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Cutrera R, d'Angela D, Orso M, Guadagni L, Vittucci AC, Bertoldi I, Polistena B, Spandonaro F, Carrieri C, Montuori EA, Iantomasi R, Orfeo L. Trends in hospitalizations of children with respiratory syncytial virus aged less than 1 year in Italy, from 2015 to 2019. Ital J Pediatr 2024; 50:119. [PMID: 38902751 PMCID: PMC11191168 DOI: 10.1186/s13052-024-01688-9] [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: 01/26/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) affects 60-80% of children below 1 year and it's the first cause of acute bronchiolitis. The aim of this study was to assess the trend and characteristics of hospitalizations for RSV infections in Italy. METHODS This is a retrospective study based on the Italian Hospital Discharge Record (HDR) database. We analysed HDRs from June 2015 to May 2019, considering two groups of infants: Group 1 had a confirmed diagnosis of RSV; Group 2 had a diagnosis of acute bronchiolitis not RSV-coded. RESULTS There were 67,746 overall hospitalizations (40.1% Group 1, and 59.9% Group 2). Hospitalization rate increased for Group 1 from 125 to 178 per 10,000 infants (+ 42.4%), and for Group 2 from 210 to 234 per 10,000 (+ 11.4%). The mean hospitalization length was 6.3 days in Group 1, longer than Group 2 (+ 1.0 day). A further analysis revealed that infants with heart disease or born premature had longer mean hospital stay compared to infants without risk factors (10.7 days versus 6.1 days, p < 0.0001; 34.0 days versus 6.1 days, p < 0.0001, respectively). Group 1 required more critical care (oxygen therapy and/or mechanical ventilation) than Group 2. We found that, in proportion to hospital admissions in pediatric and general hospitals, RSV was more frequently diagnosed in the first ones. The mean hospitalization cost increased for Group 1 (from € 2,483 to € 2,617) and Group 2 (from € 2,007 to € 2,180). CONCLUSIONS Our results confirmed that RSV pulmonary disease in infants is seasonal and often requires hospitalization. Our study suggested that RSV is responsible for an increasing hospitalization rate and related costs during the study period.
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Affiliation(s)
- Renato Cutrera
- Pediatric Pulmonology & Cystic Fibrosis Unit, Respiratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela d'Angela
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Orso
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy.
| | - Liliana Guadagni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Anna Chiara Vittucci
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Barbara Polistena
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Federico Spandonaro
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Ciro Carrieri
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
| | | | | | - Luigi Orfeo
- Neonatal Intensive Care Unit, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy
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Riccò M, Cascio A, Corrado S, Bottazzoli M, Marchesi F, Gili R, Giuri PG, Gori D, Manzoni P. Impact of Nirsevimab Immunization on Pediatric Hospitalization Rates: A Systematic Review and Meta-Analysis (2024). Vaccines (Basel) 2024; 12:640. [PMID: 38932369 PMCID: PMC11209424 DOI: 10.3390/vaccines12060640] [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: 05/11/2024] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
A systematic review with a meta-analysis was performed to gather available evidence on the effectiveness of monoclonal antibody nirsevimab in the prevention of lower respiratory tract diseases (LRTDs) due to respiratory syncytial virus (RSV) in children and newborns (CRD42024540669). Studies reporting on real-world experience and randomized controlled trials (RCTs) were searched for in three databases (PubMed, Embase, and Scopus) until 1 May 2024. Our analysis included five RCTs, seven real-world reports, and one official report from the health authorities. Due to the cross-reporting of RCTs and the inclusion of multiple series in a single study, the meta-analysis was performed on 45,238 infants from 19 series. The meta-analysis documented a pooled immunization efficacy of 88.40% (95% confidence interval (95% CI) from 84.70 to 91.21) on the occurrence of hospital admission due to RSV, with moderate heterogeneity (I2 24.3%, 95% CI 0.0 to 56.6). Immunization efficacy decreased with the overall length of the observation time (Spearman's r = -0.546, p = 0.016), and the risk of breakthrough infections was substantially greater in studies with observation times ≥150 days compared to studies lasting <150 days (risk ratio 2.170, 95% CI 1.860 to 2.532). However, the effect of observation time in meta-regression analysis was conflicting (β = 0.001, 95% CI -0.001 to 0.002; p = 0.092). In conclusion, the delivery of nirsevimab was quite effective in preventing hospital admissions due to LRTDs. However, further analyses of the whole RSV season are required before tailoring specific public health interventions.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, “G D’Alessandro”, University of Palermo, AOUP P. Giaccone, 90127 Palermo, Italy;
| | - Silvia Corrado
- ASST Rhodense, Dipartimento Della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milano, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Renata Gili
- Department of Prevention, Turin Local Health Authority, 10125 Torino, Italy
| | | | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, 10125 Turin, Italy;
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Riccò M, Corrado S, Bottazzoli M, Marchesi F, Gili R, Bianchi FP, Frisicale EM, Guicciardi S, Fiacchini D, Tafuri S. RSV Infection in Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis. EPIDEMIOLOGIA 2024; 5:221-249. [PMID: 38920751 PMCID: PMC11202732 DOI: 10.3390/epidemiologia5020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Respiratory diseases, including respiratory syncytial virus (RSV) infections, are common reasons for seeking healthcare among refugees and asylum seekers. A systematic review with meta-analysis was designed to appraise all the available evidence on RSV infections among individuals in refugee camps. Three medical databases (PubMed, Embase, and Scopus) as well as the preprint repository medRxiv.org were searched for eligible observational studies, and the collected cases were pooled in a random-effects meta-analysis model. Heterogeneity was assessed using the I2 statistics. Funnel plots and a regression analysis were calculated for analyzing reporting bias. Eventually, six studies were retrieved from three areas (Bangladesh, Thailand, and Kenya), with pooled estimates of 129.704 cases per 1000 samples (95% CI 66.393 to 237.986) for RSV compared to 110.287 per 1000 people for influenza A (95% CI 73.186 to 162.889), 136.398 cases per 1000 people (95% CI 84.510 to 212.741) for human adenovirus (HAdV), 69.553 per 1000 people (95% CI 49.802 to 96.343) for parainfluenzavirus (PIFV), and 60.338 per 1000 people (95% CI 31.933 to 111.109) for human metapneumovirus (hMPV). Using influenza A as a reference group, the risk for a positive specimen was greater for RSV (relative risk [RR] 1.514, 95% CI 1.396 to 1.641) and HAdV (RR 1.984, 95% CI 1.834 to 2.146) and lower for influenza B (RR 0.276, 95% CI: 0.239 to 0.319), PIFV (RR: 0.889, 95% CI 0.806 to 0.981), and hMPV (RR 0.594, 95% CI 0.534 to 0.662). In summary, high rates of RSV infections were documented among individuals sheltered in refugee camps, stressing the importance of specifically designed preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento Della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Garbagnate Milanese, Italy;
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Renata Gili
- Department of Prevention, Turin Local Health Authority, Via Silvio Pellico 19, 10125 Turin, Italy
| | | | | | - Stefano Guicciardi
- Health Directorate, Local Health Authority of Bologna, 40127 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy
| | - Daniel Fiacchini
- AST Ancona, Prevention Department, UOC Sorveglianza e Prevenzione Malattie Infettive e Cronico Degenerative, 60127 Ancona, Italy
| | - Silvio Tafuri
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
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Consolati A, Farinelli M, Serravalle P, Rollandin C, Apprato L, Esposito S, Bongiorno S. Safety and Efficacy of Nirsevimab in a Universal Prevention Program of Respiratory Syncytial Virus Bronchiolitis in Newborns and Infants in the First Year of Life in the Valle d'Aosta Region, Italy, in the 2023-2024 Epidemic Season. Vaccines (Basel) 2024; 12:549. [PMID: 38793800 PMCID: PMC11125727 DOI: 10.3390/vaccines12050549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Respiratory syncytial virus (RSV) bronchiolitis remains a significant global health burden, particularly in newborns and infants during their first year of life. The quest for an effective preventive strategy against RSV has long been sought, and recent developments have shown promise in the form of nirsevimab, a monoclonal antibody specifically designed for RSV prophylaxis. Valle d'Aosta was the first Italian region to propose universal prophylaxis with nirsevimab for newborns and infants in their first epidemic season as early as 2023-2024. This study describes the effectiveness and safety of the universal prevention program of RSV bronchiolitis using the monoclonal antibody nirsevimab in children resident in Valle d'Aosta born during the 2023-2024 epidemic season. There were 556 neonates born from 1 May 2023 to 15 February 2024. The risk of hospitalization for RSV bronchiolitis in 2023-2024 was 3.2%, compared to 7% in the 2022-2023 epidemic season (p < 0.001). After the start of the prophylaxis campaign with nirsevimab, the risk of hospitalization was 8.3% in the sample of infants who did not adhere to the prophylaxis, while no child in the sample of those treated (p < 0.001) was hospitalized for bronchiolitis. Few mild transient side effects were reported. This study shows the efficacy and safety of universal prophylaxis with nirsevimab in neonates, making Valle d'Aosta the first Italian region to offer universal prophylaxis to newborns without risk factors for RSV complications. Future research could further explore its long-term impact and cost-effectiveness.
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Affiliation(s)
- Alessandra Consolati
- Hygiene and Public Health Structure, Prevention Department, Local Health Authority Valle d’Aosta, 11100 Aosta, Italy; (A.C.); (M.F.); (L.A.); (S.B.)
| | - Mariapaola Farinelli
- Hygiene and Public Health Structure, Prevention Department, Local Health Authority Valle d’Aosta, 11100 Aosta, Italy; (A.C.); (M.F.); (L.A.); (S.B.)
| | - Paolo Serravalle
- Paediatrics and Neonatology Complex Structure, Mother and Child Department, Local Health Authority Valle d’Aosta, 11100 Aosta, Italy;
| | - Christine Rollandin
- School of Specialization in Health Statistics and Biometrics, University of Turin, 10124 Turin, Italy;
- Simple Departmental Structure Preventive Medicine and Risk Management, Strategic Management of the Local Health Authority of Valle d’Aosta, 11100 Aosta, Italy
| | - Laura Apprato
- Hygiene and Public Health Structure, Prevention Department, Local Health Authority Valle d’Aosta, 11100 Aosta, Italy; (A.C.); (M.F.); (L.A.); (S.B.)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Salvatore Bongiorno
- Hygiene and Public Health Structure, Prevention Department, Local Health Authority Valle d’Aosta, 11100 Aosta, Italy; (A.C.); (M.F.); (L.A.); (S.B.)
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Riccò M, Cascio A, Corrado S, Bottazzoli M, Marchesi F, Gili R, Giuri PG, Gori D, Manzoni P. Efficacy of Respiratory Syncytial Virus Vaccination to Prevent Lower Respiratory Tract Illness in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Vaccines (Basel) 2024; 12:500. [PMID: 38793751 PMCID: PMC11126042 DOI: 10.3390/vaccines12050500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
A systematic review and meta-analysis was designed in order to ascertain the effectiveness of respiratory syncytial virus (RSV) vaccination in preventing lower respiratory tract diseases (LRTD) in older adults (age ≥ 60 years). Studies reporting on randomized controlled trials (RCTs) were searched for in three databases (PubMed, Embase, and Scopus) and the preprint repository medRxiv until 31 March 2024. A total of nine studies were eventually included, two of which were conference proceedings. Our analysis included five RCTs on five RSV vaccines (RSVpreF, RSVPreF3, Ad26.RSV.preF, MEDI7510, and mRNA-1345). The meta-analysis documented a pooled vaccine efficacy of 81.38% (95% confidence interval (95% CI) 70.94 to 88.06) for prevention of LRTD with three or more signs/symptoms during the first RSV season after the delivery of the vaccine. Follow-up data were available for RSVPreF3 (2 RSV seasons), RSVpreF (mid-term estimates of second RSV season), and mRNA-1345 (12 months after the delivery of the primer), with a pooled VE of 61.15% (95% CI 45.29 to 72.40). After the first season, the overall risk for developing RSV-related LRTD was therefore substantially increased (risk ratio (RR) 4.326, 95% CI 2.415; 7.748). However, all estimates were affected by substantial heterogeneity, as suggested by the 95% CI of I2 statistics, which could be explained by inconsistencies in the design of the parent studies, particularly when dealing with case definition. In conclusion, adult RSV vaccination was quite effective in preventing LRTD in older adults, but the overall efficacy rapidly decreased in the second season after the delivery of the vaccine. Because of the heterogenous design of the parent studies, further analyses are required before tailoring specific public health interventions.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, “G D’Alessandro”, University of Palermo, AOUP P. Giaccone, 90127 Palermo, Italy;
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milano, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Renata Gili
- Department of Prevention, Turin Local Health Authority, 10125 Torino, Italy
| | | | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, 10125 Turin, Italy;
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Riccò M, Parisi S, Corrado S, Marchesi F, Bottazzoli M, Gori D. Respiratory Syncytial Virus Infections in Recipients of Bone Marrow Transplants: A Systematic Review and Meta-Analysis. Infect Dis Rep 2024; 16:317-355. [PMID: 38667752 PMCID: PMC11050314 DOI: 10.3390/idr16020026] [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: 01/22/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infections. Usually associated with infants and children, an increasing amount of evidence suggests that RSV can cause substantial morbidity and mortality in immunocompromised individuals, including recipients of bone marrow transplantation (BMT). The present systematic review was therefore designed in accordance with the PRISMA guidelines to collect available evidence about RSV infections in BMT recipients. Three medical databases (PubMed, Embase, and MedRxiv) were therefore searched for eligible observational studies published up to 30 September 2023 and collected cases were pooled in a random-effects model. Heterogeneity was assessed using I2 statistics. Reporting bias was assessed by means of funnel plots and regression analysis. Overall, 30 studies were retrieved, including 20,067 BMT cases and 821 RSV infection episodes. Of them, 351 were lower respiratory tract infections, and a total of 78 RSV-related deaths were collected. A pooled attack rate of 5.40% (95% confidence interval [95%CI] 3.81 to 7.60) was identified, with a corresponding incidence rate of 14.77 cases per 1000 person-years (95%CI 9.43 to 20.11), and a case fatality ratio (CFR) of 7.28% (95%CI 4.94 to 10.60). Attack rates were higher in adults (8.49%, 95%CI 5.16 to 13.67) than in children (4.79%, 95%CI 3.05 to 7.45), with similar CFR (5.99%, 95%CI 2.31 to 14.63 vs. 5.85%, 95%CI 3.35 to 10.02). By assuming RSV attack rates as a reference group, influenza (RR 0.518; 95%CI 0.446 to 0.601), adenovirus (RR 0.679, 95%CI 0.553 to 0.830), and human metapneumovirus (RR 0.536, 95%CI 0.438 to 0.655) were associated with a substantially reduced risk for developing corresponding respiratory infection. Despite the heterogeneous settings and the uneven proportion of adult and pediatric cases, our study has identified high attack rates and a substantial CFR of RSV in recipients of BMT, stressing the importance of specifically tailored preventive strategies and the need for effective treatment options.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
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Dovizio M, Veronesi C, Bartolini F, Cavaliere A, Grego S, Pagliaro R, Procacci C, Ubertazzo L, Bertizzolo L, Muzii B, Parisi S, Perrone V, Baraldi E, Bozzola E, Mosca F, Esposti LD. Clinical and economic burden of respiratory syncytial virus in children aged 0-5 years in Italy. Ital J Pediatr 2024; 50:57. [PMID: 38528616 DOI: 10.1186/s13052-024-01628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is among the leading causes of hospitalization due to lower respiratory tract infections (LRTIs) in children younger than 5 years worldwide and the second cause of infant death after malaria. RSV infection occurs in almost all the infants before the second year of life with variable clinical severity, often requiring medical assistance. This analysis investigated patients aged 0-5 years with RSV infection focusing on epidemiology, clinical features, and economic burden of RSV-associated hospitalizations in a setting of Italian real clinical practice. METHODS An observational retrospective analysis was conducted on administrative databases of healthcare entities covering around 2.6 million residents of whom 120,000 health-assisted infants aged < 5 years. From 2010 to 2018, pediatric patients were included in the presence of hospitalization discharge diagnosis for RSV infections, and RSV-related acute bronchiolitis or pneumonia. Epidemiology, demographics, clinical picture and costs were evaluated in RSV-infected patients, overall and stratified by age ranges (0-1, 1-2, 2-5 years) and compared with an age-matched general population. RESULTS Overall 1378 RSV-infected children aged 0-5 years were included. Among them, the annual incidence rate of RSV-related hospitalizations was 175-195/100,000 people, with a peak in neonates aged < 1 year (689-806/100,000). While nearly 85% of infected infants were healthy, the remaining 15% presented previous hospitalization for known RSV risk factors, like preterm birth, or congenital heart, lung, and immune diseases. The economic analysis revealed that direct healthcare costs per patient/year were markedly higher in RSV patients than in the general population (3605€ vs 344€). CONCLUSIONS These findings derived from the real clinical practice in Italy confirmed that RSV has an important epidemiological, clinical, and economic burden among children aged 0-5 years. While the complex management of at-risk infants was confirmed, our data also highlighted the significant impact of RSV infection in infants born at term or otherwise healthy, demonstrating that all infants need protection against RSV disease, reducing then the risk of medium and long-term complications, such as wheezing and asthma.
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Affiliation(s)
- Melania Dovizio
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | - Chiara Veronesi
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | | | | | - Stefano Grego
- Dipartimento Tecnico-Amministrativo, ASL 3 Genovese, Genova, Italy
| | - Romina Pagliaro
- UOC Farmaceutica Territoriale, Azienda Sanitaria Locale Roma 5, Rome, Italy
| | - Cataldo Procacci
- Dipartimento Farmaceutico, ASL BAT (Barletta-Trani-Andria), Trani, Italy
| | | | | | | | | | - Valentina Perrone
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padova, Italy
| | - Elena Bozzola
- Pediatric Disease Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Degli Esposti
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy.
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Fortunato F, Campanozzi A, Maffei G, Arena F, Carri VD, Rollo T, Lopalco PL, Martinelli D. Respiratory syncytial virus-associated hospitalizations among children: an Italian retrospective observational study. Ital J Pediatr 2024; 50:45. [PMID: 38454523 PMCID: PMC10921699 DOI: 10.1186/s13052-024-01617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV), a single-stranded RNA virus, is a leading cause of hospitalization in infants, especially ≤ 2 months of life. In the light new immunization strategies adoption, we described epidemiological and clinical characteristics of RSV-associated hospitalizations in pediatric and neonatal intensive care units of the Policlinico Foggia Hospital, Apulia Region, Italy. METHODS Hospitalized children with a laboratory-confirmed RSV infection from 2011 to 2023 were retrospectively evaluated. Clinical information was collected from Hospital Discharge Registry in the period 2011-2020. The proportion of the hospitalization for acute respiratory infections (ARIs) associated to RSV was calculated and the hospitalization cost was analyzed by using the diagnosis-related group reimbursement rate. The anticipated impact of immunization either with monoclonal antibodies or maternal immunization on the number of hospitalizations was estimated. All analyses and quality assessment were performed using STATA/SE15.0. RESULTS A total of 1,005 RSV-cases were included in the study, of which 86.3% occurred between December-March. In the period 2011-2020, 832 RSV-cases were matched with the corresponding hospital admissions; 75.2% were aged < 1 year (49.6% 0-2 months). Bronchiolitis was the most frequent admission diagnosis occurring in 63.3% of patients; 25% of children were affected by a very severe RSV-disease. Younger age ≤ 2 months (OR:14.8, 95%CI:8.30-26.31, p = 0.000), higher length-of-hospital-stay (OR:1.01, 95%CI:1.0-1.02, p = 0.030) and history of prematurity (OR:4.4, 95%CI:1.57-12.11, p = 0.005) were associated with a higher disease severity. RSV caused 48.9% of ARIs among children < 1 year. The mean cost of an RSV-associated hospitalization was 3,036 euros/year, with the higher cost in the 0-2 months age group (4,225 euros/year). Immunization programs with nirsevimab could prevent 51.4 RSV hospitalizations/year and 18.1 very severe RSV disease/year in infants < 1 year of age. RSV vaccine could prevent 46.1 of hospitalizations/year caused by RSV within 180 days after birth. CONCLUSIONS Our study contributes to outlining the baseline profile of RSV-associated hospitalizations among Italian children by providing epidemiological/clinical/economic estimates. While awaiting new recommendations on immunization, healthcare-workers should persist in implementing public health measures and appropriate case management to control RSV seasonal epidemics. Strengthened laboratory RSV surveillance is needed to inform the implementation of the new immunization strategies.
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Affiliation(s)
- Francesca Fortunato
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy.
- Department of Medical and Surgical Sciences, Department of Hygiene, University of Foggia, Policlinico Riuniti University Hospital of Foggia, Ospedale "Colonnello D'Avanzo" Viale degli Aviatori, 2, 71122, Foggia, Italy.
| | - Angelo Campanozzi
- Pediatrics Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gianfranco Maffei
- Neonatology and Intensive Care Unit, Policlinico Foggia Hospital, Foggia, Italy
| | - Fabio Arena
- Microbiology and Virology Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Valeria Delli Carri
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Tiziana Rollo
- Microbiology and Virology Unit, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Domenico Martinelli
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
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9
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Bechini A, Salvati C, Bonito B, Del Riccio M, Stancanelli E, Bruschi M, Ionita G, Iamarino JA, Bentivegna D, Buscemi P, Ciardi G, Cosma C, Stacchini L, Conticello C, Bega M, Paoli S, Schirripa A, Bertizzolo L, Muzii B, Azzi MV, Parisi S, Trippi F, Bonanni P, Boccalini S. Costs and healthcare utilisation due to respiratory syncytial virus disease in paediatric patients in Italy: a systematic review. Public Health 2024; 227:103-111. [PMID: 38154422 DOI: 10.1016/j.puhe.2023.11.039] [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: 09/28/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is a frequent cause of acute lower respiratory infection in children, imposing a substantial economic burden on healthcare systems. This systematic review aimed to assess the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. STUDY DESIGN Systematic review. METHODS A systematic search of PubMed, Embase, Scopus, and the International HTA Database, including studies published in English or Italian, was conducted between January 2000 and July 2022. Inclusion criteria required studies to be conducted in Italy and provide data on the economic costs and healthcare resource utilisation related to RSV infections. RESULTS Out of 20,845 records screened, 18 articles met the inclusion criteria. Only one study provided comprehensive data on RSV disease costs, including hospitalisation, diagnostic tests, and medical procedures for infants with RSV-bronchiolitis. The mean cost per inpatient was higher for RSV-positive children (€5753.43 ± €2041.62) than that for RSV-negative children. Additionally, five studies reported a median length of hospital stay of 5 days for RSV-infected children, and four studies indicated a higher frequency of intensive care unit admissions for RSV-infected children than for those with other viral infections. CONCLUSIONS This is the first systematic review to examine the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. While limited data were available, the findings underscore the urgency to conduct further research and gather additional evidence on the costs and healthcare resource utilisation associated with RSV infections. Such efforts are essential for informing the development of effective prevention strategies for paediatric RSV infections in Italy.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, Florence 50134, Italy
| | - Cristina Salvati
- Department of Health Sciences, University of Florence, Florence 50134, Italy
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, Florence 50134, Italy
| | - Marco Del Riccio
- Department of Health Sciences, University of Florence, Florence 50134, Italy.
| | - Enrica Stancanelli
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Mario Bruschi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Giulia Ionita
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Johanna Alexandra Iamarino
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Davide Bentivegna
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Primo Buscemi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Giulia Ciardi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Claudia Cosma
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Lorenzo Stacchini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Cristiana Conticello
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Manjola Bega
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Sonia Paoli
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Annamaria Schirripa
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | | | | | | | | | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence 50134, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence 50134, Italy
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10
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Riccò M, Baldassarre A, Corrado S, Bottazzoli M, Marchesi F. Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023). EPIDEMIOLOGIA 2024; 5:41-79. [PMID: 38390917 PMCID: PMC10885116 DOI: 10.3390/epidemiologia5010004] [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: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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11
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Vittucci AC, Antilici L, Russo C, Musolino AMC, Cristaldi S, Cutrera R, Persia S, Di Maio CV, Raponi M, Perno CF, Villani A. Respiratory syncytial virus: can we still believe that after pandemic bronchiolitis is not a critical issue for public health? Eur J Pediatr 2023; 182:5303-5313. [PMID: 37728752 PMCID: PMC10746572 DOI: 10.1007/s00431-023-05201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection among infants and young children, resulting in annual epidemics worldwide. Since the beginning of the COVID-19 pandemic, non-pharmacological interventions were applied, interfering with the circulation of most respiratory viruses, including RSV. The aim of this study is to analyze the RSV infection trend among hospitalized infants during the actual epidemic season (2022-2023) in comparison with the last pre-pandemic season (2018-2019), in order to outline whether significant differences emerge due to COVID-19 pandemia. We retrospectively reviewed medical data on infants hospitalized at the Bambino Gesù Children's Hospital with diagnosis of bronchiolitis in the current epidemic season and in the last pre-pandemic season, 2018-2019. RSV remains the main etiological agent of bronchiolitis in terms of frequency and severity of infections in the ongoing epidemic season. The first RSV case of the 2022-2023 season was detected at week 42 vs week 47 in the 2018-2019 season. The length of epidemic season was of 17 weeks in 2022-2023 vs 18 weeks in 2018-2019. Comparing the two seasons, age at admission was significantly higher in the current season (median age 2022-2023 65 days vs median age 2018-2019 58 days), but the disease severity was similar. Conclusions: The 2022-2023 bronchiolitis season in Italy started earlier than the usual pre-pandemic seasons but seasonality pattern may be going back to the pre-pandemic one. This season was not more severe than the previous ones. The impact of RSV disease on health care systems and costs remains a critical issue. What is Known: • RSV is one of the major leading causes of hospitalization among children aged less than 3 months. SarsCOV2 pandemic interfered with the seasonal circulation of most respiratory viruses, Including RSV. What is New: • The 2022-2023 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons but seasonality pattern may be realigning to the pre-pandemic one. The impact of RSV disease on health care systems and costs is concerning.
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Affiliation(s)
- Anna Chiara Vittucci
- Emergency, Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4-00165, Rome, Italy.
| | - Livia Antilici
- Emergency, Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4-00165, Rome, Italy
| | - Cristina Russo
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Childrens Hospital, IRCCS, Rome, Italy
| | - Anna Maria Caterina Musolino
- Emergency, Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4-00165, Rome, Italy
| | - Sebastian Cristaldi
- Emergency, Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4-00165, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Sabrina Persia
- Emergency, Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4-00165, Rome, Italy
| | - Chiara Velia Di Maio
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Childrens Hospital, IRCCS, Rome, Italy
| | | | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Childrens Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Emergency, Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4-00165, Rome, Italy
- System Medicine Department, Tor Vergata University of Rome, Rome, Italy
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12
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Aricò MO, Wrona D, Lavezzo G, Valletta E. Nasal CPAP in the Pediatric Ward to Reduce PICU Admissions for Severe Bronchiolitis? Pediatr Rep 2023; 15:599-607. [PMID: 37873801 PMCID: PMC10594455 DOI: 10.3390/pediatric15040055] [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: 08/30/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
In treating acute bronchiolitis in infants, the decision to use continuous positive airway pressure (CPAP) often involves infant referral from the pediatric ward to the pediatric intensive care unit (PICU). We present our experience of CPAP use in a general pediatric ward, aiming to reduce the pressure on the PICU in recent outbreaks of bronchiolitis. Clinical data of patients less than 12 months of age and admitted for bronchiolitis from 1 October 2021 to 31 March 2023 were retrospectively collected. Of 82 infants admitted for bronchiolitis, 16 (19%) were treated with nasal CPAP (nCPAP group); of the remaining 66, 21 (26%) were treated with a low-flow nasal cannula (LFNC) only, 1 (1%) was also treated a with high-flow nasal cannula (HFNC), 12 (15%) were treated with an HFNC only, and 41 (50%) were treated without oxygen support (no-nCPAP group). Overall, coinfection with RSV and SARS-CoV-2 was observed in three patients and SARS-CoV-2 infection was observed in two patients. None of them required any type of oxygen support. Only 3/16 (19%) infants in the nCPAP group were referred to the PICU due to worsening clinical conditions despite nCPAP support. In our experience of treating epidemic bronchiolitis, nCPAP can be safely managed in a general pediatric ward, thus reducing the burden of admissions to the PICU. Training and regular updating of the pediatric staff, careful monitoring of the patient, and close cooperation with the PICU were instrumental for our team.
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Affiliation(s)
- Melodie O. Aricò
- Department of Pediatrics, G.B. Morgagni—L. Pierantoni Hospital, AUSL Romagna, 48018 Forli, Italy;
| | - Diana Wrona
- School of Specialization in Pediatrics, University of Bologna, 40138 Bologna, Italy; (D.W.); (G.L.)
| | - Giovanni Lavezzo
- School of Specialization in Pediatrics, University of Bologna, 40138 Bologna, Italy; (D.W.); (G.L.)
| | - Enrico Valletta
- Department of Pediatrics, G.B. Morgagni—L. Pierantoni Hospital, AUSL Romagna, 48018 Forli, Italy;
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13
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O’Hagan S, Galway N, Shields MD, Mallett P, Groves HE. Review of the Safety, Efficacy and Tolerability of Palivizumab in the Prevention of Severe Respiratory Syncytial Virus (RSV) Disease. Drug Healthc Patient Saf 2023; 15:103-112. [PMID: 37720805 PMCID: PMC10503506 DOI: 10.2147/dhps.s348727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Respiratory Syncytial Virus (RSV) is a major global cause of childhood morbidity and mortality. Palivizumab, a monoclonal antibody that provides passive immunity against RSV, is currently licensed for prophylactic use in specific "high-risk" populations, including congenital heart disease, bronchopulmonary dysplasia and prematurity. Available research suggests palivizumab use in these high-risk populations can lead to a reduction in RSV-related hospitalization. However, palivizumab has not been demonstrated to reduce mortality, adverse events or length of hospital stay related to RSV. In this article, we review the management of RSV, indications for palivizumab prophylaxis, the safety, cost-effectiveness and efficacy of this preventative medication, and emerging therapeutics that could revolutionize future prevention of this significant pathogen.
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Affiliation(s)
- Shaun O’Hagan
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Niamh Galway
- Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Michael D Shields
- Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
- Centre for Medical Education, Queen’s University Belfast School of Medicine, Belfast, Northern Ireland
| | - Peter Mallett
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
- Centre for Medical Education, Queen’s University Belfast School of Medicine, Belfast, Northern Ireland
| | - Helen E Groves
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
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14
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Dervaux B, Van Berleere M, Lenne X, Wyckaert M, Dubos F. Impact of RSV test positivity, patient characteristics, and treatment characteristics on the cost of hospitalization for acute bronchiolitis in a French university medical center (2010-2015). Front Pediatr 2023; 11:1126229. [PMID: 37528879 PMCID: PMC10390249 DOI: 10.3389/fped.2023.1126229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background In young children, respiratory syncytial virus (RSV)-related bronchiolitis is typically more severe than other respiratory tract infections, with a greater need for oxygen therapy and respiratory support. Few studies have compared the cost of hospitalization with regard to virological status. The objective of this study was to compare the costs of hospitalization for RSV-positive vs. RSV-negative bronchiolitis in a French university medical center between 2010 and 2015. Methods The cost models were compared using conventional goodness-of-fit criteria. Covariates included the characteristics of the patients, pre-existing respiratory and non-respiratory comorbidities, superinfections, medical care provided, and the length of stay. Results RSV was detected in 679 (58.3%) of the 1,164 hospital stays by children under 2 years with virological data. Oxygen therapy and respiratory support were twice as frequent for the RSV-positive cases. The median hospitalization cost was estimated at €3,248.4 (interquartile range: €2,572.1). The cost distribution was positively skewed with a variation coefficient (CV = standard deviation/mean) greater than one (mean = €4,212.9, standard deviation = €5,047, CV = 1.2). In univariate analyses, there was no significant cost difference between the RSV-positive and RSV-negative cases. In the best multivariate model, the significant positive effect of RSV positivity on cost waned after the introduction of medical care variables and the length of stay. The results were sensitive to the specification of the model. Conclusions It was impossible to firmly conclude that hospitalization costs were higher for the RSV-positive cases.
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Affiliation(s)
- Benoit Dervaux
- CHU Lille, Direction de la Recherche et de l’Innovation, Lille, France
| | | | - Xavier Lenne
- CHU Lille, Département d’Information Médicale, Lille, France
| | - Marine Wyckaert
- CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France
| | - François Dubos
- CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France
- Univ Lille, ULR 2694 - Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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15
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Baldassarre ME, Loconsole D, Centrone F, Caselli D, Martire B, Quartulli L, Acquafredda A, D'Amato G, Maffei G, Latorre G, Riganti A, Di Noia M, Chironna M, Laforgia N. Hospitalization for bronchiolitis in children aged ≤ 1year, Southern Italy, year 2021: need for new preventive strategies? Ital J Pediatr 2023; 49:66. [PMID: 37280662 DOI: 10.1186/s13052-023-01455-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Bronchiolitis is a major cause of hospitalization in infants, particularly in the first six months of life, with approximately 60-80% of admissions due to respiratory syncytial virus (RSV) infection. Currently, no prophylactic options are available for healthy infants. The present study aimed at describing the demographic, clinical, and epidemiological characteristics of infants hospitalized for bronchiolitis in the Apulia region of Italy in 2021. METHODS From January to December 2021, data on children aged 0-12 months admitted for bronchiolitis in nine neonatal or pediatric units covering 61% of pediatric beds of hospitals in the Apulia region of Italy were analyzed. Demographic data, comorbidities, need for oxygen support, length of hospital stay, palivizumab administration, and outcomes were collected. For the purpose of the analysis, patients were divided into those aged 0-3 months and > 3 months. A multivariate logistic regression model was used to explore associations between the need for oxygen support and sex, age, comorbidities, history of prematurity, length of hospital stay, and palivizumab administration. RESULTS This study included 349 children aged 0-12 months admitted for bronchiolitis, with a peak of hospitalization in November (7.4 cases/1,000 children). Of these patients, 70.5% were RSV positive, 80.2% were aged 0-3 months, and 73.1% required oxygen support. Moreover, 34.9% required observation in the sub-intensive care unit, and 12.9% in the intensive care unit. Of the infants who required intensive care, 96.9% were aged 0-3 months and 78.8% were born at term. Three patients required mechanical ventilation and one, who required Extra Corporeal Membrane Oxygenation, died. Children aged 0-3 months were more likely to show dyspnea, need oxygen support, and have a longer hospital stay. CONCLUSIONS The present study showed that almost all of the children who required intensive care support were aged ≤ 3 months and most were born at term. Therefore, this age group remains the highest risk group for severe bronchiolitis. Preventive measures such as single-dose monoclonal antibody immunoprophylaxis, and maternal and childhood vaccination against RSV, may reduce the high public health burden of bronchiolitis.
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Affiliation(s)
- Maria Elisabetta Baldassarre
- Unit of Neonatology and Intensive Care, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| | - Daniela Loconsole
- Hygiene Section, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| | - Francesca Centrone
- Hygiene Section, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
| | - Desiree Caselli
- Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, 70124, Italy
| | - Baldassarre Martire
- Unit of Pediatrics and Neonatology, "Monsignor Dimiccoli" Hospital, Barletta, BT, Italy
| | | | - Angelo Acquafredda
- Unit of Pediatrics and Neonatology, "G. Tatarella" Hospital, Cerignola, Foggia, Italy
| | | | - Gianfranco Maffei
- Neonatology and Intensive Care Unit, "Ospedali Riuniti" Hospital, Foggia, Italy
| | - Giuseppe Latorre
- Neonatology and Intensive Care Unit, "Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Anita Riganti
- Neonatology Unit, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | | | - Maria Chironna
- Hygiene Section, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy.
| | - Nicola Laforgia
- Unit of Neonatology and Intensive Care, Interdisciplinary Department of Medicine, Aldo Moro University, Bari, 70124, Italy
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16
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Chi H, Chung CH. Respiratory Syncytial Virus Outbreak in Infants and Young Children during COVID-19 Pandemic in Taiwan. CHILDREN 2023; 10:children10040629. [PMID: 37189878 DOI: 10.3390/children10040629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
Respiratory syncytial virus (RSV) is a major burden of disease in babies and young children, including hospitalizations and deaths. RSV is a seasonal disease that peaks when temperatures decrease in temperate zones and humidity increases in tropical regions. Existing research reveals that RSV hospitalization activity is year-round in Taiwan, which is a subtropical region with small peaks in spring and fall. The monthly distribution and COVID-19 pandemic impact were unclear. The aim of this study was to investigate Taiwan’s RSV hospitalization seasonality and the COVID-19 pandemic effects. The National Health Insurance Database and Death Registration Files from the Center for Health and Welfare Data Science Center were connected to birth data for this study. RSV hospitalization (RSVH) in infants aged 0–1 years ranged from 0.9518% (2009) to 1.7113% (2020), substantially higher than in children aged 1–5. Most years had 2 or 3 RSV epidemic seasons in 0–5-year-olds over the 13-year follow-up. RSVH incidence was low until the autumn of 2020, when a major rise occurred after September and lasted until December 2020. We detected RSVH peaks in February–May and July–August. The 2020 RSV outbreak was found at the end of 2020.
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Riccò M, Corrado S, Cerviere MP, Ranzieri S, Marchesi F. Respiratory Syncytial Virus Prevention through Monoclonal Antibodies: A Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Pediatricians. Pediatr Rep 2023; 15:154-174. [PMID: 36810343 PMCID: PMC9944855 DOI: 10.3390/pediatric15010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/04/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
Respiratory Syncytial Virus (RSV) is a leading cause of morbidity and hospitalization in all infants. Many RSV vaccines and monoclonal antibodies (mAb) are currently under development to protect all infants, but to date preventive options are available only for preterms. In this study, we assessed the knowledge, attitudes, and practices towards RSV and the preventive use of mAb in a sample of Italian Pediatricians. An internet survey was administered through an internet discussion group, with a response rate of 4.4% over the potential respondents (No. 389 out of 8842, mean age 40.1 ± 9.1 years). The association of individual factors, knowledge, and risk perception status with the attitude towards mAb was initially inquired by means of a chi squared test, and all variables associated with mAb with p < 0.05 were included in a multivariable model calculating correspondent adjusted Odds Ratio (aOR) with 95% confidence intervals (95%CI). Of the participants, 41.9% had managed RSV cases in the previous 5 years, 34.4% had diagnosed RSV cases, and 32.6% required a subsequent hospitalization. However, only 14.4% had previously required mAb as immunoprophylaxis for RSV. Knowledge status was substantially inappropriate (actual estimate 54.0% ± 14.2, potential range 0-100), while the majority of participants acknowledged RSV as a substantial health threat for all infants (84.8%). In multivariable analysis, all these factors were characterized as positive effectors for having prescribed mAb (aOR 6.560, 95%CI 2.904-14.822 for higher knowledge score; aOR 6.579, 95%CI 2.919-14.827 for having a hospital background, and a OR 13.440, 95%CI 3.989; 45.287 for living in Italian Major Islands). In other words, reporting less knowledge gaps, having worked in settings with a higher risk of interaction with more severe cases, and being from Italian Major Islands, were identified as positive effectors for a higher reliance on mAb. However, the significant extent of knowledge gaps highlights the importance of appropriate medical education on RSV, its potential health consequences, and the investigational preventive interventions.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
- Correspondence: or ; Tel.: +39-339-2994343 or +39-522-837587
| | - Silvia Corrado
- Department of Medicine DAME–Division of Pediatrics, University of Udine, 33100 Udine, Italy
| | - Milena Pia Cerviere
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Curatola A, Graglia B, Ferretti S, Covino M, Pansini V, Eftimiadi G, Chiaretti A, Gatto A. The acute bronchiolitis rebound in children after COVID-19 restrictions: a retrospective, observational analysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023031. [PMID: 36786263 PMCID: PMC9987502 DOI: 10.23750/abm.v94i1.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Bronchiolitis represents the main cause of illness and hospitalization in infants and young children. The aim of this study was to compare the Pediatric Emergency Department (PED) admissions for bronchiolitis during the post-COVID (Coronavirus disease) period to those of previous seasons and to analyze their etiology during COVID and post-COVID period. METHODS We compared demographics, clinical and microbiological data of children admitted to PED with bronchiolitis between September 2021 and March 2022 (post-COVID period) to the previous seasons (COVID and pre-COVID period). RESULTS During the post-COVID period the bronchiolitis season started earlier than usual, with a peak reached in November 2021; a gradual reduction was subsequently observed between December 2021 and January 2022. Our data showed a prevalence of High Priority code in children admitted to the PED with bronchiolitis during the post-COVID period (61.4%) compared the pre-COVID period (34.8%) (p=0.00). Also regarding the hospitalization of these patients, we found a major rate of hospitalization during this epidemic season (p=0.035). In addition, only 4 (1.5%) of the tested children resulted positive for SARS-CoV-2 and all of them were admitted to PED during the post-COVID period. The search for the other respiratory viruses showed during the current season a prevalence of respiratory syncytial virus (RSV) (60.2%), followed by Human Rhinovirus (30.1%). CONCLUSIONS The post-COVID period was characterized by an early and short-term peak in acute bronchiolitis, with an increased rate of hospitalization. In addition, SARS-CoV-2 infection was rarely cause of bronchiolitis in children under 2 years old.
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Affiliation(s)
| | | | - Serena Ferretti
- a:1:{s:5:"en_US";s:114:"Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy ";}.
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19
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Manzoni P, Baraldi E, Luna MS, Tzialla C. Real-World Studies of Respiratory Syncytial Virus Hospitalizations among Moderate/Late Preterm Infants Exposed to Passive Immunoprophylaxis with Palivizumab. Am J Perinatol 2022; 39:S7-S13. [PMID: 36307092 DOI: 10.1055/s-0042-1757279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article aims to assess the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-associated hospitalization (RSVH) rates in otherwise healthy moderate/late preterm infants and discuss the role of palivizumab in preventing acute and long-term outcomes. We identified studies in the PubMed and Embase databases that reported patient-level data on (1) exposure to palivizumab in preterm infants born between 29 and 35 weeks of gestational age (or subsets within this range) ≤ 2 years of chronological age, and (2) the outcome of RSVH. Six studies assessed RSVH in infants this gestational age who had been exposed or not to palivizumab and reported patient-level data. Exposure was associated with a reduction in RSVH rates that was comparable to the reduction seen in controlled clinical trials (weighed mean 4.0-fold reduction). RSV immunoprophylaxis in preterm infants within 29 to 35 weeks of gestational age is associated with a considerably lower burden of RSVH. KEY POINTS: · RSV is the leading cause of lower respiratory tract infection hospitalization in infants.. · Palivizumab prevents RSVH in a real-world scenario.. · Immunoprophylaxis should be used in high-risk infants..
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Affiliation(s)
- Paolo Manzoni
- Department of Maternal Infant Medicine, Degli Infermi Hospital, Biella, Italy.,University of Torino, Turin, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuel Sánchez Luna
- Neonatology Division and NICU, University Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Italy
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20
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Bozzola E, Barni S, Villani A. Respiratory Syncytial Virus Pediatric Hospitalization in the COVID-19 Era. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315455. [PMID: 36497528 PMCID: PMC9738890 DOI: 10.3390/ijerph192315455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 05/29/2023]
Abstract
Respiratory syncytial virus (RSV) globally affects the population, mainly young children, potentially causing hospitalization. During the COVID-19 pandemic, non-pharmacological measures interfered with the circulation of most respiratory viruses. Then, with the discontinuation of restrictive measures, a new scenario appeared. With this scoping review, we want to globally explore whether the RSV paediatric hospitalization rate was influenced by COVID-19. This scoping review was performed according to PRISMA guidelines on PubMed using the Mesh terms "Respiratory Syncytial Viruses"[Mesh] AND "COVID-19"[Mesh] OR "SARS-CoV-2"[Mesh]. Among them, we identified studies pertaining to children and adolescents up to 18 years old hospitalized for RSV, including 18 records in the revision. With the onset of the COVID-19 pandemic, a drastic reduction in RSV hospitalization among the pediatric population in 2020-2021 season has been observed in the Northern and Southern hemispheres. After the relaxing of restrictive measures, unexpected outbreaks happened, leading to increased hospitalization and occupation of pediatric intensive care units.
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21
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Respiratory Syncytial Virus: An Uncommon Cause of Febrile Seizures-Results from a Systematic Review and Meta-Analysis. Pediatr Rep 2022; 14:464-478. [PMID: 36412662 PMCID: PMC9680341 DOI: 10.3390/pediatric14040055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a highly contagious viral pathogen. In infants, it is usually listed among the main causes of medical referrals and hospitalizations, particularly among newborns, and a considerable base of evidence associates RSV infections and bronchiolitis with long-term neurological sequelae. We specifically performed a systematic review and meta-analysis in order to ascertain whether RSV infections may be associated with an increased risk for febrile seizures (FS) in infected infants. According to the PRISMA statement, Pubmed, Embase, and pre-print archive medRxiv.og were searched for eligible observational studies published up to 1 July 2022. Raw data included the incidence of FS among children admitted for influenza-like illness (ILI) and/or bronchiolitis, with a confirmed diagnosis of RSV or seasonal influenza virus (SIV) infection. Data were then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 11 studies including 6847 cases of RSV infections were retrieved, with a pooled prevalence of 29.975 cases of FS per 1000 RSV cases (I2 = 88.5%). The prevalence was not substantially greater in studies performed in pediatric intensive care units (53.817 per 1000 RSV cases vs. 23.552, p = 0.12). Higher occurrence of FS was reported from studies performed after 2010 (Risk Ratio [RR] 1.429, 95% Confidence Interval [95%CI] 1.049-1.948), and in China (RR 2.105, 95%CI 1.356-3.266) and South Africa (RR 1.722, 95%CI 1.060-2.824) than in Europe, while a lower occurrence was reported form the USA (RR 0.414, 95%CI 0.265-0.649). Eventually, FS were less likely reported from RSV cases compared to subjects affected by seasonal influenza (RR 0.402; 95%CI 0.228-0.708). Although RSV is often associated with high risk of neurological complications, substantially less cases of FS are reported than in SIV infections. However, the paucity of available studies recommends a cautious appraisal of aforementioned results.
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22
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Out-of-Season Epidemic of Respiratory Syncytial Virus during the COVID-19 Pandemic: The High Burden of Child Hospitalization in an Academic Hospital in Southern Italy in 2021. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060848. [PMID: 35740785 PMCID: PMC9221938 DOI: 10.3390/children9060848] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
Respiratory syncytial virus (RSV) infection is the most common cause of hospitalization in young children. In the last 2 years, public health measures aimed at controlling the spread of SARS-CoV-2 have affected the epidemiology and seasonality of RSV worldwide. The aim of this descriptive retrospective observational study was to describe the characteristics of children hospitalized with RSV in an academic tertiary care hospital in Southern Italy in 2021. We also investigate the seasonal trends of RSV from 2017 to 2021. The demographic characteristics, comorbidities, clinical data, and coinfections were retrospectively evaluated. Compared with previous seasons, the 2021 outbreak of RSV was characterized by an increased number of patients, with a delayed peak observed in November. Overall, 179 children, including 128 (71.5%) aged <12 months, were hospitalized for RSV infection between August and December 2021. Ten children (5.6%) were admitted to the intensive care unit (ICU), all aged <5 months. One patient (0.5%) aged <1 month with severe comorbidities died. The severity of symptoms was significantly associated with younger age, underlying chronic disease, and the length of hospital stay (p < 0.05 each). History of prematurity was not significantly associated with the presence of coinfections. Because of the high burden of RSV infection and the expected larger RSV epidemics resulting from a greater number of RSV-naïve children, systematic epidemiological and virological surveillance is needed. Appropriate pathways for access to RSV prevention in all infants should also be introduced.
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23
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Rodriguez-Gonzalez M, Rodriguez-Campoy P, Estalella-Mendoza A, Castellano-Martinez A, Flores-Gonzalez JC. Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study. Tomography 2022; 8:142-157. [PMID: 35076624 PMCID: PMC8788562 DOI: 10.3390/tomography8010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 12/14/2022] Open
Abstract
We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants <12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients underwent clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 h of hospital admission. The existence of significant correlation between cardiac and respiratory parameters was the primary outcome. The association of different cardiopulmonary variables with the need of respiratory support higher than O2, the length of stay hospitalization, the PICU stay and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5–3) months; 62% males) hospitalized with acute bronchiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction (Tei index). Up to 36 (32%) infants required respiratory support during the hospitalization. This group presented with higher lung ultrasound score (p < 0.001) and increased values of NT-proBNP (p < 0.001), the Tei index (p < 0.001) and pulmonary artery pressures (p < 0.001). All the analyzed respiratory and cardiac variables showed moderate-to-strong correlations with the LOS of hospitalization and the time of respiratory support. Lung ultrasound and echocardiography showed a moderate-to-strong predictive accuracy for the need of respiratory support in the ROC analysis, with the AUC varying from 0.74 to 0.87. Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ultrasonography could be a useful tool to easily identify high-risk populations for complicated acute bronchiolitis hospitalization.
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Affiliation(s)
| | - Patricia Rodriguez-Campoy
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, 11010 Cadiz, Spain; (P.R.-C.); (A.E.-M.); (J.C.F.-G.)
| | - Ana Estalella-Mendoza
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, 11010 Cadiz, Spain; (P.R.-C.); (A.E.-M.); (J.C.F.-G.)
| | - Ana Castellano-Martinez
- Pediatric Nephrology Division, Puerta del Mar University Hospital, 11010 Cadiz, Spain
- Correspondence:
| | - Jose Carlos Flores-Gonzalez
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, 11010 Cadiz, Spain; (P.R.-C.); (A.E.-M.); (J.C.F.-G.)
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24
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Bozzola E. Respiratory Syncytial Virus Resurgence in Italy: The Need to Protect All Neonates and Young Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010380. [PMID: 35010637 PMCID: PMC8744776 DOI: 10.3390/ijerph19010380] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Abstract
Respiratory syncytial virus (RSV) is the most prevalent cause of viral respiratory infections in children up to the age of 2 years and causes a wide range of clinical manifestations [...].
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
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25
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Navarro Alonso JA, Bont LJ, Bozzola E, Herting E, Lega F, Mader S, Nunes MC, Ramilo O, Valiotis G, Olivier CW, Yates A, Faust SN. RSV: perspectives to strengthen the need for protection in all infants. Emerg Themes Epidemiol 2021; 18:15. [PMID: 34674730 PMCID: PMC8529565 DOI: 10.1186/s12982-021-00104-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Respiratory syncytial virus (RSV)-the most common viral cause of bronchiolitis-is a significant cause of serious illness among young children between the ages of 0-5 years and is especially concerning in the first year of life. Globally, RSV is a common cause of childhood acute lower respiratory illness (ALRI) and a major cause of hospital admissions in young children and infants and represents a substantial burden for health-care systems. This burden is strongly felt as there are currently no effective preventative options that are available for all infants. However, a renaissance in RSV prevention strategies is unfolding, with several new prophylactic options such as monoclonal antibodies and maternal vaccinations that are soon to be available. A key concern is that health decision makers and systems may not be ready to take full advantage of forthcoming technological innovations. A multi-stakeholder approach is necessary to bridge data gaps to fully utilise upcoming options. Knowledge must be made available at multiple levels to ensure that parents and doctors are aware of preventative options, but also to ensure that stakeholders and policymakers are given the necessary information to best advise implementation strategies.
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Affiliation(s)
| | - Louis J Bont
- Wilhelmina Children's Hospital and UMC Utrecht, Utrecht, The Netherlands
| | - Elena Bozzola
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Federico Lega
- Centre for Research on Healthcare Management, Bocconi University, Milan, Italy
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Marta C Nunes
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Octavio Ramilo
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Room WA4021, 700 Children's Drive, Columbus, OH, 43205, USA
| | - George Valiotis
- European Health Management Association (EHMA), Brussels, Belgium
| | - Catherine Weil Olivier
- University of Paris, 7 Denis Diderot, 28 rue Parmentier, Neuilly sur Seine, 92200, Paris, France
| | - Ann Yates
- International Confederation of Midwives (ICM), The Hague, The Netherlands
| | - Saul N Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Hampshire, Southampton, UK. .,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Hampshire, Southampton, UK.
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26
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Azzari C, Baraldi E, Bonanni P, Bozzola E, Coscia A, Lanari M, Manzoni P, Mazzone T, Sandri F, Checcucci Lisi G, Parisi S, Piacentini G, Mosca F. Epidemiology and prevention of respiratory syncytial virus infections in children in Italy. Ital J Pediatr 2021; 47:198. [PMID: 34600591 PMCID: PMC8487331 DOI: 10.1186/s13052-021-01148-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.
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Affiliation(s)
- Chiara Azzari
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Bozzola
- Pediatric Disease Unit, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Alessandra Coscia
- Department of Public Health and Pediatric Sciences, Complex Structure Neonatology Unit, University of Turin, Turin, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studioru, University of Bologna, Bologna, Italy
| | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | | | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Maggiore Hospital, Bologna, Italy
| | | | | | - Giorgio Piacentini
- Department of Pediatrics, Pediatric Division, University Hospital of Verona, Verona, Italy
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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27
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Rodríguez-González M, Estepa-Pedregosa L, Estalella-Mendoza A, Castellano-Martínez A, Rodríguez-Campoy P, Carlos Flores-González J. Early elevated NT-proBNP but not troponin I is associated with severe bronchiolitis in infants. Clin Chim Acta 2021; 518:173-179. [PMID: 33831420 DOI: 10.1016/j.cca.2021.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND We aimed to explore and to compare the association between the NT-proBNP and high-sensitivity troponin I (hs-cTnI) at early stages of acute bronchiolitis with echocardiographic alterations, clinical severity and outcomes. METHODS A single centre, prospective observational study including previously healthy infants aged 1-12 months with bronchiolitis admitted to a tertiary hospital from April 2019 to March 2020. All patients underwent clinical, laboratory and echocardiographic evaluation at the same time point within 12 h of hospital admission. NT-proBNP > 1121 pg/ml and hs-cTnI > 26 ng/L were considered elevated. The primary outcome measure was the association of raised cardiac biomarkers with the need for PICU admission. RESULTS We enrolled 40 infants with median levels of NT-proBNP of 1176 (520-3030) pg/ml and hs-cTnI of 11.5 (5-21) ng/L at the time of hospital admission. Raised levels of NT-proBNP and hs-cTnI in 50% and 20% of cases, respectively. Of them, 15 (37%) required PICU admission during the hospitalization. Increased NT-proBNP was associated with PICU admission (adjusted OR 9.5 (CI95% 1.4-64); p = 0.020), prolonged hospitalization (β = 2.7; p = 0.012) and duration of oxygen administration (β = 2.7; p = 0.004) in the multivariate analysis. There were no differences in hs-cTnI levels regarding PICU admission (p = 0.866). Increased hs-cTnI levels were only associated with oxygen administration duration (Spearman rho = 0.38; p = 0.017), but this association disappeared in the multivariate analysis. Only NT-proBNP was associated with echocardiographic parameters of myocardial dysfunction (p < 0.001), and pulmonary hypertension (p < 0.001) CONCLUSION: Early elevated NT-proBNP but not hs-cTnI could be used as a biomarker for myocardial strain and disease severity in bronchiolitis.
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Affiliation(s)
- Moisés Rodríguez-González
- Pediatric Cardiology Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Lorena Estepa-Pedregosa
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Ana Estalella-Mendoza
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Ana Castellano-Martínez
- Pediatric Nephrology Division, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain.
| | - Patricia Rodríguez-Campoy
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Jose Carlos Flores-González
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
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