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Pandolfi E, Loconsole D, Chironna M, van Summeren J, Paget J, Raponi M, Russo L, Campagna I, Croci I, Concato C, Perno CF, Tozzi AE, Linardos G, Bartolucci V, Ciampini S, Muda AO, De Angelis L, Ciofi Degli Atti ML, Rizzo C. Pre-COVID-19-pandemic RSV epidemiology and clinical burden in pediatric primary care in Italy: a comparative analysis across two regions for the 2019/2020 season. BMC Infect Dis 2024; 24:388. [PMID: 38605310 PMCID: PMC11007985 DOI: 10.1186/s12879-024-09229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection in children under 5 years have a significant clinical burden, also in primary care settings. This study investigates the epidemiology and burden of RSV in Italian children during the 2019/20 pre-pandemic winter season. METHODS A prospective cohort study was conducted in two Italian regions. Children with Acute Respiratory Infection (ARI) visiting pediatricians were eligible. Nasopharyngeal swabs were collected and analyzed via multiplex PCR for RSV detection. A follow-up questionnaire after 14 days assessed disease burden, encompassing healthcare utilization and illness duration. Statistical analyses, including regression models, explored associations between variables such as RSV subtype and regional variations. RESULTS Of 293 children with ARI, 41% (119) tested positive for RSV. Median illness duration for RSV-positive cases was 7 days; 6% required hospitalization (median stay: 7 days). Medication was prescribed to 95% (110/116) of RSV cases, with 31% (34/116) receiving antibiotics. RSV subtype B and regional factors predicted increased healthcare utilization. Children with shortness of breath experienced a 36% longer illness duration. CONCLUSIONS This study highlights a significant clinical burden and healthcare utilization associated with RSV in pre-pandemic Italian primary care settings. Identified predictors, including RSV subtype and symptomatology, indicate the need for targeted interventions and resource allocation strategies. RSV epidemiology can guide public health strategies for the implementation of preventive measures.
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Affiliation(s)
- Elisabetta Pandolfi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daniela Loconsole
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | | | - John Paget
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | - Luisa Russo
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ilaria Campagna
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ileana Croci
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Concato
- Virology Unit, Laboratory Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Federico Perno
- Virology Unit, Laboratory Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giulia Linardos
- Virology Unit, Laboratory Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Veronica Bartolucci
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Sara Ciampini
- Local Health Unit, Public Health Service, Rome, Italy
| | - Andrea Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luigi De Angelis
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | | | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Scarpaci M, Bracaloni S, Esposito E, De Angelis L, Baglivo F, Casini B, Panatto D, Ogliastro M, Loconsole D, Chironna M, Pariani E, Pellegrinelli L, Pandolfi E, Croci I, Rizzo C. RSV Disease Burden in Primary Care in Italy: A Multi-Region Pediatric Study, Winter Season 2022-2023. Influenza Other Respir Viruses 2024; 18:e13282. [PMID: 38622776 PMCID: PMC11018906 DOI: 10.1111/irv.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Human respiratory syncytial virus (RSV) is one of the most frequent causes of respiratory infections in children under 5 years of age, but its socioeconomic impact and burden in primary care settings is still little studied. METHODS During the 2022/2023 winter season, 55 pediatricians from five Italian regions participated in our community-based study. They collected a nasal swab for RSV molecular test from 650 patients under the age of 5 with acute respiratory infections (ARIs) and performed a baseline questionnaire. The clinical and socioeconomic burden of RSV disease in primary care was evaluated by two follow-up questionnaires completed by the parents of positive children on Days 14 and 30. RESULTS RSV laboratory-confirmed cases were 37.8% of the total recruited ARI cases, with RSV subtype B accounting for the majority (65.4%) of RSV-positive swabs. RSV-positive children were younger than RSV-negative ones (median 12.5 vs. 16.5 months). The mean duration of symptoms for all children infected by RSV was 11.47 ± 6.27 days. We did not observe substantial differences in clinical severity between the two RSV subtypes, but RSV-A positive patients required more additional pediatric examinations than RSV-B cases. The socioeconomic impact of RSV infection was considerable, causing 53% of children to be absent from school, 46% of parents to lose working days, and 25% of families to incur extra costs. CONCLUSIONS Our findings describe a baseline of the RSV disease burden in primary care in Italy before the introduction of upcoming immunization strategies.
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Affiliation(s)
- Michela Scarpaci
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Sara Bracaloni
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Enrica Esposito
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Luigi De Angelis
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Francesco Baglivo
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | | | | | - Daniela Loconsole
- Hygiene Section, Department of Interdisciplinary MedicineUniversity of Bari “A. Moro”BariItaly
| | - Maria Chironna
- Hygiene Section, Department of Interdisciplinary MedicineUniversity of Bari “A. Moro”BariItaly
| | - Elena Pariani
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | | | - Elisabetta Pandolfi
- Predictive and Preventive Medicine Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Ileana Croci
- Predictive and Preventive Medicine Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
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I G Giamberardino H, O Pacheco AP, Pereira LA, Debur MDC, Genehold G, Raboni SM. Respiratory syncytial virus: host genetic susceptibility and factors associated with disease severity in a cohort of pediatric patients. J Trop Pediatr 2022; 68:6794268. [PMID: 36323460 DOI: 10.1093/tropej/fmac091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infections are the leading cause of hospitalization in young children. We assessed the epidemiology, severity, clinical characteristics, molecular profile and genetic factors of RSV infections compared to acute respiratory illness (ARI) caused by other respiratory viruses. METHODS Prospective cohort study was conducted from 2017 to 2018 with children under 2 years old hospitalized with ARI. Detection of respiratory viruses was carried out using RT-PCR. RSVs were genotyped via nucleotide sequencing, and host interleukin 28B (IL28B) single nucleotide polymorphisms (SNPs) were determined using SNP TaqMan® Genotyping Assays. RESULTS A total of 468 children were included; 288 (61.5%) had an infection by a single virus: 202 (70.1%) cases by RSV followed by rhinovirus 36 (12.5%) and influenza 16 (5.6%). Of the RSV cases, 36% were genotyped with a higher prevalence of RSV B (62.1%). The RSV group presented median age of 2.7 months (1.6-6.8), higher frequency in: intensive care unit admission (p = 0.004), mechanical ventilation use (p = 0.018), wheezing (p < 0.001), antimicrobial use (p < 0.001) and low oxygen saturation (p < 0.001). Prematurity (27.2%) was the most frequent comorbidity. RSV patients without comorbidities demonstrated a higher frequency in the combination of IL28B rs12979860 CT/IL28B rs8099917 TG and IL28B rs12979860 TT/IL28B rs8099917 TT genotypes. Viral coinfection was detected in 27 (5.7%) children, with the most frequent being RSV and rhinovirus (14.2%). CONCLUSIONS This study highlighted the burden of RSV infection in children under 2 years of age, without comorbidities, with a higher need for pediatric ICU admission. Some IL28B allele combinations had a significant association with RSV frequency of infections.
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Affiliation(s)
- Heloisa I G Giamberardino
- Graduate Program in Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil.,Epidemiology, Immunization and Infection Control Department, Hospital Pequeno Principe, Curitiba, Paraná 80250-060, Brazil
| | - Ana P O Pacheco
- Epidemiology, Immunization and Infection Control Department, Hospital Pequeno Principe, Curitiba, Paraná 80250-060, Brazil
| | - Luciane A Pereira
- Graduate Program in Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil.,Research and Molecular Biology of Microorganisms Laboratory, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil
| | - Maria do Carmo Debur
- Health Public Laboratory, Health State Secretary, Curitiba, Paraná 80045-155, Brazil
| | - Gustavo Genehold
- Research and Molecular Biology of Microorganisms Laboratory, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil
| | - Sonia M Raboni
- Research and Molecular Biology of Microorganisms Laboratory, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil.,Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Paraná 80060-900, Brazil
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Zheng Z, Pitzer VE, Warren JL, Weinberger DM. Community factors associated with local epidemic timing of respiratory syncytial virus: A spatiotemporal modeling study. SCIENCE ADVANCES 2021; 7:7/26/eabd6421. [PMID: 34162556 PMCID: PMC8221622 DOI: 10.1126/sciadv.abd6421] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 05/10/2021] [Indexed: 05/29/2023]
Abstract
Respiratory syncytial virus (RSV) causes a large burden of morbidity in young children and the elderly. Spatial variability in the timing of RSV epidemics provides an opportunity to probe the factors driving its transmission, including factors that influence epidemic seeding and growth rates. Using hospitalization data from Connecticut, New Jersey, and New York, we estimated epidemic timing at the ZIP code level using harmonic regression and then used a Bayesian meta-regression model to evaluate correlates of epidemic timing. Earlier epidemics were associated with larger household size and greater population density. Nearby localities had similar epidemic timing. Our results suggest that RSV epidemics grow faster in areas with more local contact opportunities, and that epidemic spread follows a spatial diffusion process based on geographic proximity. Our findings can inform the timing of delivery of RSV extended half-life prophylaxis and maternal vaccines and guide future studies on the transmission dynamics of RSV.
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Affiliation(s)
- Zhe Zheng
- Department of Epidemiology of Microbial Diseases and the Public Health Modeling Unit, Yale School of Public Health, New Haven, CT 06520, USA.
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and the Public Health Modeling Unit, Yale School of Public Health, New Haven, CT 06520, USA
| | - Joshua L Warren
- Department of Biostatistics and the Public Health Modeling Unit, Yale School of Public Health, New Haven, CT 06520, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases and the Public Health Modeling Unit, Yale School of Public Health, New Haven, CT 06520, USA
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Choi Y, Meissner HC, Hampp C, Park H, Brumback B, Winterstein AG. Calibration of Chronic Lung Disease Severity as a Risk Factor for Respiratory Syncytial Virus Hospitalization. J Pediatric Infect Dis Soc 2021; 10:317-325. [PMID: 32978942 DOI: 10.1093/jpids/piaa107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Guidelines assume children with chronic lung disease (CLD) who require medical support within 6 months before the second respiratory syncytial virus (RSV) season remains at high risk of severe RSV disease. We determined the number of days since the last treatment (DSL) when the risk of RSV hospitalization among children with CLD becomes equivalent to the risk for those not qualified for immunoprophylaxis. METHODS The study cohort was assembled using Medicaid billing records from 1999 to 2010 linked to Florida and Texas birth certificate records. We developed DSL-trend discrete time logistic regression models within a survival analysis framework, adjusting for use of immunoprophylaxis, to compare the hospitalization risk of CLD infants at 4 age points to that of term infants at 1 month of age with siblings. RESULTS The study cohort included 858 830 healthy term and 5562 preterm infants with CLD. Among 1-month-old term infants, the RSV hospitalization risk averaged across all covariate strata was 14.8 (95% confidence interval [CI], 13.5-16.1) per 1000 patient season-months. Risk for preterm CLD children reached the threshold derived from term infants when DSL was 76 (95% CI, 22-198.5), 52 (95% CI, 6.5-123), 35 (95% CI, 0-93.5), and 12 (95% CI, 0-61.5) at the respective ages of 12, 15, 17.2, and 21 months. CONCLUSIONS The 180-day threshold used to define CLD severity at season start can be shortened to 120 days, 90 days, and 60 days for children with CLD at age 15, 17.2, and 21 months, respectively.
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Affiliation(s)
- Yoonyoung Choi
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - H Cody Meissner
- Department of Pediatrics, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christian Hampp
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Department of Biostatistics, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, Florida, USA
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Eichinger KM, Kosanovich JL, Lipp M, Empey KM, Petrovsky N. Strategies for active and passive pediatric RSV immunization. Ther Adv Vaccines Immunother 2021; 9:2515135520981516. [PMID: 33623860 PMCID: PMC7879001 DOI: 10.1177/2515135520981516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 11/20/2020] [Indexed: 12/26/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in children worldwide, with the most severe disease occurring in very young infants. Despite half a century of research there still are no licensed RSV vaccines. Difficulties in RSV vaccine development stem from a number of factors, including: (a) a very short time frame between birth and first RSV exposure; (b) interfering effects of maternal antibodies; and (c) differentially regulated immune responses in infants causing a marked T helper 2 (Th2) immune bias. This review seeks to provide an age-specific understanding of RSV immunity critical to the development of a successful pediatric RSV vaccine. Historical and future approaches to the prevention of infant RSV are reviewed, including passive protection using monoclonal antibodies or maternal immunization strategies versus active infant immunization using pre-fusion forms of RSV F protein antigens formulated with novel adjuvants such as Advax that avoid excess Th2 immune polarization.
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Affiliation(s)
- Katherine M. Eichinger
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Kosanovich
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Madeline Lipp
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kerry M. Empey
- Department of Pharmacy and Therapeutics, Department of Pharmaceutical Sciences, School of Medicine and Clinical and Translational Science Institute, University of Pittsburgh School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nikolai Petrovsky
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia 5042, Australia and Vaxine Pty Ltd, Warradale, SA 5046, Australia
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Fitzpatrick T, McNally JD, Stukel TA, Kwong JC, Wilton AS, Fisman D, Guttmann A. Palivizumab's real-world effectiveness: a population-based study in Ontario, Canada, 1993-2017. Arch Dis Child 2021; 106:173-179. [PMID: 32859612 PMCID: PMC7841493 DOI: 10.1136/archdischild-2020-319472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/07/2020] [Accepted: 07/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of two palivizumab programmes targeting high-risk infants, defined by prematurity, diagnosis of comorbidities and geography, and assess potential disparities by neighbourhood income. DESIGN Controlled, interrupted time series. SETTING Ontario, Canada. PATIENTS We used linked health and demographic administrative databases to identify all children born in hospitals 1 January 1993 through 31 December 2016. Follow-up ended at the earliest of second birthday or 30 June 2017. INTERVENTION Palivizumab-eligibility: child was born very preterm and ≤6 months old during respiratory syncytial virus (RSV) season; <24 months old with significant chronic lung or congenital heart disease; or ≤6 months, born preterm or residents of remote regions. MAIN OUTCOME Severe RSV-related illness, defined as hospitalisation or death with a diagnosis of bronchiolitis, RSV pneumonia or RSV. RESULTS 3 million births and 87 000 RSV-related events were identified. Over the study period, rates of severe RSV-related illness declined 65.4% among the highest risk group, eligible infants <6 months (230.6 to 79.8 admissions per 1000 child-years). Relative to changes among ineligible infants <6 months, rates dropped 10.4% (95% CI -18.6% to 39.4%) among eligible infants immediately following introduction of a national palivizumab programme in 1998. Initially, rates were considerably higher among infants from low-income neighbourhoods, but income-specific rates converged over time among eligible infants <6 months; such convergence was not seen among other children. CONCLUSIONS Incidence of severe RSV-related illness declined over the study period. While we cannot attribute causality, the timing and magnitude of these declines suggest impact of palivizumab in reducing RSV burden and diminishing social inequities among palivizumab-eligible infants.
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Affiliation(s)
- Tiffany Fitzpatrick
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James Dayre McNally
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Therese A Stukel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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8
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Identification of miRNA-mRNA Crosstalk in Respiratory Syncytial Virus- (RSV-) Associated Pediatric Pneumonia through Integrated miRNAome and Transcriptome Analysis. Mediators Inflamm 2020; 2020:8919534. [PMID: 32410870 PMCID: PMC7211260 DOI: 10.1155/2020/8919534] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/03/2020] [Accepted: 03/28/2020] [Indexed: 12/13/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the most common respiratory virus and is associated with pediatric pneumonia, causing bronchiolitis and significant mortality in infants and young children. MicroRNAs (miRNAs) are endogenous noncoding small RNAs that function in gene regulation and are associated with host immune response and disease progression. In the present study, we profiled the global transcriptome and miRNAome of whole blood samples from children with mild or severe RSV-associated pneumonia, aiming to identify the potential biomarkers and investigate the molecular mechanisms of severe RSV-associated pediatric pneumonia. We found that expression profiles of whole blood microRNAs and mRNAs were altered and distinctly different in children with severe RSV-associated pneumonia. In particular, the four most significantly upregulated miRNAs in children with severe RSV-associated pneumonia were hsa-miR-1271-5p, hsa-miR-10a-3p, hsa-miR-125b-5p, and hsa-miR-30b-3p. The severe RSV-associated pneumonia-specific differentially expressed miRNA target interaction network was also contrasted. These target genes were further analyzed with Gene Ontology enrichment analysis. We found that most of the target genes were involved in inflammatory and immune responses, including the NF-κB signaling pathway, the MAPK signaling pathway, and T cell receptor signaling. Our findings will contribute to the identification of biomarkers and new drug design strategies to treat severe RSV-associated pediatric pneumonia.
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9
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Radhakrishnan D, Ouedraogo A, Shariff SZ, McNally JD, Benchimol EI, Clemens KK. The association between climate, geography and respiratory syncitial virus hospitalizations among children in Ontario, Canada: a population-based study. BMC Infect Dis 2020; 20:157. [PMID: 32075581 PMCID: PMC7031991 DOI: 10.1186/s12879-020-4882-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/12/2020] [Indexed: 01/06/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) infection is a major cause of hospitalization in young children in Canada, despite routine immunoprophylaxis in those with medical risk factors. We aimed to determine if cold temperatures are associated with RSV hospitalization. Methods We conducted a population-based nested case–control study of children in Ontario, Canada, using health administrative data. We compared children hospitalized for RSV between September 1, 2011 and August 31, 2012 to age and sex matched controls. We used multivariable logistic regression to identify associations between minimum daily temperature and RSV hospitalizations with adjustment for sociodemographic and environmental factors. Results We identified 1670 children with RSV hospitalizations during the study period and 6680 matched controls. Warmer temperatures (OR = 0.94, 95%CI: 0.93, 0.95) were associated with lower odds of RSV hospitalization. Southern ecozone (OR = 1.6, 95%CI: 1.2, 2.1), increased ozone concentration (OR = 1.03, 95%CI: 1.01, 1.06) and living in a lower income neighbourhood (OR = 1.3, 95%CI: 1.1, 1.5) significantly increased the odds of RSV hospitalization, as did living in a household with a larger number of siblings in a sub-cohort of children (OR = 1.34, 95%CI: 1.26, 1.41). Conclusions In Ontario, the likelihood of having an RSV hospitalization is associated with colder temperature exposures and socioeconomic factors.
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Affiliation(s)
- Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. .,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. .,ICES, Toronto, Ontario, Canada.
| | | | | | - J Dayre McNally
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Eric I Benchimol
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,ICES, Toronto, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kristin K Clemens
- ICES, Toronto, Ontario, Canada. .,Department of Medicine & Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. .,St. Joseph's Health Care London, PO Box 5777, STN B, London, ON, N6A 4V2, Canada. .,Lawson Health Research Institute, London, ON, Canada.
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10
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Wang MM, Lu M, Zhang CL, Wu X, Chen JX, Lv WW, Sun T, Qiu H, Huang SH. Oxidative stress modulates the expression of toll‑like receptor 3 during respiratory syncytial virus infection in human lung epithelial A549 cells. Mol Med Rep 2018; 18:1867-1877. [PMID: 29845280 DOI: 10.3892/mmr.2018.9089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/11/2018] [Indexed: 11/05/2022] Open
Abstract
Toll‑like receptor 3 (TLR3) can react with double stranded RNA and is involved in the inflammatory response to respiratory syncytial virus (RSV) infection. Also, oxidative stress has been reported to be involved in RSV infection. However, the correlation between oxidative stress and TLR3 activation during RSV infection is unclear. Therefore, the present study investigated the association between TLR3 expression and oxidative stress modulation during RSV infection in A549 cells. For comparison, seven treatment groups were established, including RSV‑treated cells, N‑acetyl‑L‑cysteine (NAC)+RSV‑treated cells, oxidant hydrogen peroxide (H2O2)+RSV‑treated cells, normal cell control, inactivated RSV control, NAC control and H2O2 control. The mRNA expression changes of TLR3, interferon regulatory factor‑3 (IRF3), nuclear factor‑κB (NF‑κB) and superoxide dismutase 1 (SOD1) were measured using semi‑quantitative reverse transcription‑polymerase chain reaction, and the protein changes of TLR3 and phospho‑NF‑κB p65 were determined using western blot in A549 cells from the different treatment groups. The present study also evaluated the differences in hydroxyl free radical (·OH), nitric oxide (NO) and total SOD activity in the different treatment groups. The results demonstrated that RSV infection of A549 cells increased the levels of ·OH and NO, while decreasing the activity of total SOD. Pretreatment of A549 cells with H2O2 prior to RSV infection upregulated the mRNA and protein expression of TLR3 and NF‑κB, and downregulated the mRNA expression of IRF3 and SOD1, as well as the total SOD activity. When the infected cells were pretreated with NAC, the mRNA and protein expression of these genes were reversed. These variations in the TLR3‑mediated signaling pathway molecules suggested that oxidative stress may be a key regulator for TLR3 activation during RSV infection. RSV‑induced oxidative stress may potentially activate TLR3 and enhance TLR3‑mediated inflammation. These results may provide better understanding of the RSV‑induced inflammatory and immune pathways, and may also contribute to the drug development and prevention of human RSV diseases.
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Affiliation(s)
- Min-Min Wang
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Min Lu
- Department of Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Chuan-Long Zhang
- Department of Pediatrics, The People's Hospital of Lu'an City, Lu'an, Anhui 237005, P.R. China
| | - Xuan Wu
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Jing-Xian Chen
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Wei-Wei Lv
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Tao Sun
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Huan Qiu
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Sheng-Hai Huang
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
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11
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Tahamtan A, Tavakoli-Yaraki M, Shadab A, Rezaei F, Marashi SM, Shokri F, Mokhatri-Azad T, Salimi V. The Role of Cannabinoid Receptor 1 in the Immunopathology of Respiratory Syncytial Virus. Viral Immunol 2018; 31:292-298. [DOI: 10.1089/vim.2017.0098] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Alireza Tahamtan
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoumeh Tavakoli-Yaraki
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shadab
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Rezaei
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mahdi Marashi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazel Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhatri-Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Salimi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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12
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Car LT, Papachristou N, Urch C, Majeed A, Atun R, Car J, Vincent C. Prioritizing medication safety in care of people with cancer: clinicians' views on main problems and solutions. J Glob Health 2018; 7:011001. [PMID: 28685047 PMCID: PMC5475313 DOI: 10.7189/jogh.07.011001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cancer care is liable to medication errors due to the complex nature of cancer treatment, the common presence of comorbidities and the involvement of a number of clinicians in cancer care. While the frequency of medication errors in cancer care has been reported, little is known about their causal factors and effective prevention strategies. With a unique insight into the main safety issues in cancer treatment, frontline staff can help close this gap. In this study, we aimed to identify medication safety priorities in cancer patient care according to clinicians in North West London using PRIORITIZE, a novel priority-setting approach. METHODS The project steering group determined the scope, the context and the criteria for prioritization. We then invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A group of 26 clinicians from the initial cohort ranked the composite list of suggestions using predetermined criteria. RESULTS The top ranked problems focused on patients' poor understanding of treatments due to language or education difficulties, clinicians' insufficient attention to patients' psychological distress, and inadequate information sharing among health care providers. The top ranked solutions were provision of guidance to patients and their carers on what to do when unwell, pre-chemotherapy work-up for all patients and better staff training. Overall, clinicians considered improved communication between health care providers, quality assurance procedures (during prescription and monitoring stages) and patient education as key strategies for improving cancer medication safety. Prescribing stage was identified as the most vulnerable to medication safety threats. The highest ranked suggestions received the strongest agreement among the clinicians. CONCLUSIONS Clinician-identified priorities for reducing medication errors in cancer care addressed various aspects of cancer treatment. Our findings open up an opportunity to assess the congruence between health care professional suggestions, currently implemented patient safety policies and evidence base.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, Massachusetts, USA
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Catherine Urch
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, Massachusetts, USA
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK.,Health Services and Outcomes Research Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, UK
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13
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Bayer L, Fertey J, Ulbert S, Grunwald T. Immunization with an adjuvanted low-energy electron irradiation inactivated respiratory syncytial virus vaccine shows immunoprotective activity in mice. Vaccine 2018; 36:1561-1569. [DOI: 10.1016/j.vaccine.2018.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 12/23/2022]
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14
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Tang JW, Lam TT, Zaraket H, Lipkin WI, Drews SJ, Hatchette TF, Heraud JM, Koopmans MP. Global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance. THE LANCET. INFECTIOUS DISEASES 2017; 17:e320-e326. [PMID: 28457597 PMCID: PMC7164797 DOI: 10.1016/s1473-3099(17)30238-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 01/13/2023]
Abstract
Together with influenza, the non-influenza RNA respiratory viruses (NIRVs), which include respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus, represent a considerable global health burden, as recognised by WHO's Battle against Respiratory Viruses initiative. By contrast with influenza viruses, little is known about the contemporaneous global diversity of these viruses, and the relevance of such for development of pharmaceutical interventions. Although far less advanced than for influenza, antiviral drugs and vaccines are in different stages of development for several of these viruses, but no interventions have been licensed. This scarcity of global genetic data represents a substantial knowledge gap and impediment to the eventual licensing of new antiviral drugs and vaccines for NIRVs. Enhanced genetic surveillance will assist and boost research and development into new antiviral drugs and vaccines for these viruses. Additionally, understanding the global diversity of respiratory viruses is also part of emerging disease preparedness, because non-human coronaviruses and paramyxoviruses have been listed as priority concerns in a recent WHO research and development blueprint initiative for emerging infectious diseases. In this Personal View, we explain further the rationale for expanding the genetic database of NIRVs and emphasise the need for greater investment in this area of research.
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Affiliation(s)
- Julian W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK; Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, UK.
| | - Tommy T Lam
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Beirut, Lebanon
| | - W Ian Lipkin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Steven J Drews
- Alberta Provincial Laboratory for Public Health, University of Alberta, Edmonton, AB, Canada
| | - Todd F Hatchette
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | | | - Marion P Koopmans
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, Netherlands
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15
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One‐year observational study of palivizumab prophylaxis on infants at risk for respiratory syncytial virus infection in Latin America. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Castillo LM, Bugarin G, Arias JC, Barajas Rangel JI, Serra ME, Vain N. One-year observational study of palivizumab prophylaxis on infants at risk for respiratory syncytial virus infection in Latin America. J Pediatr (Rio J) 2017; 93:467-474. [PMID: 28236418 DOI: 10.1016/j.jped.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aims to describe real world palivizumab use and effectiveness in high-risk Latin American infants and young children. METHOD Prospective, multicenter observational study with infants at risk for severe RSV infection who received palivizumab according to routine clinical practice. Subjects were followed for one year with monthly visits after the first dose of palivizumab. An infant was considered adherent if receiving all the expected injections or five or fewer injections within appropriate inter-dose intervals. Annual incidence rates and risk factors of lower respiratory tract infection (LRTI) hospitalization were determined through Poisson regression models (α=0.05). RESULTS The study enrolled 458 children from seven countries in Latin America, from February 2011 to September 2012. The majority (98%) were born <36 weeks gestation. Overall, patients received 83.7% of their expected injections and 86.7% completed one year of follow-up. Of the 61 LRTI hospitalizations, 12 episodes were due to RSV infection. The RSV-associated hospitalization rate was 2.9 per 100 patient-years. Bronchopulmonary dysplasia was identified as an independent risk factor for LRTI hospitalization. A total of 1165 adverse events were recorded during one year of follow-up. One hundred and two patients (22.3%) had a total of 135 serious adverse events, but no events were considered to be related to palivizumab. CONCLUSIONS The rate of RSV hospitalization in high-risk infants in Latin America was low and aligned with those observed in randomized control trials and observational studies. Palivizumab prophylaxis appeared effective and had a good safety profile in this population.
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Affiliation(s)
| | | | | | | | - Maria Elina Serra
- FUNDASAMIN Fundación para la Salud Materno Infantil, Buenos Aires, Argentina
| | - Nestor Vain
- FUNDASAMIN Fundación para la Salud Materno Infantil, Buenos Aires, Argentina; Sanatorio de la Trinidad Palermo, Buenos Aires, Argentina
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17
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Car LT, Papachristou N, Urch C, Majeed A, El-Khatib M, Aylin P, Atun R, Car J, Vincent C. Preventing delayed diagnosis of cancer: clinicians' views on main problems and solutions. J Glob Health 2017; 6:020901. [PMID: 28028437 PMCID: PMC5140077 DOI: 10.7189/jogh.06.020901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Delayed diagnosis is a major contributing factor to the UK’s lower cancer survival compared to many European countries. In the UK, there is a significant national variation in early cancer diagnosis. Healthcare providers can offer an insight into local priorities for timely cancer diagnosis. In this study, we aimed to identify the main problems and solutions relating to delay cancer diagnosis according to cancer care clinicians. Methods We developed and implemented a new priority–setting approach called PRIORITIZE and invited North West London cancer care clinicians to identify and prioritize main causes for and solutions to delayed diagnosis of cancer care. Results Clinicians identified a number of concrete problems and solutions relating to delayed diagnosis of cancer. Raising public awareness, patient education as well as better access to specialist care and diagnostic testing were seen as the highest priorities. The identified suggestions focused mostly on the delays during referrals from primary to secondary care. Conclusions Many identified priorities were feasible, affordable and converged around common themes such as public awareness, care continuity and length of consultation. As a timely, proactive and scalable priority–setting approach, PRIORITZE could be implemented as a routine preventative system for determining patient safety issues by frontline staff.
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Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Catherine Urch
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Mona El-Khatib
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Rifat Atun
- Department of Global Health and Population & Department of Health Policy and Management, Harvard School of Public Health, Harvard, Boston, USA
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK; Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, UK
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18
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Development of an intradermal DNA vaccine delivery strategy to achieve single-dose immunity against respiratory syncytial virus. Vaccine 2017; 35:2840-2847. [PMID: 28413132 DOI: 10.1016/j.vaccine.2017.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 12/22/2022]
Abstract
Respiratory syncytial virus (RSV) is a massive medical burden in infants, children and the elderly worldwide, and an effective, safe RSV vaccine remains an unmet need. Here we assess a novel vaccination strategy based on the intradermal delivery of a SynCon® DNA-based vaccine encoding engineered RSV-F antigen using a surface electroporation device (SEP) to target epidermal cells, in clinically relevant experimental models. We demonstrate the ability of this strategy to elicit robust immune responses. Importantly we demonstrate complete resistance to pulmonary infection at a single low dose of vaccine in the cotton rat RSV/A challenge model. In contrast to the formalin-inactivated RSV (FI-RSV) vaccine, there was no enhanced lung inflammation upon virus challenge after DNA vaccination. In summary the data presented outline the pre-clinical development of a highly efficacious, tolerable and safe non-replicating vaccine delivery strategy.
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19
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Shook BC, Lin K. Recent Advances in Developing Antiviral Therapies for Respiratory Syncytial Virus. Top Curr Chem (Cham) 2017; 375:40. [DOI: 10.1007/s41061-017-0129-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/01/2017] [Indexed: 01/23/2023]
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20
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Oliwa JN, Marais BJ. Vaccines to prevent pneumonia in children - a developing country perspective. Paediatr Respir Rev 2017; 22:23-30. [PMID: 26364006 PMCID: PMC6995362 DOI: 10.1016/j.prrv.2015.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 12/11/2022]
Abstract
Pneumonia accounted for 15% of the 6.3 million deaths among children younger than five years in 2013, a total of approximately 935,000 deaths worldwide. Routine vaccination against common childhood illnesses has been identified as one of the most cost-effective strategies to prevent death from pneumonia. Vaccine-preventable or potentially preventable diseases commonly linked with respiratory tract infections include Streptococcus pneumoniae, Haemophilus influenza type-b (Hib), pertussis, influenza, measles, and tuberculosis. Although here have been great strides in the development and administration of effective vaccines, the countries that carry the largest disease burdens still struggle to vaccinate their children and newer conjugated vaccines remain out of reach for many. The Global Vaccine Action Plan (GVAP) has identified priority areas for innovation in research in all aspects of immunisation development and delivery to ensure equitable access to vaccines for all.
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Affiliation(s)
- Jacquie N Oliwa
- KEMRI Wellcome Trust Research Programme, Department of Public Health Research, Health Services Unit, Nairobi, Kenya.
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Formulation of the respiratory syncytial virus fusion protein with a polymer-based combination adjuvant promotes transient and local innate immune responses and leads to improved adaptive immunity. Vaccine 2016; 34:5114-5124. [PMID: 27591951 DOI: 10.1016/j.vaccine.2016.08.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 12/24/2022]
Abstract
Respiratory syncytial virus (RSV) causes serious upper and lower respiratory tract infections in newborns and infants. Presently, there is no licensed vaccine against RSV. We previously reported the safety and efficacy of a novel vaccine candidate (ΔF/TriAdj) in rodent and lamb models following intranasal immunization. However, the effects of the vaccine on the innate immune system in the upper and lower respiratory tracts, when delivered intranasally, have not been characterized. In the present study, we found that ΔF/TriAdj triggered transient production of chemokines, cytokines and interferons in the nasal tissues and lungs of BALB/c mice. The types of chemokines produced were consistent with the populations of immune cells recruited, i.e. dendritic cells, macrophages and neutrophils, in the nose-associated lymphoid tissue (NALT), lung and their draining lymph nodes of the ΔF/TriAdj-immunized group. In addition, ΔF/TriAdj stimulated cellular activation with generation of mucosal and systemic antibody responses, and conferred complete protection from viral infection in the lungs upon RSV challenge. The effect of ΔF/TriAdj was short-lived in the nasal tissues and more prolonged in the lungs. In addition, both innate and adaptive immune responses were lower when mice were immunized with ΔF alone. These results suggest that ΔF/TriAdj modulates the innate mucosal environment in both upper and lower respiratory tracts, which contributes to robust adaptive immune responses and long-term protective efficacy of this novel vaccine formulation.
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22
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Saha S, Pandey BG, Choudekar A, Krishnan A, Gerber SI, Rai SK, Singh P, Chadha M, Lal RB, Broor S. Evaluation of case definitions for estimation of respiratory syncytial virus associated hospitalizations among children in a rural community of northern India. J Glob Health 2016; 5:010419. [PMID: 26649172 PMCID: PMC4652925 DOI: 10.7189/jogh.05.020419] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The burden estimation studies for respiratory syncytial virus (RSV) have been based on varied case definitions, including case-definitions designed for influenza surveillance systems. We used all medical admissions among children aged 0-59 months to study the effect of case definitions on estimation of RSV-associated hospitalizations rates. METHODS The hospital-based daily surveillance enrolled children aged 0-59 months admitted with acute medical conditions from July 2009-December 2012, from a well-defined rural population in Ballabgarh in northern India. All study participants were examined and nasal and throat swabs taken for testing by real-time polymerase chain reaction (RT-PCR) for RSV and influenza virus. Clinical data were used to retrospectively evaluate World Health Organization (WHO) case definitions (2011) commonly used for surveillance of respiratory pathogens, ie, acute respiratory illness (WHO-ARI), severe ARI (SARI) and influenza-like illness (ILI), for determination of RSV-associated hospitalization. RSV-associated hospitalization rates adjusted for admissions at non-study hospitals were calculated. FINDINGS Out of 505 children enrolled, 82 (16.2%) tested positive for RSV. Annual incidence rates of RSV-associated hospitalization per 1000 children were highest among infants aged 0-5 months (15.2; 95% confidence interval (CI) 8.3-26.8), followed by ages 6-23 months (5.3, 95% CI 3.2-8.7) and lowest among children 24-59 months (0.5, 95% CI 0.1-1.5). The RSV positive children were more likely to have signs of respiratory distress like wheeze, chest in-drawing, tachypnea, and crepitation compared to RSV-negative based on bivariate comparisons. Other less commonly seen signs of respiratory distress, ie, nasal flaring, grunting, accessory muscle usage were also significantly associated with being RSV positive. Compared to the estimated RSV hospitalization rate based on all medical hospitalizations, the WHO-ARI case definition captured 86% of the total incidence, while case definitions requiring fever like ILI and SARI underestimated the incidence by 50-80%. CONCLUSIONS Our study suggests that RSV is a substantial cause of hospitalization among children aged <24months especially those aged <6 months. The WHO-ARI case definition appeared to be the most suitable screening definition for RSV surveillance because of its high sensitivity.
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Affiliation(s)
- Siddhartha Saha
- Center for Disease Control and Prevention, Influenza Programme, New Delhi, India
| | - Bharti Gaur Pandey
- Manav Rachna International University, Faridabad, India ; Equal contribution of authors
| | - Avinash Choudekar
- AIIMS-INCLEN collaborative Influenza project, New Delhi, India ; Equal contribution of authors
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Susan I Gerber
- Respiratory Pathogen Branch, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanjay K Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Renu B Lal
- Center for Disease Control and Prevention, Influenza Programme, New Delhi, India
| | - Shobha Broor
- AIIMS-INCLEN collaborative Influenza project, New Delhi, India
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Pisesky A, Benchimol EI, Wong CA, Hui C, Crowe M, Belair MA, Pojsupap S, Karnauchow T, O'Hearn K, Yasseen AS, McNally JD. Incidence of Hospitalization for Respiratory Syncytial Virus Infection amongst Children in Ontario, Canada: A Population-Based Study Using Validated Health Administrative Data. PLoS One 2016; 11:e0150416. [PMID: 26958849 PMCID: PMC4784925 DOI: 10.1371/journal.pone.0150416] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Importance RSV is a common illness among young children that causes significant morbidity and health care costs. Objective Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario’s health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients. Study Design and Setting A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children’s Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario’s administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression. Results From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5–99.2%), specificity 99.6% (95%CI: 98.2–99.8%), PPV 96.9% (95%CI: 94.2–98.6%), NPV 99.4% (95%CI: 99.4–99.9%). Incidence of hospitalized RSV in Ontario from 2005–2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable increasing or decreasing linear trend in the incidence of hospitalized RSV, hospital length of stay and PICU admission rates. Among the Ontario RSV cohort, 16.3% had one or more major risk factors, with a decreasing trend observed over time. Conclusion Children hospitalized for RSV-related disease can be accurately identified within population-based health administrative data. RSV is a major public health concern and incidence has not changed over time, suggesting a lack of progress in prevention.
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Affiliation(s)
- Andrea Pisesky
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Eric I. Benchimol
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES uOttawa), Ottawa, Ontario, Canada
| | - Coralie A. Wong
- Institute for Clinical Evaluative Sciences (ICES uOttawa), Ottawa, Ontario, Canada
| | - Charles Hui
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Megan Crowe
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc-Andre Belair
- Institute for Clinical Evaluative Sciences (ICES uOttawa), Ottawa, Ontario, Canada
| | - Supichaya Pojsupap
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Karnauchow
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Katie O'Hearn
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Abdool S. Yasseen
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - James D. McNally
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Broadbent L, Groves H, Shields MD, Power UF. Respiratory syncytial virus, an ongoing medical dilemma: an expert commentary on respiratory syncytial virus prophylactic and therapeutic pharmaceuticals currently in clinical trials. Influenza Other Respir Viruses 2016; 9:169-78. [PMID: 25847510 PMCID: PMC4474493 DOI: 10.1111/irv.12313] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/30/2022] Open
Abstract
As the most important viral cause of severe respiratory disease in infants and increasing recognition as important in the elderly and immunocompromised, respiratory syncytial virus (RSV) is responsible for a massive health burden worldwide. Prophylactic antibodies were successfully developed against RSV. However, their use is restricted to a small group of infants considered at high risk of severe RSV disease. There is still no specific therapeutics or vaccines to combat RSV. As such, it remains a major unmet medical need for most individuals. The World Health Organisations International Clinical Trials Registry Platform (WHO ICTRP) and PubMed were used to identify and review all RSV vaccine, prophylactic and therapeutic candidates currently in clinical trials. This review presents an expert commentary on all RSV-specific prophylactic and therapeutic candidates that have entered clinical trials since 2008.
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Affiliation(s)
- Lindsay Broadbent
- Centre for Infection & Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Helen Groves
- Centre for Infection & Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Michael D Shields
- Centre for Infection & Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK.,The Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Ultan F Power
- Centre for Infection & Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Immunological, Viral, Environmental, and Individual Factors Modulating Lung Immune Response to Respiratory Syncytial Virus. BIOMED RESEARCH INTERNATIONAL 2015; 2015:875723. [PMID: 26064963 PMCID: PMC4438160 DOI: 10.1155/2015/875723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/14/2015] [Accepted: 01/17/2015] [Indexed: 11/18/2022]
Abstract
Respiratory syncytial virus is a worldwide pathogen agent responsible for frequent respiratory tract infections that may become severe and potentially lethal in high risk infants and adults. Several studies have been performed to investigate the immune response that determines the clinical course of the infection. In the present paper, we review the literature on viral, environmental, and host factors influencing virus response; the mechanisms of the immune response; and the action of nonimmunological factors. These mechanisms have often been studied in animal models and in the present review we also summarize the main findings obtained from animal models as well as the limits of each of these models. Understanding the lung response involved in the pathogenesis of these respiratory infections could be useful in improving the preventive strategies against respiratory syncytial virus.
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Obodai E, Asmah R, Boamah I, Goka B, Odoom JK, Adiku T. Respiratory syncytial virus genotypes circulating in urban Ghana: February to November 2006. Pan Afr Med J 2014; 19:128. [PMID: 25745535 PMCID: PMC4341265 DOI: 10.11604/pamj.2014.19.128.4749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/14/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Respiratory syncytial virus (RSV) is the major cause of acute lower respiratory tract infection (ALRI) in young children. RSV strains have been divided into 2 major antigenic groups (A and B), which are further divided into several genotypes, but very little is known about its circulating genotypes in Ghana. This study characterized RSV genotypes detected in children with ALRI in Accra between February and November 2006. Methods Nasopharyngeal aspirates (NPA) were obtained from children diagnosed with ALRI between February and November 2006. The NPA were screened for RSV using a nested multiplex reverse transcriptase polymerase chain reaction (RT-PCR) method for genotyping RSV. Viral RNA was extracted from the NPA using guanidinium isothiocyanate method and purified with an RNAID commercial kit. Care-givers gave their consent prior to specimen collection. Administered questionnaires captured information on patient demographic and clinical history. Results A total of 53 children were enrolled in the study with a male to female ratio of 3:1. Of the 53 NPA analyzed, 60.4% (32/53) were positive for RSV. Subsequent genotypic analysis showed that 72% (23/32) of the 60.4% RSV infections were RSV B only and 28% (9/32) were co-infections of both RSV A and B. Children between the ages of 2 - 12 months were the most affected age group per an RSV infection rate of 37.5% (12/32). No significant difference was detected in the recovery rate of ALRI (98.1%) and RSV (96.9%) positive patients from the infection. One patient died resulting in a mortality rate of 3.1%. Bronchopneumonia (20 out of 32 cases) was the major diagnosis on admission. RSV infection was seasonal dependent, described by 2 peaks in October and April-May. Conclusion Both RSV A and RSV B genotypes co-circulated during the study period with RSV B predominating. RSV may possibly be the main pathogen of lower respiratory tract illness during epidemics in the wet seasons. Genotyping by the multiplex RT-PCR is one of the first attempts at molecular diagnosis of RSV infection in Ghana.
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Affiliation(s)
- Evangeline Obodai
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana ; Department of Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Richard Asmah
- School of Allied Health Sciences, College of Health Sciences, Korle-Bu, Accra, Ghana
| | - Isaac Boamah
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Bamenla Goka
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - John Kofi Odoom
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Theophilus Adiku
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana
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Ochoa TJ, Bautista R, Dávila C, Salazar JA, Bazán C, Guerra O, Llanos JP, López L, Zea-Vera A, Ecker L. Respiratory syncytial virus-associated hospitalizations in pre-mature infants in Lima, Peru. Am J Trop Med Hyg 2014; 91:1029-34. [PMID: 25294617 DOI: 10.4269/ajtmh.13-0648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a prospective cohort study in four hospitals in Lima, Peru in infants with a birth weight ≤ 1,500 g followed from birth hospital discharge up to 1 year of age to determine the incidence of respiratory syncytial virus (RSV) hospitalizations. We enrolled 222 infants from March of 2009 to March of 2010: 48 infants with a birth weight < 1,000 g and 174 infants with a birth weight of 1,000-1,500 g (birth weight = 1,197 ± 224 g; gestational age = 30.1 ± 2.6 weeks). There were 936 episodes of respiratory infections; the incidence of respiratory infections during the first 1 year of life was 5.7 episodes/child-years. The incidence of RSV respiratory infections that required emergency room management was 103.9 per 1,000 child-years, and the incidence of RSV hospitalizations was 116.2 per 1,000 child-years (244.9 in infants with a birth weight < 1,000 g and 88.9 in infants 1,000-1,500 g; P < 0.05). The incidence of RSV respiratory infections that required emergency management or hospitalization is high among pre-mature infants in Lima.
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Affiliation(s)
- Theresa J Ochoa
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Rossana Bautista
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Carmen Dávila
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - José Antonio Salazar
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Carlos Bazán
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Oscar Guerra
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Jean Pierre Llanos
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Luis López
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Alonso Zea-Vera
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
| | - Lucie Ecker
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Univeristy of Texas School of Public Health, Houston, Texas; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; Instituto Nacional Materno Perinatal, Lima, Peru; Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru; Hospital Nacional Madre Niño San Bartolome, Lima, Peru; Abbott Laboratories, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Investigacion Nutricional, Lima, Peru
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D'Arcy N, Cloutman-Green E, Klein N, Spratt DA. Environmental viral contamination in a pediatric hospital outpatient waiting area: implications for infection control. Am J Infect Control 2014; 42:856-60. [PMID: 25087137 DOI: 10.1016/j.ajic.2014.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nosocomial outbreaks of viral etiology are costly and can have a major impact on patient care. Many viruses are known to persist in the inanimate environment and may pose a risk to patients and health care workers. We investigate the frequency of environmental contamination with common health care-associated viruses and explore the use of torque-teno virus as a marker of environmental contamination. METHODS Environmental screening for a variety of clinically relevant viruses was carried out over 3 months in a UK pediatric hospital using air sampling and surface swabbing. Swabs were tested for the presence of virus nucleic acid by quantitative polymerase chain reactions. RESULTS Viral nucleic acid was found on surfaces and in the air throughout the screening period, with adenovirus DNA being the most frequent. Door handles were frequently contaminated. Torque-teno virus was also found at numerous sites. CONCLUSION Evidence of environmental contamination with viral pathogens is present in health care environments and may be indicative of an infectious virus being present. Screening for viruses should be included in infection control strategies. Torque-teno virus may provide a better marker of contamination and reduce time and cost of screening for individual viruses.
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Affiliation(s)
- Nikki D'Arcy
- Eastman Dental Institute, University College London, London, England.
| | | | - Nigel Klein
- Camelia Botnar Laboratories, Great Ormond Street Hospital, London, England
| | - David A Spratt
- Eastman Dental Institute, University College London, London, England
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McNally JD, Sampson M, Matheson LA, Hutton B, Little J. Vitamin D receptor (VDR) polymorphisms and severe RSV bronchiolitis: a systematic review and meta-analysis. Pediatr Pulmonol 2014; 49:790-9. [PMID: 24019226 DOI: 10.1002/ppul.22877] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/29/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND A number of small studies have suggested a relationship between vitamin D status and severe acute lower respiratory tract infection (ALRI), including RSV-bronchiolitis. The objective of this study was to evaluate the relationship between vitamin D receptor (VDR) polymorphism and severe RSV-bronchiolitis through a systemic literature review and meta-analysis. METHODS A comprehensive electronic literature search was conducted to identify all studies published before January 2013. Two reviewers independently screened all abstracts, followed by the full text of potential articles to evaluate eligibility. Study methodological quality was evaluated using the Newcastle Ottawa scale and individual component analysis. Meta-analysis evaluated associations at the allele and genotype levels. RESULTS Of 803 studies identified from our literature search, three met eligibility criteria. Two VDR polymorphisms were included in more than one study: TaqI (rs731236) and FokI (rs2228570). All three reported a positive relationship between the FokI minor allele and disease with random effects meta-analyses demonstrating a statistically significant relationship (OR 1.52, CI: 1.12, 2.05). Genotype analysis was highly suggestive of a dominant or incomplete dominance model with combined odds ratios for fF (OR 1.73, CI: 0.92-3.36) and ff (OR 2.24, CI: 0.98-5.14) compared to the FF genotype. No association between TaqI and severe RSV-bronchiolitis was evident at the allele or genotype level. CONCLUSIONS Available literature supports an association between the FokI polymorphism and severe RSV disease. Determination of VDR receptor polymorphism status could help predict high-risk infants who might benefit from preventive measures.
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Affiliation(s)
- J Dayre McNally
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada; Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Affiliation(s)
| | - Mark Dybul
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Tore Godal
- Special Adviser on Global Health, Norwegian Ministry of Foreign Affairs, Oslo, Norway
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Lanari M, Vandini S, Capretti MG, Lazzarotto T, Faldella G. Respiratory syncytial virus infections in infants affected by primary immunodeficiency. J Immunol Res 2014; 2014:850831. [PMID: 25089282 PMCID: PMC4095650 DOI: 10.1155/2014/850831] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 12/30/2022] Open
Abstract
Primary immunodeficiencies are rare inherited disorders that may lead to frequent and often severe acute respiratory infections. Respiratory syncytial virus (RSV) is one of the most frequent pathogens during early infancy and the infection is more severe in immunocompromised infants than in healthy infants, as a result of impaired T- and B-cell immune response unable to efficaciously neutralize viral replication, with subsequent increased viral shedding and potentially lethal lower respiratory tract infection. Several authors have reported a severe clinical course after RSV infections in infants and children with primary and acquired immunodeficiencies. Environmental prophylaxis is essential in order to reduce the infection during the epidemic season in hospitalized immunocompromised infants. Prophylaxis with palivizumab, a humanized monoclonal antibody against the RSV F protein, is currently recommended in high-risk infants born prematurely, with chronic lung disease or congenital heart disease. Currently however the prophylaxis is not routinely recommended in infants with primary immunodeficiency, although some authors propose the extension of prophylaxis to this high risk population.
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Affiliation(s)
- Marcello Lanari
- Pediatrics and Neonatology Unit, Imola Hospital, Via Montericco 4, 40026 Imola, Italy
| | - Silvia Vandini
- DIMEC, Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Via Massarenti 11, University of Bologna, 40138 Bologna, Italy
| | - Maria Grazia Capretti
- DIMEC, Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Via Massarenti 11, University of Bologna, 40138 Bologna, Italy
| | - Tiziana Lazzarotto
- DIMES, Clinical Microbiology Unit, Laboratory of Virology, St. Orsola-Malpighi Hospital, Via Massarenti 9, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- DIMEC, Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Via Massarenti 11, University of Bologna, 40138 Bologna, Italy
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Structural analysis of respiratory syncytial virus reveals the position of M2-1 between the matrix protein and the ribonucleoprotein complex. J Virol 2014; 88:7602-17. [PMID: 24760890 DOI: 10.1128/jvi.00256-14] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Respiratory syncytial virus (RSV), a member of the Paramyxoviridae family of nonsegmented, negative-sense, single-stranded RNA genome viruses, is a leading cause of lower respiratory tract infections in infants, young children, and the elderly or immunocompromised. There are many open questions regarding the processes that regulate human RSV (hRSV) assembly and budding. Here, using cryo-electron tomography, we identified virus particles that were spherical, filamentous, and asymmetric in structure, all within the same virus preparation. The three particle morphologies maintained a similar organization of the surface glycoproteins, matrix protein (M), M2-1, and the ribonucleoprotein (RNP). RNP filaments were traced in three dimensions (3D), and their total length was calculated. The measurements revealed the inclusion of multiple full-length genome copies per particle. RNP was associated with the membrane whenever the M layer was present. The amount of M coverage ranged from 24% to 86% in the different morphologies. Using fluorescence light microscopy (fLM), direct stochastic optical reconstruction microscopy (dSTORM), and a proximity ligation assay (PLA), we provide evidence illustrating that M2-1 is located between RNP and M in isolated viral particles. In addition, regular spacing of the M2-1 densities was resolved when hRSV viruses were imaged using Zernike phase contrast (ZPC) cryo-electron tomography. Our studies provide a more complete characterization of the hRSV virion structure and substantiation that M and M2-1 regulate virus organization. IMPORTANCE hRSV is a leading cause of lower respiratory tract infections in infants and young children as well as elderly or immunocompromised individuals. We used cryo-electron tomography and Zernike phase contrast cryo-electron tomography to visualize populations of purified hRSV in 3D. We observed the three distinct morphologies, spherical, filamentous, and asymmetric, which maintained comparable organizational profiles. Depending on the virus morphology examined, the amount of M ranged from 24% to 86%. We complemented the cryo-imaging studies with fluorescence microscopy, dSTORM, and a proximity ligation assay to provide additional evidence that M2-1 is incorporated into viral particles and is positioned between M and RNP. The results highlight the impact of M and M2-1 on the regulation of hRSV organization.
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Broor S, Dawood FS, Pandey BG, Saha S, Gupta V, Krishnan A, Rai S, Singh P, Erdman D, Lal RB. Rates of respiratory virus-associated hospitalization in children aged <5 years in rural northern India. J Infect 2014; 68:281-9. [PMID: 24269675 PMCID: PMC7112698 DOI: 10.1016/j.jinf.2013.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Though respiratory viruses are thought to cause substantial morbidity globally in children aged <5 years, the incidence of severe respiratory virus infections in children is unknown in India where 20% of the world's children live. METHODS During August 2009-July 2011, prospective population-based surveillance was conducted for hospitalizations of children aged <5 years in a rural community in Haryana State. Clinical data and respiratory specimens were collected. Swabs were tested by RT-PCR for influenza and parainfluenza viruses, respiratory syncytial virus (RSV), human metapneumovirus, coronaviruses, and adenovirus. Average annual hospitalization incidence was calculated using census data and adjusted for hospitalizations reported to occur at non-study hospitals according to a community healthcare utilization survey. RESULTS Of 245 hospitalized children, respiratory viruses were detected among 98 (40%), of whom 92 (94%) had fever or respiratory symptoms. RSV accounted for the highest virus-associated hospitalization incidence (34.6/10,000, 95% CI 26.3-44.7) and 20% of hospitalizations. There were 11.8/10,000 (95% CI 7.9-18.4) influenza-associated hospitalizations (7% of hospitalizations). RSV and influenza virus detection peaked in winter (November-February) and rainy seasons (July), respectively. CONCLUSION Respiratory viruses were associated with a substantial proportion of hospitalizations among young children in a rural Indian community. Public health research and prevention in India should consider targeting RSV and influenza in young children.
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Affiliation(s)
- Shobha Broor
- All India Institute of Medical Sciences, Delhi, India.
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | | | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Vivek Gupta
- All India Institute of Medical Sciences, Delhi, India
| | | | - Sanjay Rai
- All India Institute of Medical Sciences, Delhi, India
| | | | - Dean Erdman
- Division of Viral Diseases, CDC, Atlanta, GA, USA
| | - Renu B Lal
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Tempia S, Walaza S, Viboud C, Cohen AL, Madhi SA, Venter M, McAnerney JM, Cohen C. Mortality associated with seasonal and pandemic influenza and respiratory syncytial virus among children <5 years of age in a high HIV prevalence setting--South Africa, 1998-2009. Clin Infect Dis 2014; 58:1241-9. [PMID: 24567249 DOI: 10.1093/cid/ciu095] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There are few published data describing the mortality burden associated with influenza and respiratory syncytial virus (RSV) infection in children in low- and middle-income countries and particularly from Africa and settings with high prevalence of human immunodeficiency virus (HIV). METHODS We modeled the excess mortality attributable to influenza (seasonal and pandemic) and RSV infection by applying Poisson regression models to monthly all-respiratory and pneumonia and influenza deaths, using national influenza and RSV laboratory surveillance data as covariates. In addition, we estimated the seasonal influenza- and RSV-associated deaths among HIV-infected and -uninfected children using Poisson regression models that incorporated HIV prevalence and highly active antiretroviral therapy coverage as covariates. RESULTS In children <5 years of age, the mean annual numbers of seasonal influenza- and RSV-associated all-respiratory deaths were 452 (8 per 100 000 person-years [PY]) and 546 (10 per 100 000 PY), respectively. Infants <1 year of age experienced higher mortality rates compared with children 1-4 years of age for both influenza (22 vs 5 per 100 000 PY) and RSV (35 vs 4 per 100 000 PY). HIV-infected compared with HIV-uninfected children <5 years of age were at increased risk of death associated with influenza (age-adjusted relative risk [aRR], 11.5; 95% confidence interval [CI], 9.6-12.6) and RSV (aRR, 8.1; 95% CI, 6.9-9.3) infection. In 2009, we estimated 549 (11 per 100 000 PY) all-respiratory influenza A(H1N1)pdm09-associated deaths among children aged <5 years. CONCLUSIONS Our findings support increased research efforts to guide and prioritize interventions such as influenza vaccination and HIV prevention in low- and middle-income countries with high HIV prevalence such as South Africa.
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Affiliation(s)
- Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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35
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Moyes J, Cohen C, Pretorius M, Groome M, von Gottberg A, Wolter N, Walaza S, Haffejee S, Chhagan M, Naby F, Cohen AL, Tempia S, Kahn K, Dawood H, Venter M, Madhi SA. Epidemiology of respiratory syncytial virus-associated acute lower respiratory tract infection hospitalizations among HIV-infected and HIV-uninfected South African children, 2010-2011. J Infect Dis 2014; 208 Suppl 3:S217-26. [PMID: 24265481 DOI: 10.1093/infdis/jit479] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are limited data on respiratory syncytial virus (RSV) infection among children in settings with a high prevalence of human immunodeficiency virus (HIV). We studied the epidemiology of RSV-associated acute lower respiratory tract infection (ALRTI) hospitalizations among HIV-infected and HIV-uninfected children in South Africa. METHODS Children aged <5 years admitted to sentinel surveillance hospitals with physician-diagnosed neonatal sepsis or ALRTI were enrolled. Nasopharyngeal aspirates were tested by multiplex real-time polymerase chain reaction assays for RSV and other viruses. Associations between possible risk factors and severe outcomes for RSV infection among HIV-infected and uninfected children were examined. The relative risk of hospitalization in HIV-infected and HIV-uninfected children was calculated in 1 site with population denominators. RESULTS Of 4489 participants, 4293 (96%) were tested for RSV, of whom 1157 (27%) tested positive. With adjustment for age, HIV-infected children had a 3-5-fold increased risk of hospitalization with RSV-associated ALRTI (2010 relative risk, 5.6; [95% confidence interval (CI), 4.5-6.4]; 2011 relative risk, 3.1 [95% CI, 2.6-3.6]). On multivariable analysis, HIV-infected children with RSV-associated ALRTI had higher odds of death (adjusted odds ratio. 31.1; 95% CI, 5.4-179.8) and hospitalization for >5 days (adjusted odds ratio, 4.0; 95% CI, 1.5-10.6) than HIV-uninfected children. CONCLUSION HIV-infected children have a higher risk of hospitalization with RSV-associated ALRTI and a poorer outcome than HIV-uninfected children. These children should be targeted for interventions aimed at preventing severe RSV disease.
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Affiliation(s)
- Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service
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McCracken JP, Prill MM, Arvelo W, Lindblade KA, López MR, Estevez A, Müller ML, Muñoz F, Bernart C, Cortez M, Moir JC, Ortíz J, Paredes A, Iwane MK. Respiratory syncytial virus infection in Guatemala, 2007-2012. J Infect Dis 2014; 208 Suppl 3:S197-206. [PMID: 24265479 DOI: 10.1093/infdis/jit517] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute respiratory illness (ARI). Little is known about RSV disease among older children and adults in Central America. METHODS Prospective surveillance for ARI among hospital patients and clinic patients was conducted in Guatemala during 2007-2012. Nasopharyngeal and oropharyngeal swab specimens were tested for RSV, using real-time reverse-transcription polymerase chain reaction. RESULTS Of 6287 hospitalizations and 2565 clinic visits for ARI, 24% and 12%, respectively, yielded RSV-positive test results. The incidence of RSV-positive hospitalization for ARI was 5.8 cases/10 000 persons per year and was highest among infants aged <6 months (208 cases/10 000 persons per year); among adults, the greatest incidence was observed among those aged ≥ 65 years (2.9 cases/10 000 persons per year). The incidence of RSV-positive clinic visitation for ARI was 32 cases/10 000 persons per year and was highest among infants aged 6-23 months (186 cases/10 000 persons per year). Among RSV-positive hospital patients with ARI, underlying cardiovascular disease was associated with death, moribund discharge, intensive care unit admission, or mechanical ventilation (odds ratio, 4.1; 95% confidence interval, 1.9-8.8). The case-fatality proportion among RSV-positive hospital patients with ARI was higher for those aged ≥ 5 years than for those aged <5 years (13% vs 3%; P < .001). CONCLUSIONS The incidences of RSV-associated hospitalization and clinic visitation for ARI were highest among young children, but a substantial burden of ARI due to RSV was observed among older children and adults.
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Guvenel AK, Chiu C, Openshaw PJ. Current concepts and progress in RSV vaccine development. Expert Rev Vaccines 2014; 13:333-44. [PMID: 24405366 DOI: 10.1586/14760584.2014.878653] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Respiratory syncytial virus (RSV) disease is an important cause of morbidity and mortality in children and debilitated adults and remains one of the major global unmet challenges for vaccine development. Several immunological issues have delayed the development of vaccines, especially the poorly protective response to natural infection and the enhancement of disease following administration of formalin inactivated vaccines during trials conducted in the 1960s. Advances in knowledge of the immune system, of the virus and its antigenic properties combined with new vaccine technologies are now injecting new hope into the field and have given rise to many promising vaccine approaches. Some of these may be optimal for use in children, while others may be more appropriate for pregnant women or vulnerable older adults. With a multi-pronged approach to prevention, we propose that it may be possible to destabilise community circulation of RSV and thus to significantly lessen the impact of RSV disease.
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Affiliation(s)
- Aleks K Guvenel
- Centre for Respiratory Infection, National Heart and Lung Institute, Imperial College London, W2 1PG , UK
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Hussman JM, Li A, Paes B, Lanctôt KL. A review of cost–effectiveness of palivizumab for respiratory syncytial virus. Expert Rev Pharmacoecon Outcomes Res 2014; 12:553-67. [DOI: 10.1586/erp.12.45] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nair H, Lau ESM, Brooks WA, Seong AC, Theodoratou E, Zgaga L, Huda T, Jadhav SS, Rudan I, Campbell H. An evaluation of the emerging vaccines against influenza in children. BMC Public Health 2013; 13 Suppl 3:S14. [PMID: 24564565 PMCID: PMC3847180 DOI: 10.1186/1471-2458-13-s3-s14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Influenza is an under-appreciated cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 20 million new episodes of ALRI in children annually, 97% of these occurring in developing countries. It is also estimated to result in 28000 to 112000 deaths annually in young children. Apart from hospitalisations and deaths, influenza has significant economic consequences. The current egg-based inactivated influenza vaccines have several limitations: annual vaccination, high production costs, and cannot respond adequately to meet the demand during pandemics. METHODS We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging cross-protective vaccines against influenza relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from the CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. RESULTS The experts expressed very high level of optimism for deliverability, impact on equity, and acceptability to health workers and end users. However, they expressed concerns over the criteria of answerability, low development cost, low product cost, low implementation cost, affordability and, to a lesser extent sustainability. In addition they felt that the vaccine would have higher efficacy and impact on disease burden reduction on overall influenza-associated disease rather than specifically influenza-associated pneumonia. CONCLUSION Although the landscape of emerging influenza vaccines shows several promising candidates, it is unlikely that the advancements in the newer vaccine technologies will be able to progress through to large scale production in the near future. The combined effects of continued investments in researching new vaccines and improvements of available vaccines will hopefully shorten the time needed to the development of an effective seasonal and pandemic influenza vaccine suitable for large scale production.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
- Public Health Foundation of India, New Delhi, India
| | - Eva Shi May Lau
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ang Choon Seong
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Lina Zgaga
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Tanvir Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | | | - Igor Rudan
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Harry Campbell
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
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Turner P, Turner C, Watthanaworawit W, Carrara V, Cicelia N, Deglise C, Phares C, Ortega L, Nosten F. Respiratory virus surveillance in hospitalised pneumonia patients on the Thailand-Myanmar border. BMC Infect Dis 2013; 13:434. [PMID: 24498873 PMCID: PMC3847692 DOI: 10.1186/1471-2334-13-434] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/30/2013] [Indexed: 11/24/2022] Open
Abstract
Background Pneumonia is a significant cause of morbidity and mortality in the developing world. Viruses contribute significantly to pneumonia burden, although data for low-income and tropical countries are scarce. The aim of this laboratory-enhanced, hospital-based surveillance was to characterise the epidemiology of respiratory virus infections among refugees living on the Thailand-Myanmar border. Methods Maela camp provides shelter for ~45,000 refugees. Inside the camp, a humanitarian organisation provides free hospital care in a 158-bed inpatient department (IPD). Between 1st April 2009 and 30th September 2011, all patients admitted to the IPD with a clinical diagnosis of pneumonia were invited to participate. Clinical symptoms and signs were recorded and a nasopharyngeal aspirate (NPA) collected. NPAs were tested for adenoviruses, human metapneumovirus (hMPV), influenza A & B, and RSV by PCR. Results Seven hundred eight patient episodes (698 patients) diagnosed as pneumonia during the enhanced surveillance period were included in this analysis. The median patient age was 1 year (range: < 1-70), and 90.4% were aged < 5 years. At least one virus was detected in 53.7% (380/708) of episodes. Virus detection was more common in children aged < 5 years old (<1 year: OR 2.0, 95% CI 1.2-3.4, p = 0.01; 1-4 years: OR 1.4, 95% CI 0.8-2.3, p = 0.2). RSV was detected in 176/708 (24.9%); an adenovirus in 133/708 (18.8%); an influenza virus in 68/708 (9.6%); and hMPV in 33/708 (4.7%). Twenty-eight episodes of multiple viral infections were identified, most commonly adenovirus plus another virus. RSV was more likely to be detected in children <5 years (OR 12.3, 95% CI 3.0-50.8, p = 0.001) and influenza viruses in patients ≥5 years (OR 2.8, 95% CI 1.5-5.4, p = 0.002). IPD treatment was documented in 702/708 cases; all but one patient received antimicrobials, most commonly a beta-lactam (amoxicillin/ampicillin +/−gentamicin in 664/701, 94.7%). Conclusions Viral nucleic acid was identified in the nasopharynx in half the patients admitted with clinically diagnosed pneumonia. Development of immunisations targeting common respiratory viruses is likely to reduce the incidence of pneumonia in children living refugee camps and similar settings.
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Affiliation(s)
- Paul Turner
- Shoklo Malaria Research Unit, Mae Sot, Thailand.
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Biswas D, Yadav K, Borkakoty B, Mahanta J. Molecular characterization of human respiratory syncytial virus NA1 and GA5 genotypes detected in Assam in northeast India, 2009-2012. J Med Virol 2013; 85:1639-44. [DOI: 10.1002/jmv.23636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Dipankar Biswas
- Regional Medical Research Centre; NE Region (Indian Council of Medical Research); Dibrugarh; Assam; India
| | - Kaushal Yadav
- Regional Medical Research Centre; NE Region (Indian Council of Medical Research); Dibrugarh; Assam; India
| | - Biswajyoti Borkakoty
- Regional Medical Research Centre; NE Region (Indian Council of Medical Research); Dibrugarh; Assam; India
| | - Jagadish Mahanta
- Regional Medical Research Centre; NE Region (Indian Council of Medical Research); Dibrugarh; Assam; India
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The use of humanized monoclonal antibodies for the prevention of respiratory syncytial virus infection. Clin Dev Immunol 2013; 2013:359683. [PMID: 23840240 PMCID: PMC3693113 DOI: 10.1155/2013/359683] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/13/2013] [Accepted: 05/20/2013] [Indexed: 11/17/2022]
Abstract
Monoclonal antibodies are widely used both in infants and in adults for several indications. Humanized monoclonal antibodies (palivizumab) have been used for many years for the prevention of respiratory syncytial virus infection in pediatric populations (preterm infants, infants with chronic lung disease or congenital heart disease) at high risk of severe and potentially lethal course of the infection. This drug was reported to be safe, well tolerated and effective to decrease the hospitalization rate and mortality in these groups of infants by several clinical trials. In the present paper we report the development and the current use of monoclonal antibodies for prophylaxis against respiratory syncytial virus.
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Rudan I, Theodoratou E, Zgaga L, Nair H, Chan KY, Tomlinson M, Tsai A, Biloglav Z, Huda T, El Arifeen S, Chopra M, Campbell H. Setting priorities for development of emerging interventions against childhood pneumonia, meningitis and influenza. J Glob Health 2012. [PMID: 23198129 PMCID: PMC3484764 DOI: 10.7189/jogh.02.010304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Igor Rudan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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Khamis FA, Al-Kobaisi MF, Al-Areimi WS, Al-Kindi H, Al-Zakwani I. Epidemiology of respiratory virus infections among infants and young children admitted to hospital in Oman. J Med Virol 2012; 84:1323-9. [PMID: 22711362 PMCID: PMC7166482 DOI: 10.1002/jmv.23330] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this prospective study was to determine the epidemiology of respiratory viruses responsible for seasonal epidemics of influenza‐like illness in infants and young children in Oman. All children ≤5 years of age consecutively admitted to Sultan Qaboos University Hospital in Oman over a 1‐year period between December 2007 and December 2008 with acute respiratory infections were included. A multiplex polymerase chain reaction (PCR) for viral detection was performed on nasopharyngeal aspirates. Analyses were conducted using univariate statistical methods. Of the 259 infants and young children, at least one respiratory virus was detected in 130 samples (50%). The most prevalent viruses were respiratory syncytial virus (RSV; 43%; n = 56), adenovirus (15%; n = 20), and parainfluenza virus (PIV) (11%; n = 14). Dual or multiple viral infections were found in 23 cases (18%). The three most prominent symptoms of the cohort were fever (78%; n = 201), tachypnoea (77%; n = 200), and runny nose (61%; n = 158). The majority had bronchiolitis (39%; n = 101) while 37% (n = 96) had pneumonia. RSV was more likely to affect those that were young (4 months vs. 7.5 months; P = 0.002) and had tachypnoea (93% vs. 69%; P = 0.004), lower respiratory tract infections (91% vs. 80%; P = 0.039), and bronchiolitis (57% vs. 38%; P = 0.024). The study indicated that respiratory viruses are highly prevalent in children ≤5 years presenting with acute respiratory infections in Oman, of which RSV is the most prominent. J. Med. Virol. 84: 1323–1329, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- F A Khamis
- Department of Medicine, Royal Hospital, Muscat, Oman.
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Intravenous ribavirin for respiratory syncytial viral infections in pediatric hematopoietic SCT recipients. Bone Marrow Transplant 2012; 48:265-8. [PMID: 23000643 DOI: 10.1038/bmt.2012.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory syncytial virus (RSV) is a potential cause of serious morbidity and even mortality among children undergoing hematopoietic SCT (HSCT). Contrary to the available information regarding the aerosolized formulation of ribavirin, there is a paucity of published studies using i.v. ribavirin in adults, and very few single reports on pediatric patients. Aerosolized drug administration has been limited by potential toxicity and special air-flow requirements. In this regard, i.v. ribavirin could prevent these disadvantages, but its efficacy and safety remain controversial in the pediatric HSCT setting. The present study describes the outcome of six pediatric patients undergoing HSCT with nine episodes of proven RSV. Four episodes corresponded to lower respiratory tract infection (LRTI) and five presented with upper respiratory tract infection (URTI). All LRTI patients showed favorable clinical responses, with 100% survival and no progression to LRTI in the remaining five URTI. No side effects were documented during ribavirin administration. We conclude that ribavirin was well tolerated intravenously, without associated side effects, and was effective in the treatment of RSV in this limited number of pediatric HSCT patients. The role and efficacy of i.v. ribavirin needs to be further clarified by prospective controlled trials in pediatric populations.
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Current world literature. Curr Opin Allergy Clin Immunol 2012; 12:211-7. [PMID: 22382450 DOI: 10.1097/aci.0b013e3283520fda] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rudan I, Theodoratou E, Zgaga L, Nair H, Chan KY, Tomlinson M, Tsai A, Biloglav Z, Huda T, El Arifeen S, Chopra M, Campbell H. Setting priorities for development of emerging interventions against childhood pneumonia, meningitis and influenza. J Glob Health 2012. [DOI: 10.7189/jogh.01.010304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Igor Rudan
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Lina Zgaga
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Harish Nair
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Kit Yee Chan
- 2Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Mark Tomlinson
- 3Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Alex Tsai
- 5Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, USA
| | - Zrinka Biloglav
- 7Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tanvir Huda
- 8Child Health and Nutrition Research Initiative, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Shams El Arifeen
- 8Child Health and Nutrition Research Initiative, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | | | - Harry Campbell
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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Managing the morbidity associated with respiratory viral infections in children with congenital heart disease. Int J Pediatr 2012; 2012:646780. [PMID: 22518179 PMCID: PMC3299251 DOI: 10.1155/2012/646780] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/24/2011] [Indexed: 11/17/2022] Open
Abstract
Children with congenital heart disease (CHD) are at risk for increased morbidity from viral lower respiratory tract infections because of anatomical cardiac lesions than can worsen an already compromised respiratory status. Respiratory syncytial virus (RSV) remains an important pathogen in contributing toward the morbidity in this population. Although the acute treatment of RSV largely remains supportive, the development of monoclonal antibodies, such as palivuzumab, has reduced the RSV-related hospitalization rate in children with CHD. This review highlights the specific cardiac complications of RSV infection, the acute treatment of bronchiolitis in patients with CHD, and the search for new therapies against RSV, including an effective vaccine, because of the high cost associated with immunoprophylaxis and its lack of reducing RSV-related mortality.
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A study of the genetic variability of human respiratory syncytial virus (HRSV) in Cambodia reveals the existence of a new HRSV group B genotype. J Clin Microbiol 2011; 49:3504-13. [PMID: 21865418 DOI: 10.1128/jcm.01131-11] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human respiratory syncytial virus (HRSV) is the leading cause of hospitalization of children aged <5 years due to respiratory illness in industrialized countries, and pneumonia is the leading cause of mortality among children aged <5 years worldwide. Although HRSV was first identified in 1956, a preventative vaccine has yet to be developed. Here we report the results of the first study to investigate the circulation and genetic diversity of HRSV in Cambodia among an all-ages population over 5 consecutive years. The incidences of HRSV infection among all-ages outpatient and hospitalized populations were equivalent, at 9.5% and 8.2%, respectively. Infection was most prevalent among children aged <5 years, with bronchiolitis being the most frequently observed clinical syndrome in the same age group. Circulation of HRSV was seasonal, typically coinciding with the rainy season between July and November annually. Strains belonging to HRSV groups A and B were detected with equivalent frequencies; however, we observed a potentially biennial shift in the predominant circulating HRSV genotype. The majority of HRSV group B strains belonged to the recently described BA genotype, with the exception of 10 strains classified as belonging to a novel HRSV group B genotype, SAB4, first reported here.
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