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Patel DA, Marcum ZA, Chansakul A, Toyip A, Nerney K, Panozzo CA, St Laurent S, Mehta D, Ghaswalla P. Economic burden of cardiorespiratory hospitalizations associated with respiratory syncytial virus among United States adults in 2017-2019. Hum Vaccin Immunother 2024; 20:2364493. [PMID: 38982719 PMCID: PMC11238920 DOI: 10.1080/21645515.2024.2364493] [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: 03/01/2024] [Accepted: 06/02/2024] [Indexed: 07/11/2024] Open
Abstract
Morbidity and mortality caused by respiratory syncytial virus (RSV) in older adults and those with underlying health conditions can be potentially alleviated through vaccination. To assist vaccine policy decision-makers and payers, we estimated the annual economic burden of RSV-associated cardiorespiratory hospitalizations among insured US adults aged ≥18 y in the Merative MarketScan claims database from September through August of 2017-2018 and 2018-2019. Negative binomial regression models were used to estimate the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. This number was multiplied by mean cardiorespiratory hospitalization costs to estimate total costs for RSV-associated cardiorespiratory hospitalizations. Number and cost for International Classification of Diseases (ICD)-coded RSV hospitalizations were quantified from MarketScan. In 2017-2018 and 2018-2019, respectively, 18,515,878 and 16,462,120 adults with commercial or Medicare supplemental benefits were assessed. In 2017-2018, 301,248 cardiorespiratory hospitalizations were observed; 0.32% had RSV-specific ICD codes, costing $44,916,324, and 5.52% were RSV-associated cardiorespiratory hospitalizations, costing $734,078,602 (95% CI: $460,826,580-$1,103,358,799). In 2018-2019, 215,525 cardiorespiratory hospitalizations were observed; 0.34% had RSV-specific ICD codes, costing $33,053,105, and 3.14% were RSV-associated cardiorespiratory hospitalizations, costing $287,549,472 (95% CI: $173,377,778-$421,884,259). RSV contributes to substantial economic burden of cardiorespiratory hospitalizations among US adults. Modeling excess risk using viral positivity data provides a comprehensive estimation of RSV hospitalization burden and associated costs, compared with relying on ICD diagnosis codes alone.
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Affiliation(s)
| | | | | | | | | | - Catherine A Panozzo
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Samantha St Laurent
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Darshan Mehta
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Parinaz Ghaswalla
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
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Peña-López Y, Sabater-Riera J, Raj P. Severe respiratory syncytial virus disease. JOURNAL OF INTENSIVE MEDICINE 2024; 4:405-416. [PMID: 39310066 PMCID: PMC11411437 DOI: 10.1016/j.jointm.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 09/25/2024]
Abstract
The burden of respiratory syncytial virus (RSV) disease is widely recognized. Main risk factors for severe disease, such as extreme ages, chronic cardiopulmonary conditions, and immunosuppression, typically coincide with poorer outcomes. While the majority of RSV hospitalizations involve healthy children, a higher proportion of hospitalized adults with underlying conditions need intensive care. Presently, treatment primarily consists of supportive measures. RSV-induced wheezing should be distinguished from respiratory tract thickening, without response to bronchodilators. Obstructive RSV disease frequently overlaps with viral pneumonia. Non-invasive mechanical ventilation and high-flow oxygen therapy represented significant advancements in the management of severe RSV disease in children and may also hold considerable importance in specific phenotypes of RSV disease in adults. Most severe infections manifest with refractory hypoxemia necessitating more advanced ventilatory support and/or extracorporeal membrane oxygenation therapy. Although bacterial co-infection rates are low, they have been associated with worse outcomes. Antibiotic prescription rates are high. Accurately diagnosing bacterial co-infections remains a challenge. Current evidence and antibiotic stewardship policies advise against indiscriminate antibiotic usage, even in severe cases. The role of currently developing antiviral therapies in severe RSV disease will be elucidated in the coming years, contingent upon the success of new vaccines and immune passive strategies involving nirsevimab.
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Affiliation(s)
- Yolanda Peña-López
- Microbiome Research Laboratory (MRL), Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Pediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Global Health eCore, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Joan Sabater-Riera
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Prithvi Raj
- Microbiome Research Laboratory (MRL), Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wildenbeest JG, Lowe DM, Standing JF, Butler CC. Respiratory syncytial virus infections in adults: a narrative review. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00255-8. [PMID: 39265602 DOI: 10.1016/s2213-2600(24)00255-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 09/14/2024]
Abstract
Respiratory syncytial virus (RSV), an RNA virus spread by droplet infection that affects all ages, is increasingly recognised as an important pathogen in adults, especially among older people living with comorbidities. Distinguishing RSV from other acute viral infections on clinical grounds alone, with sufficient precision to be clinically useful, is not possible. The reference standard diagnosis is by PCR: point-of-care tests perform less well with lower viral loads. Testing samples from a single respiratory tract site could result in underdetection. RSV is identified in 6-11% of outpatient respiratory tract infection (RTI) consultations in older adults (≥60 years, or ≥65 years, depending on the study) and accounts for 4-11% of adults (≥18 years) hospitalised with RTI, with 6-15% of those hospitalised admitted to intensive care, and 1-12% of all adults hospitalised with RSV respiratory tract infection dying. Community-based studies estimate the yearly incidence of RSV infection at around 3-7% in adults aged 60 years and older in high-income countries. Although RSV accounts for a similar disease burden as influenza in adults, those hospitalised with severe RSV disease are typically older (most ≥60 years) and have more comorbidities, more respiratory symptoms, and are frequently without fever. Long-term sequelae are common and include deterioration of underlying disease (typically heart failure and COPD). There are few evidence-based RSV-specific treatments currently available, with supportive care being the main modality. Two protein subunit vaccines for protection from severe RSV in adults aged 60 years and older were licensed in 2023, and a third-an mRNA-based vaccine-recently gained market approval in the USA. The phase 3 studies in these three vaccines showed good protection against severe disease. Data on real-world vaccine effectiveness in older adults, including subgroups at high risk for RSV-associated hospitalisation, are needed to establish the best use of these newly approved RSV vaccines. New diagnostics and therapeutics are being developed, which will also need rigorous evaluation within their target populations to ensure they are used only for those in whom there is evidence of improved outcomes. There is an urgent need to reconceptualise this illness from one that is serious in children, but far less important than influenza in older people, to thinking of RSV as also a major risk to health for older people that needs targeted prevention and treatment.
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Affiliation(s)
- Joanne G Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, UK; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Infection, Inflammation and Immunology, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Philippot Q, Rammaert B, Dauriat G, Daubin C, Schlemmer F, Costantini A, Tandjaoui-Lambiotte Y, Neuville M, Desrochettes E, Ferré A, Contentin LB, Lescure FX, Megarbane B, Belle A, Dellamonica J, Jaffuel S, Meynard JL, Messika J, Lau N, Terzi N, Runge I, Sanchez O, Zuber B, Guerot E, Rouze A, Pavese P, Bénézit F, Quenot JP, Souloy X, Fanton AL, Boutoille D, Bunel V, Vabret A, Gaillat J, Bergeron A, Lapidus N, Fartoukh M, Voiriot G. Human metapneumovirus infection is associated with a substantial morbidity and mortality burden in adult inpatients. Heliyon 2024; 10:e33231. [PMID: 39035530 PMCID: PMC11259828 DOI: 10.1016/j.heliyon.2024.e33231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Background Human metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients. Methods Consecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used. Results Between March 2018 and May 2019, 208 patients were included. The median age was 74 [62-84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2-7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course. Conclusion hMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.
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Affiliation(s)
- Quentin Philippot
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | | | | | - Cédric Daubin
- CHU de Caen Normandie, médecine intensive réanimation, 14000, CAEN, France
| | - Frédéric Schlemmer
- Université Paris Est Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Unité de Pneumologie, Service de Médecine Intensive et Réanimation, Créteil, France
| | | | | | - Mathilde Neuville
- Service de médecine intensive réanimation, AP-HP, Hôpital Bichat Claude-Bernard, France
| | | | - Alexis Ferré
- Service de réanimation médico-chirurgicale, centre hospitalier de Versailles, France
| | - Laetitia Bodet Contentin
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and methodS in Patient-Centered Outcomes and Health ResEarch (SPHERE), INSERM UMR 1246, Université de Tours, Tours, France
| | | | - Bruno Megarbane
- Service de médecine intensive réanimation, AP-HP, Hôpital Lariboisière, France
| | - Antoine Belle
- Service de pneumologie, centre hospitalier intercommunal Compiègne Moyon, France
| | - Jean Dellamonica
- Service de médecine intensive réanimation, UR2CA - Université Cote d’Azur, CHU de Nice, France
| | - Sylvain Jaffuel
- Service de maladies infectieuses et tropicales, CHRU de Brest, France
| | - Jean-Luc Meynard
- Maladies infectieuses et tropicales, AP-HP, Hôpital Saint Antoine, France
| | - Jonathan Messika
- Réanimation médico-chirurgicale, AP-HP, Hôpital Louis Mourier, France
| | - Nicolas Lau
- Réanimation, surveillance continue, Site de Longjumeau Groupe Hospitalier Nord-Essone, France
| | - Nicolas Terzi
- Médecine Intensive Réanimation, CHU Grenoble Alpes, France
| | | | - Olivier Sanchez
- Université Paris Cité, Service de pneumologie et soins Intensifs, HEGP, AP-HP Centre Université Paris Cité, France
| | | | - Emmanuel Guerot
- Service de médecine intensive réanimation, AP-HP, HEGP, France
| | - Anahita Rouze
- Univ. Lille, Inserm U1285, CHU Lille, Service de Médecine Intensive – Réanimation, CNRS, UMR 8576, UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France
| | - Patricia Pavese
- Service des maladies infectieuses, CHU Grenoble Alpes, France
| | - François Bénézit
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, France
| | | | - Xavier Souloy
- Réanimation polyvalente, Centre hospitalier public du Cotentin, France
| | - Anne Lyse Fanton
- Service de pneumologie et soins intensifs respiratoires, CHU Dijon Bourgogne, France
| | - David Boutoille
- Service de maladies infectieuses et tropicales, CHU de Nantes, France
| | - Vincent Bunel
- Service de Pneumologie B, Hôpital Bichat, Paris, France
| | - Astrid Vabret
- FéNoMIH, CHU de Caen et de Rouen, GRAM EA2656, laboratoire de virologie, Normandie université, CHU de Caen, France
| | | | - Anne Bergeron
- Service de pneumologie, Hôpitaux universitaires de Genève, Genève, Switzerland
| | - Nathanaël Lapidus
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Public Health Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Groupe de Recherche Clinique CARMAS Université Paris Est Créteil, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
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5
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Njuma Libwea J, Esso L, Njoh AA, Ngwa CH, Ngomba Armelle V, Bilounga Ndongo C, Etoundi Mballa GA, Nwaru BI, Weinberger D, Njouom R, Koulla-Shiro S. Generating the evidence to support the establishment of a Respiratory Syncytial Virus surveillance system in Cameroon: A study protocol. PLoS One 2024; 19:e0303468. [PMID: 38861519 PMCID: PMC11166269 DOI: 10.1371/journal.pone.0303468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is one of the major pathogens frequently associated with severe respiratory tract infections in younger children and older adults globally. There is an unmet need with a lack of routine country-specific databases and/or RSV surveillance systems on RSV disease burden among adults in most low- and middle-income countries, including Cameroon. We aim to estimate the adult RSV burden needed to develop a framework for establishing an RSV surveillance database in Cameroon. METHODS AND ANALYSIS A two-phase study approach will be implemented, including a literature review and a review of medical records. First, a systematic review of available literature will provide insights into the current burden of RSV in adults in Cameroon, searching the following databases: Global Health, PubMed, CINAHL, Embase, African Journal Online Library, Scopus, Global Index Medicus, Cochrane databases, and grey literature search. Identified studies will be included if they reported on the RSV burden of disease among Cameroonian adults aged ≥18 years from 1st January 1990 to 31st December 2023. A narrative synthesis of the evidence will be provided. A meta-analysis will be conducted using a random effect model, when feasible. Two co-authors will independently perform data screening, extraction, and synthesis and will be reported according to the PRISMA-P guidelines for writing systematic review protocols. Secondly, a retrospective cohort design will permit data analysis on RSV among adults in the laboratory registers at the National Influenza Center. Medical records will be reviewed to link patients' files from emanating hospitals to capture relevant demographic, laboratory, and clinical data. The International Classification of Diseases and Clinical Modifications 10th revision (ICD-10-CM) codes will be used to classify the different RSV outcomes retrospectively. RESULTS The primary outcome is quantifying the RSV burden among the adult population, which can help inform policy on establishing an RSV surveillance database in Cameroon. The secondary outcomes include (i) estimates of RSV prevalence among Cameroonian adult age groups, (ii) RSV determinants, and (iii) clinical outcomes, including proportions of RSV-associated morbidity and/or death among age-stratified Cameroonian adults with medically attended acute respiratory tract infections. CONCLUSIONS The evidence generated from the two projects will be used for further engagement with relevant stakeholders, including policymakers, clinicians, and researchers, to develop a framework for systematically establishing an RSV surveillance database in Cameroon. This study proposal has been registered (CRD42023460616) with the University of York Center for Reviews and Dissemination of the International Prospective Register of Systematic Reviews (PROSPERO).
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Affiliation(s)
- John Njuma Libwea
- Directorate for Disease Control, Epidemics and Pandemics Ministry of Public Health, Yaoundé, Cameroon
- Cameroon Academy of Sciences, Yaoundé, Cameroon
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- African Science Frontiers Initiatives [ASFI], Lagos, Nigeria
| | - Linda Esso
- Directorate for Disease Control, Epidemics and Pandemics Ministry of Public Health, Yaoundé, Cameroon
| | - Andreas Ateke Njoh
- Central Coordination, Expanded Programme on Immunization, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui, Central Africa Republic
| | - Che Henry Ngwa
- African Science Frontiers Initiatives [ASFI], Lagos, Nigeria
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Global Action for Public Health Services (GAPS), Buea, Cameroon
| | - Vivienne Ngomba Armelle
- Directorate for Disease Control, Epidemics and Pandemics Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Bright I. Nwaru
- African Science Frontiers Initiatives [ASFI], Lagos, Nigeria
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Dan Weinberger
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Richard Njouom
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Centre Pasteur of Cameroon, Yaoundé, Cameroon
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6
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Alfano F, Bigoni T, Caggiano FP, Papi A. Respiratory Syncytial Virus Infection in Older Adults: An Update. Drugs Aging 2024; 41:487-505. [PMID: 38713299 PMCID: PMC11193699 DOI: 10.1007/s40266-024-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
Respiratory syncytial virus (RSV) infection represents one of the most common infections during childhood, with significant morbidity and mortality in newborns and in the early years of life. RSV is a common infection throughout all age groups, largely undetected and underestimated in adults, with a disproportionately high impact in older individuals. RSV infection has a wide range of clinical presentations, from asymptomatic conditions to acute pneumonia and severe life-threatening respiratory distress, including exacerbations of underlying chronic conditions. Overall, the incidence of RSV infections requiring medical attention increases with age, and it is highest among persons ≥ 70 years of age. As a consequence of a combination of an aging population, immunosenescence, and the related increased burden of comorbidities, high-income countries are at risk of developing RSV epidemics. The standard of care for RSV-infected patients remains supportive, including fluids, antipyretics, and oxygen support when needed. There is an urgent need for antivirals and preventive strategies in this population, particularly in individuals at higher risk of severe outcomes following RSV infection. In this review, we describe prevention and treatment strategies for RSV illnesses, with a deep focus on the novel data on vaccination that has become available (Arexvy, GSK, and Abrysvo, Pfizer) for older adults.
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Affiliation(s)
- Franco Alfano
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Tommaso Bigoni
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Francesco Paolo Caggiano
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Alberto Papi
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy.
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7
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Woodruff RC, Melgar M, Pham H, Sperling LS, Loustalot F, Kirley PD, Austin E, Yousey-Hindes K, Openo KP, Ryan P, Brown C, Lynfield R, Davis SS, Barney G, Tesini B, Sutton M, Talbot HK, Zahid H, Kim L, Havers FP. Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection. JAMA Intern Med 2024; 184:602-611. [PMID: 38619857 PMCID: PMC11019447 DOI: 10.1001/jamainternmed.2024.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 04/16/2024]
Abstract
Importance Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection. Objective To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection. Design, Setting, and Participants This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events. Exposures Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review. Main Outcomes and Measures Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events. Results The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31). Conclusions and Relevance In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.
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Affiliation(s)
- Rebecca C. Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Huong Pham
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurence S. Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | | | | | | | - Kyle P. Openo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
- Research, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Patricia Ryan
- Emerging Infections Program, Maryland Department of Health, Baltimore
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing
| | - Ruth Lynfield
- Health Protection Bureau, Minnesota Department of Health, St. Paul
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque
| | - Grant Barney
- Division of Epidemiology, New York State Department of Health, Albany
| | - Brenda Tesini
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland
| | - H. Keipp Talbot
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hafsa Zahid
- Epidemiology Bureau, Salt Lake County Health Department, Salt Lake City, Utah
| | - Lindsay Kim
- US Public Health Service Commissioned Corps, Rockville, Maryland
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fiona P. Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
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8
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Moghadas SM, Shoukat A, Bawden CE, Langley JM, Singer BH, Fitzpatrick MC, Galvani AP. Cost-effectiveness of Prefusion F Protein-based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States. Clin Infect Dis 2024; 78:1328-1335. [PMID: 38035791 PMCID: PMC11093660 DOI: 10.1093/cid/ciad658] [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: 07/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. METHODS We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the United States. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained as a measure of effectiveness and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. RESULTS Using a willingness-to-pay of $95 000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD up to $127 with Arexvy and $118 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the United States, the budget impact of these programs at the maximum PPD ranged from $6.48 to $6.78 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $235 for Arexvy and $245 for Abrysvo, with 2-year budget impacts of $11.78 and $12.25 billion, respectively. CONCLUSIONS Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
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Affiliation(s)
- Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Affan Shoukat
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Carolyn E Bawden
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, USA
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9
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Rademacher J, Therre M, Hinze CA, Buder F, Böhm M, Welte T. Association of respiratory infections and the impact of vaccinations on cardiovascular diseases. Eur J Prev Cardiol 2024; 31:877-888. [PMID: 38205961 DOI: 10.1093/eurjpc/zwae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
Influenza, pneumococcal, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus infections are important causes of high morbidity and mortality in the elderly. Beyond the burden of infectious diseases, they are also associated with several non-infectious complications like cardiovascular events. A growing body of evidence in prospective studies and meta-analyses has shown the impact of influenza and pneumococcal vaccines on types of cardiovascular outcomes in the general population. Influenza vaccination showed a potential benefit for primary and secondary prevention of cardiovascular diseases across all ages. A reduced risk of cardiovascular events for individuals aged 65 years and older was associated with pneumococcal vaccination. Despite scientific evidence on the effectiveness, safety, and benefits of the vaccines and recommendations to vaccinate elderly patients and those with risk factors, vaccination rates remain sub-optimal in this population. Doubts about vaccine necessity or efficacy and concerns about possible adverse events in patients and physicians refer to delayed acceptance. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years. The aim of this review paper is to summarize the effect of vaccination in the field of cardiovascular disease to achieve a higher vaccination rate in this patient population.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
| | - Markus Therre
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Christopher Alexander Hinze
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Felix Buder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
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10
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Malik A, Szpunar S, Sharma M, Johnson LB, Saravolatz L, Bhargava A. Predictors of prolonged length of stay in adult patients with respiratory syncytial virus infections - a multi-center historical cohort study. Front Microbiol 2024; 15:1385439. [PMID: 38638901 PMCID: PMC11024437 DOI: 10.3389/fmicb.2024.1385439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Objectives Several studies have reported risk factors for severe disease and mortality in hospitalized adults with RSV infections. There is limited information available regarding the factors that affect the duration of a patient's hospital length of stay (LOS). Methods This was a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using the International Classification of Diseases, Tenth Revision 10 codes for RSV infection. Mean LOS was computed; prolonged LOS was defined as greater than the mean. Results We included 360 patients with a mean age (SD) of 69.9 ± 14.7 years, 63.6% (229) were female and 63.3% (228) of white race. The mean hospital LOS was 7.1 ± 5.4 days. Factors associated with prolonged LOS in univariable analysis were old age, body mass index (BMI), smoking status, Charlson Weighted Index of Comorbidity (CWIC), home oxygen, abnormal chest x-ray (CXR), presence of sepsis, use of oxygen, and antibiotics at the time of presentation. Predictors for prolonged LOS on admission in multivariable analysis were age on admission (p < 0.001), smoking status (p = 0.001), CWIC (p = 0.038) and abnormal CXR (p = 0.043). Interpretation Our study found that age on admission, smoking history, higher CWIC and abnormal CXR on admission were significantly associated with prolonged LOS among adult patients hospitalized with RSV infection. These findings highlight the significance of promptly recognizing and implementing early interventions to mitigate the duration of hospitalization for adult patients suffering from RSV infection.
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Affiliation(s)
- Ambreen Malik
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, United States
| | - Mamta Sharma
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Leonard B. Johnson
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
- Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital, Detroit, MI, United States
| | - Louis Saravolatz
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
- Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital, Detroit, MI, United States
| | - Ashish Bhargava
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
- Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital, Detroit, MI, United States
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11
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Loubet P, Fernandes J, de Pouvourville G, Sosnowiez K, Elong A, Guilmet C, Omichessan H, Bureau I, Fagnani F, Emery C, Abou Chakra CN. Respiratory syncytial virus-related hospital stays in adults in France from 2012 to 2021: A national hospital database study. J Clin Virol 2024; 171:105635. [PMID: 38215557 DOI: 10.1016/j.jcv.2023.105635] [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: 10/29/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes lower respiratory tract infections (LRTI) that may lead to hospitalization or death. The present study aimed to assess the burden of RSV infections in hospitalized adults. METHODS RSV-related hospitalizations were identified from the nationwide hospital claims database in France (PMSI) from 2012 to 2021 using ICD-10 codes J12.1, J20.5, J21.0 or B97.4, and outcomes assessment focused on 2016-2020. In-hospital outcomes included length of stay, need for intensive care (ICU) and in-hospital all-cause mortality. Post-discharge outcomes included 30-day readmission for decompensation, 90-day RSV-related readmission, and 30 and 60-day in-hospital mortality. RESULTS A cumulated number of 17 483 RSV-related stays were identified representing a rate of 72.0 cases per million stays. The outcomes assessment included 12,987 patients: 55.8 % were females and the mean age was 74.1 ± 16.4 years, with 57 % ≥ 75 years. Most of patients (78.6 %) had at least one comorbidity, mainly chronic respiratory (56.3 %) and cardiovascular diseases (41.3 %), or diabetes (23.5 %). A co-infection was found in 22.4 %, primarily bacterial (12 %). The mean length of stay was 12.3 ± 13.1 days. Overall, 10.9 % were admitted to an ICU and in-hospital mortality was 7.3 %. In-hospital outcomes were higher in cases of co-infection. Among 12 033 patients alive at discharge from the index stay, 6.5 % were readmitted with RSV within 90 days, 8.1 % for decompensation within 30 days, and 5.6 % died within 60-day. CONCLUSION This study demonstrated the high burden of RSV infections in older adults and those with chronic conditions, and the need for preventive strategies.
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Affiliation(s)
- Paul Loubet
- Service des Maladies Infectieuses et Tropicales, CHU Nîmes Carémeau, Université de Montpellier, Nîmes, France.
| | | | | | - Katia Sosnowiez
- Department of Medical Affairs, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Anne Elong
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Caroline Guilmet
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Hanane Omichessan
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
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12
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Boattini M, Almeida A, Comini S, Bianco G, Cavallo R, Costa C. From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults. Viruses 2024; 16:531. [PMID: 38675874 PMCID: PMC11053843 DOI: 10.3390/v16040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory syncytial virus (RSV) is increasingly recognized as being implicated in acute illness in older adults, with a significant weight in hospitalizations for respiratory illness and death. By means of a best-evidence review, this paper aims to investigate whether RSV can be considered a forgotten pathogen in older patients, looking at trends in the literature volume and exploring possible epidemiological and clinical features underlying the focus given to it. We then present an assessment of its disease burden and present and future strategies for its reduction, particularly in light of the recent availability of new vaccines.
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Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - André Almeida
- Department of Internal Medicine 4, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-024 Lisbon, Portugal;
- NOVA Medical School, Universidade Nova de Lisboa, Centro Clínico Académico de Lisboa, 1169-056 Lisbon, Portugal
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, 60035 Jesi, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Department of Experimental Medicine, University of Salento, Via Provinciale Monteroni n. 165, 73100 Lecce, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (G.B.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
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13
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Osei-Yeboah R, Johannesen CK, Egeskov-Cavling AM, Chen J, Lehtonen T, Fornes AU, Paget J, Fischer TK, Wang X, Nair H, Campbell H. Respiratory Syncytial Virus-Associated Hospitalization in Adults With Comorbidities in 2 European Countries: A Modeling Study. J Infect Dis 2024; 229:S70-S77. [PMID: 37970679 DOI: 10.1093/infdis/jiad510] [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: 08/30/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Individuals with comorbidities are at increased risk of severe respiratory syncytial virus (RSV) infection. We estimated RSV-associated respiratory hospitalization among adults aged ≥45 years with comorbidities in Denmark and Scotland. METHODS By analyzing national hospital and virologic data, we estimated annual RSV-associated hospitalizations by 7 selected comorbidities and ages between 2010 and 2018. We estimated rate ratios of RSV-associated hospitalization for adults with comorbidity than the overall population. RESULTS In Denmark, annual RSV-associated hospitalization rates per 1000 adults ranged from 3.1 for asthma to 19.4 for chronic kidney disease (CKD). In Scotland, rates ranged from 2.4 for chronic liver disease to 9.0 for chronic obstructive pulmonary disease (COPD). In both countries, we found a 2- to 4-fold increased risk of RSV hospitalization for adults with COPD, ischemic heart disease, stroke, and diabetes; a 1.5- to 3-fold increased risk for asthma; and a 3- to 7-fold increased risk for CKD. RSV hospitalization rates among adults aged 45 to 64 years with COPD, asthma, ischemic heart disease, or CKD were higher than the overall population. CONCLUSIONS This study provides important evidence for identifying risk groups and assisting health authorities in RSV vaccination policy making.
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Affiliation(s)
- Richard Osei-Yeboah
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - Caroline Klint Johannesen
- Department of Virology and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Amanda Marie Egeskov-Cavling
- Department of Clinical Research, Nordsjaellands Hospital Hilleroed, and Department of Public Health, University of Copenhagen, Denmark
| | - Junru Chen
- School of Public Health, Nanjing Medical University, China
| | - Toni Lehtonen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki
| | - Arantxa Urchueguía Fornes
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - John Paget
- Department of Primary Care, Netherlands Institute for Health Services Research, Utrecht
| | - Thea K Fischer
- Department of Virology and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Xin Wang
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
- School of Public Health, Nanjing Medical University, China
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
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14
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Williams V, DeMuro Romano C, Finelli L, Qin S, Saretsky TL, Ma J, Lewis S, Phillips M, Osborne RH, Norquist JM. Psychometric evaluation of the respiratory syncytial virus infection, intensity and impact questionnaire (RSV-iiiQ) in adults. Health Qual Life Outcomes 2024; 22:19. [PMID: 38378572 PMCID: PMC10880342 DOI: 10.1186/s12955-023-02174-2] [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: 02/17/2023] [Accepted: 07/25/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Despite a number of respiratory syncytial virus (RSV) vaccine candidates being tested in clinical trials, disease-specific, self-reported instruments assessing symptom severity of RSV infection from the perspective of adult patients are still needed. The RSV Infection, Intensity and Impact Questionnaire (RSV-iiiQ) was adapted from the Influenza Intensity and Impact Questionnaire (FluiiQ™). This study evaluated some measurement properties of the RSV-iiiQ. METHODS Data were collected in a web-based survey over two consecutive days. Participants completed the RSV-iiiQ, the Patient Global Impression of Severity, Sheehan Disability Scale, Patient Global Impression of Change, EQ-5D-5L, and a demographic questionnaire. Test-retest reliability, internal consistency, construct validity, and responsiveness of the RSV-iiiQ scales were assessed. RESULTS 111 adults with RSV were enrolled and self-reported a variety of symptoms across the range of disease severity via a web-based platform. The RSV-iiiQ scales demonstrated satisfactory test-retest reliability, construct validity, and discriminating ability. One-factor confirmatory factor analyses confirmed that each of the four scales was sufficiently unidimensional, and internal consistencies indicated that the computation of RSV-iiiQ scale scores was plausible. Correlation-based analyses provided support for the construct validity of the RSV-iiiQ scores, and known groups analyses supported discriminating ability. Estimates of responsiveness of the scale scores were also satisfactory. CONCLUSIONS RSV infection is highly symptomatic and causes significant disease burden, and self-report instruments assessing symptom severity and impact are important for evaluation of new treatments. This study describes the preliminary psychometric properties of the RSV-iiiQ and indicates this tool may be useful for the assessment of the severity of symptoms and impact of acute RSV infection in adults. The findings also indicated two items, Runny nose and Ear pain, may be unnecessary and should be revisited using item response theory analysis with a larger sample size.
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Affiliation(s)
- Valerie Williams
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA.
| | - Carla DeMuro Romano
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
| | | | - Shanshan Qin
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
| | | | - Jia Ma
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
| | - Sandy Lewis
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
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15
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Ponticelli D, Losa L, Antonazzo IC, Zampella A, Di Marino F, Mottola G, Fede MN, Gallucci F, Magliuolo R, Rainone A, Arcari A, Del Giudice C, Ferrara P. Respiratory Syncytial Virus (RSV) and Intention to Recommend RSV Vaccination: A Cross-Sectional Survey of Cardiologists and Cardiac Nurses in Southern Italy. Infect Dis Rep 2024; 16:128-141. [PMID: 38391588 PMCID: PMC10888396 DOI: 10.3390/idr16010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
As respiratory syncytial virus (RSV) vaccine distribution gains traction in Europe and Italy, healthcare workers (HCWs) can strategize about vaccine promotion to increase uptake among patients at risk of RSV consequences, such cardiac patients. This cross-sectional survey investigated the knowledge about and attitude towards RSV and RSV vaccines, and the intention to recommend vaccination within a cardiological hospital in Italy. To explore factors associated with the outcomes of interest, multivariate logistic regression analyses were conducted. Of 197 invited HCWs, 78.2% returned the survey. The knowledge about market authorisation for new RSV vaccines for older adults (present in 46.9% of respondents) was significantly associated with the HCWs' age, education, and previous update on vaccinations. HCWs with a higher educational level and those with a positive attitude towards RSV vaccines safety reported a higher attitude towards the importance of vaccinating people at risk. The willingness of recommending RSV vaccination to patients (70.5% of respondents) was more likely in HCWs who were knowledgeable about market authorisation for RSV vaccines and in physicians. This tempestive research sheds light on current factors influencing the strategies of cardiac HCWs regarding RSV vaccination. The results suggest the need for training events on the protective role of RSV vaccination in cardiac patients.
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Affiliation(s)
| | - Lorenzo Losa
- Center for Public Health Research, University of Milan-Bicocca, 20900 Monza, Italy
| | - Ippazio Cosimo Antonazzo
- Center for Public Health Research, University of Milan-Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy
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16
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Osei-Yeboah R, Spreeuwenberg P, Del Riccio M, Fischer TK, Egeskov-Cavling AM, Bøås H, van Boven M, Wang X, Lehtonen T, Bangert M, Campbell H, Paget J. Estimation of the Number of Respiratory Syncytial Virus-Associated Hospitalizations in Adults in the European Union. J Infect Dis 2023; 228:1539-1548. [PMID: 37246742 PMCID: PMC10681866 DOI: 10.1093/infdis/jiad189] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in adults that can result in hospitalizations. Estimating RSV-associated hospitalization is critical for planning RSV-related healthcare across Europe. METHODS We gathered RSV-associated hospitalization estimates from the RSV Consortium in Europe (RESCEU) for adults in Denmark, England, Finland, Norway, Netherlands, and Scotland from 2006 to 2017. We extrapolated these estimates to 28 European Union (EU) countries using nearest-neighbor matching, multiple imputations, and 2 sets of 10 indicators. RESULTS On average, 158 229 (95% confidence interval [CI], 140 865-175 592) RSV-associated hospitalizations occur annually among adults in the EU (≥18 years); 92% of these hospitalizations occur in adults ≥65 years. Among 75-84 years, the annual average is estimated at 74 519 (95% CI, 69 923-79 115) at a rate of 2.24 (95% CI, 2.10-2.38) per 1000. Among ≥85 years, the annual average is estimated at 37 904 (95% CI, 32 444-43 363) at a rate of 2.99 (95% CI, 2.56-3.42). CONCLUSIONS Our estimates of RSV-associated hospitalizations in adults are the first analysis integrating available data to provide the disease burden across the EU. Importantly, for a condition considered in the past to be primarily a disease of young children, the average annual hospitalization estimate in adults was lower but of a similar magnitude to the estimate in young children (0-4 years): 158 229 (95% CI, 140 865-175 592) versus 245 244 (95% CI, 224 688-265 799).
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Affiliation(s)
- Richard Osei-Yeboah
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Marco Del Riccio
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Postgraduate Medical School in Public Health, University of Florence, Italy
| | - Thea K Fischer
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen, Denmark
| | - Amanda Marie Egeskov-Cavling
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen, Denmark
| | - Håkon Bøås
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Xin Wang
- School of Public Health, Nanjing Medical University, China
| | - Toni Lehtonen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki
| | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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17
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Sivgin H, Cetin S, Ulgen A, Li W. Diabetes and bacterial co-infection are two independent risk factors for respiratory syncytial virus disease severity. Front Med (Lausanne) 2023; 10:1231641. [PMID: 38020119 PMCID: PMC10646962 DOI: 10.3389/fmed.2023.1231641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Diabetes mellitus (DM) is common among older adults hospitalized with lower respiratory tract infection, yet information on the impact of DM on disease severity is limited. This study retrospectively analyzed 46 Turkish patients infected with respiratory syncytial virus (RSV), with information on their comorbidities, co-infection status, and symptoms. Patients are grouped into four severity levels from mild to severe, according to lung parenchymal infiltration status and oxygen level. Similar to previously published studies, we found that comorbidities of diabetes, heart failure, hypertension, co-infection of any type, bacterial co-infection, and age are associated with the disease severity. Cough is the most common symptom (89%) followed by fever (26%) and myalgia, dyspnea, and weakness (around 20%). Using a second-order analysis (two-variable regression), we identified two independent risks for disease severity, the first is represented by diabetes, and the second is represented by bacterial co-infection. We observed two patients whose more severe symptoms were not associated with an older age, but associated with a combination of diabetes and bacterial co-infection. To confirm the true causality from the statistical correlation, further studies are needed.
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Affiliation(s)
- Hakan Sivgin
- Department of Internal Medicine, Faculty of Medicine, Tokat GaziosmanPasa University, Tokat, Türkiye
| | - Sirin Cetin
- Department of Biostatistics, Faculty of Medicine, Amasya University, Amasya, Türkiye
| | - Ayse Ulgen
- Department of Biostatistics, Faculty of Medicine, Girne American University, Karmi, Cyprus
- Department of Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Wentian Li
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, United States
- The Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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18
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Jordan E, Kabir G, Schultz S, Silbernagl G, Schmidt D, Jenkins VA, Weidenthaler H, Stroukova D, Martin BK, De Moerlooze L. Reduced Respiratory Syncytial Virus Load, Symptoms, and Infections: A Human Challenge Trial of MVA-BN-RSV Vaccine. J Infect Dis 2023; 228:999-1011. [PMID: 37079393 PMCID: PMC10582911 DOI: 10.1093/infdis/jiad108] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes significant disease burden in older adults. MVA-BN-RSV is a novel poxvirus-vectored vaccine encoding internal and external RSV proteins. METHODS In a phase 2a randomized double-blind, placebo-controlled trial, healthy participants aged 18 to 50 years received MVA-BN-RSV or placebo, then were challenged 4 weeks later with RSV-A Memphis 37b. Viral load was assessed from nasal washes. RSV symptoms were collected. Antibody titers and cellular markers were assessed before and after vaccination and challenge. RESULTS After receiving MVA-BN-RSV or placebo, 31 and 32 participants, respectively, were challenged. Viral load areas under the curve from nasal washes were lower (P = .017) for MVA-BN-RSV (median = 0.00) than placebo (median = 49.05). Total symptom scores also were lower (median = 2.50 and 27.00, respectively; P = .004). Vaccine efficacy against symptomatic, laboratory-confirmed or culture-confirmed infection was 79.3% to 88.5% (P = .022 and .013). Serum immunoglobulin A and G titers increased approximately 4-fold after MVA-BN-RSV vaccination. Interferon-γ-producing cells increased 4- to 6-fold after MVA-BN-RSV in response to stimulation with the encoded RSV internal antigens. Injection site pain occurred more frequently with MVA-BN-RSV. No serious adverse events were attributed to vaccination. CONCLUSIONS MVA-BN-RSV vaccination resulted in lower viral load and symptom scores, fewer confirmed infections, and induced humoral and cellular responses. CLINICAL TRIALS REGISTRATION NCT04752644.
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19
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Jasti JR, Chaudhry HS, Chaudhary SS, Jasti NR. A Rare Association: Non-ST Elevation Myocardial Infarction (NSTEMI) Secondary to Respiratory Syncytial Virus (RSV) Infection. Cureus 2023; 15:e47518. [PMID: 37877110 PMCID: PMC10591788 DOI: 10.7759/cureus.47518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 10/26/2023] Open
Abstract
We present a case report on a rare association between non-ST elevation myocardial infarction (NSTEMI) and respiratory syncytial virus (RSV) infection in a patient with no traditional risk factors for cardiovascular disease (CVD) including a family history of premature coronary artery disease (CAD). While RSV is commonly known for its respiratory manifestations, it has been increasingly recognized as a cause of significant morbidity and mortality in adults, particularly those with underlying comorbidities. However, the association between RSV infection and NSTEMI, especially in patients without traditional risk factors, remains relatively unexplored. Our case involves a 31-year-old healthy adult who presented with progressive exertional chest pain and flu-like symptoms. Electrocardiogram (EKG) changes and elevated troponin levels indicated NSTEMI. Laboratory tests confirmed RSV infection. Angiography revealed significant coronary artery disease requiring percutaneous coronary intervention. This case highlights the need for healthcare professionals to be aware of the potential cardiovascular (CV) complications associated with RSV infection, even in patients without traditional risk factors. It expands our understanding of viral respiratory infections as potential triggers for acute coronary syndromes (ACS) and emphasizes the importance of considering RSV infection in the differential diagnosis of NSTEMI, especially in young otherwise healthy individuals. Further research is warranted to explore the underlying mechanisms and develop preventive strategies for RSV-related cardiovascular complications.
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Affiliation(s)
- Jaswanth R Jasti
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Hammad S Chaudhry
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Sunia S Chaudhary
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Narsimha R Jasti
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
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20
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Moghadas SM, Shoukat A, Bawden CE, Langley JM, Singer BH, Fitzpatrick MC, Galvani AP. Cost-Effectiveness of Prefusion F Protein-Based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.14.23294076. [PMID: 37645896 PMCID: PMC10462221 DOI: 10.1101/2023.08.14.23294076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against Respiratory Syncytial Virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. Methods We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the US. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-years (QALY) gained as a measure of effectiveness, and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. Results Using a willingness-to-pay of $95,000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD under $120 with Arexvy and $111 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the US, the budget impact of these programs at the maximum PPD ranged from $5.74 to $6.10 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $250 for Arexvy and $233 for Abrysvo, with two-year budget impacts of $11.59 and $10.89 billion, respectively. Conclusions Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
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21
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Mac S, Shi S, Millson B, Tehrani A, Eberg M, Myageri V, Langley JM, Simpson S. Burden of illness associated with Respiratory Syncytial Virus (RSV)-related hospitalizations among adults in Ontario, Canada: A retrospective population-based study. Vaccine 2023; 41:5141-5149. [PMID: 37422377 DOI: 10.1016/j.vaccine.2023.06.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Globally, RSV is a common viral pathogen that causes 64 million acute respiratory infections annually. Our objective was to determine the incidence of hospitalization, healthcare resource use and associated costs of adults hospitalized with RSV in Ontario, Canada. METHODS To describe the epidemiology of adults hospitalized with RSV, we used a validated algorithm applied to a population-based healthcare utilization administrative dataset in Ontario, Canada. We created a retrospective cohort of incident hospitalized adults with RSV between September 2010 and August 2017 and followed each person for up to two years. To determine the burden of illness associated with hospitalization and post-discharge healthcare encounters each RSV-admitted patient was matched to two unexposed controls based on demographics and risk factors. Patient demographics were described and mean attributable 6-month and 2-year healthcare costs (2019 Canadian dollars) were estimated. RESULTS There were 7,091 adults with RSV-associated hospitalizations between 2010 and 2019 with a mean age of 74.6 years; 60.4 % were female. RSV-coded hospitalization rates increased from 1.4 to 14.6 per 100,000 adults between 2010-2011 and 2018-2019. The mean difference in healthcare costs between RSV-admitted patients and matched controls was $28,260 (95 % CI: $27,728 - $28,793) in the first 6 months and $43,721 over 2 years (95 % CI: $40,383 - $47,059) post-hospitalization. CONCLUSIONS RSV hospitalizations among adults increased in Ontario between 2010/11 to 2018/19 RSV seasons. RSV hospitalizations in adults were associated with increased attributable short-term and long-term healthcare costs compared to matched controls. Interventions that could prevent RSV in adults may reduce healthcare burden.
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Affiliation(s)
| | | | | | | | | | | | - Joanne M Langley
- Canadian Center for Vaccinology (Dalhousie University, IWK Health and Nova Scotia Health) Halifax, Nova Scotia, Canada
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22
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Postma MJ, Cheng CY, Buyukkaramikli NC, Hernandez Pastor L, Vandersmissen I, Van Effelterre T, Openshaw P, Simoens S. Predicted Public Health and Economic Impact of Respiratory Syncytial Virus Vaccination with Variable Duration of Protection for Adults ≥60 Years in Belgium. Vaccines (Basel) 2023; 11:vaccines11050990. [PMID: 37243094 DOI: 10.3390/vaccines11050990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection (ARI) in older adults. This study used a static, cohort-based decision-tree model to estimate the public health and economic impact of vaccination against RSV in Belgians aged ≥60 years compared with no vaccination for different vaccine duration of protection profiles from a healthcare payer perspective. Three vaccine protection durations were compared (1, 3, and 5 years), and several sensitivity and scenario analyses were performed. Results showed that an RSV vaccine with a 3-year duration of protection would prevent 154,728 symptomatic RSV-ARI cases, 3688 hospitalizations, and 502 deaths over three years compared to no vaccination in older adults and would save EUR 35,982,857 in direct medical costs in Belgium. The number needed to vaccinate to prevent one RSV-ARI case was 11 for the 3-year duration profile, while it was 28 and 8 for the 1- and 5-year vaccine duration profiles, respectively. The model was generally robust in sensitivity analyses varying key input values. This study suggested that vaccination could substantially decrease the public health and economic burden of RSV in adults ≥60 years in Belgium, with benefits increasing with a longer duration of vaccine protection.
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Affiliation(s)
- Maarten J Postma
- Department of Health Sciences, Unit of Global Health, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, 9749 AE Groningen, The Netherlands
| | | | | | | | | | | | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
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23
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Romano CD, Finelli L, Lewis S, Williams V, Martin E, Phillips M, Saretsky TL, Norquist J. Assessing the patient experience of respiratory syncytial virus infection: development of a patient-reported outcome measure. Health Qual Life Outcomes 2023; 21:20. [PMID: 36855175 PMCID: PMC9976435 DOI: 10.1186/s12955-022-02066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/04/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes significant morbidity and mortality in older adults. Despite a number of RSV vaccine candidates in clinical trials, there are no existing disease-specific, self-reported measures that assess the symptoms and severity of RSV infection from the perspective of adult patients with acute RSV. The objective of this study was to describe the initial conceptualization and development of the RSV Infection, Intensity and Impact Questionnaire (RSV-iiiQ), a new patient-reported outcome measure. METHODS A targeted review of the literature identified relevant existing measures, symptoms, and impacts of RSV. A draft version of the RSV-iiiQ was developed based on the Influenza Intensity and Impact Questionnaire (Flu-iiQ) with expert input. Qualitative interviews (N = 20) were conducted with participants to optimize the RSV-iiiQ conceptual model and confirm the content validity of the RSV-iiiQ. Interviews included concept elicitation and a cognitive debriefing assessment. A draft conceptual framework was developed, and the electronic clinical outcome assessment was piloted. All steps of instrument development followed Food and Drug Administration guidance for patient-reported outcomes. RESULTS In-depth concept elicitation interviews followed by cognitive debriefings demonstrated that the content of the items was comprehensive, covered the breadth of RSV symptoms and impacts, and was relevant to the experiences of individuals with RSV. Both the paper and electronic versions of the RSV-iiiQ were easily completed. Minor refinements were made to some items based on participant feedback, and the draft conceptual framework was refined. CONCLUSIONS The RSV-iiiQ was developed for use in clinical trials to measure the symptom intensity and impact of acute RSV infection from the perspective of adult patients. The tool was developed in accordance with current regulatory guidance and is useful to support patient-focused drug development.
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Affiliation(s)
- Carla DeMuro Romano
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194 Research Triangle Park, Durham, NC, 27709-2194, USA.
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck and Co., Inc, Rahway, NJ, USA
| | - Sandy Lewis
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194 Research Triangle Park, Durham, NC, 27709-2194, USA
| | - Valerie Williams
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194 Research Triangle Park, Durham, NC, 27709-2194, USA
| | - Emily Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Phillips
- Center for Observational and Real-World Evidence, Merck and Co., Inc, Rahway, NJ, USA
| | - Todd L Saretsky
- Biostatistics and Research Data Sciences, Patient-Centered Endpoints and Strategy Group, Merck and Co., Inc, Rahway, NJ, USA
| | - Josephine Norquist
- Biostatistics and Research Data Sciences, Patient-Centered Endpoints and Strategy Group, Merck and Co., Inc, Rahway, NJ, USA
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24
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Vaccination against Community-Acquired Pneumonia in Spanish Adults: Practical Recommendations by the NeumoExperts Prevention Group. Antibiotics (Basel) 2023; 12:antibiotics12010138. [PMID: 36671339 PMCID: PMC9854614 DOI: 10.3390/antibiotics12010138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.
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Franczuk P, Tkaczyszyn M, Kulak M, Domenico E, Ponikowski P, Jankowska EA. Cardiovascular Complications of Viral Respiratory Infections and COVID-19. Biomedicines 2022; 11:71. [PMID: 36672579 PMCID: PMC9856218 DOI: 10.3390/biomedicines11010071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Paweł Franczuk
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Michał Tkaczyszyn
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Maria Kulak
- Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Esabel Domenico
- Faculty of Medicine, Wroclaw Medical University, 50-345 Wroclaw, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
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26
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Heppe-Montero M, Gil-Prieto R, del Diego Salas J, Hernández-Barrera V, Gil-de-Miguel Á. Impact of Respiratory Syncytial Virus and Influenza Virus Infection in the Adult Population in Spain between 2012 and 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14680. [PMID: 36429399 PMCID: PMC9690810 DOI: 10.3390/ijerph192214680] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Respiratory syncytial virus (RSV) infection is increasingly recognized as a cause of significant morbidity and mortality in adults. We aimed to estimate the rates of age-specific hospitalization and in-hospital mortality caused by acute lower respiratory tract infections (ALRTIs) in Spain between 2012 and 2020 and to compare the relative impact of RSV and influenza virus infection in adults. We used the discharge reports from the Minimum Basic Data Set to retrospectively analyze hospital discharge data on the basis of the ICD-9-CM and ICD-10-CM diagnosis codes. A total of 1,518,244 patients were hospitalized for ALRTIs, of whom 137,794 (9.1%) were admitted for RSV-related infections and 46,288 (3.0%) for influenza-related infections. In patients aged 60 years or older, the hospitalization rates (per 100,000 population) were estimated at 1.69 (95% CI 1.68-1.70) and 2.72 (95% CI 2.71-2.73) for RSV and influenza patients, respectively. However, in-hospital mortality rates were significantly higher among RSV patients than among influenza patients, 7.91% (95% CI 7.89-7.93) (83.0% of all RSV-related deaths) versus 6.91% (95% CI 6.89-6.93) (85.6% of all influenza-related deaths), respectively (p = 0.007). RSV-associated in-hospital mortality increases exponentially with age, posing a greater risk for older adults, particularly frail and high-risk patients.
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Affiliation(s)
- Marco Heppe-Montero
- Department of Preventive Medicine & Public Health, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Madrid, Spain
- Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009 Madrid, Spain
| | - Ruth Gil-Prieto
- Department of Preventive Medicine & Public Health, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Madrid, Spain
| | - Jorge del Diego Salas
- Health Promotion and Prevention, Spanish Ministry of Health, Paseo del Prado 18-20, 28014 Madrid, Spain
| | - Valentín Hernández-Barrera
- Department of Preventive Medicine & Public Health, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Madrid, Spain
| | - Ángel Gil-de-Miguel
- Department of Preventive Medicine & Public Health, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Madrid, Spain
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27
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Nowalk MP, D'Agostino H, Dauer K, Stiegler M, Zimmerman RK, Balasubramani GK. Estimating the burden of adult hospitalized RSV infection including special populations. Vaccine 2022; 40:4121-4127. [PMID: 35667912 PMCID: PMC10642722 DOI: 10.1016/j.vaccine.2022.05.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Numerous studies in the U.S. have made estimates of the RSV burden among adults that vary widely due to differences in methodology, reliance on influenza surveillance, which does not adequately capture all RSV clinical symptoms, and lack of diagnostic methods to identify RSV when viral loads are low. Nevertheless, accurate burden estimates can inform healthcare planning, resource allocation and potentially, RSV vaccine policy. METHODS A simple method combined with statewide and local hospitalization, medical record and U.S. Census data were used to estimate population-based RSV hospitalization burden among adults ages 18-64 years, ≥65 years, and including immunocompetent, immunocompromised and pregnant individuals during 2015-2018 for Allegheny County, Pennsylvania. Economic burden of hospitalization was estimated using state-provided average hospitalization charges for comparisons across patient groups. RESULTS The largest burden was borne by adults ≥ 65 years of age whose rates per 100,000 population of that age group (939/100,000) were 7.0-9.0 times those of adults 18-64 years of age (118/100,000). Immunosuppressed patients bore the greatest relative burden of RSV hospitalizations (1,288-1,562/100,000 immunosuppressed individuals). RSV burden ranged from 0 to 808/100,000 pregnant women. Average total charges for RSV hospitalization in Allegheny County across all adults increased from $39 million in 2015-2016 to $57 million in 2016-2017 to $89 million in 2017-2018, due to both increased average charges for an acute respiratory hospitalization and increased numbers of RSV cases. CONCLUSIONS These RSV burden estimates add to the body of knowledge to guide public health policy makers and offer a method for simply and easily producing population-based burden estimates.
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Affiliation(s)
- Mary Patricia Nowalk
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh PA, USA.
| | - Helen D'Agostino
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Klancie Dauer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Myla Stiegler
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Richard K Zimmerman
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh PA, USA
| | - G K Balasubramani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
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28
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AlRayess S, Sleiman A, Alameddine I, Abou Fayad A, Matar GM, El-Fadel M. Airborne bacterial and PM characterization in intensive care units: correlations with physical control parameters. AIR QUALITY, ATMOSPHERE & HEALTH 2022; 15:1869-1880. [PMID: 35815238 PMCID: PMC9255450 DOI: 10.1007/s11869-022-01222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
In this study, the spatial variation of airborne bacteria in intensive care units (ICUs) was characterized. Fine particulate matter and several physical parameters were also monitored including temperature and relative humidity. The results showed that the total bacterial load ranged between 20.4 and 134.3 CFU/m3 across the ICUs. Bacterial cultures of the collected samples did not isolate any multi-drug-resistant Gram-negative bacilli indicating the absence of such aerosolized pathogens in the ICUs. Meanwhile, particulate matter levels in several ICUs were found to exceed the international guidelines set for 24-h PM exposure. Moreover, examining bacterial load contribution by size suggested that bacteria with sizes less than 0.65 µm contributed the least to the total bacterial loads, while those with sizes between 0.65 and 1.1 µm contributed the most. A multiple linear regression model was also built to predict the bacterial loads in the ICUs. The regression analysis explained 77% of the variability observed in the measured bacterial concentrations. The model showed that the level of activity in the ICU rooms as well as its occupancy level had strong positive correlations with bacterial loads, while distance away from the patient had a non-linear relationship with measured loads. No statistically significant correlation was found between bacterial load and particulate matter concentrations.
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Affiliation(s)
- S. AlRayess
- Department of Civil & Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - A. Sleiman
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research (CIDR), American University of Beirut, Beirut, Lebanon
- WHO Collaborating Center for Reference and Research On Bacterial Pathogens, Beirut, Lebanon
| | - I. Alameddine
- Department of Civil & Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - A. Abou Fayad
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research (CIDR), American University of Beirut, Beirut, Lebanon
- WHO Collaborating Center for Reference and Research On Bacterial Pathogens, Beirut, Lebanon
| | - G. M. Matar
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research (CIDR), American University of Beirut, Beirut, Lebanon
- WHO Collaborating Center for Reference and Research On Bacterial Pathogens, Beirut, Lebanon
| | - M. El-Fadel
- Department of Civil & Environmental Engineering, American University of Beirut, Beirut, Lebanon
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, UAE
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Walsh E, Lee N, Sander I, Stolper R, Zakar J, Wyffels V, Myers D, Fleischhackl R. RSV-associated hospitalization in adults in the USA: A retrospective chart review investigating burden, management strategies, and outcomes. Health Sci Rep 2022; 5:e556. [PMID: 35509398 PMCID: PMC9059216 DOI: 10.1002/hsr2.556] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/03/2021] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Abstract
Background and Aims The burden of respiratory syncytial virus (RSV) infection in adults is of growing concern. This study was designed to quantify disease burden, treatment approaches, and outcomes associated with RSV infections in adult subpopulations, from prehospitalization to hospital discharge. Methods A retrospective chart analysis was conducted to collect patient-case data from hospitalized US adults (aged >18 years) with RSV infection during two RSV seasons. Patients were categorized into risk groups: comorbid lung disease, immunocompromised, older adults (aged ≥65 years), and other adults (aged <65 years). Physicians reported diagnosis, treatment choices including respiratory supportive therapy (oxygen and fluid supplementation), and outcome variables using a standardized online case form. Results The majority (277/379; 73%) of patients presented to the emergency room, with a mean age of 60 years. Once hospitalized, the median length of stay was 6.0 days (3.0-9.0), with disease severity having the greatest impact on duration of stay. No significant between-group differences in rates of patients requiring management in intensive care units were found (comorbid lung disease, 28%; immunocompromised, 36%; older adults, 26%; and other adults, 23%). Overall, respiratory supportive therapy was the most commonly used form of treatment. Antibiotics were administered in over half of all risk groups (comorbid lung disease, 61%; immunocompromised, 59%; older adults, 59%; and other adults, 51%). Patients usually required follow-up visits following discharge, with 10%-16% requiring skilled nursing care and approximately 25% requiring assistance from a social worker. Conclusion RSV in adult subpopulations, irrespective of age, is a significant burden to healthcare systems.
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Affiliation(s)
- Edward Walsh
- Department of MedicineUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Nelson Lee
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Ian Sander
- University of Notre DameNotre DameIndianaUSA
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Kujawski SA, Whitaker M, Ritchey MD, Reingold AL, Chai SJ, Anderson EJ, Openo KP, Monroe M, Ryan P, Bye E, Como-Sabetti K, Barney GR, Muse A, Bennett NM, Felsen CB, Thomas A, Crawford C, Talbot HK, Schaffner W, Gerber SI, Langley GE, Kim L. Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure—United States, 2015–2017. PLoS One 2022; 17:e0264890. [PMID: 35263382 PMCID: PMC8906631 DOI: 10.1371/journal.pone.0264890] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause severe disease in adults with cardiopulmonary conditions, such as congestive heart failure (CHF). We quantified the rate of RSV-associated hospitalization in adults by CHF status using population-based surveillance in the United States. Methods Population-based surveillance for RSV (RSV-NET) was performed in 35 counties in seven sites during two respiratory seasons (2015–2017) from October 1–April 30. Adults (≥18 years) admitted to a hospital within the surveillance catchment area with laboratory-confirmed RSV identified by clinician-directed testing were included. Presence of underlying CHF was determined by medical chart abstraction. We calculated overall and age-stratified (<65 years and ≥65 years) RSV-associated hospitalization rates by CHF status. Estimates were adjusted for age and the under-detection of RSV. We also report rate differences (RD) and rate ratios (RR) by comparing the rates for those with and without CHF. Results 2042 hospitalized RSV cases with CHF status recorded were identified. Most (60.2%, n = 1230) were ≥65 years, and 28.3% (n = 577) had CHF. The adjusted RSV hospitalization rate was 26.7 (95% CI: 22.2, 31.8) per 10,000 population in adults with CHF versus 3.3 (95% CI: 3.3, 3.3) per 10,000 in adults without CHF (RR: 8.1, 95% CI: 6.8, 9.7; RD: 23.4, 95% CI: 18.9, 28.5). Adults with CHF had higher rates of RSV-associated hospitalization in both age groups (<65 years and ≥65 years). Adults ≥65 years with CHF had the highest rate (40.5 per 10,000 population, 95% CI: 35.1, 46.6). Conclusions Adults with CHF had 8 times the rate of RSV-associated hospitalization compared with adults without CHF. Identifying high-risk populations for RSV infection can inform future RSV vaccination policies and recommendations.
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Affiliation(s)
- Stephanie A. Kujawski
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Michael Whitaker
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- Eagle Global Scientific, Atlanta, GA, United States of America
| | - Matthew D. Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- US Public Health Service, Rockville, MD, United States of America
| | - Arthur L. Reingold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Shua J. Chai
- US Public Health Service, Rockville, MD, United States of America
- California Emerging Infections Program, Oakland, CA, United States of America
- Career Epidemiology Field Officer, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Evan J. Anderson
- Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Georgia Emerging Infections Program, Atlanta, GA, United States of America
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America
| | - Kyle P. Openo
- Georgia Emerging Infections Program, Atlanta, GA, United States of America
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Foundation for Atlanta Veterans Education and Research, Decatur, GA, United States of America
| | - Maya Monroe
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Patricia Ryan
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Erica Bye
- Minnesota Department of Health, St. Paul, MN, United States of America
| | | | - Grant R. Barney
- New York State Department of Health, Albany, NY, United States of America
| | - Alison Muse
- New York State Department of Health, Albany, NY, United States of America
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Christina B. Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Ann Thomas
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - Courtney Crawford
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - William Schaffner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Gayle E. Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Lindsay Kim
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- US Public Health Service, Rockville, MD, United States of America
- * E-mail:
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Auvinen R, Syrjänen R, Ollgren J, Nohynek H, Skogberg K. Clinical characteristics and population-based attack rates of respiratory syncytial virus versus influenza hospitalizations among adults-An observational study. Influenza Other Respir Viruses 2022; 16:276-288. [PMID: 34605172 PMCID: PMC8818833 DOI: 10.1111/irv.12914] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The clinical significance of respiratory syncytial virus (RSV) among adults remains underinvestigated. We compared the characteristics and population-based attack rates of RSV and influenza hospitalizations. METHODS During 2018-2020, we recruited hospitalized adults with respiratory infection to our prospective substudy at a tertiary care hospital in Finland and compared the characteristics of RSV and influenza patients. In our retrospective substudy, we calculated the attack rates of all RSV and influenza hospitalizations among adults in the same geographic area during 2016-2020. RESULTS Of the 537 prospective substudy patients, 31 (6%) had RSV, and 106 (20%) had influenza. Duration of hospitalization, need for intensive care or outcome did not differ significantly between RSV and influenza patients. RSV was more often missed or its diagnosis omitted from medical record (13% vs 1% p = 0.016 and 48% vs 15%, p > 0.001). In the retrospective substudy, the mean attack rates of RSV, influenza A, and influenza B hospitalizations rose with age from 4.1 (range by season 1.9-5.9), 15.4 (12.3-23.3), and 4.7 (0.5-16.2) per 100,000 persons among 18- to 64-year-olds to 58.3 (19.3-117.6), 204.1 (31.0-345.0), and 60.4 (0.0-231.0) per 100,000 persons among 65+-year-olds and varied considerably between seasons. DISCUSSION While the attack rates of influenza hospitalizations were higher compared with RSV, RSV and influenza hospitalizations were similar in severity. Missing or underreporting of RSV infections may lead to underestimating its disease burden. Both RSV and influenza caused a substantial amount of hospitalizations among the elderly, stressing the need for more effective interventions.
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Affiliation(s)
- Raija Auvinen
- Inflammation CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Infectious Disease Control and Vaccinations Unit, Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
- Internal Medicine and RehabilitationUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Ritva Syrjänen
- Population Health Unit, Department of Public Health and WelfareFinnish Institute for Health and WelfareHelsinkiFinland
| | - Jukka Ollgren
- Infectious Disease Control and Vaccinations Unit, Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Kirsi Skogberg
- Inflammation CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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Abstract
Human respiratory syncytial virus (RSV) is a negative sense single-stranded RNA virus that can result in epidemics of seasonal respiratory infections. Generally, one of the two genotypes (A and B) predominates in a single season and alternate annually with regional variation. RSV is a known cause of disease and death at both extremes of ages in the pediatric and elderly, as well as immunocompromised populations. The clinical impact of RSV on the hospitalized adults has been recently clarified with the expanded use of multiplex molecular assays. Among adults, RSV can produce a wide range of clinical symptoms due to upper respiratory tract infections potentially leading to severe lower respiratory tract infections, as well as exacerbations of underlying cardiac and lung diseases. While supportive care is the mainstay of therapy, there are currently multiple therapeutic and preventative options under development.
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Affiliation(s)
- Hannah H Nam
- Department of Infectious Diseases, University of California, Irvine, Orange, California
| | - Michael G Ison
- Division of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Debes S, Haug JB, de Blasio BF, Jonassen CM, Dudman SG. Etiology of viral respiratory tract infections in hospitalized adults, and evidence of the high frequency of prehospitalization antibiotic treatment in Norway. Health Sci Rep 2021; 4:e403. [PMID: 34646942 PMCID: PMC8499681 DOI: 10.1002/hsr2.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIMS Respiratory tract infections (RTIs) cause considerable morbidity and mortality in all age groups, but the epidemiology and role of several of the viral RTIs in the adult and elderly patients are still unclear, as is the extent of prehospitalization antibacterial drug use in this population. METHODS We conducted a three-year (2015-2018) observational study of viral RTIs in hospitalized patients in a 500-bed hospital in Southeastern Norway, including all patients ≥18 years with RTI symptoms where one of the following viral agents was detected in a respiratory specimen (Seegene Allplex): Influenza A/B, RSV A/B, human metapneumovirus (hMPV), adenovirus and parainfluenza virus 1-4. Viral findings, demographical data, and information on prehospital antibiotic prescriptions were recorded. RESULTS In 1182 patients 1222 viral infection events occurred. The mean patient age was 69.6 years, and 53% were females. Influenza virus A/B (63%), RSV A/B (15%) and hMPV (13%) were the most common agents detected. The proportional burden of influenza A H1 was found to be relatively high (65%) in the age groups <69 years, compared to older patients (P = .001, chi-square).As many as 20% of the patients had been treated with antibiotics prior to admission, with the lowest rate for influenza A H3 group at 17% (P = .036, chi-square), and highest for the RSV group at 28% (P = .004, chi-square).Oseltamivir was prescribed prior to hospitalization in only 3 cases (0.2%). CONCLUSIONS We found a high rate of prehospital antibiotic prescription in adults hospitalized with viral RTIs, warranting better stewardship programs to tackle the increasing antibiotic resistance problem.
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Affiliation(s)
- Sara Debes
- Østfold Hospital Trust, Center for Laboratory MedicineSarpsborgNorway
- Faculty of MedicineInstitute of Clinical Medicine, University of OsloOsloNorway
| | - Jon Birger Haug
- Department of Infection ControlØstfold Hospital TrustSarpsborgNorway
| | - Birgitte Freiesleben de Blasio
- Department of Methods Development and Analytics, Division of Infection Control and Environmental HealthNorwegian Institute of Public HealthOsloNorway
- Department of BiostatisticsCentre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of OsloOsloNorway
| | - Christine Monceyron Jonassen
- Østfold Hospital Trust, Center for Laboratory MedicineSarpsborgNorway
- Department of Chemistry, Biotechnology and Food ScienceNorwegian University of Life SciencesÅsNorway
| | - Susanne Gjeruldsen Dudman
- Faculty of MedicineInstitute of Clinical Medicine, University of OsloOsloNorway
- Department of MicrobiologyOslo University HospitalOsloNorway
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Leaver BA, Smith BJ, Irving L, Johnson DF, Tong SYC. Hospitalisation, morbidity and outcomes associated with respiratory syncytial virus compared with influenza in adults of all ages. Influenza Other Respir Viruses 2021; 16:474-480. [PMID: 34850564 PMCID: PMC8983890 DOI: 10.1111/irv.12909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is understood to be a cause of significant disease in older adults and children. Further analysis of RSV in younger adults may reveal further insight into its role as an important pathogen in all age groups. Methods We identified, through laboratory data, adults who tested positive for either influenza or RSV between January 2017 and June 2019 at a single Australian hospital. We compared baseline demographics, testing patterns, hospitalisations and outcomes between these groups. Results Of 1128 influenza and 193 RSV patients, the RSV cohort was older (mean age 54.7 vs. 64.9, p < 0.001) and was more comorbid as determined by the Charlson Comorbidity Index (2.4 vs. 3.2, p < 0.001). For influenza hospitalisations, the majority admitted were aged under 65 which was not the case for RSV (61.8% vs. 45.6%, p < 0.001). Testing occurred later in RSV hospitalisations as measured by the proportion tested in the emergency department (ED) (80.3% vs. 69.2%, p < 0.001), and this was strongly associated with differences in presenting phenotype (the presence of fever). RSV was the biggest predictor of 6‐month representation, with age and comorbidities predicting this less strongly. Conclusion RSV is a significant contributor to morbidity and hospitalisation, sometimes outweighing that of influenza, and is not limited to elderly cohorts. Understanding key differences in the clinical syndrome and consequent testing paradigms may allow better detection and potentially treatment of RSV to reduce individual morbidity and health system burden. This growing area of research helps quantify the need for directed therapies for RSV.
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Affiliation(s)
- Benjamin Andrew Leaver
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin John Smith
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Forsyth Johnson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Beran J, Ramirez Villaescusa A, Devadiga R, Nguyen TLA, Gruselle O, Pirçon JY, Struyf F, Devaster JM. Respiratory syncytial virus acute respiratory infections in ≥ 65-year-old adults in long-term care facilities in the Czech Republic. Cent Eur J Public Health 2021; 29:167-176. [PMID: 34623114 DOI: 10.21101/cejph.a6861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Due to immunosenescence and presence of comorbidities, respiratory syncytial virus (RSV) disease burden is a major health concern in older adults, which is expected to increase with the life expectancy rise. Data on RSV burden are scarce in older adults residing in long-term care facilities, a vulnerable population living in crowded settings. Therefore, two independent prospective studies were conducted during the 2003-2004 and 2004-2005 RSV seasons to assess RSV acute respiratory illnesses (ARIs) and lower respiratory tract infections (LRTIs) in ≥ 65-year-old adults residing in long-term care facilities in the Czech Republic. METHODS RSV ARI episodes were confirmed by polymerase chain reaction in nasal swabs collected within 3 days of symptoms onset. The mortality and morbidity of RSV-confirmed ARIs, as well as the risk factors associated with RSV-confirmed ARIs were evaluated. RESULTS Among 1,251 participants in the 2003-2004 season (ARI surveillance between October and March), there were no RSV-positive cases in 255 ARI and 105 LRTI episodes. Among 1,280 participants in the 2004-2005 season (ARI surveillance between October and April), there were 39 and 26 RSV-positive cases in 335 ARI and 217 LRTI episodes, respectively, and RSV-positive ARI and LRTI episode incidence rates were 45.82 and 30.40 per 1,000 person-years. Among 290 RSV-negative and 39 RSV-positive ARI cases in the 2004-2005 season, 15 and 4 hospitalizations, 188 and 26 LRTIs, and 11 and 3 deaths were reported. Risk factors associated with RSV-positive ARI were female gender (odds ratio: 4.98), chronic heart failure class II (odds ratio: 2.31) and diabetes requiring insulin treatment (odds ratio: 9.82). CONCLUSIONS These studies showed that RSV was an important cause of ARI in older adults living in long-term care facilities in the 2004-2005 season, with fluctuating yearly incidences.
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Affiliation(s)
- Jiří Beran
- Vaccination and Travel Medicine Centre, Hradec Kralove, Czech Republic
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Park YE, Sung H, Oh YM. Respiratory Viruses in Acute Exacerbations of Bronchiectasis. J Korean Med Sci 2021; 36:e217. [PMID: 34463061 PMCID: PMC8405402 DOI: 10.3346/jkms.2021.36.e217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bacterial infections are well known factors underlying acute exacerbations in bronchiectasis. However, viral infections may also contribute to acute exacerbations. We aimed to assess the rate of viral detection in acute exacerbations of bronchiectasis, and the associated clinical factors. METHODS Diagnostic tests for viral and bacterial etiologies were performed in 792 patients with bronchiectasis who visited the emergency room or the respiratory care inpatient unit in a tertiary referral center in South Korea. All patients were diagnosed with bronchiectasis by chest computerized tomography and were prescribed antibiotics for a minimum of 3 days. RESULTS Viral pathogens were detected in 202 of the 792 enrolled patients (25.5%). The most common viral pathogen isolated was influenza A virus (24.8%), followed by rhinovirus (22.4%), influenza B virus (9.8%), respiratory syncytial virus B (8.9%), and human metapneumovirus (6.1%). In 145 patients, a viral, but not bacterial, pathogen was detected, whereas no pathogens were found in 443 patients with exacerbations. Multivariable analysis revealed that female sex and chronic heart disease as a comorbidity were positively associated with viral detection in acute exacerbations of patients with bronchiectasis, whereas the presence of radiographic infiltration was negatively associated. CONCLUSION Respiratory viruses were identified in approximately 25% of the acute exacerbations observed among patients with bronchiectasis. Of the viruses detected, influenza viruses and rhinovirus made up over 50%. More attention to viruses as possible causative pathogens for acute deteriorating symptoms in patients with bronchiectasis is warranted.
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Affiliation(s)
- Yea Eun Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Descamps A, Lenzi N, Galtier F, Lainé F, Lesieur Z, Vanhems P, Amour S, L'Honneur AS, Fidouh N, Foulongne V, Lagathu G, Duval X, Merle C, Lina B, Carrat F, Launay O, Loubet P. In-hospital and midterm out-hospital complications of adults hospitalised with respiratory syncytial virus infection in France, 2017-2019: an observational study. Eur Respir J 2021; 59:13993003.00651-2021. [PMID: 34446468 DOI: 10.1183/13993003.00651-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/06/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe the clinical characteristics and in/out-hospital outcomes of respiratory syncytial virus (RSV) infection among adults hospitalised with influenza-like illness (ILI) and compared against patients admitted for influenza. METHODS Adults hospitalised with ILI were prospectively included from five French university hospitals over two consecutive winter seasons (2017/2018 and 2018/2019). RSV and influenza virus were detected by multiplex RT-PCR on nasopharyngeal swabs. RSV-positive patients were compared to RSV-negative and influenza-positive hospitalised patients. Poisson regression models were used to estimate the adjusted prevalence ratio (aPR) associated with in-hospital and post-discharge outcomes between RSV and influenza infections. The in-hospital outcome was a composite of the occurrence of at least one complication, length of stay ≥7 days, intensive care unit (ICU) admission, use of mechanical ventilation and in-hospital death. Post-discharge outcome included 30/90-day all-cause mortality and 90-day readmission rates. RESULTS Overall, 1,428 hospitalised adults with ILI were included. RSV was detected in 8% (114/1428) and influenza virus in 31% (437/1428). Patients hospitalised with RSV were older than those with influenza (mean age, 73.0 versus 68.8 years; p=0.015) with a higher frequency of respiratory (52% versus 39%, p=0.012) or cardiac chronic diseases (52% versus 41%, p=0.039) and longer hospitalisation duration (median stay 8 versus 6 days, p<0.001). Anti-influenza therapies were less prescribed among RSV than influenza patients (20% versus 66%, p<0.001). In-hospital composite outcome was poorer in RSV patients (adjusted prevalence ratio (aPR)=1.5; 95% Confidence Interval (95% CI) 1.1-2.1) than in those hospitalised with influenza. No difference was observed for the post-discharge composite outcome (aPR=1.1; 95% CI 0.8-1.6). CONCLUSION RSV infection results in serious respiratory illness with in-hospital outcomes worse than influenza and with similar midterm post-discharge outcomes.
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Affiliation(s)
- Alexandre Descamps
- Université de Paris, Inserm CIC 1417, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, CIC Cochin Pasteur, Paris, France
| | - Nezha Lenzi
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Florence Galtier
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.,Inserm CIC 1411, Montpellier University Hospital, Montpellier, France
| | - Fabrice Lainé
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.,Inserm CIC 1414, CHU Rennes, Rennes, France
| | - Zineb Lesieur
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Philippe Vanhems
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.,Service Hygiène, Épidémiologie, Infection, Vigilance et Prévention (SHEIP), Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Equipe Public Health Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Sélilah Amour
- Service Hygiène, Épidémiologie, Infection, Vigilance et Prévention (SHEIP), Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Equipe Public Health Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | | | | | - Vincent Foulongne
- Service de Virologie, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Gisèle Lagathu
- Laboratoire de virologie, Pôle micro-organismes, CHU Rennes, Rennes, France
| | - Xavier Duval
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, Paris, France.,Université de Paris, IAME, INSERM, Paris, France
| | - Corinne Merle
- Infectious Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Bruno Lina
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Centre National de Référence des virus Respiratoires France Sud, Hôpital de la Croix-Rousse, Lyon, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Odile Launay
- Université de Paris, Inserm CIC 1417, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, CIC Cochin Pasteur, Paris, France.,Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.,Last authors contributed equally to this article
| | - Paul Loubet
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France .,Department of Infectious and Tropical Disease, VBMI, INSERM U1047, CHU Nîmes, Univ Montpellier, Nîmes, France.,Last authors contributed equally to this article
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Tong S, Amand C, Kieffer A, Kyaw MH. Incidence of respiratory syncytial virus related health care utilization in the United States. J Glob Health 2021; 10:020422. [PMID: 33110581 PMCID: PMC7568930 DOI: 10.7189/jogh.10.020422] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Respiratory Syncytial Virus (RSV) is one of the most frequent causes of acute respiratory infection worldwide. Understanding age-specific health care utilization is necessary to guide effective prevention strategies. This retrospective database analysis assessed the incidence rates of RSV-related health care utilization in the USA over a 7-year period. Methods Episodes of RSV were identified in the Truven Health MarketScan® Commercial Claims and Encounters database between 2008 and 2014 using ICD-9-CM codes for pneumonia, bronchiolitis and RSV (480-486, 487.0, 466.1, 491.2, 079.6). Annual RSV-related health care utilization was calculated for the total population, by age group (<1, 1, 2-4, 5-17, 18-49, 50-64, 65-74, 75-84 and ≥85 years) and the proportion of cases for each setting (hospitalization, outpatient, or emergency department [ED] / urgent care [UC]). Results Over the 7-year study period, the mean rate of all RSV-associated health care utilization was 2.4 per 1000 person-years, with mean rates ranging from 2.0 to 2.6). The highest rate was seen in infants aged <1 year (mean 79.0 per 1000 over the 7-year period), which decreased with increasing age in the range 2-49 years before increasing with age in older adults (mean rate 8.1 per 1000 over the 7-year period in those ≥85 years). Of all RSV cases, 82% were reported in an outpatient setting, 11% in the ED/UC and 7% were hospitalized. Conclusions The annual RSV-related healthcare utilization rates were substantial, especially in infants and young children. These results underscore the need to accelerate the development of RSV prevention strategies to reduce the healthcare burden of RSV.
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Affiliation(s)
| | | | | | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA
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Tseng HF, Sy LS, Ackerson B, Solano Z, Slezak J, Luo Y, Fischetti CA, Shinde V. Severe Morbidity and Short- and Mid- to Long-term Mortality in Older Adults Hospitalized with Respiratory Syncytial Virus Infection. J Infect Dis 2021; 222:1298-1310. [PMID: 32591787 DOI: 10.1093/infdis/jiaa361] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We describe the clinical epidemiology and outcomes among a large cohort of older adults hospitalized with respiratory syncytial virus (RSV) infection in the United States. METHODS Hospitalized adults aged ≥60 years who tested positive for RSV between 1 January 2011 and 30 June 2015 were identified from Kaiser Permanente Southern California. Patient-level demographics, comorbidities, clinical presentation, utilization, complications, and mortality were evaluated. RESULTS There were 664 patients hospitalized with RSV (61% female, 64% aged ≥75 years). Baseline chronic diseases were prevalent (all >30%); 66% developed pneumonia, 80% of which were radiographically confirmed. Very severe tachypnea (≥26 breaths/minute) was common (56%); 21% required ventilator support and 18% were admitted to intensive care unit. Mortality during hospitalization was 5.6% overall (4.6% in 60-74 year olds and 6.1% in ≥75 year olds). Cumulative mortality within 1, 3, 6, and 12 months of admission was 8.6%, 12.3%, 17.2%, and 25.8%, respectively. CONCLUSION RSV infection in hospitalized older adults often manifested as severe, life-threatening lower respiratory tract illness with high rates of pneumonia, requirement for ventilatory support, and short- and long-term mortality. Increased recognition of the substantial RSV disease burden in adults will be important in evaluation and use of urgently needed interventions.
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Affiliation(s)
- Hung Fu Tseng
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bradley Ackerson
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Zendi Solano
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jeff Slezak
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Yi Luo
- Kaiser Permanente Southern California, Pasadena, California, USA
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40
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Borochova K, Niespodziana K, Focke-Tejkl M, Hofer G, Keller W, Valenta R. Dissociation of the respiratory syncytial virus F protein-specific human IgG, IgA and IgM response. Sci Rep 2021; 11:3551. [PMID: 33574352 PMCID: PMC7878790 DOI: 10.1038/s41598-021-82893-y] [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] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023] Open
Abstract
Human respiratory syncytial virus (RSV) is one of the most important causes of severe respiratory tract infections in early childhood. The only prophylactic protection is the neutralizing antibody, palivizumab, which targets a conformational epitope of the RSV fusion (F) protein. The F protein is generated as a F0 precursor containing two furin cleavage sites allowing excision of the P27 fragment and then gives rise to a fusion-competent version consisting of the N-terminal F2 subunit and the a C-terminal F1 subunits linked by two disulphide bonds. To investigate natural human F-specific antibody responses, F2 conferring the species-specificity of RSV, was expressed in Escherichia coli. Furthermore, the F0 protein, comprising both subunits F2 and F1, was expressed as palivizumab-reactive glycoprotein in baculovirus-infected insect cells. Six overlapping F2-derived peptides lacking secondary structure were synthesized. The analysis of IgG, IgA and IgM responses of adult subjects to native versions and denatured forms of F2 and F0 and to unfolded F2-derived peptides revealed that mainly non-conformational F epitopes, some of which represented cryptic epitopes which are not exposed on the proteins were recognized. Furthermore, we found a dissociation of IgG, IgA and IgM antibody responses to F epitopes with F2 being a major target for the F-specific IgM response. The scattered and dissociated immune response to F may explain why the natural RSV-specific antibody response is only partially protective underlining the need for vaccines focusing human antibody responses towards neutralizing RSV epitopes.
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Affiliation(s)
- Kristina Borochova
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Katarzyna Niespodziana
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Margarete Focke-Tejkl
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hofer
- Institute of Molecular Biosciences, BioTechMed Graz, University of Graz, Graz, Austria
| | - Walter Keller
- Institute of Molecular Biosciences, BioTechMed Graz, University of Graz, Graz, Austria
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia.
- Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia.
- Karl Landsteiner University of Health Sciences, Krems, Austria.
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41
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Chamseddine A, Soudani N, Kanafani Z, Alameddine I, Dbaibo G, Zaraket H, El-Fadel M. Detection of influenza virus in air samples of patient rooms. J Hosp Infect 2021. [PMID: 33152397 DOI: 10.1016/j.jhin.2020.10.020,pubmed:33152397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Understanding the transmission and dispersal of influenza virus and respiratory syncytial virus (RSV) via aerosols is essential for the development of preventative measures in hospital environments and healthcare facilities. METHODS During the 2017-2018 influenza season, patients with confirmed influenza or RSV infections were enrolled. Room air samples were collected close (0.30 m) to and distant (2.20 m) from patients' heads. Real-time polymerase chain reaction was used to detect and quantify viral particles in the air samples. The plaque assay was used to determine the infectiousness of the detected viruses. FINDINGS Fifty-one air samples were collected from the rooms of 29 patients with laboratory-confirmed influenza; 51% of the samples tested positive for influenza A virus (IAV). Among the IAV-positive patients, 65% were emitters (had at least one positive air sample), reflecting a higher risk of nosocomial transmission compared with non-emitters. The majority (61.5%) of the IAV-positive air samples were collected 0.3 m from a patient's head, while the remaining IAV-positive air samples were collected 2.2 m from a patient's head. The positivity rate of IAV in air samples was influenced by distance from the patient's head and day of sample collection after hospital admission. Only three patients with RSV infection were recruited and none of them were emitters. CONCLUSION Influenza virus can be aerosolized beyond 1 m in patient rooms, which is the distance considered to be safe by infection control practices. Further investigations are needed to determine the extent of infectivity of aerosolized virus particles.
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Affiliation(s)
- A Chamseddine
- Department of Civil and Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - N Soudani
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon; Doctoral School of Science and Technology, Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Z Kanafani
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - I Alameddine
- Department of Civil and Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - G Dbaibo
- Department of Paediatric and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - H Zaraket
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
| | - M El-Fadel
- Department of Civil and Environmental Engineering, American University of Beirut, Beirut, Lebanon.
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Zhou JA, Schweinle JE, Lichenstein R, Walker RE, King JC. Severe Illnesses Associated With Outbreaks of Respiratory Syncytial Virus and Influenza in Adults. Clin Infect Dis 2021; 70:773-779. [PMID: 30944930 PMCID: PMC7108153 DOI: 10.1093/cid/ciz264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/09/2019] [Indexed: 11/14/2022] Open
Abstract
Background Recent reports have described the contribution of adult respiratory syncytial virus (RSV) infections to the use of advanced healthcare resources and death. Methods Data regarding patients aged ≥18 years admitted to any of Maryland’s 50 acute-care hospitals were evaluated over 12 consecutive years (2001–2013). We examined RSV and influenza (flu) surveillance data from the US National Respiratory and Enteric Virus Surveillance System and the Centers for Disease Control and Prevention and used this information to define RSV and flu outbreak periods in the Maryland area. Outbreak periods consisted of consecutive individual weeks during which at least 10% of RSV and/or flu diagnostic tests were positive. We examined relationships of RSV and flu outbreaks to occurrence of 4 advanced medical outcomes (hospitalization, intensive care unit admission, intubated mechanical ventilation, and death) due to medically attended acute respiratory illness (MAARI). Results Occurrences of all 4 MAARI-related hospital advanced medical outcomes were consistently greater for all adult ages during RSV, flu, and combined RSV–flu outbreak periods compared to nonoutbreak periods and tended to be greatest in adults aged ≥65 years during combined RSV–flu outbreak periods. Rate ratios for all 4 MAARI-related advanced medical outcomes ranged from 1.04 to 1.38 during the RSV, flu, or combined RSV–flu outbreaks compared to the nonoutbreak periods, with all 95% lower confidence limits >1. Conclusions Both RSV and flu outbreaks were associated with surges in MAARI-related advanced medical outcomes (hospitalization, intensive care unit admission, intubated mechanical ventilation, and death) for adults of all ages.
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Affiliation(s)
- James A Zhou
- US Department of Health and Human Services/Assistant Secretary for Preparedness and Response/Biomedical Advanced Research and Development Authority, Washington, DC
| | - Jo Ellen Schweinle
- US Department of Health and Human Services/Assistant Secretary for Preparedness and Response/Biomedical Advanced Research and Development Authority, Washington, DC
| | - Richard Lichenstein
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Robert E Walker
- US Department of Health and Human Services/Assistant Secretary for Preparedness and Response/Biomedical Advanced Research and Development Authority, Washington, DC
| | - James C King
- US Department of Health and Human Services/Assistant Secretary for Preparedness and Response/Biomedical Advanced Research and Development Authority, Washington, DC
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Comparative virulence of seasonal viruses responsible for lower respiratory tract infections: a southern European multi-centre cohort study of hospital admissions. Infection 2021; 49:483-490. [PMID: 33389699 PMCID: PMC7778853 DOI: 10.1007/s15010-020-01569-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022]
Abstract
Objectives Our study aimed to compare the clinical severity of lower respiratory tract infections (LRTI’s) caused by Influenza and Respiratory Syncytial Virus (RSV). Methods We conducted a retrospective cohort study of LRTI admissions with positive PCR results for Influenza or RSV from 2017 to 2019 in three teaching hospitals in southern Europe. Data on clinical characteristics, viral agents and disease outcome were collected. Nosocomial infection was excluded. Main outcomes were invasive mechanical ventilation and in-hospital death. Results A total of 984 patients were included. Median age was 75 years. Influenza A was the most frequently identified virus (56.5%), of which 27.1% were subtype H1N1 and 53.0% H3N2. Influenza B was isolated in 22.3% and RSV in 21.0%. There were 10.5% of patients who died during admission and 8.3% submitted to IMV. Influenza A H1N1 was associated with lower age and less co-morbidity, while the opposite was observed for RSV. Influenza A H1N1 was independently associated with both higher risk of death (adjusted odds ratio 2.0 [1.2–3.4] p = 0.008) and IMV (adjusted odds ratio 5.1 [3.0–8.5] p < 0.001). Conclusion Influenza A H1N1 was an independent predictor of mortality and IMV. These findings may have implications on hospital resource planning and vaccination policies.
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44
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Niya MHK, Jeda AS, Tavakoli A, Sohani H, Tameshkel FS, Panahi M, Izadi M, Zamani F, Keyvani H. Molecular epidemiology of human respiratory syncytial virus (HRSV) in Iranian military trainees with acute respiratory symptoms in 2017. IRANIAN JOURNAL OF MICROBIOLOGY 2020; 12:495-502. [PMID: 33604006 PMCID: PMC7867691 DOI: 10.18502/ijm.v12i5.4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in many populations, including military recruits receiving basic training. Therefore, this study was set out to determine the molecular epidemiology, genotype and phylogenetic features of RSVs in patients with respiratory infection as a case study. Materials and Methods In this study, military barracks of Tehran, Iran, between January to March 2017 exposed to respiratory diseases were used for sampling. Throat swabs were taken, a reverse transcriptase-polymerase chain reaction (RTPCR) assay was performed to identify RSV and then the genotyping and phylogenetic analyses of RSVs in patients with a respiratory infection. Results Among 400 Iranian military trainees with respiratory symptoms, RSV infection was identified in 2.75% (11/400) using RT-PCR. Sequencing showed the incidence of type A (2.5%, n=10) to be much higher than type B (0.25%, n=1); Sore throat was the most common symptom among RSV patients. Phylogenetic analysis revealed that the majority of strains from the studied samples were more consistent with those from the Philippines and the US strains. Conclusion This study is the first to document RSV as a major cause of acute respiratory illness among military trainees in Iran. The prevalence of RSV is substantial in the cold season and the prevalence of genotype A is dominant in the country, leading to take essential steps in preparing a preventive vaccine against this viral infection.
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Affiliation(s)
- Mohammad Hadi Karbalaie Niya
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Salimi Jeda
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Sohani
- Department of Microbiology, Faculty of Biology, College of Sciences, University of Sciences and Research, Tehran, Iran
| | | | - Mahshid Panahi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Keyvani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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45
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Chamseddine A, Soudani N, Kanafani Z, Alameddine I, Dbaibo G, Zaraket H, El-Fadel M. Detection of influenza virus in air samples of patient rooms. J Hosp Infect 2020; 108:33-42. [PMID: 33152397 PMCID: PMC7605760 DOI: 10.1016/j.jhin.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding the transmission and dispersal of influenza virus and respiratory syncytial virus (RSV) via aerosols is essential for the development of preventative measures in hospital environments and healthcare facilities. METHODS During the 2017-2018 influenza season, patients with confirmed influenza or RSV infections were enrolled. Room air samples were collected close (0.30 m) to and distant (2.20 m) from patients' heads. Real-time polymerase chain reaction was used to detect and quantify viral particles in the air samples. The plaque assay was used to determine the infectiousness of the detected viruses. FINDINGS Fifty-one air samples were collected from the rooms of 29 patients with laboratory-confirmed influenza; 51% of the samples tested positive for influenza A virus (IAV). Among the IAV-positive patients, 65% were emitters (had at least one positive air sample), reflecting a higher risk of nosocomial transmission compared with non-emitters. The majority (61.5%) of the IAV-positive air samples were collected 0.3 m from a patient's head, while the remaining IAV-positive air samples were collected 2.2 m from a patient's head. The positivity rate of IAV in air samples was influenced by distance from the patient's head and day of sample collection after hospital admission. Only three patients with RSV infection were recruited and none of them were emitters. CONCLUSION Influenza virus can be aerosolized beyond 1 m in patient rooms, which is the distance considered to be safe by infection control practices. Further investigations are needed to determine the extent of infectivity of aerosolized virus particles.
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Affiliation(s)
- A Chamseddine
- Department of Civil and Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - N Soudani
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon; Doctoral School of Science and Technology, Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Z Kanafani
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - I Alameddine
- Department of Civil and Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - G Dbaibo
- Department of Paediatric and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - H Zaraket
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
| | - M El-Fadel
- Department of Civil and Environmental Engineering, American University of Beirut, Beirut, Lebanon.
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Sáez-López E, Pechirra P, Costa I, Cristóvão P, Conde P, Machado A, Rodrigues AP, Guiomar R. Performance of surveillance case definitions for respiratory syncytial virus infections through the sentinel influenza surveillance system, Portugal, 2010 to 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 31718741 PMCID: PMC6852315 DOI: 10.2807/1560-7917.es.2019.24.45.1900140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BackgroundWell-established influenza surveillance systems (ISS) can be used for respiratory syncytial virus (RSV) surveillance. In Portugal, RSV cases are detected through the ISS using the European Union (EU) influenza-like illness (ILI) case definition.AimTo investigate clinical predictors for RSV infection and how three case definitions (EU ILI, a modified EU acute respiratory infection, and one respiratory symptom) performed in detecting RSV infections in Portugal.MethodsThis observational retrospective study used epidemiological and laboratory surveillance data (October 2010-May 2018). Associations between clinical characteristics and RSV detection were analysed using logistic regression. Accuracy of case definitions was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A 0.05 significance level was accepted.ResultsThe study involved 6,523 persons, including 190 (2.9%) RSV cases. Among 183 cases with age information, RSV infection was significantly more frequent among individuals < 5 years (n = 23; 12.6%) and ≥ 65 years (n = 45; 24.6%) compared with other age groups (p < 0.0001). Cough (odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2-6.5) was the best RSV-infection predictor considering all age groups, while shortness of breath was particularly associated with RSV-positivity among ≤ 14 year olds (OR: 6.7; 95% CI: 2.6-17.4 for 0-4 year olds and OR: 6.7; 95% CI: 1.5-28.8 for 5-14 year olds). Systemic symptoms were significantly associated with RSV-negative and influenza-positive cases. None of the case definitions were suitable to detect RSV infections (AUC = 0.51).ConclusionTo avoid underestimating the RSV disease burden, RSV surveillance within the Portuguese sentinel ISS would require a more sensitive case definition than ILI and, even a different case definition according to age.
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Affiliation(s)
- Emma Sáez-López
- European Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Pedro Pechirra
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Inês Costa
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Paula Cristóvão
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Patrícia Conde
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ausenda Machado
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ana Paula Rodrigues
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Raquel Guiomar
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
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Vos LM, Teirlinck AC, Lozano JE, Vega T, Donker GA, Hoepelman AI, Bont LJ, Oosterheert JJ, Meijer A. Use of the moving epidemic method (MEM) to assess national surveillance data for respiratory syncytial virus (RSV) in the Netherlands, 2005 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31115311 PMCID: PMC6530251 DOI: 10.2807/1560-7917.es.2019.24.20.1800469] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background To control respiratory syncytial virus (RSV), which causes acute respiratory infections, data and methods to assess its epidemiology are important. Aim We sought to describe RSV seasonality, affected age groups and RSV-type distribution over 12 consecutive seasons in the Netherlands, as well as to validate the moving epidemic method (MEM) for monitoring RSV epidemics. Methods We used 2005−17 laboratory surveillance data and sentinel data. For RSV seasonality evaluation, epidemic thresholds (i) at 1.2% of the cumulative number of RSV-positive patients per season and (ii) at 20 detections per week (for laboratory data) were employed. We also assessed MEM thresholds. Results In laboratory data RSV was reported 25,491 times (no denominator). In sentinel data 5.6% (767/13,577) of specimens tested RSV positive. Over 12 seasons, sentinel data showed percentage increases of RSV positive samples. The average epidemic length was 18.0 weeks (95% confidence intervals (CI): 16.3–19.7) and 16.5 weeks (95% CI: 14.0–18.0) for laboratory and sentinel data, respectively. Epidemics started on average in week 46 (95% CI: 45–48) and 47 (95% CI: 46–49), respectively. The peak was on average in the first week of January in both datasets. MEM showed similar results to the other methods. RSV incidence was highest in youngest (0–1 and >1–2 years) and oldest (>65–75 and > 75 years) age groups, with age distribution remaining stable over time. RSV-type dominance alternated every one or two seasons. Conclusions Our findings provide baseline information for immunisation advisory groups. The possibility of employing MEM to monitor RSV epidemics allows prospective, nearly real-time use of surveillance data.
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Affiliation(s)
- Laura M Vos
- University Medical Centre Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht, the Netherlands
| | - Anne C Teirlinck
- Centre for infectious Disease Control Bilthoven, Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - José E Lozano
- Dirección General de Salud Pública, Consejería de Sanidad, Valladolid, Spain
| | - Tomás Vega
- Dirección General de Salud Pública, Consejería de Sanidad, Valladolid, Spain
| | - Gé A Donker
- NIVEL Primary Care Database - Sentinel Practices, Utrecht, the Netherlands
| | - Andy Im Hoepelman
- University Medical Centre Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht, the Netherlands
| | - Louis J Bont
- Wilhelmina Children's Hospital, Utrecht University, Department of Paediatric Infectious Diseases, Utrecht, the Netherlands
| | - Jan Jelrik Oosterheert
- University Medical Centre Utrecht, Utrecht University, Department of Internal Medicine and Infectious Diseases, Utrecht, the Netherlands
| | - Adam Meijer
- Centre for infectious Disease Control Bilthoven, Centre for Infectious Diseases Research, Diagnostics and laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Reckziegel M, Weber-Osel C, Egerer R, Gruhn B, Kubek F, Walther M, Wilhelm S, Zell R, Krumbholz A. Viruses and atypical bacteria in the respiratory tract of immunocompromised and immunocompetent patients with airway infection. Eur J Clin Microbiol Infect Dis 2020; 39:1581-1592. [PMID: 32462500 PMCID: PMC7253234 DOI: 10.1007/s10096-020-03878-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/24/2020] [Indexed: 01/08/2023]
Abstract
Respiratory tract infections (RTI) can take a serious course under immunosuppression. Data on the impact of the underlying pathogens are still controversial. Samples from the upper (n = 322) and lower RT (n = 169) were collected from 136 children and 355 adults; 225 among them have been immunocompromised patients. Exclusion criteria were presence of relevant cultivable microorganisms, C-reactive protein > 20 mg/dl, or procalcitonin > 2.0 ng/ml. Samples were tested by PCR for the presence of herpesviruses (HSV-1/-2; VZV; CMV; HHV6; EBV), adenoviruses, bocaviruses, entero-/rhinoviruses (HRV), parechoviruses, coronaviruses, influenza viruses (IV), parainfluenza viruses as well as for pneumoviruses (HMPV and RSV), and atypical bacteria (Mycoplasma pneumoniae, M.p.; Chlamydia pneumoniae, C.p.). Viral/bacterial genome equivalents were detected in more than two-thirds of specimens. Under immunosuppression, herpesviruses (EBV 30.9%/14.6%, p < 0.001; CMV 19.6%/7.9%, p < 0.001; HSV-1: 14.2%/7.1%, p = 0.012) were frequently observed, mainly through their reactivation in adults. Immunocompromised adults tended to present a higher RSV prevalence (6.4%/2.4%, p = 0.078). Immunocompetent patients were more frequently tested positive for IV (15.0%/5.8%, p = 0.001) and M.p. (6.4%/0.4%, p < 0.001), probably biased due to the influenza pandemic of 2009 and an M.p. epidemic in 2011. About 41.8% of samples were positive for a single pathogen, and among them EBV (19.9%) was most prevalent followed by HRV (18.2%) and IV (16.6%). HSV-2 and C.p. were not found. Marked seasonal effects were observed for HRV, IV, and RSV. Differences in pathogen prevalence were demonstrated between immunocompetent and immunocompromised patients. The exact contribution of some herpesviruses to the development of RTI remains unclear.
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Affiliation(s)
- Maria Reckziegel
- Section of Experimental Virology, Institute of Medical Microbiology, Jena University Hospital, Jena, Germany.,Department of Hematology/Oncology, Clinic of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Claudia Weber-Osel
- Section of Experimental Virology, Institute of Medical Microbiology, Jena University Hospital, Jena, Germany.,Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Renate Egerer
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Florian Kubek
- Section of Experimental Virology, Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Jena University of Applied Sciences, Jena, Germany
| | - Stefanie Wilhelm
- Section of Experimental Virology, Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Roland Zell
- Section of Experimental Virology, Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Andi Krumbholz
- Institute of Infection Medicine, Christian-Albrechts-Universität zu Kiel and University Medical Center Schleswig-Holstein, Brunswiker Straße 4, D-24105, Kiel, Germany.
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Bruyndonckx R, Coenen S, Butler C, Verheij T, Little P, Hens N, Beutels P, Ieven M, Goossens H. Respiratory syncytial virus and influenza virus infection in adult primary care patients: Association of age with prevalence, diagnostic features and illness course. Int J Infect Dis 2020; 95:384-390. [PMID: 32320810 PMCID: PMC7167228 DOI: 10.1016/j.ijid.2020.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 02/05/2023] Open
Abstract
RSV prevalence in patients age 75+ was twice the prevalence in those under 60. Influenza prevalence is not associated with age. Diagnostics are not associated with age for RSV and influenza. Illness course is associated with age for both RSV and influenza.
Objectives To better target new vaccines and treatments being developed for respiratory syncytial virus (RSV) and influenza virus (influenza), we studied the association of age with prevalence, diagnostic features and course of illness of these infections in primary care patients. Methods Secondary analysis of observational data on the aetiology, diagnosis and prognosis in adults presenting to primary care with acute cough in 12 European countries (2007–2010) using regression analyses corrected for clustering of patients within countries. Age groups were 18–59 years, 60–74 years, and 75 years and older (75+). Results Nasopharyngeal swabs for 144 (4.6%), 169 (5.4%) and 104 (3.4%) out of 3104 patients were polymerase chain reaction (PCR) positive for RSV, influenza A and influenza B, respectively. RSV prevalence in patients 75+ (8.5%) was twice the prevalence in those under 60 years (4.2%). Influenza prevalence was not associated with age. Diagnostic features for these viruses were not associated with age. Symptom duration was associated with age for RSV and influenza B, but not for influenza A. The odds of unresolved symptoms after 28 days were associated with age for RSV only. Illness deterioration was associated with age for RSV, with patients 75+ at increased risk, but not for influenza. Conclusion In adults presenting to primary care with acute cough, the diagnostic features of RSV or influenza infection are not associated with age. For RSV both the prevalence and illness course are significantly worse at higher age, for influenza only the illness course is.
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Affiliation(s)
- Robin Bruyndonckx
- Data Science Institute (DSI), Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium; Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Chris Butler
- Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Theo Verheij
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paul Little
- Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Niel Hens
- Data Science Institute (DSI), Hasselt University, Hasselt, Belgium; Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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The journey to a respiratory syncytial virus vaccine. Ann Allergy Asthma Immunol 2020; 125:36-46. [PMID: 32217187 DOI: 10.1016/j.anai.2020.03.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The high burden associated with respiratory syncytial virus (RSV) has made the development of RSV vaccine(s) a global health high priority. This review summarizes the journey to an RSV vaccine, the different strategies and challenges associated with the development of preventive strategies for RSV, and the diverse products that are undergoing clinical testing. DATA SOURCES Studies on RSV biology, immunology, epidemiology, and monoclonal antibodies (mAbs) and vaccines were searched using MEDLINE. We also searched PATH.org and ClinicalTrials.gov for updated information regarding the status of RSV vaccines and mAbs undergoing clinical trials. STUDY SELECTIONS We selected relevant studies conducted in infants and young children, pregnant women, and elderly population for the prevention of RSV infection. RESULTS Identification of a safe and immunogenic vaccine has been an important but elusive initiative for more than 60 years for different reasons, including the legacy of formalin-inactivated vaccine, our limited understanding of the immune response to RSV and how it relates to clinical disease severity, or the need for different end points according to the different vaccine platforms. Nevertheless, there are currently 39 vaccines and mAbs under development and 19 undergoing clinical trials. CONCLUSION Over the past decade, there have been significant advances in our knowledge of RSV molecular and structural biology and in understanding the human immune response to RSV. Despite the barriers, there are several promising mAbs and RSV vaccines undergoing clinical trials that hope to offer protection to the most vulnerable populations.
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