1
|
Yunker M, Fall A, Norton JM, Abdullah O, Villafuerte DA, Pekosz A, Klein E, Mostafa HH. Genomic Evolution and Surveillance of Respiratory Syncytial Virus during the 2023-2024 Season. Viruses 2024; 16:1122. [PMID: 39066284 PMCID: PMC11281595 DOI: 10.3390/v16071122] [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: 04/29/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a significant cause of morbidity, particularly in infants. This study describes RSV genomic diversity and disease outcomes during the 2023-2024 season in the Johns Hopkins Hospital System (JHHS). Between August and December 2023, 406 patient samples were sequenced, showing that RSV-B GB5.0.5a was the dominant genotype detected. RSV-A genotype GA2.3.5 was detected less frequently. Metadata analysis of patient data revealed that, although RSV-B was more commonly detected, patients with RSV-A infections were more frequently hospitalized. Analysis of both the G- and F-genes revealed multiple amino acid substitutions in both RSV-A and RSV-B, with some positions within the F-protein that could be associated with evasion of antibody responses. Phylogenetic analysis revealed the genetic diversity of circulating GB5.0.5a and GA2.3.5 genotypes. This study serves as an important baseline for genomic surveillance of RSV within the JHHS and will assist in characterizing the impact of the newly approved RSV vaccines on RSV genomic evolution and the emergence of escape mutations.
Collapse
Affiliation(s)
- Madeline Yunker
- Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121F, 600 N. Wolfe St., Baltimore, MD 21287, USA; (M.Y.); (A.F.); (J.M.N.); (O.A.); (D.A.V.)
| | - Amary Fall
- Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121F, 600 N. Wolfe St., Baltimore, MD 21287, USA; (M.Y.); (A.F.); (J.M.N.); (O.A.); (D.A.V.)
| | - Julie M. Norton
- Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121F, 600 N. Wolfe St., Baltimore, MD 21287, USA; (M.Y.); (A.F.); (J.M.N.); (O.A.); (D.A.V.)
| | - Omar Abdullah
- Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121F, 600 N. Wolfe St., Baltimore, MD 21287, USA; (M.Y.); (A.F.); (J.M.N.); (O.A.); (D.A.V.)
| | - David A. Villafuerte
- Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121F, 600 N. Wolfe St., Baltimore, MD 21287, USA; (M.Y.); (A.F.); (J.M.N.); (O.A.); (D.A.V.)
| | - Andrew Pekosz
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (A.P.); (E.K.)
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Eili Klein
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (A.P.); (E.K.)
- Center for Disease Dynamics, Economics, and Policy, Washington, DC 20005, USA
| | - Heba H. Mostafa
- Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121F, 600 N. Wolfe St., Baltimore, MD 21287, USA; (M.Y.); (A.F.); (J.M.N.); (O.A.); (D.A.V.)
| |
Collapse
|
2
|
Scarpaci M, Bracaloni S, Esposito E, De Angelis L, Baglivo F, Casini B, Panatto D, Ogliastro M, Loconsole D, Chironna M, Pariani E, Pellegrinelli L, Pandolfi E, Croci I, Rizzo C. RSV Disease Burden in Primary Care in Italy: A Multi-Region Pediatric Study, Winter Season 2022-2023. Influenza Other Respir Viruses 2024; 18:e13282. [PMID: 38622776 PMCID: PMC11018906 DOI: 10.1111/irv.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Human respiratory syncytial virus (RSV) is one of the most frequent causes of respiratory infections in children under 5 years of age, but its socioeconomic impact and burden in primary care settings is still little studied. METHODS During the 2022/2023 winter season, 55 pediatricians from five Italian regions participated in our community-based study. They collected a nasal swab for RSV molecular test from 650 patients under the age of 5 with acute respiratory infections (ARIs) and performed a baseline questionnaire. The clinical and socioeconomic burden of RSV disease in primary care was evaluated by two follow-up questionnaires completed by the parents of positive children on Days 14 and 30. RESULTS RSV laboratory-confirmed cases were 37.8% of the total recruited ARI cases, with RSV subtype B accounting for the majority (65.4%) of RSV-positive swabs. RSV-positive children were younger than RSV-negative ones (median 12.5 vs. 16.5 months). The mean duration of symptoms for all children infected by RSV was 11.47 ± 6.27 days. We did not observe substantial differences in clinical severity between the two RSV subtypes, but RSV-A positive patients required more additional pediatric examinations than RSV-B cases. The socioeconomic impact of RSV infection was considerable, causing 53% of children to be absent from school, 46% of parents to lose working days, and 25% of families to incur extra costs. CONCLUSIONS Our findings describe a baseline of the RSV disease burden in primary care in Italy before the introduction of upcoming immunization strategies.
Collapse
Affiliation(s)
- Michela Scarpaci
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Sara Bracaloni
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Enrica Esposito
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Luigi De Angelis
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Francesco Baglivo
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | | | | | - Daniela Loconsole
- Hygiene Section, Department of Interdisciplinary MedicineUniversity of Bari “A. Moro”BariItaly
| | - Maria Chironna
- Hygiene Section, Department of Interdisciplinary MedicineUniversity of Bari “A. Moro”BariItaly
| | - Elena Pariani
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | | | - Elisabetta Pandolfi
- Predictive and Preventive Medicine Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Ileana Croci
- Predictive and Preventive Medicine Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| |
Collapse
|
3
|
Tavakolian S, Goudarzi H, Alavi Darazam I, Faghihloo E. Human Respiratory Syncytial Virus and Coronavirus Rates in Iranian Elderly Patients More than 60 Years Old with Acute Respiratory Symptoms. Adv Biomed Res 2023; 12:180. [PMID: 37694251 PMCID: PMC10492601 DOI: 10.4103/abr.abr_395_22] [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: 11/19/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 09/12/2023] Open
Abstract
Background Scientists have believed that a number of risk factors, especially viral infectious agents, can be related to respiratory diseases. Due to the pandemics in 2019, Human Respiratory Syncytial Virus and Coronavirus have attracted the attention of different kinds of research. In this study, we attempted to evaluate the prevalence of these viruses. Materials and Methods After extracting the RNA and DNA of these viruses, molecular tests were employed to report the rate of them in patients suffering from respiratory symptoms. Results Our results demonstrated that 31 samples were COVID-19 positive. Furthermore, two cases had Respiratory syncytial virus (RSV) subgroup A infections. However, no cases showed a coinfection of both viruses. Conclusions It seems that during the pandemic of COVID-19, RSV should not be ignored as it can be responsible for the respiratory syndrome.
Collapse
Affiliation(s)
- Shaian Tavakolian
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Faghihloo
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Wilkins D, Langedijk AC, Lebbink RJ, Morehouse C, Abram ME, Ahani B, Aksyuk AA, Baraldi E, Brady T, Chen AT, Chi H, Choi EH, Cohen R, Danilenko DM, Gopalakrishnan V, Greenough A, Heikkinen T, Hosoya M, Keller C, Kelly EJ, Kragten-Tabatabaie L, Martinón-Torres F, de Los Santos AHM, Nunes MC, Palomino MA, Papenburg J, Pernica JM, Richmond P, Stein RT, Tuffy KM, Verwey C, Esser MT, Tabor DE, Bont LJ. Nirsevimab binding-site conservation in respiratory syncytial virus fusion glycoprotein worldwide between 1956 and 2021: an analysis of observational study sequencing data. THE LANCET. INFECTIOUS DISEASES 2023; 23:856-866. [PMID: 36940703 DOI: 10.1016/s1473-3099(23)00062-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Nirsevimab is an extended half-life monoclonal antibody to the respiratory syncytial virus (RSV) fusion protein that has been developed to protect infants for an entire RSV season. Previous studies have shown that the nirsevimab binding site is highly conserved. However, investigations of the geotemporal evolution of potential escape variants in recent (ie, 2015-2021) RSV seasons have been minimal. Here, we examine prospective RSV surveillance data to assess the geotemporal prevalence of RSV A and B, and functionally characterise the effect of the nirsevimab binding-site substitutions identified between 2015 and 2021. METHODS We assessed the geotemporal prevalence of RSV A and B and nirsevimab binding-site conservation between 2015 and 2021 from three prospective RSV molecular surveillance studies (the US-based OUTSMART-RSV, the global INFORM-RSV, and a pilot study in South Africa). Nirsevimab binding-site substitutions were assessed in an RSV microneutralisation susceptibility assay. We contextualised our findings by assessing fusion-protein sequence diversity from 1956 to 2021 relative to other respiratory-virus envelope glycoproteins using RSV fusion protein sequences published in NCBI GenBank. FINDINGS We identified 5675 RSV A and RSV B fusion protein sequences (2875 RSV A and 2800 RSV B) from the three surveillance studies (2015-2021). Nearly all (25 [100%] of 25 positions of RSV A fusion proteins and 22 [88%] of 25 positions of RSV B fusion proteins) amino acids within the nirsevimab binding site remained highly conserved between 2015 and 2021. A highly prevalent (ie, >40·0% of all sequences) nirsevimab binding-site Ile206Met:Gln209Arg RSV B polymorphism arose between 2016 and 2021. Nirsevimab neutralised a diverse set of recombinant RSV viruses, including new variants containing binding-site substitutions. RSV B variants with reduced susceptibility to nirsevimab neutralisation were detected at low frequencies (ie, prevalence <1·0%) between 2015 and 2021. We used 3626 RSV fusion-protein sequences published in NCBI GenBank between 1956 and 2021 (2024 RSV and 1602 RSV B) to show that the RSV fusion protein had lower genetic diversity than influenza haemagglutinin and SARS-CoV-2 spike proteins. INTERPRETATION The nirsevimab binding site was highly conserved between 1956 and 2021. Nirsevimab escape variants were rare and have not increased over time. FUNDING AstraZeneca and Sanofi.
Collapse
Affiliation(s)
- Deidre Wilkins
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Annefleur C Langedijk
- Division of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Robert Jan Lebbink
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Michael E Abram
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Bahar Ahani
- Bioinformatics, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Anastasia A Aksyuk
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Eugenio Baraldi
- Woman's and Child's Health, Neonatal Intensive Care Unit, University of Padova, Padova, Italy; Institute of Pediatric Research, Città della Speranza, Padova, Italy
| | - Tyler Brady
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Albert Tian Chen
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Biological and Biomedical Sciences, Harvard University, Cambridge, MA, USA
| | - Hsin Chi
- Department of Paediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Robert Cohen
- Université Paris XII, Créteil, FranceAssociation Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Daria M Danilenko
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russia
| | | | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, UK; ReSViNET foundation, Zeist, Netherlands
| | - Terho Heikkinen
- ReSViNET foundation, Zeist, Netherlands; Department of Pediatrics, University of Turku, Turku, Finland; Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Mitsuaki Hosoya
- School of Medicine, Fukushima Medical University, Fukushima, Japan
| | | | - Elizabeth J Kelly
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | | | - Federico Martinón-Torres
- ReSViNET foundation, Zeist, Netherlands; Translational Paediatrics and Infectious Diseases, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago, Galicia, Spain
| | | | - Marta C Nunes
- ReSViNET foundation, Zeist, Netherlands; South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesse Papenburg
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey M Pernica
- Division of Infectious Diseases, McMaster University, Hamilton, ON, Canada
| | - Peter Richmond
- Division of Pediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Renato T Stein
- ReSViNET foundation, Zeist, Netherlands; Pontificia Universidade Catolica de Rio Grande do Sul, Porto Alegre, Brazil
| | - Kevin M Tuffy
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Charl Verwey
- Department of Paediatrics and Child Health, School of Clinical Medicine and South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark T Esser
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
| | - David E Tabor
- Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Louis J Bont
- Department of Paediatrics, University Medical Centre Utrecht, Utrecht, Netherlands; ReSViNET foundation, Zeist, Netherlands
| |
Collapse
|
5
|
Kim HN, Hwang J, Yoon SY, Lim CS, Cho Y, Lee CK, Nam MH. Molecular characterization of human respiratory syncytial virus in Seoul, South Korea, during 10 consecutive years, 2010-2019. PLoS One 2023; 18:e0283873. [PMID: 37023101 PMCID: PMC10079039 DOI: 10.1371/journal.pone.0283873] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/19/2023] [Indexed: 04/07/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections and hospitalization in infants and young children. Here, we analyzed the genetic diversity of RSV using partial G gene sequences in 84 RSV-A and 78 RSV- B positive samples collected in Seoul, South Korea, for 10 consecutive years, from 2010 to 2019. Our phylogenetic analysis revealed that RSV-A strains were classified into either the ON1 (80.9%) or NA1 (19.0%) genotypes. On the other hand, RSV-B strains demonstrated diversified clusters within the BA genotype. Notably, some sequences designated as BA-SE, BA-SE1, and BA-DIS did not cluster with previously identified BA genotypes in the phylogenetic trees. Despite this, they did not meet the criteria for the assignment of a new genotype based on recent classification methods. Selection pressure analysis identified three positive selection sites (amino acid positions 273, 274, and 298) in RSV-A, and one possible positive selection site (amino acid position 296) in RSV-B, respectively. The mean evolutionary rates of Korean RSV-A from 1999 to 2019 and RSV-B strains from 1991 and 2019 were estimated at 3.51 × 10-3 nucleotides (nt) substitutions/site/year and 3.32 × 10-3 nt substitutions/site/year, respectively. The population dynamics in the Bayesian skyline plot revealed fluctuations corresponding to the emergence of dominant strains, including a switch of the dominant genotype from NA1 to ON1. Our study on time-scaled cumulative evolutionary analysis contributes to a better understanding of RSV epidemiology at the local level in South Korea.
Collapse
Affiliation(s)
- Ha Nui Kim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jinha Hwang
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soo-Young Yoon
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chae Seung Lim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yunjung Cho
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang-Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung-Hyun Nam
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Goya S, Lucion MF, Shilts MH, Juárez MDV, Gentile A, Mistchenko AS, Viegas M, Das SR. Evolutionary dynamics of respiratory syncytial virus in Buenos Aires: Viral diversity, migration, and subgroup replacement. Virus Evol 2023; 9:vead006. [PMID: 36880065 PMCID: PMC9985318 DOI: 10.1093/ve/vead006] [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: 06/03/2022] [Revised: 09/25/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Globally, the human respiratory syncytial virus (RSV) is one of the major causes of lower respiratory tract infections (LRTIs) in children. The scarcity of complete genome data limits our understanding of RSV spatiotemporal distribution, evolution, and viral variant emergence. Nasopharyngeal samples collected from hospitalized pediatric patients from Buenos Aires tested positive for RSV LRTI during four consecutive outbreaks (2014-2017) were randomly subsampled for RSV complete genome sequencing. Phylodynamic studies and viral population characterization of genomic variability, diversity, and migration of viruses to and from Argentina during the study period were performed. Our sequencing effort resulted in one of the largest collections of RSV genomes from a given location (141 RSV-A and 135 RSV-B) published so far. RSV-B was dominant during the 2014-2016 outbreaks (60 per cent of cases) but was abruptly replaced by RSV-A in 2017, with RSV-A accounting for 90 per cent of sequenced samples. A significant decrease in RSV genomic diversity-represented by both a reduction in genetic lineages detected and the predominance of viral variants defined by signature amino acids-was observed in Buenos Aires in 2016, the year prior to the RSV subgroup predominance replacement. Multiple introductions to Buenos Aires were detected, some with persistent detection over seasons, and also, RSV was observed to migrate from Buenos Aires to other countries. Our results suggest that the decrease in viral diversity may have allowed the dramatic predominance switch from RSV-B to RSV-A in 2017. The immune pressure generated against circulating viruses with limited diversity during a given outbreak may have created a fertile ground for an antigenically divergent RSV variant to be introduced and successfully spread in the subsequent outbreak. Overall, our RSV genomic analysis of intra- and inter-outbreak diversity provides an opportunity to better understand the epochal evolutionary dynamics of RSV.
Collapse
Affiliation(s)
- Stephanie Goya
- Virology Laboratory, Ricardo Gutiérrez Children’s Hospital, Gallo 1330, Buenos Aires 1425, Argentina
- National Scientific and Technical Research Council, Godoy Cruz 2290, Buenos Aires 1425, Argentina
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN 37232, USA
| | - Maria Florencia Lucion
- Department of Epidemiology, Ricardo Gutiérrez Children’s Hospital, Gallo 1330, Buenos Aires 1425, Argentina
| | - Meghan H Shilts
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN 37232, USA
| | - María del Valle Juárez
- Department of Epidemiology, Ricardo Gutiérrez Children’s Hospital, Gallo 1330, Buenos Aires 1425, Argentina
| | - Angela Gentile
- Department of Epidemiology, Ricardo Gutiérrez Children’s Hospital, Gallo 1330, Buenos Aires 1425, Argentina
| | - Alicia S Mistchenko
- Virology Laboratory, Ricardo Gutiérrez Children’s Hospital, Gallo 1330, Buenos Aires 1425, Argentina
| | - Mariana Viegas
- Virology Laboratory, Ricardo Gutiérrez Children’s Hospital, Gallo 1330, Buenos Aires 1425, Argentina
- National Scientific and Technical Research Council, Godoy Cruz 2290, Buenos Aires 1425, Argentina
| | - Suman R Das
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN 37232, USA
- Department Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA
| |
Collapse
|
7
|
Córdova-Dávalos LE, Hernández-Mercado A, Barrón-García CB, Rojas-Martínez A, Jiménez M, Salinas E, Cervantes-García D. Impact of genetic polymorphisms related to innate immune response on respiratory syncytial virus infection in children. Virus Genes 2022; 58:501-514. [PMID: 36085536 PMCID: PMC9462631 DOI: 10.1007/s11262-022-01932-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
Respiratory syncytial virus (RSV) causes lower respiratory tract infections and bronchiolitis, mainly affecting children under 2 years of age and immunocompromised patients. Currently, there are no available vaccines or efficient pharmacological treatments against RSV. In recent years, tremendous efforts have been directed to understand the pathological mechanisms of the disease and generate a vaccine against RSV. Although RSV is highly infectious, not all the patients who get infected develop bronchiolitis and severe disease. Through various sequencing studies, single nucleotide polymorphisms (SNPs) have been discovered in diverse receptors, cytokines, and transcriptional regulators with crucial role in the activation of the innate immune response, which is implicated in the susceptibility to develop or protect from severe forms of the infection. In this review, we highlighted how variations in the key genes affect the development of innate immune response against RSV. This data would provide crucial information about the mechanisms of viral infection, and in the future, could help in generation of new strategies for vaccine development or generation of the pharmacological treatments.
Collapse
Affiliation(s)
- Laura Elena Córdova-Dávalos
- Laboratorio de Inmunología, Departamento de Microbiología, Universidad Autónoma de Aguascalientes, 20100, Aguascalientes, México
| | - Alicia Hernández-Mercado
- Laboratorio de Inmunología, Departamento de Microbiología, Universidad Autónoma de Aguascalientes, 20100, Aguascalientes, México
| | - Claudia Berenice Barrón-García
- Laboratorio de Inmunología, Departamento de Microbiología, Universidad Autónoma de Aguascalientes, 20100, Aguascalientes, México
| | - Augusto Rojas-Martínez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto 3000 Pte, Los Doctores, 64710, Monterrey, Nuevo León, México
| | - Mariela Jiménez
- Laboratorio de Inmunología, Departamento de Microbiología, Universidad Autónoma de Aguascalientes, 20100, Aguascalientes, México
| | - Eva Salinas
- Laboratorio de Inmunología, Departamento de Microbiología, Universidad Autónoma de Aguascalientes, 20100, Aguascalientes, México.
| | - Daniel Cervantes-García
- Laboratorio de Inmunología, Departamento de Microbiología, Universidad Autónoma de Aguascalientes, 20100, Aguascalientes, México. .,Consejo Nacional de Ciencia y Tecnología, 03940, Ciudad de México, México.
| |
Collapse
|
8
|
Impact of COVID-19 on the Changing Patterns of Respiratory Syncytial Virus Infections. Infect Dis Rep 2022; 14:558-568. [PMID: 35893478 PMCID: PMC9394296 DOI: 10.3390/idr14040059] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Seasonal epidemics of respiratory syncytial virus (RSV) is one of the leading causes of hospitalization and mortality among children. Preventive measures implemented to reduce the spread of SARS-CoV-2, including facemasks, stay-at-home orders, closure of schools and local-national borders, and hand hygiene, may have also prevented the transmission of RSV and influenza. However, with the easing of COVID-19 imposed restrictions, many regions are noticing a delayed RSV outbreak. Some of these regions have also noted an increase in severity of these delayed RSV outbreaks partly due to a lack of protective immunity in the community following a lack of exposure from the previous season. Lessons learned from the COVID-19 pandemic can be implemented for controlling RSV outbreaks, including: (1) measures to reduce the spread, (2) effective vaccine development, and (3) genomic surveillance tools and computational modeling to predict the timing and severity of RSV outbreaks. These measures can help reduce the severity and prepare the health care system to deal with future RSV outbreaks by appropriate and timely allocation of health care resources.
Collapse
|
9
|
Esposito S, Abu Raya B, Baraldi E, Flanagan K, Martinon Torres F, Tsolia M, Zielen S. RSV Prevention in All Infants: Which Is the Most Preferable Strategy? Front Immunol 2022; 13:880368. [PMID: 35572550 PMCID: PMC9096079 DOI: 10.3389/fimmu.2022.880368] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Respiratory syncytial virus (RSV) causes a spectrum of respiratory illnesses in infants and young children that may lead to hospitalizations and a substantial number of outpatient visits, which result in a huge economic and healthcare burden. Most hospitalizations happen in otherwise healthy infants, highlighting the need to protect all infants against RSV. Moreover, there is evidence on the association between early-life RSV respiratory illness and recurrent wheezing/asthma-like symptoms As such, RSV is considered a global health priority. However, despite this, the only prevention strategy currently available is palivizumab, a monoclonal antibody (mAb) indicated in a subset of preterm infants or those with comorbidities, hence leaving the majority of the infant population unprotected against this virus. Therefore, development of prevention strategies against RSV for all infants entering their first RSV season constitutes a large unmet medical need. The aim of this review is to explore different immunization approaches to protect all infants against RSV. Prevention strategies include maternal immunization, immunization of infants with vaccines, immunization of infants with licensed mAbs (palivizumab), and immunization of infants with long-acting mAbs (e.g., nirsevimab, MK-1654). Of these, palivizumab use is restricted to a small population of infants and does not offer a solution for all-infant protection, whereas vaccine development in infants has encountered various challenges, including the immaturity of the infant immune system, highlighting that future pediatric vaccines will most likely be used in older infants (>6 months of age) and children. Consequently, maternal immunization and immunization of infants with long-acting mAbs represent the two feasible strategies for protection of all infants against RSV. Here, we present considerations regarding these two strategies covering key areas which include mechanism of action, "consistency" of protection, RSV variability, duration of protection, flexibility and optimal timing of immunization, benefit for the mother, programmatic implementation, and acceptance of each strategy by key stakeholders. We conclude that, based on current data, immunization of infants with long-acting mAbs might represent the most effective approach for protecting all infants entering their first RSV season.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Parma, Italy
| | - Bahaa Abu Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, Padova University Hospital, Padova, Italy
| | - Katie Flanagan
- School of Medicine, Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
| | - Federico Martinon Torres
- Genetics, Vaccines, Infections and Pediatrics Research group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Tsolia
- Second Department of Pediatrics, National and Kapodistrian University of Athens, “A&P Kyriakou” Children’s Hospital, Athens, Greece
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe-University Hospital, Frankfurt am Main, Germany
| |
Collapse
|
10
|
Langedijk AC, Bont LJ. How Viral Sequence Analysis May Guide Development of Respiratory Syncytial Virus Monoclonal Antibodies. Clin Infect Dis 2021; 73:e4409-e4410. [PMID: 32640025 DOI: 10.1093/cid/ciaa944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Annefleur C Langedijk
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Louis J Bont
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
11
|
Langedijk AC, Harding ER, Konya B, Vrancken B, Lebbink RJ, Evers A, Willemsen J, Lemey P, Bont LJ. A systematic review on global RSV genetic data: Identification of knowledge gaps. Rev Med Virol 2021; 32:e2284. [PMID: 34543489 PMCID: PMC9285027 DOI: 10.1002/rmv.2284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022]
Abstract
Respiratory syncytial virus (RSV) is a major health problem. A better understanding of the geographical and temporal dynamics of RSV circulation will assist in tracking resistance against therapeutics currently under development. Since 2015, the field of RSV molecular epidemiology has evolved rapidly with around 20–30 published articles per year. The objective of this systematic review is to identify knowledge gaps in recent RSV genetic literature to guide global molecular epidemiology research. We included 78 studies published between 2015 and 2020 describing 12,998 RSV sequences of which 8,233 (63%) have been uploaded to GenBank. Seventeen (22%) studies were performed in low‐ and middle‐income countries (LMICs), and seven (9%) studies sequenced whole‐genomes. Although most reported polymorphisms for monoclonal antibodies in clinical development (nirsevimab, MK‐1654) have not been tested for resistance in neutralisation essays, known resistance was detected at low levels for the nirsevimab and palivizumab binding site. High resistance was found for the suptavumab binding site. We present the first literature review of an enormous amount of RSV genetic data. The need for global monitoring of RSV molecular epidemiology becomes increasingly important in evaluating the effectiveness of monoclonal antibody candidates as they reach their final stages of clinical development. We have identified the following three knowledge gaps: whole‐genome data to study global RSV evolution, data from LMICs and data from global surveillance programs.
Collapse
Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatrics, Division of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eline R Harding
- Department of Paediatrics, Division of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Burak Konya
- Department of Paediatrics, Division of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bram Vrancken
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Leuven, Belgium
| | - Robert Jan Lebbink
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk Evers
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joukje Willemsen
- Department of Paediatrics, Division of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Leuven, Belgium
| | - Louis J Bont
- Department of Paediatrics, Division of Paediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,ReSViNET Foundation, Zeist, The Netherlands
| |
Collapse
|
12
|
Kim S, Williams TC, Viboud C, Campbell H, Chen J, Spiro DJ. RSV genomic diversity and the development of a globally effective RSV intervention. Vaccine 2021; 39:2811-2820. [PMID: 33895016 DOI: 10.1016/j.vaccine.2021.03.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of serious lower respiratory tract illness in infants and children and causes significant disease in the elderly and immunocompromised. Recently there has been an acceleration in the development of candidate RSV vaccines, monoclonal antibodies and therapeutics. However, the effects of RSV genomic variability on the implementation of vaccines and therapeutics remain poorly understood. To address this knowledge gap, the National Institute of Allergy and Infectious Diseases and the Fogarty International Center held a workshop to summarize what is known about the global burden and transmission of RSV disease, the phylogeographic dynamics and genomics of the virus, and the networks that exist to improve the understanding of RSV disease. Discussion at the workshop focused on the implications of viral evolution and genomic variability for vaccine and therapeutics development in the context of various immunization strategies. This paper summarizes the meeting, highlights research gaps and future priorities, and outlines what has been achieved since the meeting took place. It concludes with an examination of what the RSV community can learn from our understanding of SARS-CoV-2 genomics and what insights over sixty years of RSV research can offer the rapidly evolving field of COVID-19 vaccines.
Collapse
Affiliation(s)
- Sonnie Kim
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Thomas C Williams
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Cecile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | | | - David J Spiro
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
13
|
Safety, tolerability, and immunogenicity of the respiratory syncytial virus prefusion F subunit vaccine DS-Cav1: a phase 1, randomised, open-label, dose-escalation clinical trial. THE LANCET RESPIRATORY MEDICINE 2021; 9:1111-1120. [PMID: 33864736 DOI: 10.1016/s2213-2600(21)00098-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple active vaccination approaches have proven ineffective in reducing the substantial morbidity and mortality caused by respiratory syncytial virus (RSV) in infants and older adults (aged ≥65 years). A vaccine conferring a substantial and sustainable boost in neutralising activity is required to protect against severe RSV disease. To that end, we evaluated the safety and immunogenicity of DS-Cav1, a prefusion F subunit vaccine. METHODS In this randomised, open-label, phase 1 clinical trial, the stabilised prefusion F vaccine DS-Cav1 was evaluated for dose, safety, tolerability, and immunogenicity in healthy adults aged 18-50 years at a single US site. Participants were assigned to receive escalating doses of either 50 μg, 150 μg, or 500 μg DS-Cav1 at weeks 0 and 12, and were randomly allocated in a 1:1 ratio within each dose group to receive the vaccine with or without aluminium hydroxide (AlOH) adjuvant. After 71 participants had been randomised, the protocol was amended to allow some participants to receive a single vaccination at week 0. The primary objectives evaluated the safety and tolerability at every dose within 28 days following each injection. Neutralising activity and RSV F-binding antibodies were evaluated from week 0 to week 44 as secondary and exploratory objectives. Safety was assessed in all participants who received at least one vaccine dose; secondary and exploratory immunogenicity analysis included all participants with available data at a given visit. The trial is registered with ClinicalTrials.gov, NCT03049488, and is complete and no longer recruiting. FINDINGS Between Feb 21, 2017, and Nov 29, 2018, 244 participants were screened for eligibility and 95 were enrolled to receive DS-Cav1 at the 50 μg (n=30, of which n=15 with AlOH), 150 μg (n=35, of which n=15 with AlOH), or 500 μg (n=30, of which n=15 with AlOH) doses. DS-Cav1 was safe and well tolerated and no serious vaccine-associated adverse events deemed related to the vaccine were identified. DS-Cav1 vaccination elicited robust neutralising activity and binding antibodies by 4 weeks after a single vaccination (p<0·0001 for F-binding and neutralising antibodies). In analyses of exploratory endpoints at week 44, pre-F-binding IgG and neutralising activity were significantly increased compared with baseline in all groups. At week 44, RSV A neutralising activity was 3·1 fold above baseline in the 50 μg group, 3·8 fold in the 150 μg group, and 4·5 fold in the 500 μg group (p<0·0001). RSV B neutralising activity was 2·8 fold above baseline in the 50 μg group, 3·4 fold in the 150 μg group, and 3·7 fold in the 500 μg group (p<0·0001). Pre-F-binding IgG remained significantly 3·2 fold above baseline in the 50 μg group, 3·4 fold in the 150 μg group, and 4·0 fold in the 500 μg group (p<0·0001). Pre-F-binding serum IgA remained 4·1 fold above baseline in the 50 μg group, 4·3 fold in the 150 μg group, and 4·8 fold in the 500 μg group (p<0·0001). Although a higher vaccine dose or second immunisation elicited a transient advantage compared with lower doses or a single immunisation, neither significantly impacted long-term neutralisation. There was no long-term effect of dose, number of vaccinations, or adjuvant on neutralising activity. INTERPRETATION In this phase 1 study, DS-Cav1 vaccination was safe and well tolerated. DS-Cav1 vaccination elicited a robust boost in RSV F-specific antibodies and neutralising activity that was sustained above baseline for at least 44 weeks. A single low-dose of pre-F immunisation of antigen-experienced individuals might confer protection that extends throughout an entire RSV season. FUNDING The National Institutes of Allergy and Infectious Diseases.
Collapse
|
14
|
Buchwald AG, Tamboura B, Tennant SM, Haidara FC, Coulibaly F, Doumbia M, Diallo F, Keita AM, Sow SO, Kotloff KL, Levine MM, Tapia MD. Epidemiology, Risk Factors, and Outcomes of Respiratory Syncytial Virus Infections in Newborns in Bamako, Mali. Clin Infect Dis 2021; 70:59-66. [PMID: 30810160 PMCID: PMC6912158 DOI: 10.1093/cid/ciz157] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/22/2019] [Indexed: 11/30/2022] Open
Abstract
Background Few studies describe the respiratory syncytial virus (RSV) burden in African populations, and most have utilized hospital-based surveillance. In Mali, no community-based studies exist of the incidence or epidemiology of RSV infection. This study provides the first estimates of RSV incidence in Mali. Methods In a cohort of infants enrolled in a clinical trial of maternal influenza vaccination, we estimate incidence of RSV-associated febrile illness in the first 6 months of life and identify risk factors for RSV infection and progression to severe disease. Infants (N = 1871) were followed from birth to 6 months of age and visited weekly to detect pneumonia and influenza-like illness. Baseline covariates were explored as risk factors for RSV febrile illness and RSV pneumonia or hospitalization. Results Incidence of RSV illness was estimated at 536.8 per 1000 person-years, and 86% (131/153) of RSV illness episodes were positive for RSV-B. RSV illness was most frequent in the fifth month of life and associated with having older mothers and with lower parity. The incidence of RSV-associated hospitalizations was 45.6 per 1000 person-years. Among infants with RSV illness, males were more likely to be hospitalized. The incidence of RSV pneumonia was 29 cases per 1000 person-years. Conclusions In the first 6 months of life, Malian infants have a high incidence of RSV illness, primarily caused by RSV-B. Prevention of early RSV will require passive protection via maternal immunization in pregnancy. Mali is the first country where RSV-B has been identified as the dominant subtype, with potential implications for vaccine development.
Collapse
Affiliation(s)
- Andrea G Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | | | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | | | | | | | | | - Adama M Keita
- Centre pour le Developpement des Vaccins, Bamako, Mali
| | - Samba O Sow
- Centre pour le Developpement des Vaccins, Bamako, Mali
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| |
Collapse
|
15
|
Global Molecular Epidemiology of Respiratory Syncytial Virus from the 2017-2018 INFORM-RSV Study. J Clin Microbiol 2020; 59:JCM.01828-20. [PMID: 33087438 PMCID: PMC7771447 DOI: 10.1128/jcm.01828-20] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection among infants and young children, resulting in annual epidemics worldwide. INFORM-RSV is a multiyear clinical study designed to describe the global molecular epidemiology of RSV in children under 5 years of age by monitoring temporal and geographical evolution of current circulating RSV strains, F protein antigenic sites, and their relationships with clinical features of RSV disease. During the pilot season (2017–2018), 410 RSV G-F gene sequences were obtained from 476 RSV-positive nasal samples collected from 8 countries (United Kingdom, Spain, The Netherlands, Finland, Japan, Brazil, South Africa, and Australia). Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection among infants and young children, resulting in annual epidemics worldwide. INFORM-RSV is a multiyear clinical study designed to describe the global molecular epidemiology of RSV in children under 5 years of age by monitoring temporal and geographical evolution of current circulating RSV strains, F protein antigenic sites, and their relationships with clinical features of RSV disease. During the pilot season (2017–2018), 410 RSV G-F gene sequences were obtained from 476 RSV-positive nasal samples collected from 8 countries (United Kingdom, Spain, The Netherlands, Finland, Japan, Brazil, South Africa, and Australia). RSV B (all BA9 genotype) predominated over RSV A (all ON1 genotype) globally (69.0% versus 31.0%) and in all countries except South Africa. Geographic clustering patterns highlighted wide transmission and continued evolution with viral spread. Most RSV strains were from infants of <1 year of age (81.2%), males (56.3%), and patients hospitalized for >24 h (70.5%), with no differences in subtype distribution. Compared to 2013 reference sequences, variations at F protein antigenic sites were observed for both RSV A and B strains, with high-frequency polymorphisms at antigenic site Ø (I206M/Q209R) and site V (L172Q/S173L/K191R) in RSV B strains. The INFORM-RSV 2017–2018 pilot season establishes an important molecular baseline of RSV strain distribution and sequence variability with which to track the emergence of new strains and provide an early warning system of neutralization escape variants that may impact transmission or the effectiveness of vaccines and MAbs under development.
Collapse
|
16
|
Harshbarger W, Tian S, Wahome N, Balsaraf A, Bhattacharya D, Jiang D, Pandey R, Tungare K, Friedrich K, Mehzabeen N, Biancucci M, Chinchilla-Olszar D, Mallett CP, Huang Y, Wang Z, Bottomley MJ, Malito E, Chandramouli S. Convergent structural features of respiratory syncytial virus neutralizing antibodies and plasticity of the site V epitope on prefusion F. PLoS Pathog 2020; 16:e1008943. [PMID: 33137810 PMCID: PMC7660905 DOI: 10.1371/journal.ppat.1008943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/12/2020] [Accepted: 08/28/2020] [Indexed: 11/21/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a global public health burden for which no licensed vaccine exists. To aid vaccine development via increased understanding of the protective antibody response to RSV prefusion glycoprotein F (PreF), we performed structural and functional studies using the human neutralizing antibody (nAb) RSB1. The crystal structure of PreF complexed with RSB1 reveals a conformational, pre-fusion specific site V epitope with a unique cross-protomer binding mechanism. We identify shared structural features between nAbs RSB1 and CR9501, elucidating for the first time how diverse germlines obtained from different subjects can develop convergent molecular mechanisms for recognition of the same PreF site of vulnerability. Importantly, RSB1-like nAbs were induced upon immunization with PreF in naturally-primed cattle. Together, this work reveals new details underlying the immunogenicity of site V and further supports PreF-based vaccine development efforts. Respiratory syncytial virus (RSV) is a persistent, contagious seasonal pathogen and a serious public health threat. While infants are the most at-risk population, with infections potentially leading to bronchiolitis, adults, especially the elderly, are also burdened by RSV-induced respiratory infections. The only treatment currently available for RSV is passive immunization for high-risk infants. Thus, there is a critical need to develop a vaccine for the vast majority of the vulnerable population for which there is no preventative treatment. The RSV fusion protein in its prefusion form (PreF) is the target of the majority of naturally-induced neutralizing antibodies, and several clinical trials are currently evaluating PreF as a promising vaccine candidate. In this study, we solved the X-ray structure of PreF bound to the Fab fragment of a human neutralizing antibody. The structure reveals plasticity of the epitope, as well as a unique molecular signature for antibodies elicited towards this region of PreF. We also find that similar antibodies are induced upon immunization of naturally-primed cattle with a PreF vaccine antigen, suggesting that this epitope is highly immunogenic. These results will help us better understand the human immune response to RSV infection and vaccination, and guide future vaccine-design efforts.
Collapse
Affiliation(s)
| | - Sai Tian
- GSK, Rockville, MD, United States of America
| | | | | | | | | | | | | | | | | | | | | | | | - Ying Huang
- GSK, Rockville, MD, United States of America
| | - Zihao Wang
- GSK, Rockville, MD, United States of America
| | | | - Enrico Malito
- GSK, Rockville, MD, United States of America
- * E-mail: (EM); (SC)
| | | |
Collapse
|
17
|
Fergie J, Suh M, Jiang X, Fryzek JP, Gonzales T. Respiratory Syncytial Virus and All-Cause Bronchiolitis Hospitalizations Among Preterm Infants Using the Pediatric Health Information System (PHIS). J Infect Dis 2020; 225:1197-1204. [PMID: 32691037 PMCID: PMC8974836 DOI: 10.1093/infdis/jiaa435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background In 2014, the American Academy of Pediatrics stopped recommending palivizumab to otherwise healthy 29–34 weeks’ gestational age (wGA) infants aged <12 months at respiratory syncytial virus (RSV) season start. Here, we compare the burden of RSV hospitalizations (RSVH) and all-cause bronchiolitis hospitalizations (BH) before and after 2014 among otherwise healthy 29–34 wGA infants hospitalized at ≤6 months of age. Methods A historical, observational cohort study was conducted to evaluate RSVH and BH in 29–34 wGA infants during the 2010–2017 RSV seasons using encounter data from 51 United States children’s hospitals that comprise the Pediatric Health Information System. Results The overall cohort included 67 570 RSVH out of 96 281 patients with BH. wGA was known for 22 937 RSVH and 33 289 BH. For 29–34 wGA infants, there were 8.7% and 14.2% RSVH before and after 2014, respectively (P < .0001). Intensive care unit admissions increased for RSVH (from 54.5% to 64.2%; P = .0002) and BH (from 46.7% to 54.5%; P = .0005) after controlling for sex, race, comorbidity, and cluster. The total cost of care increased for RSVH from $37 million to nearly $60 million. Conclusions RSVH, BH, and their severity increased among 29–34 wGA infants in the 3 RSV seasons following 2014.
Collapse
Affiliation(s)
- Jaime Fergie
- Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi, Texas, USA
| | - Mina Suh
- EpidStrategies, Rockville, Maryland, USA
| | | | | | | |
Collapse
|
18
|
Langedijk AC, Lebbink RJ, Naaktgeboren C, Evers A, Viveen MC, Greenough A, Heikkinen T, Stein RT, Richmond P, Martinón-Torres F, Nunes M, Hosoya M, Keller C, Bauck M, Cohen R, Papenburg J, Pernica J, Hennus MP, Jin H, Tabor DE, Tovchigrechko A, Ruzin A, Abram ME, Wilkins D, Wildenbeest JG, Kragten-Tabatabaie L, Coenjaerts FEJ, Esser MT, Bont LJ. Global molecular diversity of RSV - the "INFORM RSV" study. BMC Infect Dis 2020; 20:450. [PMID: 32591017 PMCID: PMC7316634 DOI: 10.1186/s12879-020-05175-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is a global cause of severe respiratory morbidity and mortality in infants. While preventive and therapeutic interventions are being developed, including antivirals, vaccines and monoclonal antibodies, little is known about the global molecular epidemiology of RSV. INFORM is a prospective, multicenter, global clinical study performed by ReSViNET to investigate the worldwide molecular diversity of RSV isolates collected from children less than 5 years of age. Methods The INFORM study is performed in 17 countries spanning all inhabited continents and will provide insight into the molecular epidemiology of circulating RSV strains worldwide. Sequencing of > 4000 RSV-positive respiratory samples is planned to detect temporal and geographical molecular patterns on a molecular level over five consecutive years. Additionally, RSV will be cultured from a subset of samples to study the functional implications of specific mutations in the viral genome including viral fitness and susceptibility to different monoclonal antibodies. Discussion The sequencing and functional results will be used to investigate susceptibility and resistance to novel RSV preventive or therapeutic interventions. Finally, a repository of globally collected RSV strains and a database of RSV sequences will be created.
Collapse
Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robert Jan Lebbink
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christiana Naaktgeboren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anouk Evers
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marco C Viveen
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,ReSViNET foundation, Zeist, the Netherlands
| | - Terho Heikkinen
- ReSViNET foundation, Zeist, the Netherlands.,Department of Paediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Renato T Stein
- Centro INFANT at Pontificia Universidade Catolica de Rio Grande do Sul, Porto Alegre, Brazil
| | - Peter Richmond
- Department of Paediatrics, The University of Queensland, Brisbane, Australia
| | | | - Marta Nunes
- ReSViNET foundation, Zeist, the Netherlands.,Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mitsuaki Hosoya
- Department of Paediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Christian Keller
- Department of Virology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Monika Bauck
- Department of Paediatrics, University Hospital Giessen and Marburg, Marburg, Germany
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, CHI Créteil, GRC Gemini, Université Paris XII, Créteil, France
| | - Jesse Papenburg
- Department of Paediatrics, Division of Pediatric Infectious Diseases, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Jeffrey Pernica
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Marije P Hennus
- Paediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hong Jin
- AstraZeneca, Gaithersburg/South San Francisco, USA
| | | | | | - Alexey Ruzin
- AstraZeneca, Gaithersburg/South San Francisco, USA
| | | | | | - Joanne G Wildenbeest
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Frank E J Coenjaerts
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark T Esser
- AstraZeneca, Gaithersburg/South San Francisco, USA
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands. .,ReSViNET foundation, Zeist, the Netherlands.
| |
Collapse
|
19
|
Expansion of the 1st WHO international standard for antiserum to respiratory syncytial virus to include neutralisation titres against RSV subtype B: An international collaborative study. Vaccine 2020; 38:800-807. [DOI: 10.1016/j.vaccine.2019.10.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022]
|
20
|
Respiratory syncytial, parainfluenza and influenza virus infection in young children with acute lower respiratory infection in rural Gambia. Sci Rep 2019; 9:17965. [PMID: 31784567 PMCID: PMC6884537 DOI: 10.1038/s41598-019-54059-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/23/2019] [Indexed: 01/06/2023] Open
Abstract
Respiratory viral infections contribute significantly to morbidity and mortality worldwide, but representative data from sub-Saharan Africa are needed to inform vaccination strategies. We conducted population-based surveillance in rural Gambia using standardized criteria to identify and investigate children with acute lower respiratory infection (ALRI). Naso- and oropharyngeal swabs were collected. Each month from February through December 2015, specimens from 50 children aged 2–23 months were randomly selected to test for respiratory syncytial (RSV), parainfluenza (PIV) and influenza viruses. The expected number of viral-associated ALRI cases in the population was estimated using statistical simulation that accounted for the sampling design. RSV G and F proteins and influenza hemagglutinin genes were sequenced. 2385 children with ALRI were enrolled, 519 were randomly selected for viral testing. One or more viruses were detected in 303/519 children (58.4%). RSV-A was detected in 237 and RSV-B in seven. The expected incidence of ALRI associated with RSV, PIV or influenza was 140 cases (95% CI, 131–149) per 1000 person-years; RSV incidence was 112 cases (95% CI, 102–122) per 1000 person-years. Multiple strains of RSV and influenza circulated during the year. RSV circulated throughout most of the year and was associated with eight times the number of ALRI cases compared to PIV or IV. Gambian RSV viruses were closely related to viruses detected in other continents. An effective RSV vaccination strategy could have a major impact on the burden of ALRI in this setting.
Collapse
|