spada E, Brescianini S, Culasso M, Di Toro F, Frassanito A, Richiardi L, Ronfani L, Stella I, Gagliardi L. Lung function at school age in infants with lower respiratory tract infections with and without wheezing: A birth cohort study. Pediatr Pulmonol 2022; 57:857-861. [PMID: 35048563 DOI: 10.1002/ppul.25835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the relationship between lower respiratory tract infections (LRTI), in the first 2 years of life and lung function at school age in the Piccolipiù birth cohort (Italy). METHODS Data on LRTI (doctor diagnosis of bronchitis, bronchiolitis, pneumonia) and wheezing (≥3 episodes or a diagnosis of asthmatic bronchitis) in the first 2 years of life were obtained from parental questionnaires. Lung function was assessed at 7 years by spirometry and forced volume vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, forced expiratory flow between 25% and 75%, and at 75% of FVC (FEF25-75 and FEF75 ) were reported as Z-scores. The associations between LRTI and spirometric variables were estimated with linear regression models. RESULTS Among 877 children studied, 22.1% had LRTI only, 5.4% wheezing only, 13.2% had both, and 59.3% had neither LRTI nor wheezing. Children with LRTI had lower FVC and FEV1 than children without (Z-score differences: -0.18 [95% confidence intervals: -0.31; -0.06] and -0.15 [-0.27; -0.03]). When children were stratified by history of both LRTI and wheezing, there was no association between LRTI only and spirometric values. Conversely, having had both LRTI and wheezing was inversely associated with all lung function measures: Z-score differences of -0.24 (-0.42; -0.07); -0.42 (-0.59; -0.24); -0.25 (-0.41; -0.08); -0.37 (-0.54; -0.21); -0.30 (-0.46; -0.14) for FVC, FEV1, FEV1 /FVC, FEF25-75 and FEF75, respectively. CONCLUSION Infants with wheezing and LRTI, but not those with LRTI only, had reduced lung function at school-age.
Collapse
Affiliation(s)
- Franca Rusconi
- Division of Epidemiology, Meyer Children's University Hospital, Florence, Italy.,Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Enrico Lombardi
- Division of Pediatric Pulmonology, Meyer Children's University Hospital, Florence, Italy
| | - Elena Spada
- Division of Epidemiology, Meyer Children's University Hospital, Florence, Italy
| | - Sonia Brescianini
- Department of Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Culasso
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesca Di Toro
- Division of Clinical Epidemiology and Public Health Research, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Antonella Frassanito
- Department of Maternal Infantile and Urological Sciences, Sapienza University, Rome, Italy
| | - Lorenzo Richiardi
- Department of Medical Sciences, University of Turin, CPO Piemonte, Turin, Italy
| | - Luca Ronfani
- Division of Clinical Epidemiology and Public Health Research, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Ileana Stella
- Division of Pediatrics, Maria Vittoria Hospital, Turin, Italy.,Division of Pediatrics, Department of Health Sciences, Eastern Piedmont University, Novara, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, AUSL Toscana Nord Ovest, Pisa, Italy
| |
Collapse
|
9
|
Manti S, Piedimonte G. An overview on the RSV-mediated mechanisms in the onset of non-allergic asthma. Front Pediatr 2022; 10:998296. [PMID: 36204661 PMCID: PMC9530042 DOI: 10.3389/fped.2022.998296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/19/2022] [Indexed: 12/13/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is recognized as an important risk factor for wheezing and asthma, since it commonly affects babies during lung development. While the role of RSV in the onset of atopic asthma is widely recognized, its impact on the onset of non-atopic asthma, mediated via other and independent causal pathways, has long been also suspected, but the association is less clear. Following RSV infection, the release of local pro-inflammatory molecules, the dysfunction of neural pathways, and the compromised epithelial integrity can become chronic and influence airway development, leading to bronchial hyperreactivity and asthma, regardless of atopic status. After a brief review of the RSV structure and its interaction with the immune system and neuronal pathways, this review summarizes the current evidence about the RSV-mediated pathogenic pathways in predisposing and inducing airway dysfunction and non-allergic asthma development.
Collapse
Affiliation(s)
- Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Pediatric Unit, Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, Messina, Italy
| | - Giovanni Piedimonte
- Department of Pediatrics, Biochemistry and Molecular Biology, Tulane University, New Orleans, LA, United States
| |
Collapse
|
10
|
Abdullah K, Fell DB, Radhakrishnan D, Hawken S, Johnson DW, Mandhane P, To T, Joubert G, Plint AC. Risk of asthma in children diagnosed with bronchiolitis during infancy: protocol of a longitudinal cohort study linking emergency department-based clinical data to provincial health administrative databases. BMJ Open 2021; 11:e048823. [PMID: 33941638 PMCID: PMC8098926 DOI: 10.1136/bmjopen-2021-048823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST) and the Bronchiolitis Severity Cohort (BSC) study enrolled infants with bronchiolitis during the first year of life. The CanBEST trial suggested that treatment of infants with a combined therapy of high-dose corticosteroids and nebulised epinephrine reduced the risk of admission to hospital. Our study aims to-(1) quantify the risk of developing asthma by age 5 and 10 years in children treated with high-dose corticosteroid and epinephrine for bronchiolitis during infancy, (2) identify risk factors associated with development of asthma in children with bronchiolitis during infancy, (3) develop asthma prediction models for children diagnosed with bronchiolitis during infancy. METHODS AND ANALYSIS We propose a longitudinal cohort study in which we will link data from the CanBEST and BSC study with routinely collected data from provincial health administrative databases. Our outcome is asthma incidence measured using a validated health administrative data algorithm. Primary exposure will be treatment with a combined therapy of high-dose corticosteroids and nebulised epinephrine for bronchiolitis. Covariates will include type of viral pathogen, disease severity, medication use, maternal, prenatal, postnatal and demographic factors and variables related to health service utilisation for acute lower respiratory tract infection. The risk associated with development of asthma in children treated with high-dose corticosteroid and epinephrine for bronchiolitis will be assessed using multivariable Cox proportional hazards regression models. Prediction models will be developed using multivariable logistic regression analysis and internally validated using a bootstrap approach. ETHICS AND DISSEMINATION Our study has been approved by the ethics board of all four participating sites of the CanBEST and BSC study. Finding of the study will be disseminated to the academic community and relevant stakeholders through conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN56745572; Post-results.
Collapse
Affiliation(s)
- Kawsari Abdullah
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dhenuka Radhakrishnan
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Hawken
- ICES, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David W Johnson
- Departments of Pediatrics and Physiology and Pharmacology, University of Calgary, Calgery, Alberta, Canada
- Maternal Newborn Child & Youth SCN, Alberta Health Services, Calgery, Alberta, Canada
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Teresa To
- ICES, Ottawa, Ontario, Canada
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gary Joubert
- London Health Sciences Centre, London, Ontario, Canada
| | - Amy C Plint
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Kenmoe S, Bowo-Ngandji A, Kengne-Nde C, Ebogo-Belobo JT, Mbaga DS, Mahamat G, Demeni Emoh CP, Njouom R. Association between early viral LRTI and subsequent wheezing development, a meta-analysis and sensitivity analyses for studies comparable for confounding factors. PLoS One 2021; 16:e0249831. [PMID: 33857215 PMCID: PMC8049235 DOI: 10.1371/journal.pone.0249831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/25/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Consideration of confounding factors about the association between Lower Respiratory Tract Infections (LRTI) in childhood and the development of subsequent wheezing has been incompletely described. We determined the association between viral LRTI at ≤ 5 years of age and the development of wheezing in adolescence or adulthood by a meta-analysis and a sensitivity analysis including comparable studies for major confounding factors. Methods We performed searches through Pubmed and Global Index Medicus databases. We selected cohort studies comparing the frequency of subsequent wheezing in children with and without LRTI in childhood regardless of the associated virus. We extracted the publication data, clinical and socio-demographic characteristics of the children, and confounding factors. We analyzed data using random effect model. Results The meta-analysis included 18 publications (22 studies) that met the inclusion criteria. These studies showed that viral LRTI in children ≤ 3 years was associated with an increased risk of subsequent development of wheezing (OR = 3.1, 95% CI = 2.4–3.9). The risk of developing subsequent wheezing was conserved when considering studies with comparable groups for socio-demographic and clinical confounders. Conclusions When considering studies with comparable groups for most confounding factors, our results provided strong evidence for the association between neonatal viral LRTI and the subsequent wheezing development. Further studies, particularly from lower-middle income countries, are needed to investigate the role of non-bronchiolitis and non-HRSV LRTI in the association between viral LRTI in childhood and the wheezing development later. In addition, more studies are needed to investigate the causal effect between childhood viral LRTI and the wheezing development later. Trial registration Review registration: PROSPERO, CRD42018116955; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018116955.
Collapse
Affiliation(s)
- Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- * E-mail: (SK); (RN)
| | - Arnol Bowo-Ngandji
- Faculty of Science, Department of Microbiology, The University of Yaounde I, Yaoundé, Cameroon
| | - Cyprien Kengne-Nde
- National AIDS Control Committee, Epidemiological Surveillance, Evaluation and Research Unit, Yaounde, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Donatien Serge Mbaga
- Faculty of Science, Department of Microbiology, The University of Yaounde I, Yaoundé, Cameroon
| | - Gadji Mahamat
- Faculty of Science, Department of Microbiology, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- * E-mail: (SK); (RN)
| |
Collapse
|
12
|
van Heerden D, van Binnendijk RS, Tromp SAM, Savelkoul HFJ, van Neerven RJJ, den Hartog G. Asthma-Associated Long TSLP Inhibits the Production of IgA. Int J Mol Sci 2021; 22:ijms22073592. [PMID: 33808333 PMCID: PMC8036615 DOI: 10.3390/ijms22073592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/19/2022] Open
Abstract
Thymic stromal lymphopoietin (TSLP) contributes to asthmatic disease. The concentrations of protective IgA may be reduced in the respiratory tract of asthma patients. We investigated how homeostatic short TSLP (shTSLP) and asthma-associated long TSLP (loTSLP) regulate IgA production. B cells from healthy donors were stimulated in the presence or absence of shTSLP or loTSLP; the concentrations of IgA, IgM, IgE, and IgG antibodies were determined in cell culture supernatants; and B cells were analyzed by flow cytometry. LoTSLP, but not shTSLP, suppressed the secretion of IgA but not of IgE. The type 2 cytokine IL-4, which in addition to loTSLP contributes to asthmatic disease, did not affect the production of IgA or the frequency of IgA+ B cells. Instead, IL-4 increased IgG production, especially of the subclasses IgG2 and IgG4. LoTSLP inhibited IgA secretion by sorted memory B cells but not by naïve B cells. Although loTSLP inhibited IgA production, the vitamin A metabolite retinoic acid promoted the secretion of IgA, also in the presence of loTSLP, suggesting that vitamin A may promote IgA production in asthma. Our data demonstrate that asthma-associated loTSLP negatively regulates the secretion of IgA, which may negatively impact the surveillance of mucosal surfaces in asthma.
Collapse
Affiliation(s)
- Dorianne van Heerden
- Cell Biology and Immunology Group, Wageningen University, 6700 AH Wageningen, The Netherlands; (D.v.H.); (H.F.J.S.); (R.J.J.v.N.)
- Center for Immunology of Infectious Diseases and Vaccination, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (R.S.v.B.); (S.A.M.T.)
| | - Robert S. van Binnendijk
- Center for Immunology of Infectious Diseases and Vaccination, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (R.S.v.B.); (S.A.M.T.)
| | - Samantha A. M. Tromp
- Center for Immunology of Infectious Diseases and Vaccination, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (R.S.v.B.); (S.A.M.T.)
- Infection and Immunity Department, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Huub F. J. Savelkoul
- Cell Biology and Immunology Group, Wageningen University, 6700 AH Wageningen, The Netherlands; (D.v.H.); (H.F.J.S.); (R.J.J.v.N.)
| | - R. J. Joost van Neerven
- Cell Biology and Immunology Group, Wageningen University, 6700 AH Wageningen, The Netherlands; (D.v.H.); (H.F.J.S.); (R.J.J.v.N.)
| | - Gerco den Hartog
- Center for Immunology of Infectious Diseases and Vaccination, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (R.S.v.B.); (S.A.M.T.)
- Correspondence: ; Tel.: +31-(0)631135216
| |
Collapse
|
13
|
Novak N, Cabanillas B. Viruses and asthma: the role of common respiratory viruses in asthma and its potential meaning for SARS-CoV-2. Immunology 2020; 161:83-93. [PMID: 32687609 PMCID: PMC7405154 DOI: 10.1111/imm.13240] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 12/20/2022] Open
Abstract
Viral infections and atopic diseases are closely related and contribute to each other. The physiological deficiencies and immune mechanisms that underlie atopic diseases can result in a suboptimal defense against multiple viruses, and promote a suitable environment for their proliferation and dissemination. Viral infections, on the other hand, can induce per se several immunological mechanisms involved in allergic inflammation capable to promote the initiation or exacerbation of atopic diseases such as atopic asthma. In a world that is affected more and more by factors that significantly impact the prevalence of atopic diseases, coronavirus disease 2019 (COVID-19) induced by the novel coronavirus severe acute respiratory syndrome (SARS-CoV-2) is having an unprecedented impact with still unpredictable consequences. Therefore, it is of crucial importance to revise the available scientific literature regarding the association between common respiratory viruses and asthma, as well as the newly emerging data about the molecular mechanisms of SARS-CoV-2 infection and its possible relation with asthma, to better understand the interrelation between common viruses and asthma and its potential meaning on the current global pandemic of COVID-19.
Collapse
Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Beatriz Cabanillas
- Department of Allergy, Research Institute Hospital 12 de Octubre, Madrid, Spain
| |
Collapse
|
14
|
Brunwasser SM, Snyder BM, Driscoll AJ, Fell DB, Savitz DA, Feikin DR, Skidmore B, Bhat N, Bont LJ, Dupont WD, Wu P, Gebretsadik T, Holt PG, Zar HJ, Ortiz JR, Hartert TV. Assessing the strength of evidence for a causal effect of respiratory syncytial virus lower respiratory tract infections on subsequent wheezing illness: a systematic review and meta-analysis. THE LANCET RESPIRATORY MEDICINE 2020; 8:795-806. [PMID: 32763206 PMCID: PMC7464591 DOI: 10.1016/s2213-2600(20)30109-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
Background Although a positive association has been established, it is unclear whether lower respiratory tract infections (LRTIs) with respiratory syncytial virus (RSV) cause chronic wheezing illnesses. If RSV-LRTI were causal, we would expect RSV-LRTI prevention to reduce the incidence of chronic wheezing illnesses in addition to reducing acute disease. We aimed to evaluate the strength of evidence for a causal effect of RSV-LRTI on subsequent chronic wheezing illness to inform public health expectations for RSV vaccines. Methods We did a systematic review and meta-analysis of observational studies evaluating the association between RSV-LRTI and subsequent wheezing illness (exposure studies) and studies evaluating the association between RSV immunoprophylaxis and subsequent wheezing illness (immunoprophylaxis studies). Exposure studies were included if the exposure group members had an LRTI with laboratory-confirmed RSV and if the exposure ascertainment period began before 2 years of age and ended before 5 years of age. We required a wash-out period of more than 30 days between the index RSV-LRTI and the outcome measurement to allow for resolution of the acute illness. Comparisons between RSV-LRTI and non-RSV-LRTI were not included. Immunoprophylaxis studies were included if they measured the association with subsequent wheezing illness relative to a control group, either in a randomised controlled trial (RCT) or an observational design. For the immunoprophylaxis drugs in question, we required evidence of efficacy in targeting RSV-LRTI from at least one RCT to ensure biological plausibility. All variations of wheezing illness were combined into a single outcome that refers broadly to asthma or any other respiratory illness with wheezing symptoms. Ovid MEDLINE and Embase databases were searched from inception up to Aug 28, 2018. We evaluated whether data from exposure studies could provide evidence against the most viable non-causal theory that RSV-LRTI is a marker of respiratory illness susceptibility rather than a causal factor. Additionally, we tested whether RSV immunoprophylaxis reduces the odds of subsequent wheezing illnesses. We used a random-effects modelling framework and, to accommodate studies providing multiple correlated estimates, robust variance estimation meta-regressions. Meta-regression coefficients (b) quantify differences between exposure and comparator groups on the loge odds ratio (loge OR) scale. Findings From 14 235 records we identified 57 eligible articles that described 42 studies and provided 153 effect estimates. 35 studies estimated the direct effect of RSV-LRTI on wheezing illnesses (exposure studies) and eight evaluated the effect of RSV immunoprophylaxis (immunoprophylaxis studies). Exposure studies that adjusted for genetic influences yielded a smaller mean adjusted OR estimate (aOR+ 2·45, 95% CI 1·23–4·88) compared with those that did not (4·17, 2·36–7·37), a significant difference (b 0·53, 95% CI 0·04–1·02). Infants who were not protected with RSV immunoprophylaxis tended to have higher odds of subsequent wheezing illness, as we would expect if RSV-LRTI were causal, but the effect was not significant (OR+ 1·21, 95% CI 0·73–1·99). There was generally a high threat of confounding bias in the observational studies. Additionally, in both the observational studies and immunoprophylaxis RCTs, there was high risk of bias due to missing outcome data. Interpretation Our findings, limited to exposure and immunoprophylaxis studies, do not support basing policy decisions on an assumption that prevention of RSV-LRTI will reduce recurrent chronic wheezing illnesses. Funding Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Steven M Brunwasser
- Department of Psychology, Rowan University, Glassboro, NJ, USA; Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amanda J Driscoll
- Centre for Vaccine Development and Global Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David A Savitz
- School of Public Health, Brown University, Providence, RI, USA
| | - Daniel R Feikin
- Department of Immunizations, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | | | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Washington, DC, USA
| | - Louis J Bont
- Wilhelmina Children's Hospital and University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Pingsheng Wu
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Heather J Zar
- Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Justin R Ortiz
- Centre for Vaccine Development and Global Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Tina V Hartert
- Department of Psychology, Rowan University, Glassboro, NJ, USA.
| |
Collapse
|
15
|
Verwey C, Nunes MC, Dangor Z, Madhi SA. Pulmonary function sequelae after respiratory syncytial virus lower respiratory tract infection in children: A systematic review. Pediatr Pulmonol 2020; 55:1567-1583. [PMID: 32364320 DOI: 10.1002/ppul.24804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/23/2020] [Indexed: 01/08/2023]
Abstract
Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) during early childhood may be associated with subsequent pulmonary sequelae, including recurrent wheezing and asthma. We undertook a systematic review to investigate the pulmonary function sequelae following RSV LRTI in the first 3 years of life. The systematic review protocol was registered on PROSPERO (CRD42018087168). PubMed, Scopus, Cochrane Library, and World Health Organization Global Index Medicus, as well as ClinicalTrials.gov and Cochrane Central Register of Controlled Trials, were searched up until 15 June 2019 for published and unpublished interventional and observational studies with the end-point outcome of pulmonary function testing (PFT) after a proven RSV LRTI in the first 3 years of life. Two independent reviewers screened all the titles, abstracts and full texts. Data were extracted using a standardized data extraction form. Corresponding authors were contacted for additional information if required. All studies were assessed for risk of bias using the Newcastle-Ottawa quality assessment scale. The final analysis included 31 studies. Thirteen studies using spirometry reported no association between RSV LRTI and pulmonary function sequelae. The remaining 16 reported abnormal spirometry; 12 obstructive airways disease, three restrictive lung disease, and one mixed lung disease. The heterogeneity in PFT techniques, different ages at testing, and methods used for reporting outcomes made direct comparisons or pooled effect estimates impossible. Children with confirmed RSV LRTI during the first 3 years of life often have abnormal PFTs, favoring obstructive airways disease. The evidence, however, is not overwhelming with conflicting results between studies.
Collapse
Affiliation(s)
- Charl Verwey
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
16
|
Differential asthma odds following respiratory infection in children from three minority populations. PLoS One 2020; 15:e0231782. [PMID: 32369487 PMCID: PMC7199930 DOI: 10.1371/journal.pone.0231782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/31/2020] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Severe early-life respiratory illnesses, particularly those caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV), are strongly associated with the development of asthma in children. Puerto Rican children in particular have a strikingly high asthma burden. However, prior studies of the potential associations between early-life respiratory illnesses and asthma in Puerto Rican and other minority populations have been limited. OBJECTIVES We sought to determine whether early-life respiratory illness was associated with asthma in Puerto Rican, Mexican American, and African American children. METHODS Using a logistic regression analysis, we examined the association between early-life respiratory illnesses (report of upper respiratory infection (URI), pneumonia, bronchitis, and bronchiolitis/RSV) within the first two years of life and physician-diagnosed asthma after the age of two in a large cohort of Puerto Rican, Mexican American, and African American children. MEASUREMENTS AND MAIN RESULTS While early-life respiratory illnesses were associated with greater asthma odds in Puerto Ricans, Mexican Americans, and African Americans, these associations were stronger among Puerto Rican children. Specifically, in Puerto Ricans, the odds was 6.15 (95% CI: 4.21-9.05) if the child reported at least one of the following respiratory illness: URI, pneumonia, bronchitis or bronchiolitis. The odds were also higher in Puerto Ricans when considering these conditions separately. CONCLUSIONS We observed population-specific associations between early-life respiratory illnesses and asthma, which were especially significant and stronger in Puerto Ricans. Taken together with the known high burden of RSV in Puerto Rico, our results may help explain the high burden of asthma in Puerto Ricans.
Collapse
|
17
|
A Durable Relationship: Respiratory Syncytial Virus Bronchiolitis and Asthma past Their Golden Anniversary. Vaccines (Basel) 2020; 8:vaccines8020201. [PMID: 32357557 PMCID: PMC7350256 DOI: 10.3390/vaccines8020201] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
Numerous preventive strategies against respiratory syncytial virus (RSV) are undergoing late stage evaluation in humans and, in addition to their intended benefit for acute illness, may impact long term consequences of infection in infants. Severe RSV infection has been repeatedly associated in the literature with long term complications, including impaired lung function, recurrent wheezing, and asthma. However, whether RSV lower respiratory tract infection (LRTI) causally affects the odds for developing wheezing and/or asthma during childhood requires further study, and the biological mechanisms underlying this hypothetical progression from viral illness to chronic lung disease are poorly characterized. In this review, we summarize the literature exploring the association between RSV LRTI in infancy and subsequent recurrent wheezing and pediatric asthma.
Collapse
|
18
|
Kenmoe S, Kengne-Nde C, Modiyinji AF, Bigna JJ, Njouom R. Association of early viral lower respiratory infections and subsequent development of atopy, a systematic review and meta-analysis of cohort studies. PLoS One 2020; 15:e0231816. [PMID: 32330171 PMCID: PMC7182231 DOI: 10.1371/journal.pone.0231816] [Citation(s) in RCA: 4] [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: 10/03/2019] [Accepted: 03/11/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Existing evidence on the relationship between childhood lower respiratory tract infections (LRTI) and the subsequent atopy development is controversial. We aimed to investigate an association between viral LRTI at <5 years and the development of atopy at > 2 years. METHODS We conducted a search at Embase, Pubmed, Web of Science, and Global Index Medicus. We collected data from the included articles. We estimated the odds ratio and the 95% confidence intervals with a random effect model. We determined factors associated with atopy development after childhood LRTI using univariate and multivariate meta-regression analyses. We recorded this systematic review at PROSPERO with the number CRD42018116955. RESULTS We included 24 studies. There was no relationship between viral LRTI at <5 years and skin prick test-diagnosed-atopy (OR = 1.2, [95% CI = 0.7-2.0]), unknown diagnosed-atopy (OR = 0.7, [95% CI = 0.4-1.3]), atopic dermatitis (OR = 1.2, [95% CI = 0.9-1.6]), hyperreactivity to pollen (OR = 0.8, [95% CI = 0.3-2.7]), food (OR = 0.8, [95% CI = 0.3-2.5]), or house dust mite (OR = 1.1, [95% CI = 0.6-2.2]). Although not confirmed in all studies with a symmetric distribution of the 23 confounding factors investigated, the overall analyses showed that there was a relationship between childhood viral LRTI at < 5 years and serum test diagnosed-atopy (OR = 2.0, [95% CI = 1.0-4.1]), allergic rhinoconjunctivitis (OR = 1.7, [95% CI = 1.1-2.9]), hyperreactivity diagnosed by serum tests with food (OR = 5.3, [1.7-16.7]) or inhaled allergens (OR = 4.2, [95% CI = 2.1-8.5]), or furred animals (OR = 0.6, [95% CI = 0.5-0.9]). CONCLUSION These results suggest that there is no association between viral LRTI at < 5 years and the majority of categories of atopy studied during this work. These results, however, are not confirmed for the remaining categories of atopy and more particularly those diagnosed by serum tests. There is a real need to develop more accurate atopy diagnostic tools.
Collapse
MESH Headings
- Allergens/adverse effects
- Animals
- Asthma/blood
- Asthma/diagnosis
- Asthma/epidemiology
- Asthma/immunology
- Child
- Conjunctivitis, Allergic/blood
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/epidemiology
- Conjunctivitis, Allergic/immunology
- Dermatitis, Atopic/blood
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/epidemiology
- Dermatitis, Atopic/immunology
- Dermatophagoides pteronyssinus/immunology
- Humans
- Pollen/adverse effects
- Pollen/immunology
- Respiratory Tract Infections/immunology
- Respiratory Tract Infections/virology
- Rhinitis, Allergic/blood
- Rhinitis, Allergic/diagnosis
- Rhinitis, Allergic/epidemiology
- Rhinitis, Allergic/immunology
- Skin Tests
- Time Factors
Collapse
Affiliation(s)
- Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Cyprien Kengne-Nde
- National AIDS Control Committee, Epidemiological Surveillance, Evaluation and Research Unit, Yaounde, Cameroon
| | - Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Department of Animals Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| |
Collapse
|
19
|
Hu M, Bogoyevitch MA, Jans DA. Impact of Respiratory Syncytial Virus Infection on Host Functions: Implications for Antiviral Strategies. Physiol Rev 2020; 100:1527-1594. [PMID: 32216549 DOI: 10.1152/physrev.00030.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Respiratory syncytial virus (RSV) is one of the leading causes of viral respiratory tract infection in infants, the elderly, and the immunocompromised worldwide, causing more deaths each year than influenza. Years of research into RSV since its discovery over 60 yr ago have elucidated detailed mechanisms of the host-pathogen interface. RSV infection elicits widespread transcriptomic and proteomic changes, which both mediate the host innate and adaptive immune responses to infection, and reflect RSV's ability to circumvent the host stress responses, including stress granule formation, endoplasmic reticulum stress, oxidative stress, and programmed cell death. The combination of these events can severely impact on human lungs, resulting in airway remodeling and pathophysiology. The RSV membrane envelope glycoproteins (fusion F and attachment G), matrix (M) and nonstructural (NS) 1 and 2 proteins play key roles in modulating host cell functions to promote the infectious cycle. This review presents a comprehensive overview of how RSV impacts the host response to infection and how detailed knowledge of the mechanisms thereof can inform the development of new approaches to develop RSV vaccines and therapeutics.
Collapse
Affiliation(s)
- MengJie Hu
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia; and Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria, Australia
| | - Marie A Bogoyevitch
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia; and Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria, Australia
| | - David A Jans
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia; and Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Kumar P, Mukherjee A, Randev S, Medigeshi GR, Jat KR, Kapil A, Lodha R, Kabra SK. Effect of acute respiratory infections in infancy on pulmonary function test at 3 years of age: a prospective birth cohort study. BMJ Open Respir Res 2020; 7:7/1/e000436. [PMID: 32079606 PMCID: PMC7047475 DOI: 10.1136/bmjresp-2019-000436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/27/2019] [Accepted: 11/03/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Acute respiratory infections (ARIs) in infancy may have a long-term impact on the developing respiratory system. We planned a prospective cohort study to determine the impact of ARI during infancy on the pulmonary function test indices at 3 years of age. METHODS A cohort of normal, full-term newborns were followed up 6 monthly and during ARI episodes. Infant pulmonary function tests (IPFTs) were performed at baseline and each follow-up visit using tidal breathing flow-volume loop, rapid thoracoabdominal compression (RTC) and raised volume RTC manoeuvres. During each ARI episode, nasopharyngeal aspirates were tested for respiratory pathogens by real-time PCR. RESULTS We screened 3421 neonates; 310 were enrolled; IPFT was performed in 225 (boys: 125 (55.6%)) at 3 years. During infancy, 470 ARI episodes were documented in 173 infants. At 3 years, children with history of any ARI episode during infancy had lower forced expiratory volume in 1 s (FEV1.0), forced expiratory volume in 0.75 s (FEV0.75), forced expiratory volume in 0.5 s (FEV0.5), forced expiratory flow between 25% and 75% of FVC (FEF25-75), and maximal expiratory flow at 25% of FVC (MEF25) as compared with those without any ARI episode during infancy. The ratio of tidal expiratory flow (TEF) at 25% or 50% of tidal expiratory volume to peak TEF (TEF50 or TEF25/peak TEF) at 3 years was significantly increased in children who had ARI in infancy. CONCLUSIONS ARI during infancy is associated with impaired pulmonary function indices such as increased resistance and decreased forced expiratory flow and volume at 3 years of age.
Collapse
Affiliation(s)
- Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shivani Randev
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Guruprasad R Medigeshi
- Vaccine and Infectious Disease Research Center, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| |
Collapse
|
21
|
Driscoll AJ, Arshad SH, Bont L, Brunwasser SM, Cherian T, Englund JA, Fell DB, Hammitt LL, Hartert TV, Innis BL, Karron RA, Langley GE, Mulholland EK, Munywoki PK, Nair H, Ortiz JR, Savitz DA, Scheltema NM, Simões EAF, Smith PG, Were F, Zar HJ, Feikin DR. Does respiratory syncytial virus lower respiratory illness in early life cause recurrent wheeze of early childhood and asthma? Critical review of the evidence and guidance for future studies from a World Health Organization-sponsored meeting. Vaccine 2020; 38:2435-2448. [PMID: 31974017 PMCID: PMC7049900 DOI: 10.1016/j.vaccine.2020.01.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/20/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) and hospitalization in infants and children globally. Many observational studies have found an association between RSV LRTI in early life and subsequent respiratory morbidity, including recurrent wheeze of early childhood (RWEC) and asthma. Conversely, two randomized placebo-controlled trials of efficacious anti-RSV monoclonal antibodies (mAbs) in heterogenous infant populations found no difference in physician-diagnosed RWEC or asthma by treatment group. If a causal association exists and RSV vaccines and mAbs can prevent a substantial fraction of RWEC/asthma, the full public health value of these interventions would markedly increase. The primary alternative interpretation of the observational data is that RSV LRTI in early life is a marker of an underlying predisposition for the development of RWEC and asthma. If this is the case, RSV vaccines and mAbs would not necessarily be expected to impact these outcomes. To evaluate whether the available evidence supports a causal association between RSV LRTI and RWEC/asthma and to provide guidance for future studies, the World Health Organization convened a meeting of subject matter experts on February 12-13, 2019 in Geneva, Switzerland. After discussing relevant background information and reviewing the current epidemiologic evidence, the group determined that: (i) the evidence is inconclusive in establishing a causal association between RSV LRTI and RWEC/asthma, (ii) the evidence does not establish that RSV mAbs (and, by extension, future vaccines) will have a substantial effect on these outcomes and (iii) regardless of the association with long-term childhood respiratory morbidity, severe acute RSV disease in young children poses a substantial public health burden and should continue to be the primary consideration for policy-setting bodies deliberating on RSV vaccine and mAb recommendations. Nonetheless, the group recognized the public health importance of resolving this question and suggested good practice guidelines for future studies.
Collapse
Affiliation(s)
- Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - S Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport PO30 5TG, Isle of Wight, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Louis Bont
- The ReSViNET Foundation, Zeist, the Netherlands; Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands; Department of Translational Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Steven M Brunwasser
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Thomas Cherian
- MM Global Health Consulting, Chemin Maurice Ravel 11C, 1290 Versoix, Switzerland
| | - Janet A Englund
- Seattle Children's Hospital, 4800 Sand Point Way NE Seattle, WA 98105, USA; Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, CPCR, Room L-1154, Ottawa, Ontario K1H 8L1, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Tina V Hartert
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Bruce L Innis
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Avenue NW, Suite 1000, WA, DC 20001, USA
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 217, Baltimore, MD 21205, USA
| | - Gayle E Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Rd, Parkville, VIC 3052, Australia; Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Patrick K Munywoki
- Division of Global Health Protection, US Centers for Disease Control and Prevention, PO Box 606-00621, Nairobi, Kenya
| | - Harish Nair
- The ReSViNET Foundation, Zeist, the Netherlands; Centre for Global Health Research, Usher Institute, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA
| | - Nienke M Scheltema
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and Children's Hospital Colorado 13123 E. 16th Ave, B065, Aurora, CO 80045, USA; Department of Epidemiology, Center for Global Health Colorado School of Public Health, 13001 E 17th Pl B119, Aurora, CO 80045, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Fred Were
- Department of Pediatrics and Child Health, University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, 5th Floor ICH Building, Klipfontein Road, Cape Town, South Africa
| | - Daniel R Feikin
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| |
Collapse
|
22
|
Perret JL, Lodge CJ, Lowe AJ, Johns DP, Thompson BR, Bui DS, Gurrin LC, Matheson MC, McDonald CF, Wood-Baker R, Svanes C, Thomas PS, Giles GG, Chang AB, Abramson MJ, Walters EH, Dharmage SC. Childhood pneumonia, pleurisy and lung function: a cohort study from the first to sixth decade of life. Thorax 2019; 75:28-37. [PMID: 31666389 DOI: 10.1136/thoraxjnl-2019-213389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Adult spirometry following community-acquired childhood pneumonia has variably been reported as showing obstructive or non-obstructive deficits. We analysed associations between doctor-diagnosed childhood pneumonia/pleurisy and more comprehensive lung function in a middle-aged general population cohort born in 1961. METHODS Data were from the prospective population-based Tasmanian Longitudinal Health Study cohort. Analysed lung function was from ages 7 years (prebronchodilator spirometry only, n=7097), 45 years (postbronchodilator spirometry, carbon monoxide transfer factor and static lung volumes, n=1220) and 53 years (postbronchodilator spirometry and transfer factor, n=2485). Parent-recalled histories of doctor-diagnosed childhood pneumonia and/or pleurisy were recorded at age 7. Multivariable linear and logistic regression were used. RESULTS At age 7, compared with no episodes, childhood pneumonia/pleurisy-ever was associated with reduced FEV1:FVC for only those with current asthma (beta-coefficient or change in z-score=-0.20 SD, 95% CI -0.38 to -0.02, p=0.028, p interaction=0.036). At age 45, for all participants, childhood pneumonia/pleurisy-ever was associated with a restrictive pattern: OR 3.02 (1.5 to 6.0), p=0.002 for spirometric restriction (FVC less than the lower limit of normal plus FEV1:FVC greater than the lower limit of normal); total lung capacity z-score -0.26 SD (95% CI -0.38 to -0.13), p<0.001; functional residual capacity -0.16 SD (-0.34 to -0.08), p=0.001; and residual volume -0.18 SD (-0.31 to -0.05), p=0.008. Reduced lung volumes were accompanied by increased carbon monoxide transfer coefficient at both time points (z-score +0.29 SD (0.11 to 0.49), p=0.001 and +0.17 SD (0.04 to 0.29), p=0.008, respectively). DISCUSSION For this community-based population, doctor-diagnosed childhood pneumonia and/or pleurisy were associated with obstructed lung function at age 7 for children who had current asthma symptoms, but with evidence of 'smaller lungs' when in middle age.
Collapse
Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia .,Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David P Johns
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce R Thompson
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Richard Wood-Baker
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, University of Tasmania, Hobart, Tasmania, Australia
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Paul S Thomas
- Prince of Wales' Hospital Clinical School and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Graham G Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre of Research Excellence for Chronic Respiratory Disease, University of Tasmania, Hobart, Tasmania, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
23
|
Divarathne MVM, Ahamed RR, Noordeen F. The Impact of RSV-Associated Respiratory Disease on Children in Asia. J PEDIAT INF DIS-GER 2019; 14:79-88. [PMID: 32300274 PMCID: PMC7117084 DOI: 10.1055/s-0038-1637752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
Acute respiratory tract infections (ARTIs) are leading contributors to the global infectious disease burden, which is estimated to be 112,900,000 disability adjusted life years. Viruses contribute to the etiology of ARTIs in a big way compared with other microorganisms. Since the discovery of respiratory syncytial virus (RSV) 61 years ago, the virus has been recognized as a major cause of ARTI and hospitalization in children. The morbidity and mortality attributable to RSV infection appear to be higher in infants < 3 months and in those with known risk factors such as prematurity, chronic lung, and congenital heart diseases. Crowded living conditions, exposure to tobacco smoke, and industrial or other types of air pollution also increase the risk of RSV-associated ARTI. Many epidemiological studies have been conducted in developed countries to understand the seasonal patterns and risk factors associated with RSV infections. Dearth of information on RSV-associated morbidity and mortality in Asian and developing countries indicates the need for regional reviews to evaluate RSV-associated disease burden in these countries. Epidemiological studies including surveillance is the key to track the disease burden including risk factors, seasonality, morbidity, and mortality associated with RSV infection in these countries. These data will contribute to improve the clinical diagnosis and plan preventive strategies in resource-limited developing countries.
Collapse
Affiliation(s)
| | - Rukshan Rafeek Ahamed
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
24
|
Ginsberg GM, Somekh E, Schlesinger Y. Should we use Palivizumab immunoprophylaxis for infants against respiratory syncytial virus? - a cost-utility analysis. Isr J Health Policy Res 2018; 7:63. [PMID: 30554570 PMCID: PMC6296113 DOI: 10.1186/s13584-018-0258-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Passive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. However, immunoprophylaxis costs are extremely high ($2800-$4200 per infant). Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV. METHODS Epidemiological, demographic, health service utilisation and economic data were integrated from primary (National Hospitalization Data, etc.) and secondary data sources (ie: from published articles) into a spread-sheet to calculate the cost per averted disability-adjusted life year (DALY) of vaccinating various infant risk groups. Costs of intervention included antibody plus administration costs. Treatment savings and DALYs averted were estimated from applying vaccine efficacy data to relative risks of being hospitalised and treated for RSV, including possible long-term sequelae like asthma and wheezing. RESULTS For all the groups RSV immunoprophylaxis is clearly not cost effective as its cost per averted DALY exceeds the $105,986 guideline representing thrice the per capita Gross Domestic Product. Vaccine price would have to fall by 48.1% in order to justify vaccinating Congenital Heart Disease or Congenital Lung Disease risk groups respectively on pure cost-effectiveness grounds. For premature babies of < 29 weeks, 29-32 and 33-36 weeks gestation, decreases of 36.8%, 54.5% and 83.3% respectively in vaccine price are required. CONCLUSIONS Based solely on cost-utility analysis, at current price levels it is difficult to justify the current indications for passive vaccination with Palivizumab against RSV. However, if the manufacturers would reduce the price by 54.5% then it would be cost-effective to vaccinate the Congenital Heart Disease or Congenital Lung Disease risk groups as well as premature babies born before the 33rd week of gestation.
Collapse
Affiliation(s)
- Gary M. Ginsberg
- Department of Technology Assessment, Public Health Service, Ministry of Health, Jerusalem, Israel
| | - Eli Somekh
- Department of Pediatrics, Wolfson Hospital, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaarae Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
25
|
Gerretsen HE, Capone S, Vitelli A, Reyes LS, Thompson A, Jones C, Green CA, Pollard AJ, Sande CJ. Antibodies in lymphocyte supernatants can distinguish between neutralising antibodies induced by RSV vaccination and pre-existing antibodies induced by natural infection. Vaccine 2018; 36:6988-6994. [PMID: 30318168 DOI: 10.1016/j.vaccine.2018.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/25/2018] [Accepted: 09/29/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is the single most important cause of severe respiratory illness in infants. There is no effective vaccine and the only effective treatment available is the monoclonal antibody palivizumab which reduces the risk of severe RSV disease in prematurely born infants. However, palivizumab is too costly to allow for wide implementation and thus treatment is restricted to supportive care. Despite extensive efforts to develop a vaccine, progress has been hindered by the difficulty in measuring and assessing immunological correlates of RSV vaccine efficacy in the presence of high levels of pre-existing RSV antibodies. METHODS Here we describe a new method for measuring the functional activity of antibodies induced by vaccination distinct from pre-existing antibodies. Antibodies in lymphocyte supernatants (ALS) from the cultured peripheral blood mononuclear cells (PBMCs) of young adults who had recently been vaccinated with a novel RSV candidate vaccine were directly assayed for virus neutralising activity. An ELISA method was used to measure antibodies in nasal and serum samples and then compared with the adapted ALS based method. RESULTS There was a wide background distribution of RSV-specific antibodies in serum and nasal samples that obscured vaccine-specific responses measured two weeks after vaccination. No RSV-specific antibodies were observed at baseline in ALS samples, but a clear vaccine-specific antibody response was observed in ALS seven days after the administration of each dose of vaccine. These vaccine-specific antibodies in ALS displayed functional activity in vitro, and quantification of this functional activity was unperturbed by pre-existing antibodies from natural exposure. The results demonstrate a promising new approach for assessing functional immune responses attributed to RSV vaccines.
Collapse
Affiliation(s)
- Hannah E Gerretsen
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK
| | | | | | - Laura S Reyes
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK
| | - Amber Thompson
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK
| | - Claire Jones
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK
| | - Christopher A Green
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK
| | - Charles J Sande
- Oxford Vaccine Group, Department of Paediatrics, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE,UK; KEMRI-Wellcome Trust Research Programme, Bofa Road, Kilifi, Kenya.
| |
Collapse
|
26
|
Perret JL, Matheson MC, Gurrin LC, Johns DP, Burgess JA, Thompson BR, Lowe AJ, Markos J, Morrison SS, McDonald CF, Wood-Baker R, Svanes C, Thomas PS, Hopper JL, Giles GG, Abramson MJ, Walters EH, Dharmage SC. Childhood measles contributes to post-bronchodilator airflow obstruction in middle-aged adults: A cohort study. Respirology 2018; 23:780-787. [PMID: 29560611 DOI: 10.1111/resp.13297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/09/2018] [Accepted: 02/20/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) has potential origins in childhood but an association between childhood measles and post-bronchodilator (BD) airflow obstruction (AO) has not yet been shown. We investigated whether childhood measles contributed to post-BD AO through interactions with asthma and/or smoking in a non-immunized middle-aged population. METHODS The population-based Tasmanian Longitudinal Health Study (TAHS) cohort born in 1961 (n = 8583) underwent spirometry in 1968 before immunization was introduced. A history of childhood measles infection was obtained from school medical records. During the fifth decade follow-up (n = 5729 responses), a subgroup underwent further lung function measurements (n = 1389). Relevant main associations and interactions by asthma and/or smoking on post-BD forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC; continuous variable) and AO (FEV1 /FVC < lower limit of normal) were estimated by multiple regression. RESULTS Sixty-nine percent (n = 950) had a history of childhood measles. Childhood measles augmented the combined adverse effect of current clinical asthma and smoking at least 10 pack-years on post-BD FEV1 /FVC ratio in middle age (z-score: -0.70 (95% CI: -1.1 to -0.3) vs -1.36 (-1.6 to -1.1), three-way interaction: P = 0.009), especially for those with childhood-onset asthma. For never- and ever-smokers of <10 pack-years who had current asthma symptoms, compared with those without childhood measles, paradoxically, the odds for post-BD AO was not significant in the presence of childhood measles (OR: 12.0 (95% CI: 3.4-42) vs 2.17 (0.9-5.3)). CONCLUSION Childhood measles infection appears to compound the associations between smoking, current asthma and post-BD AO. Differences between asthma subgroups provide further insight into the complex aetiology of obstructive lung diseases for middle-aged adults.
Collapse
Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, VIC, Australia
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - David P Johns
- "Breathe Well" Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Bruce R Thompson
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - James Markos
- Launceston General Hospital, Hobart, TAS, Australia
| | - Stephen S Morrison
- Department of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, VIC, Australia
| | - Richard Wood-Baker
- "Breathe Well" Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukelaud University Hospital, Bergen, Norway
| | - Paul S Thomas
- Prince of Wales' Hospital Clinical School and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John L Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Graham G Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia.,Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - E Haydn Walters
- "Breathe Well" Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
27
|
MacBean V, Drysdale SB, Yarzi MN, Peacock JL, Rafferty GF, Greenough A. Respiratory viral infections in infancy and school age respiratory outcomes and healthcare costs. Pediatr Pulmonol 2018; 53:342-348. [PMID: 29314779 DOI: 10.1002/ppul.23937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/02/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine the impact of viral lower respiratory tract infections (LRTIs) in infancy including rhinovirus (RV) and infancy respiratory syncytial virus (RSV), on school age pulmonary function and healthcare utilization in prematurely born children. WORKING HYPOTHESIS School age respiratory outcomes would be worse and healthcare utilization greater in children who had viral LRTIs in infancy. STUDY DESIGN Prospective study. SUBJECT SELECTION A cohort of prematurely born children who had symptomatic LRTIs during infancy documented, was recalled. METHODS Pulmonary function was assessed at 5 to 7 years of age and health related costs of care from aged one to follow-up determined. RESULTS Fifty-one children, median gestational age 33+6 weeks, were assessed at a median (IQR) age 7.03 (6.37-7.26) years. Twenty-one children had no LRTI, 14 RV LRTI, 10 RSV LRTI, and 6 another viral LRTI (other LRTI). Compared to the no LRTI group, the RV group had a lower FEV1 (P = 0.033) and the other LRTI group a lower FVC (P = 0.006). Non-respiratory medication costs were higher in the RV (P = 0.018) and RSV (P = 0.013) groups. Overall respiratory healthcare costs in the RV (£153/year) and RSV (£27/year) groups did not differ significantly from the no LRTI group (£56/year); the other LRTI group (£431/year) had higher respiratory healthcare costs (P = 0.042). CONCLUSIONS In moderately prematurely born children, RV and RSV LRTIs in infancy were not associated with higher respiratory healthcare costs after infancy. Children who experienced LRTIs caused by other respiratory viruses (including RV) had higher respiratory healthcare costs and greater pulmonary function impairment.
Collapse
Affiliation(s)
- Victoria MacBean
- Faculty of Life Sciences & Medicine, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Muska N Yarzi
- Cellular & Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Janet L Peacock
- School of Population Health & Environmental Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - Gerrard F Rafferty
- Faculty of Life Sciences & Medicine, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Anne Greenough
- Faculty of Life Sciences & Medicine, School of Basic & Medical Biosciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| |
Collapse
|
28
|
|
29
|
van Meel ER, den Dekker HT, Elbert NJ, Jansen PW, Moll HA, Reiss IK, de Jongste JC, Jaddoe VWV, Duijts L. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax 2017. [PMID: 29101282 DOI: 10.1136/thoraxjnl‐2017‐210149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent. OBJECTIVE We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children. METHODS This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years. RESULTS Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns. CONCLUSION Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
Collapse
Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
30
|
van Meel ER, den Dekker HT, Elbert NJ, Jansen PW, Moll HA, Reiss IK, de Jongste JC, Jaddoe VWV, Duijts L. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax 2017; 73:167-173. [PMID: 29101282 DOI: 10.1136/thoraxjnl-2017-210149] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent. OBJECTIVE We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children. METHODS This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years. RESULTS Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns. CONCLUSION Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
Collapse
Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
31
|
Canedo-Marroquín G, Acevedo-Acevedo O, Rey-Jurado E, Saavedra JM, Lay MK, Bueno SM, Riedel CA, Kalergis AM. Modulation of Host Immunity by Human Respiratory Syncytial Virus Virulence Factors: A Synergic Inhibition of Both Innate and Adaptive Immunity. Front Cell Infect Microbiol 2017; 7:367. [PMID: 28861397 PMCID: PMC5561764 DOI: 10.3389/fcimb.2017.00367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/31/2017] [Indexed: 01/27/2023] Open
Abstract
The Human Respiratory Syncytial Virus (hRSV) is a major cause of acute lower respiratory tract infections (ARTIs) and high rates of hospitalizations in children and in the elderly worldwide. Symptoms of hRSV infection include bronchiolitis and pneumonia. The lung pathology observed during hRSV infection is due in part to an exacerbated host immune response, characterized by immune cell infiltration to the lungs. HRSV is an enveloped virus, a member of the Pneumoviridae family, with a non-segmented genome and negative polarity-single RNA that contains 10 genes encoding for 11 proteins. These include the Fusion protein (F), the Glycoprotein (G), and the Small Hydrophobic (SH) protein, which are located on the virus surface. In addition, the Nucleoprotein (N), Phosphoprotein (P) large polymerase protein (L) part of the RNA-dependent RNA polymerase complex, the M2-1 protein as a transcription elongation factor, the M2-2 protein as a regulator of viral transcription and (M) protein all of which locate inside the virion. Apart from the structural proteins, the hRSV genome encodes for the non-structural 1 and 2 proteins (NS1 and NS2). HRSV has developed different strategies to evade the host immunity by means of the function of some of these proteins that work as virulence factors to improve the infection in the lung tissue. Also, hRSV NS-1 and NS-2 proteins have been shown to inhibit the activation of the type I interferon response. Furthermore, the hRSV nucleoprotein has been shown to inhibit the immunological synapsis between the dendritic cells and T cells during infection, resulting in an inefficient T cell activation. Here, we discuss the hRSV virulence factors and the host immunological features raised during infection with this virus.
Collapse
Affiliation(s)
- Gisela Canedo-Marroquín
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Orlando Acevedo-Acevedo
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Emma Rey-Jurado
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Juan M Saavedra
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Margarita K Lay
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile.,Departamento de Biotecnología, Facultad de Ciencias del Mar y Recursos Biológicos, Universidad de AntofagastaAntofagasta, Chile
| | - Susan M Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile
| | - Claudia A Riedel
- Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas y Medicina, Universidad Andres Bello, Millennium Institute on Immunology and ImmunotherapySantiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de ChileSantiago, Chile.,Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de ChileSantiago, Chile
| |
Collapse
|
32
|
New Insights Contributing to the Development of Effective Vaccines and Therapies to Reduce the Pathology Caused by hRSV. Int J Mol Sci 2017; 18:ijms18081753. [PMID: 28800119 PMCID: PMC5578143 DOI: 10.3390/ijms18081753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Abstract
Human Respiratory Syncytial Virus (hRSV) is one of the major causes of acute lower respiratory tract infections (ALRTI) worldwide, leading to significant levels of immunocompromisation as well as morbidity and mortality in infants. Its main target of infection is the ciliated epithelium of the lungs and the host immune responses elicited is ineffective at achieving viral clearance. It is thought that the lack of effective immunity against hRSV is due in part to the activity of several viral proteins that modulate the host immune response, enhancing a Th2-like pro-inflammatory state, with the secretion of cytokines that promote the infiltration of immune cells to the lungs, with consequent damage. Furthermore, the adaptive immunity triggered by hRSV infection is characterized by weak cytotoxic T cell responses and secretion of low affinity antibodies by B cells. These features of hRSV infection have meant that, to date, no effective and safe vaccines have been licensed. In this article, we will review in detail the information regarding hRSV characteristics, pathology, and host immune response, along with several prophylactic treatments and vaccine prototypes. We will also expose significant data regarding the newly developed BCG-based vaccine that promotes protective cellular and humoral response against hRSV infection, which is currently undergoing clinical evaluation.
Collapse
|
33
|
Mochizuki H, Kusuda S, Okada K, Yoshihara S, Furuya H, Simões EAF. Palivizumab Prophylaxis in Preterm Infants and Subsequent Recurrent Wheezing. Six-Year Follow-up Study. Am J Respir Crit Care Med 2017; 196:29-38. [PMID: 28152315 DOI: 10.1164/rccm.201609-1812oc] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Respiratory syncytial virus (RSV) induces not only infantile recurrent wheezing but also potentially atopic asthma. OBJECTIVES To test the effect of RSV infection on development of subsequent atopic asthma, we evaluated whether palivizumab, an anti-RSV monoclonal antibody, by preventing severe RSV disease in the first year of life, could impact subsequent recurrent wheezing and atopic asthma at 6 years of age. METHODS During the 2007 to 2008 RSV season, the decision to administer palivizumab was made based on standard medical practice and an observational prospective multicenter (n = 52) case-control study in preterm infants with a gestational age between 33 and 35 weeks followed from 0 to 3 years (preceding Committee on Recurrent Wheezing study). The 52 investigators at hospitals then followed these subjects until 6 years of age, reported here (Effects of Preventive Treatment for Respiratory Syncytial [RS] Virus Infection During Infancy on Later Atopic Asthma in Preterm Infants; Scientific Committee for Elucidation of Infantile Asthma). Parents of study subjects reported the infants' physicians' assessment of recurrent wheezing, using a report card and a novel mobile phone-based reporting system using the Internet. The primary endpoint was the incidence of atopic asthma. MEASUREMENTS AND MAIN RESULTS Of 444 preterm infants enrolled, 349 received palivizumab during the first year of life. At 6 years, atopic asthma was not different in the groups: 15.3 and 18.2% of infants in the treated and untreated groups, respectively (P = 0.57). On the other hand, physician-diagnosed recurrent wheezing was observed in 15.3 and 31.6% in the treated and untreated groups, respectively (P = 0.003). CONCLUSIONS Palivizumab prophylaxis administered to preterm infants did not suppress the onset of atopic asthma but resulted in a significantly lower incidence of recurrent wheezing during the first 6 years. Clinical trial registered with www.clinicaltrials.gov (NCT 01545245).
Collapse
Affiliation(s)
| | - Satoshi Kusuda
- 2 Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Okada
- 3 Section of Pediatrics, Department of Medicine, Division of Oral and Medical Management, Fukuoka Dental College, Fukouka, Japan
| | - Shigemi Yoshihara
- 4 Department of Pediatrics, Dokkyo Medical University, Mibu, Japan; and
| | - Hiroyuki Furuya
- 5 Department of Basic Clinical Science and Public Health, Tokai University School of Medicine, Isehara, Japan
| | - Eric A F Simões
- 6 University of Colorado School of Medicine and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | | |
Collapse
|
34
|
Rinawi F, Kassis I, Tamir R, Kugelman A, Srugo I, Miron D. Bronchiolitis in young infants: is it a risk factor for recurrent wheezing in childhood? World J Pediatr 2017; 13:41-48. [PMID: 27650524 DOI: 10.1007/s12519-016-0056-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood. The present study assessed prevalence, clinical manifestations and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchiolitis. METHODS Two groups of children aged 6 years were included. The study group comprised 150 children with a history of hospitalization for bronchiolitis, with the first event at <6 months of age. The control group comprised 66 age- and sex-matched children with no history of bronchiolitis before 6 months of age. Children in both groups had been followed until 6 years of age by their pediatricians; data were obtained retrospectively by reviewing ambulatory records during children's visits in pediatricians' clinics. The data included epidemiological parameters, prevalence, age at onset, number of and treatments given for episodes of wheezing events prior to 6 years of age, pathogens detected, and severity of acute bronchiolitis in the study group. RESULTS Overall, 58% and 27% of children in the study and control groups, respectively (P=0.001) had recurrent wheezing episodes prior to the age of 3 years. Children in the study group had earlier onset of recurrent wheezing, had more episodes of wheezing, and required more bronchodilator and systemic steroids treatments compared to the control group. CONCLUSION Hospitalization within the first six months of life for acute bronchiolitis is an independent risk factor for recurrent wheezing episodes during the first 3 years of life.
Collapse
Affiliation(s)
- Firas Rinawi
- Pediatric Department A', HaEmeq Medical Center, POB 10535, 16100, Afula, Israel.
| | - Imad Kassis
- Pediatric Infectious Disease unit, Meyer Children Hospital, Haifa, Israel.,The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Rina Tamir
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Dan Miron
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Infectious Disease Consultation Service, HaEmeq Medical Center, Afula, Israel
| |
Collapse
|
35
|
Hood RD, Wu JM, Witorsch RJ, Witorsch P. Environmental Tobacco Smoke Exposure and Respiratory Health in Children: An Updated Critical Review and Analysis of the Epidemiological Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1420326x9200100105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
36
|
Larkin EK, Hartert TV. Genes associated with RSV lower respiratory tract infection and asthma: the application of genetic epidemiological methods to understand causality. Future Virol 2015; 10:883-897. [PMID: 26478738 DOI: 10.2217/fvl.15.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Infants with respiratory syncytial virus (RSV) lower respiratory tract infections (LRIs) are at increased risk for childhood asthma. The objectives of this article are to review the genes associated with both RSV LRI and asthma, review analytic approaches to assessing shared genetic risk and propose a future perspective on how these approaches can help us to understand the role of infant RSV infection as both an important risk factor for asthma and marker of shared genetic etiology between the two conditions. The review of shared genes and thus pathways associated with severity of response to RSV infection and asthma risk can help us to understand mechanisms of disease and ultimately propose new and novel targets for primary prevention of both diseases.
Collapse
Affiliation(s)
- Emma K Larkin
- Department of Medicine, Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Tina V Hartert
- Department of Medicine, Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| |
Collapse
|
37
|
Bønnelykke K, Vissing NH, Sevelsted A, Johnston SL, Bisgaard H. Association between respiratory infections in early life and later asthma is independent of virus type. J Allergy Clin Immunol 2015; 136:81-86.e4. [PMID: 25910716 PMCID: PMC7112259 DOI: 10.1016/j.jaci.2015.02.024] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 01/14/2015] [Accepted: 02/12/2015] [Indexed: 12/03/2022]
Abstract
Background Lower respiratory tract infections in the first years of life are associated with later asthma, and this observation has led to a focus on the potential causal role of specific respiratory viruses, such as rhinoviruses and respiratory syncytial virus, in asthma development. However, many respiratory viruses and bacteria trigger similar respiratory symptoms and it is possible that the important risk factors for asthma are the underlying susceptibility to infection and the exaggerated reaction to such triggers rather than the particular triggering agent. Objective We sought to study the association between specific infections in early life and development of asthma later in childhood. Methods Three hundred thirteen children were followed prospectively in the Copenhagen Prospective Studies of Asthma in Childhood2000 high-risk birth cohort. Nine respiratory virus types (respiratory syncytial virus, rhinoviruses, other picornaviruses, coronaviruses 229E and OC43, parainfluenza viruses 1-3, influenza viruses AH1, AH3, and B, human metapneumovirus, adenoviruses, and bocavirus) and 3 pathogenic airway bacteria (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) were identified in airway secretions sampled during episodes of troublesome lung symptoms in the first 3 years of life. Asthma was determined by age 7 years. Results In unadjusted analyses, all viruses and pathogenic bacteria identified during episodes of troublesome lung symptoms were associated with increased risk of asthma by age 7 years with similar odds ratios for all viruses and pathogenic bacteria. After adjustment for the frequency of respiratory episodes, the particular triggers were no longer associated with asthma. Conclusion The number of respiratory episodes in the first years of life, but not the particular viral trigger, was associated with later asthma development. This suggests that future research should focus on the susceptibility and exaggerated response to lower respiratory tract infections in general rather than on the specific triggering agent.
Collapse
Affiliation(s)
- Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nadja Hawwa Vissing
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sevelsted
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian L Johnston
- Airway Disease Infection Section, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and Centre for Respiratory Infection, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
38
|
Chan JY, Stern DA, Guerra S, Wright AL, Morgan WJ, Martinez FD. Pneumonia in childhood and impaired lung function in adults: a longitudinal study. Pediatrics 2015; 135:607-16. [PMID: 25733757 PMCID: PMC4379462 DOI: 10.1542/peds.2014-3060] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diminished lung function and increased prevalence of asthma have been reported in children with a history of early lower respiratory illnesses (LRIs), including pneumonia. Whether these associations persist up to adulthood has not been established. METHODS As part of the prospective Tucson Children's Respiratory Study, LRIs during the first 3 years of life were ascertained by pediatricians. Spirometry was performed at ages 11, 16, 22, and 26 years. The occurrence of asthma/wheeze during the previous year was ascertained at ages 11, 13, 16, 18, 22, 24, 26, and 29 years. Longitudinal random effects models and generalized estimating equations were used to assess the relation of LRIs to lung function and asthma. RESULTS Compared with participants without early-life LRIs, those with pneumonia had the most severe subsequent lung function impairment, with mean ± SE deficits of -3.9% ± 0.9% (P < .001) and -2.5% ± 0.8% (P = .001) for pre- and post-bronchodilator FEV1:FVC ratio from age 11 to 26 years, respectively. Pneumonia was associated with increased risk for asthma (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.11-3.44) and wheeze (OR: 1.94; 95% CI: 1.28-2.95) over the same age range. Early non-pneumonia LRIs were associated with mildly impaired pre-bronchodilator FEV1 (-62.8 ± 27.9 mL, P = .024) and FEV1:FVC ratio (-1.1 ± 0.5%, P = .018), and wheeze (OR: 1.37; 95% CI: 1.09-1.72). CONCLUSIONS Early pneumonia is associated with asthma and impaired airway function, which is partially reversible with bronchodilators and persists into adulthood. Early pneumonia may be a major risk factor for adult chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Johnny Y.C. Chan
- Department of Pediatrics, Kwong Wah Hospital, Hospital Authority, Kowloon, Hong Kong; and,Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Debra A. Stern
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Stefano Guerra
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Anne L. Wright
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Wayne J. Morgan
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | | |
Collapse
|
39
|
Hutchison AA, Leclerc F, Nève V, Pillow JJ, Robinson PD. The Respiratory System. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193717 DOI: 10.1007/978-3-642-01219-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This chapter addresses upper airway physiology for the pediatric intensivist, focusing on functions that affect ventilation, with an emphasis on laryngeal physiology and control in breathing. Effective control of breathing ensures that the airway is protected, maintains volume homeostasis, and provides ventilation. Upper airway structures are effectors for all of these functions that affect the entire airway. Nasal functions include air conditioning and protective reflexes that can be exaggerated and involve circulatory changes. Oral cavity and pharyngeal patency enable airflow and feeding, but during sleep pharyngeal closure can result in apnea. Coordination of breathing with sucking and nutritive swallowing alters during development, while nonnutritive swallowing at all ages limits aspiration. Laryngeal functions in breathing include protection of the subglottic airway, active maintenance of its absolute volume, and control of tidal flow patterns. These are vital functions for normal lung growth in fetal life and during rapid adaptations to breathing challenges from birth through adulthood. Active central control of breathing focuses on the coordination of laryngeal and diaphragmatic activities, which adapts according to the integration of central and peripheral inputs. For the intensivist, knowledge of upper airway physiology can be applied to improve respiratory support. In a second part the mechanical properties of the respiratory system as a critical component of the chain of events that result in translation of the output of the respiratory rhythm generator to ventilation are described. A comprehensive understanding of respiratory mechanics is essential to the delivery of optimized and individualized mechanical ventilation. The basic elements of respiratory mechanics will be described and developmental changes in the airways, lungs, and chest wall that impact on measurement of respiratory mechanics with advancing postnatal age are reviewed. This will be follwowed by two sections, the first on respiratory mechanics in various neonatal pathologies and the second in pediatric pathologies. The latter can be classified in three categories. First, restrictive diseases may be of pulmonary origin, such as chronic interstitial lung diseases or acute lung injury/acute respiratory distress syndrome, which are usually associated with reduced lung compliance. Restrictive diseases may also be due to chest wall abnormalities such as obesity or scoliosis (idiopathic or secondary to neuromuscular diseases), which are associated with a reduction in chest wall compliance. Second, obstructive diseases are represented by asthma and wheezing disorders, cystic fibrosis, long term sequelae of neonatal lung disease and bronchiolitis obliterans following hematopoietic stem cell transplantation. Obstructive diseases are defined by a reduced FEV1/VC ratio. Third, neuromuscular diseases, mainly represented by DMD and SMA, are associated with a decrease in vital capacity linked to respiratory muscle weakness that is better detected by PImax, PEmax and SNIP measurements.
Collapse
|
40
|
Lambert L, Sagfors AM, Openshaw PJM, Culley FJ. Immunity to RSV in Early-Life. Front Immunol 2014; 5:466. [PMID: 25324843 PMCID: PMC4179512 DOI: 10.3389/fimmu.2014.00466] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023] Open
Abstract
Respiratory Syncytial Virus (RSV) is the commonest cause of severe respiratory infection in infants, leading to over 3 million hospitalizations and around 66,000 deaths worldwide each year. RSV bronchiolitis predominantly strikes apparently healthy infants, with age as the principal risk factor for severe disease. The differences in the immune response to RSV in the very young are likely to be key to determining the clinical outcome of this common infection. Remarkable age-related differences in innate cytokine responses follow recognition of RSV by numerous pattern recognition receptors, and the importance of this early response is supported by polymorphisms in many early innate genes, which associate with bronchiolitis. In the absence of strong, Th1 polarizing signals, infants develop T cell responses that can be biased away from protective Th1 and cytotoxic T cell immunity toward dysregulated, Th2 and Th17 polarization. This may contribute not only to the initial inflammation in bronchiolitis, but also to the long-term increased risk of developing wheeze and asthma later in life. An early-life vaccine for RSV will need to overcome the difficulties of generating a protective response in infants, and the proven risks associated with generating an inappropriate response. Infantile T follicular helper and B cell responses are immature, but maternal antibodies can afford some protection. Thus, maternal vaccination is a promising alternative approach. However, even in adults adaptive immunity following natural infection is poorly protective, allowing re-infection even with the same strain of RSV. This gives us few clues as to how effective vaccination could be achieved. Challenges remain in understanding how respiratory immunity matures with age, and the external factors influencing its development. Determining why some infants develop bronchiolitis should lead to new therapies to lessen the clinical impact of RSV and aid the rational design of protective vaccines.
Collapse
Affiliation(s)
- Laura Lambert
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Agnes M. Sagfors
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Fiona J. Culley
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
41
|
Hamasaki Y, Kohno Y, Ebisawa M, Kondo N, Nishima S, Nishimuta T, Morikawa A, Aihara Y, Akasawa A, Adachi Y, Arakawa H, Ikebe T, Ichikawa K, Inoue T, Iwata T, Urisu A, Ohya Y, Okada K, Odajima H, Katsunuma T, Kameda M, Kurihara K, Sakamoto T, Shimojo N, Suehiro Y, Tokuyama K, Nambu M, Fujisawa T, Matsui T, Matsubara T, Mayumi M, Mochizuki H, Yamaguchi K, Yoshihara S. Japanese pediatric guideline for the treatment and management of bronchial asthma 2012. Pediatr Int 2014; 56:441-50. [PMID: 25252046 DOI: 10.1111/ped.12389] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
A new version of the Japanese pediatric guideline for the treatment and management of bronchial asthma was published in Japanese at the end of 2011. The guideline sets the pragmatic goal for clinicians treating childhood asthma as maintaining a "well-controlled level" for an extended period in which the child patient can lead a trouble-free daily life, not forgetting the ultimate goal of obtaining remission and/or cure. Important factors in the attainment of the pragmatic goal are: (i) appropriate use of anti-inflammatory drugs; (ii) elimination of environmental risk factors; and (iii) educational and enlightening activities for the patient and caregivers regarding adequate asthma management in daily life. The well-controlled level refers to a symptom-free state in which no transient coughs, wheezing, dyspnea or other symptoms associated with bronchial asthma are present, even for a short period of time. As was the case in the previous versions of the guideline, asthmatic children younger than 2 years of age are defined as infantile asthma patients. Special attention is paid to these patients in the new guideline: they often have rapid exacerbation and easily present chronic asthmatic conditions after the disease is established.
Collapse
Affiliation(s)
- Yuhei Hamasaki
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan; Japanese Society of Pediatric Allergy and Clinical Immunology, Gifu, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
A population-based study of childhood respiratory morbidity after severe lower respiratory tract infections in early childhood. J Pediatr 2014; 165:123-128.e3. [PMID: 24725580 DOI: 10.1016/j.jpeds.2014.02.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/30/2014] [Accepted: 02/24/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To estimate the risk of childhood chronic respiratory morbidity among those hospitalized for severe lower respiratory tract infection (LRTI) in early childhood, and to determine whether severe LRTI is an independent predictor. STUDY DESIGN The population-based Régie de l'Assurance Maladie du Québec datasets were used to identify LRTI hospitalizations before age 2 years in a birth cohort from 1996-1997 and a comparison cohort of children without an LRTI hospitalization. The incidence rate and incidence rate ratio of chronic respiratory morbidity before age 10 years were calculated, and multivariable logistic regression was performed to estimate the impact of LRTI hospitalization on chronic respiratory morbidity. Population-attributable risks of chronic respiratory morbidity due to severe LRTI were estimated, and similar analyses were performed for respiratory syncytial virus LRTI. RESULTS Among the birth cohort, 7104 patients (4.9%) were hospitalized for LRTI before age 2 years. By age 10 years, 52.5% of the LRTI cohort and 27.9% of the nonhospitalized cohort had developed chronic respiratory morbidity; the incidence rate ratio was 1.81 (95% CI, 1.76-1.86) for males and 1.91 (95% CI, 1.84-1.99) for females. The OR for chronic respiratory morbidity based on LRTI hospitalization before age 2 years was 2.79 (95% CI, 2.66-2.93). The population-attributable risk of chronic respiratory morbidity due to any LRTI was approximately 25%, and that for respiratory syncytial virus LRTI was similar. CONCLUSIONS Hospitalization of young children for LRTIs is associated with two-fold increased risk of childhood chronic respiratory morbidity, demonstrating the ongoing impact of LRTI in infancy.
Collapse
|
43
|
Knudson CJ, Varga SM. The relationship between respiratory syncytial virus and asthma. Vet Pathol 2014; 52:97-106. [PMID: 24513802 DOI: 10.1177/0300985814520639] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Asthma is a chronic inflammatory disease of the lung that is a leading cause of morbidity and mortality in children worldwide. Most infants who experience wheezing episodes also exhibit evidence of an ongoing respiratory viral infection. Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in children and is a common cause of wheezing in infants and young children. In the past several decades, a number of studies have demonstrated a relationship between infants with severe RSV infections and the subsequent development of asthma later during childhood. This review provides an overview of data that suggests a severe RSV infection early in childhood is linked to development of asthma later in life. In addition, the current and potential future use of various animal models to gain additional insight into the relationship between RSV and asthma is discussed.
Collapse
Affiliation(s)
- C J Knudson
- Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, USA
| | - S M Varga
- Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, USA Department of Microbiology, University of Iowa, Iowa City, IA, USA Department of Pathology, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
44
|
Zomer-Kooijker K, van der Ent CK, Ermers MJJ, Uiterwaal CSPM, Rovers MM, Bont LJ. Increased risk of wheeze and decreased lung function after respiratory syncytial virus infection. PLoS One 2014; 9:e87162. [PMID: 24498037 PMCID: PMC3909049 DOI: 10.1371/journal.pone.0087162] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/18/2013] [Indexed: 01/27/2023] Open
Abstract
Background A relationship between hospitalization for respiratory syncytial virus (RSV) bronchiolitis and asthma development has been suggested in case-control studies. Objective The aim of this study was to assess the risk of current wheeze, asthma, and lung function at school age in infants previously hospitalized for RSV bronchiolitis compared to non-hospitalized children. Methods For this study, data from a prospective birth cohort of unselected, term-born infants (n = 553), of whom 4 (0.7%) were hospitalized for RSV bronchiolitis, and a prospective patient cohort of 155 term infants hospitalized for RSV bronchiolitis were used. Respiratory outcomes at age 6 in children hospitalized for RSV bronchiolitis were compared to non-hospitalized children. Results The risk of current wheeze was higher in hospitalized patients (n = 159) compared to non-hospitalized children (n = 549) (adjusted odds ratio (OR) 3.2 (95% CI 1.2–8.1). Similarly, the risk of current asthma, defined as a doctor’s diagnosis of asthma plus current symptoms or medication use, was higher in hospitalized patients (adjusted OR 3.1 (95% CI 1.3–7.5). Compared to non-hospitalized children, RSV bronchiolitis hospitalization was associated with lower lung function (mean difference FEV1% predicted −6.8 l (95% CI (−10.2 to −3.4). Conclusions and Clinical Relevance This is the first study showing that hospitalization for RSV bronchiolitis during infancy is associated with increased risk of wheezing, current asthma, and impaired lung function as compared to an unselected birth cohort at age 6.
Collapse
Affiliation(s)
- Kim Zomer-Kooijker
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marieke J. J. Ermers
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maroeska M. Rovers
- Department of Epidemiology, Biostatistics & HTA and operating rooms, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Louis J. Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| | | |
Collapse
|
45
|
Zomer-Kooijker K, van der Ent CK, Ermers MJJ, Rovers MM, Bont LJ. Lack of long-term effects of high-dose inhaled beclomethasone for respiratory syncytial virus bronchiolitis: a randomized placebo-controlled trial. Pediatr Infect Dis J 2014; 33:19-23. [PMID: 24346594 DOI: 10.1097/01.inf.0000437807.83845.d6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previously, we showed that high-dose early initiated inhaled corticosteroids during respiratory syncytial virus bronchiolitis partially and transiently prevents subsequent recurrent wheeze. Here, we study treatment effect on lung function at age 6. METHODS This is a 6-year follow-up report of a randomized placebo-controlled trial, in which 185 infants hospitalized for respiratory syncytial virus bronchiolitis were treated with early initiated, high-dose inhaled beclomethasone (n = 86) or placebo (n = 99) for 3 months. The primary outcome was forced expiratory volume in 1 second as percentage predicted. Secondary outcomes were bronchial hyperresponsiveness, physician-diagnosed asthma, hay fever and eczema. Possible toxicity was assessed by linear growth measurements. RESULTS At age 6, no significant differences were found in mean forced expiratory volume in 1 second percentage predicted between beclomethasone-treated and placebo-treated patients (91.4 vs. 93.4, mean difference 2.05 (95% confidence interval: -1.98 to 6.08). The proportion of bronchial hyperresponsiveness, physician-diagnosed asthma, parent reported hay fever and eczema was comparable between groups. There were no differences in linear growth. CONCLUSIONS Early initiated prolonged treatment with high-dose inhaled beclomethasone during hospitalization for respiratory syncytial virus infection during infancy did not improve the long-term respiratory outcome, but was safe.
Collapse
Affiliation(s)
- Kim Zomer-Kooijker
- From the *Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital; †Department of Psychiatry, University Medical Centre Utrecht; ‡Department of Epidemiology, Biostatistics & HTA and operating rooms, Radboud University Medical Centre Nijmegen; §Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital; and ¶Department of Immunology, University Medical Centre Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Abstract
Respiratory syncytial virus (RSV) is amongst the most important pathogenic infections of childhood and is associated with significant morbidity and mortality. Although there have been extensive studies of epidemiology, clinical manifestations, diagnostic techniques, animal models and the immunobiology of infection, there is not yet a convincing and safe vaccine available. The major histopathologic characteristics of RSV infection are acute bronchiolitis, mucosal and submucosal edema, and luminal occlusion by cellular debris of sloughed epithelial cells mixed with macrophages, strands of fibrin, and some mucin. There is a single RSV serotype with two major antigenic subgroups, A and B. Strains of both subtypes often co-circulate, but usually one subtype predominates. In temperate climates, RSV infections reflect a distinct seasonality with onset in late fall or early winter. It is believed that most children will experience at least one RSV infection by the age of 2 years. There are several key animal models of RSV. These include a model in mice and, more importantly, a bovine model; the latter reflects distinct similarity to the human disease. Importantly, the prevalence of asthma is significantly higher amongst children who are hospitalized with RSV in infancy or early childhood. However, there have been only limited investigations of candidate genes that have the potential to explain this increase in susceptibility. An atopic predisposition appears to predispose to subsequent development of asthma and it is likely that subsequent development of asthma is secondary to the pathogenic inflammatory response involving cytokines, chemokines and their cognate receptors. Numerous approaches to the development of RSV vaccines are being evaluated, as are the use of newer antiviral agents to mitigate disease. There is also significant attention being placed on the potential impact of co-infection and defining the natural history of RSV. Clearly, more research is required to define the relationships between RSV bronchiolitis, other viral induced inflammatory responses, and asthma.
Collapse
Affiliation(s)
- Andrea T. Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6501, Davis, CA 95616 USA
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6501, Davis, CA 95616 USA
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6501, Davis, CA 95616 USA
| | - Laurel J. Gershwin
- Department of Pathology, Microbiology and Immunology, University of California, Davis, School of Veterinary Medicine, Davis, CA USA
| |
Collapse
|
48
|
Association between respiratory syncytial virus hospitalizations in infants and respiratory sequelae: systematic review and meta-analysis. Pediatr Infect Dis J 2013; 32:820-6. [PMID: 23518824 DOI: 10.1097/inf.0b013e31829061e8] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The association between hospitalization for respiratory syncytial virus (RSV) infection in infancy and asthma/wheezing in later life has long been studied. However, no published studies have combined systematic review and meta-analysis of existing evidence. PURPOSE To quantify the link between RSV hospitalization in early life and subsequent diagnosis of asthma. METHOD A systematic search was conducted using MEDLINE and EMBASE databases. Studies were selected for meta-analysis if they assessed the association between RSV-confirmed hospitalization for up to 3 years of age and asthma/wheezing later in life. Potential sources of heterogeneity were identified by stratified analysis. RESULTS Twenty articles representing 15 unique studies of 82,008 unique individuals (including 1533 with RSV-confirmed hospitalization) were selected for meta-analysis. Children who had RSV disease in early life had a higher incidence of asthma/wheezing in later life (odds ratio: 3.84; 95% confidence interval: 3.23-4.58). There was moderate heterogeneity between studies (I² = 45%). The association was found to decrease with age at follow-up, consistent with the findings of longitudinal studies. When age at follow-up was considered, heterogeneity was low (residual I² = 17%). LIMITATIONS Study quality was generally poor because randomization to hospitalization for RSV infection was not possible, appropriate blinding was rare and adjustment for confounding variables was not always appropriate. CONCLUSIONS The meta-analysis suggests an association between infant RSV hospitalization and respiratory morbidity that decreases with age. If the association is causal, the development of an effective vaccine against RSV could decrease the burden of asthma.
Collapse
|
49
|
Yoo JK, Kim TS, Hufford MM, Braciale TJ. Viral infection of the lung: host response and sequelae. J Allergy Clin Immunol 2013; 132:1263-76; quiz 1277. [PMID: 23915713 PMCID: PMC3844062 DOI: 10.1016/j.jaci.2013.06.006] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/21/2013] [Accepted: 06/05/2013] [Indexed: 02/06/2023]
Abstract
Because of its essential role in gas exchange and oxygen delivery, the lung has evolved a variety of strategies to control inflammation and maintain homeostasis. Invasion of the lung by pathogens (and in some instances exposure to certain noninfectious particulates) disrupts this equilibrium and triggers a cascade of events aimed at preventing or limiting colonization (and more importantly infection) by pathogenic microorganisms. In this review we focus on viral infection of the lung and summarize recent advances in our understanding of the triggering of innate and adaptive immune responses to viral respiratory tract infection, mechanisms of viral clearance, and the well-recognized consequences of acute viral infection complicating underlying lung diseases, such as asthma.
Collapse
Affiliation(s)
- Jae-Kwang Yoo
- Beirne B. Carter Center for Immunology Research, University of Virginia, Charlottesville, Va
| | - Taeg S. Kim
- Beirne B. Carter Center for Immunology Research, University of Virginia, Charlottesville, Va
- Department of Pathology and Molecular Medicine, University of Virginia, Charlottesville, Va
| | - Matthew M. Hufford
- Beirne B. Carter Center for Immunology Research, University of Virginia, Charlottesville, Va
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, Va
| | - Thomas J. Braciale
- Beirne B. Carter Center for Immunology Research, University of Virginia, Charlottesville, Va
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, Va
- Department of Pathology and Molecular Medicine, University of Virginia, Charlottesville, Va
- Corresponding author: Thomas J. Braciale, MD, PhD, Beirne B. Carter Center for Immunology Research, University of Virginia, Charlottesville, VA 22908.
| |
Collapse
|
50
|
A novel influenza virus hemagglutinin-respiratory syncytial virus (RSV) fusion protein subunit vaccine against influenza and RSV. J Virol 2013; 87:10792-804. [PMID: 23903841 DOI: 10.1128/jvi.01724-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Influenza A virus and respiratory syncytial virus (RSV) cause substantial morbidity and mortality afflicting the ends of the age spectrum during the autumn through winter months in the United States. The benefit of vaccination against RSV and influenza using a subunit vaccine to enhance immunity and neutralizing antibody was investigated. Influenza virus hemagglutinin (HA) and RSV fusion (F) protein were tested as vaccine components alone and in combination to explore the adjuvant properties of RSV F protein on HA immunity. Mice vaccinated with HA and F exhibited robust immunity that, when challenged, had reduced viral burden for both influenza and RSV. These studies show an enhancing and cross-protective benefit of F protein for anti-HA immunity.
Collapse
|