1
|
Sallam M, Kherfan T, Al‐Farajat A, Nemrawi L, Atawneh N, Fram R, Al‐Tammemi AB, Barakat M, Fram K. Attitude to RSV Vaccination Among a Cohort of Pregnant Women in Jordan: A Cross-Sectional Survey Study. Health Sci Rep 2025; 8:e70319. [PMID: 39777284 PMCID: PMC11705457 DOI: 10.1002/hsr2.70319] [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: 07/17/2024] [Revised: 11/16/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025] Open
Abstract
Background and Aims The recently approved maternal vaccination against respiratory syncytial virus (RSV) can reduce its burden among infants. However, vaccine hesitancy/resistance can undermine the beneficial impact of RSV vaccination. The aim of this study was to assess the willingness of pregnant women in Jordan to receive RSV vaccination and its associated determinants. Methods Face-to-face interviews were conducted in obstetrics/gynecology clinics in the Central, Northern, and Southern regions of Jordan during January-February 2024, using a convenience sampling approach. Attitude to RSV vaccination was assessed using the previously validated ABCDEF scale. Results A total of 404 pregnant women participated in the study with a mean age of 30.1 ± 6.2 years. A majority of the participants showed willingness to receive RSV vaccination (n = 313, 77.5%), with hesitancy among 25 participants (6.2%), and resistance among 66 participants (16.3%). Variables that were significantly associated with a higher RSV vaccine acceptance in multivariate analysis were: age < 30 years (adjusted odds ratio (aOR): 2.45, p = 0.010), undergraduates (aOR: 3.27, p = 0.026), being a healthcare worker (aOR: 4.50, p = 0.036), and the history of previous COVID-19/influenza vaccine uptake (aOR: 2.47, p = 0.045). Two out of the six ABCDEF constructs were significantly associated with RSV vaccine acceptance, namely the "Advice" construct (aOR: 10.38, p < 0.001) and the "Fear" construct (aOR: 21.49, p < 0.001). Conclusion This study highlighted the complex nature of attitude towards maternal RSV vaccination among pregnant women. The study showed the role of demographic variables, prior vaccination experience, trust in credible health institutions and vaccine safety, and the fear of RSV disease consequences in infants in shaping maternal attitude to RSV vaccination. Addressing these factors can help to effectively promote RSV vaccine uptake among pregnant women, subsequently helping to protect infants from the significant RSV disease burden.
Collapse
Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of MedicineThe University of JordanAmmanJordan
- Department of Clinical Laboratories and Forensic MedicineJordan University HospitalAmmanJordan
| | - Tleen Kherfan
- Department of Pathology, Microbiology and Forensic Medicine, School of MedicineThe University of JordanAmmanJordan
| | | | | | - Nada Atawneh
- School of MedicineThe University of JordanAmmanJordan
| | - Rand Fram
- School of MedicineThe University of JordanAmmanJordan
| | - Ala'a B. Al‐Tammemi
- Research, Policy and Training Directorate, Jordan Center for Disease ControlAmmanJordan
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of PharmacyApplied Science Private UniversityAmmanJordan
| | - Kamil Fram
- Department of Obstetrics & Gynecology, School of MedicineThe University of JordanAmmanJordan
- Department of Obstetrics & GynecologyJordan University HospitalAmmanJordan
| |
Collapse
|
2
|
Luo XP, Chen Q, Li L, Zhu XH, Huang P, Wang J. [Epidemiological characteristics of respiratory syncytial virus infection in children in Nanchang and its correlation with climate environmental factors]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:1282-1287. [PMID: 39725390 DOI: 10.7499/j.issn.1008-8830.2406109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
OBJECTIVES To explore the epidemiological characteristics of respiratory syncytial virus (RSV) infection in children in Nanchang and its correlation with climate environmental factors. METHODS The clinical data were collected from children with acute respiratory infection in Nanchang who were tested for RSV at Jiangxi Provincial Children's Hospital from January 2019 to December 2023, along with climate environmental data for the same period. The epidemiological characteristics of RSV and their correlation with climate environmental factors were investigated. RESULTS A total of 178 127 children underwent RSV testing from January 2019 to December 2023, with a positive detection rate of 8.35% (14 873/178 127). The positive detection rate in males was 8.92% (10 137/113 660), which was higher than that in females (7.35%, 4 736/64 467). The differences in RSV positive detection rates among different age groups were statistically significant (P<0.001), with the highest rate observed in the 0 to <3 months age group (14.38%, 3 328/23 142). Peaks in RSV positive detection occurred during winter and spring periods in 2019, 2020, and 2022, while in 2023, it occurred in spring and summer periods, with no seasonality noted in 2021. The RSV positive detection rate showed a positive correlation with average humidity, average atmospheric pressure, monthly PM2.5, and monthly carbon monoxide levels (P<0.05), while it showed a negative correlation with average wind speed, average temperature, and maximum 8-hour ozone levels (P<0.05). CONCLUSIONS In Nanchang, the RSV positive detection rate in children with acute respiratory infection is higher in males than in females. Among children of all age groups, the infants aged 0 to <3 months have the highest detection rate of RSV. RSV infection predominantly occurs in winter and spring periods. Lower temperatures, lower wind speeds, higher humidity, and elevated levels of PM2.5 and carbon monoxide may increase the risk of RSV infection in children.
Collapse
Affiliation(s)
- Xu-Peng Luo
- Department of Respiratory Medicine, Jiangxi Children's Hospital, Nanchang 330003, China
| | - Qiang Chen
- Department of Respiratory Medicine, Jiangxi Children's Hospital, Nanchang 330003, China
| | - Lan Li
- Department of Respiratory Medicine, Jiangxi Children's Hospital, Nanchang 330003, China
| | - Xiao-Hua Zhu
- Department of Respiratory Medicine, Jiangxi Children's Hospital, Nanchang 330003, China
| | - Peng Huang
- Department of Respiratory Medicine, Jiangxi Children's Hospital, Nanchang 330003, China
| | | |
Collapse
|
3
|
Andreoni M, Bonanni P, Gabutti G, Maggi S, Siliquini R, Ungar A. RSV vaccination as the optimal prevention strategy for older adults. LE INFEZIONI IN MEDICINA 2024; 32:478-488. [PMID: 39660164 PMCID: PMC11627484 DOI: 10.53854/liim-3204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 11/12/2024] [Indexed: 12/12/2024]
Abstract
Respiratory syncytial virus (RSV) is a respiratory virus that usually causes mild upper respiratory tract symptoms. However, it can lead to a severe lower respiratory tract disease in high-risk populations, with severe complications such as pneumonia and respiratory failure. RSV poses a significant public health threat not only to children, but also to adults, particularly those over 75 years of age and individuals with comorbidities. The high incidence and severity of RSV infections in these vulnerable groups highlights the urgent need for effective preventive strategies. Despite advancements in the clinical management of respiratory infections, preventing RSV remains a significant challenge. The symptoms of RSV are often underestimated and misdiagnosed due to their similarity to other respiratory infections like influenza and COVID-19. This leads to a substantial disease burden not only for patients but also for healthcare systems, due to increased hospitalizations and prolonged treatments. In recent years, there has been a significant progress in the development of RSV vaccines, offering new hope for disease prevention. Our aim is to promote RSV vaccination, emphasizing the importance of large-scale prevention efforts to enhance the quality of life for at-risk individuals and optimize healthcare resource allocation. This paper will report efficacy and safety data for the three main vaccines currently available for healthcare practitioners, providing a comprehensive and balanced overview of vaccine options and supporting informed decision-making by healthcare professionals and regulatory authorities.
Collapse
Affiliation(s)
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence,
Italy
| | - Giovanni Gabutti
- Coordinator Working Group “Vaccines and Immunization Policies”, Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Cogorno (Ge),
Italy
| | - Stefania Maggi
- National Research Council (CNR), Aging Section, Padua,
Italy
| | - Roberta Siliquini
- Department of Public Health University of Torino, AOU Città della Salute e della Scienza, Torino,
Italy
| | - Andrea Ungar
- Department of Geriatrics, University of Florence,
Italy
| |
Collapse
|
4
|
Koivisto KM, Nieminen T, Hermunen T, Rantanen M, Saxén H, Madanat-Harjuoja L. Parental Socioeconomic Status and an Infant's Risk of Hospital Admission for Respiratory Syncytial Virus. J Pediatric Infect Dis Soc 2024; 13:568-575. [PMID: 39302123 PMCID: PMC11599146 DOI: 10.1093/jpids/piae101] [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: 03/08/2024] [Accepted: 09/19/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND While clinical risk factors for respiratory syncytial virus (RSV) bronchiolitis are well established, data on socioeconomic risk factors is lacking. We explored the association of parental education, income, and employment status on an infant's risk of hospitalization for RSV bronchiolitis. METHODS This population-based retrospective case-control study covered all RSV-related hospital admissions of under 1-year-old children in Finland between 2004 and 2018. Controls were matched by month and year of birth, sex, province of residence, and family size. Registry data were linked using unique personal identity codes. Cases and controls were compared using adjusted odds ratios (aOR) calculated for socioeconomic outcomes including maternal and paternal education, household income, and parental employment. RESULTS A total of 10 767 infants and 50 054 controls were included in the study. Lower parental education significantly raised the risk for RSV hospital admission in infants, the risk growing with decreasing education levels; aOR 1.03 (0.96-1.09) with post-secondary education, 1.12 (1.05-1.2) with secondary education, and 1.33 (1.2-1.47) with primary education. Combined parental income was not significant: aOR 0.97 (confidence interval [CI] 0.91-1.05), 1.02 (CI 0.95-1.1), 1 (CI 0.92-1.08), and 0.94 (CI 0.85-1.04), respectively with decreasing income level. Unemployment of both parents seemed to be a risk factor for the child's RSV hospital admission, aOR 1.24 (1.12-1.38). CONCLUSIONS Lower parental socioeconomic status may increase the risk of an infant's RSV hospitalization. Socioeconomic risk factors should be considered when designing RSV infection primary prevention strategies.
Collapse
Affiliation(s)
- Karoliina M Koivisto
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Matti Rantanen
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxén
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
5
|
Mitiku H, Tesfa T, Edae M, Assefa N. Prevalence of Respiratory Syncytial Virus Among Children Under 5 Years of Age in Sub-Saharan Africa. Glob Pediatr Health 2024; 11:2333794X241298803. [PMID: 39559718 PMCID: PMC11571251 DOI: 10.1177/2333794x241298803] [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: 04/02/2024] [Revised: 10/15/2024] [Accepted: 10/24/2024] [Indexed: 11/20/2024] Open
Abstract
Background. Pneumonia and bronchiolitis are common childhood illnesses caused by the respiratory syncytial virus. A systematic analysis of published epidemiological data in sub-Saharan African children under the age of 5 was conducted. Methods. To retrieve literature, electronic databases, indexing services, and directories such as PubMed/MEDLINE, Scopus, EMBASE (Elsevier), Google Scholar, and Worldcat were utilized. Data from the included studies were extracted after screening and eligibility evaluation. Results. The pooled prevalence rate of respiratory syncytial virus was 21% (95% CI: 17, 25). Subgroup analysis based on participants' ages showed that, prevalence was highest in children <6 months (32%). High prevalence was also found in children who were hospitalized (27%), children co-infected with HIV (28%), and children co-infected with bacteria respiratory pathogens (22%). Conclusion. The prevalence of respiratory syncytial virus infection was high in children in sub-Saharan African countries. Therefore, it should be prioritized as a major health problem.
Collapse
Affiliation(s)
- Habtamu Mitiku
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Tewodros Tesfa
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Mekuria Edae
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Nega Assefa
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| |
Collapse
|
6
|
Joury J, Al Kaabi N, Al Dallal S, Mahboub B, Zayed M, Abdelaziz M, Onwumeh-Okwundu J, Fletcher MA, Kumaresan S, Ramachandrachar BC, Farghaly M. Retrospective Analysis of RSV Infection in Pediatric Patients: Epidemiology, Comorbidities, Treatment, and Costs in Dubai (2014-2023). JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2024; 11:133-144. [PMID: 39575134 PMCID: PMC11580195 DOI: 10.36469/001c.123889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/23/2024] [Indexed: 11/24/2024]
Abstract
Background: Infections attributable to respiratory syncytial virus (RSV) are a major cause of hospitalization among young children worldwide. Despite substantial clinical and economic burden, real-world data associated with RSV infections in the United Arab Emirates (UAE) are limited. Objectives: This study aimed to assess among children (<18 years) diagnosed with RSV the epidemiology, seasonality, comorbidities, treatment patterns, length of hospital stay, healthcare resource utilization (HCRU), and costs associated with pediatric infection in Dubai, UAE. Methods: This 10-year retrospective cohort study (Jan. 1, 2014-Sept. 30, 2023) utilized Dubai Real-World Database, a private insurance claims database. Patients aged <18 years with a first-episode diagnosis claim (primary or secondary, or a hospital admission) for RSV any time during the index period (Jan. 1, 2014-June 30, 2023) were included. Outcomes were analyzed during a 3-month follow-up. Patients were stratified into 3 cohorts: Cohort 1 (<2 years), Cohort 2 (2 to <6 years), and Cohort 3 (6 to <18 years). Results: Of 28 011 patients identified, 25 729 were aged <18 years with RSV infection. An increasing trend in reported cases was observed from 2014 to 2022, with an average annual increase of 55%. Half of study patients (49.3%) belonged to Cohort 1, with a mean age of 0.6 years, while less than 2% had known risk factors and 22% of the patients in cohort 1 were hospitalized. In Cohort 1, 32.0% had upper respiratory tract infections, 39.4% had lower respiratory tract infections, and 44.4% of patients had an "other respiratory disease." The average length of hospitalization was about 4 days across all cohorts. The total hospitalization cost was highest in patients <2 years, amounting to US 9 798 174 ( m e d i a n , U S 2241.30). Conclusion: Among the RSV patients, 49.3% were <2 years of age and few had recognized risk factors. Among patients <2 years, 22% were hospitalized, with an average hospital stay of 4 days; the cost of hospitalization totaled US $9 798 174. These findings can inform healthcare stakeholders about future policy measures and the need for effective preventive strategies.
Collapse
Affiliation(s)
| | - Nawal Al Kaabi
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, UAE
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | | | | | | | | | | | | | | | | | - Mohamed Farghaly
- Health Economics & Insurance Policies DepartmentDubai Health Authority, Dubai, UAE
| |
Collapse
|
7
|
Moyes J, Tempia S, Walaza S, Cohen AL, Treurnicht F, Hellferscee O, Wolter N, von Gottberg A, Dawood H, Variava E, Kahn K, Madhi SA, Cohen C. Risk factors for severe respiratory syncytial virus-associated respiratory tract infection in a high HIV prevalence setting, South Africa, 2012 - 2018. BMC Infect Dis 2024; 24:1128. [PMID: 39385077 PMCID: PMC11465802 DOI: 10.1186/s12879-024-10024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 10/01/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Identifying risk factors for respiratory syncytial virus (RSV)-associated severe acute respiratory illness (SARI) will assist with targeting vaccine interventions. METHODS Using surveillance data from South Africa (2012-2018), we compared the characteristics of individuals with RSV-associated influenza-like illness (ILI) (reference group) to those with RSV-associated SARI to describe factors associated with SARI using a multivariable analysis. RESULTS RSV was detected in 6% (483/7792) of ILI cases and 15% (844/5672) of SARI cases. Factors associated with SARI in children included age < 2 months, compared to age 2-4 years (adjusted odds ratio (aOR) 54.4; 95% confidence interval (CI) 23.5-125.8), malnutrition (aOR 1.9; 95% CI 1.2-3.2), prematurity (aOR 2.4; 95% CI 1.3-4.6) and living with HIV (LWH) (aOR 22.5; 95% CI 2.9-174.3). In individuals ≥ 5 years, factors associated with SARI included age ≥ 65 years compared to age 5-24 years (aOR 10.7; 95% CI 1.1-107.5), symptom duration ≥ 5 days (aOR 2.7; 95% CI 1.1-6.3), underlying illness (aOR 2.7; 95% CI 1.5-26.1) and LWH (aOR 16.8, 95% CI: 4.8-58.2). CONCLUSION Individuals at the extremes of age and those with identified risk factors might benefit most from RSV prevention interventions. CLINICAL TRIAL NUMBER Not applicable, this is not a clinical trial.
Collapse
Affiliation(s)
- Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Stefano Tempia
- MassGenics, Duluth, GA, United States of America
- Centers for Disease Control and Prevention, Influenza Program, Pretoria, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Expanded Programme On Immunization Department of Immunization, Vaccines and Biologicals World Health Organization, Geneva, Switzerland
| | - Florette Treurnicht
- Division of Virology, Faculty of Health Sciences, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa
| | - Nicole Wolter
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Greys Hospital, Pietermaritzburg, South Africa
- Caprisa, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- School of Public Health, Faculty of Health Sciences, SAMRC/Wits Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
8
|
Martin L, Bainier A, Darviot E, Forgeron A, Sarthou L, Wagner AC, Blanchais T, Brigly T, Troussier F, Branger B. Interaction of the protective effect of breastfeeding and the aggravating effect of pacifier use in the occurrence of bronchiolitis in children. Arch Pediatr 2024; 31:426-432. [PMID: 39358122 DOI: 10.1016/j.arcped.2024.05.004] [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: 08/10/2023] [Revised: 01/12/2024] [Accepted: 05/05/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Acute bronchiolitis affects around 30 % of infants each winter in France. Breastfeeding (BF) is described as being protective against acute lower respiratory infections in developing countries, but this effect is more difficult to demonstrate in industrialized countries. Moreover, the effect of using a pacifier in the occurrence of bronchiolitis is not clearly established. In this context, the aim of the study was to investigate the link between BF and the use of a pacifier in the occurrence of bronchiolitis in children under 1 year of age who presented to five pediatric emergency centers in Pays de la Loire, France. METHOD A questionnaire collecting data on diet, sociodemographic characteristics, and the reason for presentation was provided at the admission to pediatric emergency centers in five hospitals in Pays de Loire, France, between 2018 and 2020. Children with bronchiolitis were included in group 1, and children consulting for other reasons (except gastrointestinal infections or otitis) were included in group 2. Breastfeeding was classified as exclusive breastfeeding (EBF) and partial breastfeeding (PBF). Pacifier use was classified as frequent and during sleep or not used. RESULTS The study included 671 children under 1 year of age, including 174 (25.8 %) who were admitted with bronchiolitis. In univariate analysis, a significantly smaller number of children in group 1 s were breastfed (EBF and PBF) at admission compared with children in group 2:21.8 % versus 32.8 %, respectively, (OR=0.57, 95 % CI: 0.38-0.86, p = 0.006); furthermore, children in group 1 used a pacifier more often than those in group 2: 84.5 % versus 75.8 % (OR=1.74, 95 % CI: 1.10-2.76, p = 0.017). In multivariate analysis, after adjusting for age, ongoing BF or EBF beyond 9 and 12 months of age remained a protective factor; however, the protective effect of BF disappeared with the introduction of a pacifier, and pacifier use was significantly associated with bronchiolitis. CONCLUSION The protective effect of BF against bronchiolitis was demonstrated independently of pacifier use. However, due to the strong association between pacifier use and bronchiolitis, the effect of BF weakened. The advice to be given to parents for BF and pacifier use is discussed.
Collapse
Affiliation(s)
| | - Amaïa Bainier
- Centre Hospitalier Universitaire - 4, rue Larrey- 49933 Angers Cedex 9, France
| | - Estelle Darviot
- Centre Hospitalier Universitaire - 4, rue Larrey- 49933 Angers Cedex 9, France
| | - Aude Forgeron
- Centre Hospitalier, 194 Avenue Rubillard, 72037 Le Mans, France
| | - Laurent Sarthou
- Centre Hospitalier, 1 rue Marengo, 49325 Cholet Cedex, France
| | - Anne-Claire Wagner
- Centre Hospitalier- 11 bd Georges Centre Hospitalier Charpak, 44 606 Saint-Nazaire Cedex, France
| | - Thomas Blanchais
- Centre Hospitalier - Les Oudairies, 85925 La Roche-sur-Yon, France
| | - Thomas Brigly
- Centre Hospitalier Universitaire - 4, rue Larrey- 49933 Angers Cedex 9, France
| | - Françoise Troussier
- Centre Hospitalier Universitaire - 4, rue Larrey- 49933 Angers Cedex 9, France
| | | |
Collapse
|
9
|
Liu HF, Wang YY, Zhang XZ, Li HY, Xiang M, Lu R, Liu CY, Li W, Feng QL, Guo YJ, Huang RW, Fu HM. Comparison of characteristics of children hospitalized for respiratory syncytial virus infection during the pre- and post-COVID-19 eras: a multicenter retrospective study. BMC Infect Dis 2024; 24:1009. [PMID: 39300365 DOI: 10.1186/s12879-024-09783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/21/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection (LRTI) among children, has resurged in the form of endemic or even pandemic in many countries and areas after the easing of COVID-19 containment measures. This study aimed to investigate the differences in epidemiological and clinical characteristics of children hospitalized for RSV infection during pre- and post-COVID-19 eras in Yunnan, China. METHODS A total of 2553 pediatric RSV inpatients from eight hospitals in Yunnan were retrospectively enrolled in this study, including 1451 patients admitted in 2018-2019 (pre-COVID-19 group) and 1102 patients admitted in 2023 (post-COVID-19 group). According to the presence or absence of severe LRTI (SLRTI), patients in the pre- and post-COVID-19 groups were further divided into the respective severe or non-severe subgroups, thus analyzing the risk factors for RSV-associated SLRTI in the two eras. Demographic, epidemiological, clinical, and laboratory data of the patients were collected for the final analysis. RESULTS A shift in the seasonal pattern of RSV activity was observed between the pre-and post-COVID-19 groups. The peak period of RSV hospitalizations in the pre-COVID-19 group was during January-April and October-December in both 2018 and 2019, whereas that in the post-COVID-19 group was from April to September in 2023. Older age, more frequent clinical manifestations (fever, acute otitis media, seizures), and elevated laboratory indicators [neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP), interleukin 6 (IL-6), co-infection rate] were identified in the post-COVID-19 group than those in the pre-COVID-19 group (all P < 0.05). Furthermore, compared to the pre-COVID-19 group, the post-COVID-19 group displayed higher rates of SLRTI and mechanical ventilation, with a longer length of hospital stay (all P < 0.05). Age, low birthweight, preterm birth, personal history of atopy, underlying condition, NLR, IL-6 were the shared independent risk factors for RSV-related SLRTI in both pre- and post-COVID-19 groups, whereas seizures and co-infection were independently associated with SLRTI only in the post-COVID-19 group. CONCLUSIONS An off-season RSV endemic was observed in Yunnan during the post-COVID-19 era, with changed clinical features and increased severity. Age, low birthweight, preterm birth, personal history of atopy, underlying condition, NLR, IL-6, seizures, and co-infection were the risk factors for RSV-related SLRTI in the post-COVID-19 era.
Collapse
Affiliation(s)
- Hai-Feng Liu
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Ya-Yu Wang
- Department of Pediatrics, The People's Hospital of Dali, The Third Affiliated Hospital of Dali University, Dali, 671000, China
| | - Xue-Zu Zhang
- Department of Pediatrics, The People's Hospital of Lincang, Lincang, 677000, China
| | - He-Yun Li
- Department of Pediatrics, The First People's Hospital of Zhaotong, Zhaotong Hospital, Affiliated to Kunming Medical University, Zhaotong, 657000, China
| | - Mei Xiang
- Department of Pediatrics, The People's Hospital of Honghe, Mengzi, 651400, China
| | - Rui Lu
- Department of Pediatrics, The People's Hospital of Wenshan Zhuang & Miao Autonomous Prefecture, Wenshan, 663000, China
| | - Cong-Yun Liu
- Department of Pediatrics, The People's Hospital of Baoshan, Baoshan, 678000, China
| | - Wang Li
- Department of Pediatrics, The People's Hospital of Guandu District, The Fifth People's Hospital of Kunming, Kunming, 650200, China
| | - Quan-Li Feng
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Yun-Jie Guo
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Rong-Wei Huang
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Hong-Min Fu
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China.
| |
Collapse
|
10
|
Inoue M, Maeda M, Murata F, Fukuda H. Factors Associated With Hospitalization, Length of Stay, and Hospital Expenditures for Respiratory Syncytial Virus Infection in Japanese Infants and Children According to Palivizumab-indicated Underlying Conditions: The LIFE Study. Pediatr Infect Dis J 2024:00006454-990000000-01008. [PMID: 39259860 DOI: 10.1097/inf.0000000000004543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of pediatric respiratory tract infections. In Japan, children with specific underlying conditions are eligible to receive palivizumab to prevent severe RSV disease. However, the association between palivizumab eligibility and RSV infection severity remains unclear. This study examined RSV infection severity and hospitalization outcomes in Japanese infants and children according to palivizumab eligibility and identified their associated factors. METHODS Using insurance claims data from 12 municipalities, we identified RSV cases aged ≤24 months between April 2017 and March 2022. The patients' characteristics and hospitalization status were analyzed according to the presence of palivizumab-indicated underlying conditions. Regression models were used to identify factors associated with hospitalization, length of stay (LOS), and hospital expenditures. RESULTS We analyzed 1025 first-time RSV cases (860 infants <12 months and 165 children 12-24 months old). There were 777 (90.3%) palivizumab-ineligible infants and 83 (9.7%) palivizumab-eligible infants. Only 13 (15.7%) palivizumab-eligible infants had received palivizumab in the month before RSV infection, and 8 required hospitalization. RSV hospitalization was significantly associated with age (odds ratio: 0.84, 95% confidence interval: 0.79-0.88), palivizumab-indicated underlying conditions (1.82, 1.13-2.89), and non-indicated high-risk conditions (4.87, 2.28-10.99). These factors were also associated with LOS. Hospital expenditures were associated with age, high-risk conditions and LOS. CONCLUSIONS Palivizumab-indicated underlying conditions, high-risk conditions, and younger age are risk factors for RSV hospitalization. Most hospitalized patients did not receive palivizumab in the month before RSV infection despite being eligible, suggesting that some hospitalizations were preventable through appropriate palivizumab use.
Collapse
Affiliation(s)
- Masako Inoue
- From the Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | |
Collapse
|
11
|
Saager ES, van Stigt AH, Lerkvaleekul B, Lutter L, Hellinga AH, van der Wal MM, Bont LJ, Leusen JH, van’t Land B, van Wijk F. Human breastmilk memory T cells throughout lactation manifest activated tissue-oriented profile with prominent regulation. JCI Insight 2024; 9:e181788. [PMID: 39435660 PMCID: PMC11530127 DOI: 10.1172/jci.insight.181788] [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] [Indexed: 10/23/2024] Open
Abstract
Breastfeeding provides important immunological benefits to the neonate, but how the different immunoactive components in breastmilk contribute to immunity remains poorly understood. Here, we characterized human breastmilk T cells using single-cell RNA-Seq and flow cytometry. Breastmilk contained predominantly memory T cells, with expression of immune signaling genes, high proliferation, and an effector Th1/cytotoxic profile with high cytokine production capacities. Elevated activation was balanced by an enriched Treg population and immune regulatory markers in conventional memory T cells. Gene and surface expression of tissue-residency markers indicate that breastmilk T cells represented tissue-adapted rather than circulatory T cells. In addition, breastmilk T cells had a broad homing profile and higher activation markers in these migratory subsets. The partly overlapping transcriptome profile between breastmilk and breast tissue T cells, particularly cytotoxic T cells, might support a role in local immune defense in the mammary gland. However, unique features of breastmilk, such as Tregs, might imply an additional role in neonatal immune support. We found some correlations between the breastmilk T cell profile and clinical parameters, most notably with maternal and household factors. Together, our data suggest that breastmilk contains an adapted T cell population that exerts their function in specific tissue sites.
Collapse
Affiliation(s)
- Elise S. Saager
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Arthur H. van Stigt
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Butstabong Lerkvaleekul
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lisanne Lutter
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Pathology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Anneke H. Hellinga
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - M. Marlot van der Wal
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Louis J. Bont
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, Netherlands
- ReSViNET foundation, Zeist, Netherlands
| | - Jeanette H.W. Leusen
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Belinda van’t Land
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
- CoE Immunology, Danone Global Research & Innovation Center, Utrecht, Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | |
Collapse
|
12
|
Stucki M, Lenzin G, Agyeman PK, Posfay-Barbe KM, Ritz N, Trück J, Fallegger A, Oberle SG, Martyn O, Wieser S. Inpatient burden of respiratory syncytial virus (RSV) in Switzerland, 2003 to 2021: an analysis of administrative data. Euro Surveill 2024; 29:2400119. [PMID: 39328156 PMCID: PMC11484346 DOI: 10.2807/1560-7917.es.2024.29.39.2400119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/13/2024] [Indexed: 09/28/2024] Open
Abstract
BackgroundRespiratory syncytial virus (RSV) is a leading cause of acute respiratory infections and hospitalisations in infants (age < 1 year) and young children. Little is known on RSV epidemiology and related inpatient healthcare resource use (HCRU) in Switzerland.AimTo explore RSV-related hospitalisations, inpatient HCRU and medical costs in all age groups, and risk factors for infant hospitalisations in Switzerland.MethodsWe used national hospital registry data from 2003 to 2021 identifying RSV cases with ICD-10-GM codes, and described demographic characteristics, HCRU and associated medical costs of RSV inpatients. The effect of risk factors on infant hospitalisation was estimated with logistic regression.ResultsWe observed a general increase and biannual pattern in RSV hospitalisations between 2003/04 and 2018/19, with 3,575 hospitalisations in 2018/19 and 2,487 in 2019/20 before numbers declined in 2020/21 (n = 902). Around two thirds of all hospitalisations occurred in infants. Mean (median) age was 118 (85) days in hospitalised infants and 74 (77) years in hospitalised adult patients (> 18 years); 7.2% of cases required intensive care unit stay. Mean inpatient medical costs were estimated at EUR 8,046. Most (90.8%) hospitalised infants with RSV were born after 35 weeks of gestation without bronchopulmonary dysplasia or congenital heart disease. Low birth weight, gestational age and congenital disorders were associated with a higher risk for hospitalisation.ConclusionsRSV leads to a substantial number of hospitalisations and peaks in hospital capacity utilisation. Measures to protect all infants from an RSV hospitalisation are essential in addressing this public health challenge.
Collapse
Affiliation(s)
- Michael Stucki
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Golda Lenzin
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Philipp Ka Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klara M Posfay-Barbe
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicole Ritz
- Children's Hospital of Central Switzerland, Department of Paediatrics and Infectious Diseases Unit and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
| | - Johannes Trück
- Divisions of Allergy and Immunology, University Children's Hospital and Children's Research Center, University of Zurich (UZH), Zurich, Switzerland
| | | | | | - Oliver Martyn
- Sanofi A/S, Vaccines Medical Affairs, Copenhagen, Denmark
| | - Simon Wieser
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| |
Collapse
|
13
|
Fonseca MJ, Hagenaars S, Bangert M, Flach C, Hudson RD. Respiratory Syncytial Virus Hospital Admission Rates and Patients' Characteristics Before the Age of 2 Years in England, 2015-2019. Pediatr Infect Dis J 2024; 43:909-915. [PMID: 39163535 PMCID: PMC11319075 DOI: 10.1097/inf.0000000000004467] [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] [Accepted: 05/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND A granular understanding of respiratory syncytial virus (RSV) burden in England is needed to prepare for new RSV prevention strategies. We estimated the rates of RSV hospital admissions before the age of 2 years in England and described baseline characteristics. METHODS A birth cohort of all infants born between March 1, 2015, and February 28, 2017 (n = 449,591) was established using Clinical Practice Research Datalink-Hospital Episode Statistics. Case cohorts included infants with admission for (1) RSV, (2) bronchiolitis, (3) any respiratory tract infection (RTI) <24 months and (4) RSV predicted by an algorithm <12 months. Baseline characteristics were described in the case and comparative cohorts (infants without corresponding admission). Cumulative incidence and admission rates were calculated. Multiple linear regression was used to estimate the proportion of RTI healthcare visits attributable to RSV. RESULTS The RSV-coded/RSV-predicted case cohorts were composed of 4813/12,694 infants (cumulative incidence: 1.1%/2.8%). Case cohort infants were more likely to have low birth weight, comorbidities and to be born during RSV season than comparative cohort infants, yet >77% were term-healthy infants and >54% were born before the RSV season. During the first year of life, 11.6 RSV-coded and 34.4 RSV-predicted hospitalizations occurred per 1000 person-years. Overall, >25% of unspecified lower RTI admissions were estimated to be due to RSV. CONCLUSIONS In England, 1 in 91 infants had an RSV-coded admission, likely underestimated by ~3-fold. Most infants were term-healthy infants born before the RSV season. To decrease the total burden of RSV at the population level, immunization programs need to protect all infants.
Collapse
|
14
|
Köse B, Schaumburg F. Diagnostic accuracy of Savanna RVP4 (QuidelOrtho) for the detection of Influenza A virus, RSV, and SARS-CoV-2. Microbiol Spectr 2024; 12:e0115324. [PMID: 38990032 PMCID: PMC11302293 DOI: 10.1128/spectrum.01153-24] [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: 05/17/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024] Open
Abstract
Seasonal increase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus A/B (Flu A/B), and respiratory syncytial virus (RSV) require rapid diagnostic test methods for the management of respiratory tract infections. In this study, we compared the diagnostic accuracy of Savanna RVP4 (RVP4, QuidelOrtho) with Xpert Xpress Plus SARS-CoV-2/Flu/RSV (Xpert, Cepheid). Nasopharyngeal swabs from patients treated at a tertiary care hospital (Germany) were tested for SARS-CoV-2, Flu A/B, and RSV by RVP4 to assess diagnostic accuracy (reference standard: Xpert). The intra and inter assay precision of Ct-values was assessed by repeated test in triplicates (on day 1) and duplicates (days 2-3). All patients with a physician's order for a multiplex test for SARS-CoV-2, Flu, and RSV test were included. Duplicate swabs from the same patient, samples with a total volume ≤1 mL, or inappropriate shipment/storage were excluded. In total, 229 swabs were included between September 2023 and February 2024. The concordance between both tests was 96.5% (SARS-CoV-2), 98.7% (Flu A), and 99.6% (RSV). Flu B was not detected by both tests. The RVP4 test had a sensitivity of 85%-95% and a specificity of 100% for the detection of SARS-CoV-2, Flu A, and RSV. The intra and inter assay precision of Ct-values from RVP4 was 3% and 2% (SARS-CoV-2), 5% and 4% (Flu A), and 0% and 3% (RSV), respectively. The Savanna RVP4 has a favorable diagnostic accuracy for the detection of SARS-CoV-2, Flu A, and RSV. IMPORTANCE We assessed the diagnostic accuracy of a new point-of-care test for the rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus A/B (Flu A/B), and respiratory syncytial virus (RSV). The new test has a concordance with the reference standard of 96.5% (SARS-CoV-2), 98.7% (Flu A), and 99.1% (RSV). The sensitivity of 85%-95% and specificity of 100% for the detection of SARS-CoV-2, Flu A, and RSV is comparable with similar nucleic acid amplification-based point of care tests but at lower costs.
Collapse
Affiliation(s)
- Büsra Köse
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| |
Collapse
|
15
|
Manzoni P, Viora E, Lanari M, Iantomasi R, Montuori EA, Rodgers-Gray B, Waghorne N, Masturzo B. Maternal Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infection in Otherwise Healthy Preterm and Term Infants: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2024; 43:763-771. [PMID: 38754000 DOI: 10.1097/inf.0000000000004387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND/OBJECTIVE To date, there is no published, formal assessment of all maternal risk factors for respiratory syncytial virus lower respiratory tract infection (RSV-LRTI) in infants. A systematic literature review and meta-analysis were undertaken to ascertain: What maternal risk factors are associated with an increased risk of RSV-LRTI in infants? METHODS The systematic literature review used explicit methods to identify, select and analyze relevant data. PubMed, Embase and the Cochrane Library were searched (November 2022) using terms regarding: (1) RSV/LRTI; (2) risk factors; (3) pregnant/postpartum population. Bayesian meta-analysis compared RSV hospitalization (RSVH) risk in infants born to mothers with or without certain risk factors. RESULTS A total of 2353 citations were assessed and 20 were included in the final review (10 individual studies; 10 pooled analyses). In 10 studies examining infants (<1 year) without comorbidities (primary outcome), 10 maternal risk factors were associated with RSV-LRTI/RSVH in multivariate analyses. Meta-analysis revealed smoking while pregnant increased infant RSVH risk by 2.01 (95% credible interval: 1.52-2.64) times, while breast-feeding was protective (0.73, 95% credible interval: 0.58-0.90). Risk scoring tools have reported that maternal risk factors contribute between 9% and 21% of an infant's total risk score for RSVH. CONCLUSIONS A greater understanding of maternal risk factors and their relative contribution to infant RSV-LRTI will enable more accurate assessments of the impact of preventive strategies.
Collapse
Affiliation(s)
- Paolo Manzoni
- From the Department of Maternal-Infant Medicine, "Degli Infermi" Hospital, University of Torino School of Medicine, Ponderano, Biella, Italy
| | - Elsa Viora
- Obstetrics and Gynecology Department, Città della Salute e della Scienza S. Anna Hospital, Torino, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | - Bianca Masturzo
- Obstetrics and Gynecology Unit, Department of Maternal-Infant Medicine, "Degli Infermi" Hospital, Ponderano, Biella, Italy
| |
Collapse
|
16
|
Chen KYA, van Ingen T, Smith BT, Fitzpatrick T, Whelan M, Parpia AS, Alessandrini J, Buchan SA. Neighborhood-Level Burden of Social Risk Factors on Respiratory Syncytial Virus Hospitalization in Ontario, Canada, 2016-2019. Open Forum Infect Dis 2024; 11:ofae384. [PMID: 39100531 PMCID: PMC11298255 DOI: 10.1093/ofid/ofae384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Background Beyond clinical risk factors, little is known about the impact of social determinants on respiratory syncytial virus (RSV) burden. Our study aimed to estimate RSV-related hospitalization rates across sociodemographic and housing characteristics. Methods We conducted a population-based study of all RSV-related hospitalizations in Ontario, Canada, between September 1, 2016, and August 31, 2019, using validated hospital discharge codes and census data. Crude and age-standardized annualized RSV incidence rates and rate ratios (RRs) were estimated for a range of individual-level demographics and neighborhood-level measures of marginalization and housing characteristics. Results Overall, the annual RSV-related hospitalization rate was 27 per 100 000, with the highest rates observed in children age <12 months (1049 per 100 000) and 12-23 months (294 per 100 000) and adults age ≥85 years (155 per 100 000). Higher RSV-related hospitalization rates were associated with increasing marginalization quintile (Q) of material resources (RR, 1.4; Q5: 33 per 100 000 vs Q1: 24 per 100 000) and household instability (RR, 1.5; Q5: 31 per 100 000 vs Q1: 22 per 100 000). Conclusions The burden of RSV-related hospitalization was greatest in young children and older adults, with variation by sociodemographic and housing factors. Understanding the role of these social factors is crucial for informing equitable preventive program delivery.
Collapse
Affiliation(s)
- Kitty Y A Chen
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Fitzpatrick
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Alyssa S Parpia
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
17
|
De R, Jiang M, Sun Y, Huang S, Zhu R, Guo Q, Zhou Y, Qu D, Cao L, Lu F, Zhao L. A Scoring System to Predict Severe Acute Lower Respiratory Infection in Children Caused by Respiratory Syncytial Virus. Microorganisms 2024; 12:1411. [PMID: 39065180 PMCID: PMC11278654 DOI: 10.3390/microorganisms12071411] [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: 06/20/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
There were several factors associated with respiratory syncytial virus (RSV) severe acute lower respiratory infection (RSV-sALRI) in infants and young children. It is vital to develop a convenient scoring system to predict RSV-sALRI in children. Pediatric patients with RSV-ALRI from January 2009 to December 2021 were recruited retrospectively. Two-third of them were randomly grouped into the development set and one-third to the validation set. In the development set, risk factors for RSV-sALRI were transferred into the logistic regression analysis, then their receiver operating characteristic (ROC) curves were built to obtain the area under the ROC curve (AUC), and regression coefficients for each predictor were converted to points. Finally, the value of the scoring system was evaluated in the validation set. A total of 1 066 children with RSV-ALRI were recruited, including 710 in the development set and 356 in the validation set. By logistic regression analysis, six factors (younger than 2 years, gestational age <37 weeks, have siblings, birth weight ≤2500 g, artificial/mix feeding, CHD) showed statistical difference and then were scored with points according to the coefficient value (OR) in the development set. In the validation set, the sensitivity of the scoring system was 70.25%, the specificity 85.53%, the positive predictive value 71.43%, the negative predictive value 84.81%, and coincidence rate 0.80. The Kolmogorov-Smirnov test showed the distribution of AUC 0.765 (SE = 0.027; 95% CI = 0.713-0.818; p < 0.001). A simplified scoring system was developed in the study with high prediction value for RSV-sALRI in children.
Collapse
Affiliation(s)
- Ri De
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China;
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| | - Mingli Jiang
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| | - Yu Sun
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| | - Siyuan Huang
- Department of Intensive Care Unit, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing 100020, China; (S.H.); (D.Q.)
| | - Runan Zhu
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| | - Qi Guo
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| | - Yutong Zhou
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| | - Dong Qu
- Department of Intensive Care Unit, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing 100020, China; (S.H.); (D.Q.)
| | - Ling Cao
- Department of Respiratory Medicine, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing 100020, China;
| | - Fengmin Lu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China;
| | - Linqing Zhao
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing 100020, China; (M.J.); (Y.S.); (R.Z.); (Q.G.); (Y.Z.)
| |
Collapse
|
18
|
Crow R, Satav A, Potdar V, Satav S, Dani V, Simões EAF. Risk factors for the development of severe or very severe respiratory syncytial virus-related lower respiratory tract infection in Indian infants: A cohort study in Melghat, India. Trop Med Int Health 2024; 29:612-621. [PMID: 38741367 DOI: 10.1111/tmi.14003] [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] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is undoubtedly the single most important cause of severe lower respiratory tract infection (LRTI) globally. While new prevention measures in young infants have become available, their use in developing countries is likely many years away. While risk factors for severe or very severe RSV LRTI in impoverished rural areas likely differ to urban areas, there are very few studies, especially those conducted in India, the major country contributing to the global burden of disease. METHODS Active surveillance for acute LRTI in enrolled infants and children <2 years of age, was conducted through weekly home visits in 93 villages of Melghat, India, from August 2016 to December 2020. Local hospitals and primary health centres were surveyed for admissions of enrolled subjects. Nasopharyngeal swabs were collected from children with severe, or very severe LRTIs and all who died, with RSV testing using nucleic acid tests at ICMR, National Institute of Virology Pune. Risk factors for both RSV associated and non-RSV associated, severe and very severe LRTI were identified through univariate and multivariate logistic regression. RESULTS There were 483 severe or very severe RSV LRTI cases and 2807 non-RSV severe or very severe LRTI infections in a cohort of 13,318 children. Weight for age z-score ≤-2, the use of kerosene or wood for cooking, obtaining drinking water from a public tap and low gestational age significantly increased the risk of RSV LRTI. A higher wealth score index and water purification were protective. Comparison with non-RSV LRTI showed male sex as an additional risk factor. The analysis highlighted the risk of kerosene use [OR = 17.8 (3.0-104.4) (p ≤ 0.001)] and [OR = 3.4 (0.8-14.4) (p ≤ 0.05)] for RSV and non-RSV LRTIs, respectively. CONCLUSIONS Nutritional status and environmental air quality are predisposing factors for developing an RSV LRI in young children, factors which are amenable to environmental and behavioural interventions.
Collapse
Affiliation(s)
- Rowena Crow
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Amravati, India
| | - Varsha Potdar
- National Institute of Virology, Indian Council of Medical Research, Pune, India
| | - Shilpa Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Amravati, India
| | - Vibhawari Dani
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Amravati, India
| | - Eric A F Simões
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
- Centre for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| |
Collapse
|
19
|
Trautmannsberger I, Plagg B, Adamek I, Mader S, de Luca D, Esposito S, Silfverdal SA, Zimmermann LJI, Tischer C. The Multifaceted Burden of Respiratory Syncytial Virus (RSV) Infections in Young Children on the Family: A European Study. Infect Dis Ther 2024; 13:1531-1573. [PMID: 38767780 PMCID: PMC11219685 DOI: 10.1007/s40121-024-00989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Since the majority of hospitalisations due to RSV occur in young children, the illness profoundly influences the entire family. However, comprehensive evidence regarding its overall effects remains limited. The ResQ Family study aims to investigate the burden of RSV-induced pediatric hospitalisation on affected families. METHODS Spanning the 2022-2023 RSV season, an interdisciplinary, observational study was conducted in Germany, France, Italy and Sweden. Using an online questionnaire, parents and caregivers of children (< 24 months of age) with an RSV-induced hospitalisation were recruited. Information was gathered on topics related to RSV and parental health-related quality of life (HRQoL) during the acute infection phase (t0) and 6 weeks later (t1). Descriptive evaluations of the data set were performed during t0 and regarding a potential change over the observation period (t0 vs. t1). Subgroup analysis aimed to further identify differences across the countries. RESULTS A total set of 138 affected parents/caregivers were included in the study, with 59 participants responding to the follow-up survey (t1). Particularly during the acute infection phase, parental HRQoL was shown to be negatively influenced by the child's RSV infection [total score (p < 0.001, d = 0.54), parent HRQoL summary score (p < 0.001, d = 0.67) and family functioning summary score (p = 0.007, d = 0.33)]. Significant disparities in disease awareness and support structures were observed across Europe, with France and Sweden showing notably higher levels. CONCLUSION The ResQ Family study provides convincing evidence that RSV-associated hospitalisations in young children across Europe generate a multifaced burden for the entire family, partly even beyond the acute infection phase. Standardised approaches for disease prevention at societal, educational and policy levels are needed to guarantee every newborn the best possible start into life. TRIAL REGISTRATION ClinicalTrials.gov, identifier, NCT05550545.
Collapse
Affiliation(s)
- Ilona Trautmannsberger
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
- Department of Paediatrics, Research School for Oncology and Reproduction, Maastricht UMC+, 6229 ER, Maastricht, The Netherlands
| | - Barbara Plagg
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100, Bolzano, Italy
| | - Ina Adamek
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany.
| | - Daniele de Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | | | - Luc J I Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
- Department of Paediatrics, Research School for Oncology and Reproduction, Maastricht UMC+, 6229 ER, Maastricht, The Netherlands
| | - Christina Tischer
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
| |
Collapse
|
20
|
Sullivan K, Sullivan B. Does nirsevimab prevent lower respiratory infections caused by respiratory syncytial virus? J Perinatol 2024; 44:767-769. [PMID: 38637681 DOI: 10.1038/s41372-024-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Kelsey Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
| | - Brynne Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
21
|
Belachew AB, Rantala AK, Jaakkola MS, Hugg TT, Sofiev M, Kukkonen J, Jaakkola JJK. Prenatal and early life exposure to air pollution and the risk of severe lower respiratory tract infections during early childhood: the Espoo Cohort Study. Occup Environ Med 2024; 81:209-216. [PMID: 38604660 PMCID: PMC11103339 DOI: 10.1136/oemed-2023-109112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND There is inconsistent evidence of the effects of exposure to ambient air pollution on the occurrence of lower respiratory tract infections (LRTIs) in early childhood. We assessed the effects of individual-level prenatal and early life exposure to air pollutants on the risk of LRTIs in early life. METHODS We studied 2568 members of the population-based Espoo Cohort Study born between 1984 and 1990 and living in 1991 in the City of Espoo, Finland. Exposure assessment was based on dispersion modelling and land-use regression for lifetime residential addresses. The outcome was a LRTI based on data from hospital registers. We applied Poisson regression to estimate the incidence rate ratio (IRR) of LTRIs, contrasting incidence rates in the exposure quartiles to the incidence rates in the first quartile. We used weighted quantile sum (WQS) regression to estimate the joint effect of the studied air pollutants. RESULTS The risk of LRTIs during the first 2 years of life was significantly related to exposure to individual and multiple air pollutants, measured with the Multipollutant Index (MPI), including primarily sulphur dioxide (SO2), particulate matter with a dry diameter of up to 2.5 µm (PM2.5) and nitrogen dioxide (NO2) exposures in the first year of life, with an adjusted IRR of 1.72 per unit increase in MPI (95% CI 1.20 to 2.47). LRTIs were not related to prenatal exposure. CONCLUSIONS We provide evidence that ambient air pollution exposure during the first year of life increases the risk of LRTIs during the first 2 years of life. SO2, PM2.5 and NO2 were found to contribute the highest weights on health effects.
Collapse
Affiliation(s)
- Abate Bekele Belachew
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Aino K Rantala
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Maritta S Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Timo T Hugg
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | | | - Jaakko Kukkonen
- Finnish Meteorological Institute, Helsinki, Finland
- Centre for Climate Change Research (C3R), University of Hertfordshire, Hertfordshire, UK
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Finnish Meteorological Institute, Helsinki, Finland
| |
Collapse
|
22
|
Hak SF, Venekamp RP, Wildenbeest JG, Bont LJ. Outpatient respiratory syncytial virus infections and novel preventive interventions. Curr Opin Pediatr 2024; 36:171-181. [PMID: 38085019 PMCID: PMC10919273 DOI: 10.1097/mop.0000000000001323] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE OF REVIEW With interventions to prevent respiratory syncytial virus (RSV) infection within reach, this review aims to provide healthcare professionals with the latest information necessary to inform parents and assess the potential impact of RSV prevention on everyday practice. We address frequently asked questions for parental counseling. RECENT FINDINGS Numerous studies emphasize the major burden of RSV on young children, parents, healthcare and society. In the first year of life, about 14% of healthy term infants visit a doctor and 2% require hospitalization due to RSV. In older children (1--5 years), RSV infections and associated morbidity (wheeze, acute otitis media) are major drivers of outpatient visits. A novel maternal RSV vaccine and long-acting mAb can provide protection during infants' first months of life. This maternal vaccine showed 70.9% efficacy against severe RSV infection within 150 days after birth; the mAb nirsevimab reduces medically attended RSV infections by 79.5% within 150 days after administration. Both gained regulatory approval in the USA (FDA) and Europe (EMA). SUMMARY Novel RSV immunizations hold promise to reduce the RSV burden in infants, with substantial impact on everyday practice. Tailored parental guidance will be instrumental for successful implementation. Awaiting pediatric vaccines, RSV infections beyond infancy will still pose a significant outpatient burden.
Collapse
Affiliation(s)
- Sarah F. Hak
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center Utrecht
| | - Roderick P. Venekamp
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Joanne G. Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center Utrecht
| | - Louis J. Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center Utrecht
- Respiratory Syncytial Virus NETwork (ReSViNET) Foundation, Zeist, The Netherlands
| |
Collapse
|
23
|
Zhan S, Lin H, Yang Y, Chen T, Mao S, Fu C. Investigating Nonspecific Effects of the Live-Attenuated Japanese Encephalitis Vaccine on Lower Respiratory Tract Infections in Children Aged 25-35 Months: Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e53040. [PMID: 38498052 PMCID: PMC10993859 DOI: 10.2196/53040] [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: 09/23/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Live attenuated vaccines may be used to prevent nontargeted diseases such as lower respiratory tract infections (LRTIs) due to their nonspecific effects (NSEs). OBJECTIVE We aimed to analyze the NSEs of the Japanese encephalitis vaccine on pediatric LRTIs in children aged 25 months to 35 months. METHODS A retrospective cohort study was conducted by using a population-based electronic health record database in Zhejiang, China. Enrolled participants were children born from January 1, 2017, to December 31, 2017, and who were inoculated with the live-attenuated Japanese encephalitis vaccine (JE-L) or inactivated Japanese encephalitis vaccine (JE-I) as the most recent vaccine at 24 months of age. The study was carried out between January 1, 2019, and December 31, 2019. All inpatient and outpatient hospital visits for LRTIs among children aged 25 months to 35 months were recorded. The Andersen-Gill model was used to assess the NSEs of JE-L against LRTIs in children and compared with those of JE-I as the most recent vaccine. RESULTS A total of 810 children born in 2017 were enrolled, of whom 585 received JE-L (JE-L cohort) and 225 received JE-I (JE-I cohort) as their last vaccine. The JE-L cohort showed a reduced risk of LRTIs (adjusted hazard ratio [aHR] 0.537, 95% CI 0.416-0.693), including pneumonia (aHR 0.501, 95% CI 0.393-0.638) and acute bronchitis (aHR 0.525, 95% CI 0.396-0.698) at 25 months to 35 months of age. The NSEs provided by JE-L were especially pronounced in female children (aHR 0.305, 95% CI 0.198-0.469) and children without chronic diseases (aHR 0.553, 95% CI 0.420-0.729), without siblings (aHR 0.361, 95% CI 0.255-0.511), with more than 30 inpatient and outpatient hospital visits prior to 24 months of age (aHR 0.163, 95% CI 0.091-0.290), or with 5 to 10 inpatient and outpatient hospital visits due to infectious diseases prior to 24 months old (aHR 0.058, 95% CI 0.017-0.202). CONCLUSIONS Compared with JE-I, receiving JE-L as the most recent vaccine was associated with lower risk of inpatient and outpatient hospital visits for LRTIs among children aged 25 months to 35 months. The nature of NSEs induced by JE-L should be considered for policymakers and physicians when recommending JE vaccines to those at high risk of infection from the Japanese encephalitis virus.
Collapse
Affiliation(s)
- Siyi Zhan
- The Institute of Infectious Disease and Vaccine, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongbo Lin
- Center for Disease Control and Prevention of Yinzhou District, Ningbo, China
| | - Yingying Yang
- The Institute of Infectious Disease and Vaccine, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tao Chen
- The Institute of Infectious Disease and Vaccine, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Sheng Mao
- The Institute of Infectious Disease and Vaccine, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chuanxi Fu
- The Institute of Infectious Disease and Vaccine, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
24
|
Kwon JH, Paek SH, Park SH, Kim MJ, Byun YH, Song HY. COVID-19, Influenza, and RSV in Children and Adults: A Clinical Comparative Study of 12,000 Cases. J Clin Med 2024; 13:1702. [PMID: 38541927 PMCID: PMC10971566 DOI: 10.3390/jcm13061702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 11/12/2024] Open
Abstract
(1) Background: Respiratory virus infections, including Coronavirus disease 2019 (COVID-19), seasonal influenza (FLU), and respiratory syncytial virus (RSV) as prominent examples, can severely affect both children and adults. This study aimed to investigate the clinical characteristics of respiratory viral infections in pediatric and adult populations and to identify determinants influencing patient hospitalization. (2) Methods: This retrospective study analyzed the electronic medical records of patients admitted to a regional hospital's emergency department from 1 January 2015 to 31 December 2022, to investigate the clinical characteristics and hospitalization risk factors associated with these three viruses. (3) Results: Infants aged 1 to 11 months were most affected by COVID-19 and RSV, whereas FLU more commonly infected children aged 3 to 5 years. Key factors influencing hospitalization included age and abnormal chest X-ray findings, with higher risks observed in younger children and adults over 65. Notably, the presence of abnormal chest x-ray findings significantly increased the hospitalization risk by 1.9 times [1.5-2.4] in children and 21.4 times [2.4-189.0] in adults. (4) Conclusions: This analysis underscores the impact of COVID-19, FLU, and RSV on hospitalization risk, offering insights for managing these respiratory viral infections (RVIs). Age-related risk differences highlight the necessity for tailored strategies, improving understanding of and treatment development for RVIs.
Collapse
Affiliation(s)
- Jae-Hyun Kwon
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea; (S.-H.P.); (S.-H.P.); (M.-J.K.); (Y.-H.B.); (H.-Y.S.)
| | | | | | | | | | | |
Collapse
|
25
|
Fröhlich GC, Gregianini TS, Pinheiro FG, Nascimento R, Cezar TM, Pscheidt VM, Selayaran T, Martins LG, Gomes MFDC, Salvato RS, Pereira EC, Guimarães-Ribeiro V, Scalioni LDP, Siqueira MM, Resende PC, Veiga ABG. Resurgence of human respiratory syncytial virus during COVID-19 pandemic in Southern Brazil. J Med Virol 2024; 96:e29551. [PMID: 38506236 DOI: 10.1002/jmv.29551] [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: 12/15/2023] [Revised: 02/16/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Respiratory Syncytial Virus (RSV) is an important cause of respiratory infection in humans. Severe cases are common in children ≤2 years old, immunocompromised individuals, and the elderly. In 2020, RSV infection reduced in Rio Grande do Sul (RS), southern Brazil; however, in 2021 resurgence of RSV was observed. This study analyzed epidemiological and genetic features of RSV infection cases reported in 2021 in RS. Nasopharyngeal samples collected from individuals with respiratory infection negative for SARS-CoV-2, Influenza A and B viruses were assessed for the presence of RSV by real time RT-qPCR. RSV-A and RSV-B genomic sequencing and phylogenetic reconstructions were performed for genotyping and clade characterization. Among 21,035 respiratory samples analyzed, 2,947 were positive for RSV, 947 of which were hospitalized patients. Positive cases were detected year-round, with the highest number in June-July (winter). Children <1 year comprised 56.28% (n = 533) of the hospitalized patients infected with RSV, whereas 14.46% (n = 137) were individuals >60 years. Of a total of 361 deaths, 14.68% (n = 53) were RSV positive, mostly patients >60 years old (73.58%, n = 39). Chronic kidney disease, cardiopathy, Down syndrome and neurological diseases were associated with RSV infection. RSV-A was identified in 58.5% (n = 117/200) of the patients, and RSV-B in 41.5% (n = 83/200). Of 95 RSV genomes recovered from SARI cases, 66 were RSV-A GA.2.3.5 genotype, while 29 were RSV-B GB.5.0.5a genotype. This study provides epidemiological and molecular data on RSV cases in RS during the COVID-19 pandemic and highlights that investigation of different respiratory viruses is essential for decision-making and disease prevention and control measures.
Collapse
Affiliation(s)
- Guilherme C Fröhlich
- Laboratório Central de Saúde Pública, Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul-LACEN/CEVS/SES-RS, Porto Alegre, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
| | - Tatiana S Gregianini
- Laboratório Central de Saúde Pública, Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul-LACEN/CEVS/SES-RS, Porto Alegre, Brazil
| | - Felipe G Pinheiro
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
| | - Rodrigo Nascimento
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
| | - Thiago M Cezar
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
| | - Veridiane M Pscheidt
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
| | - Tainá Selayaran
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
- Centro de Desenvolvimento Científico e Tecnológico, Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul-CDCT/CEVS/SES-RS, Porto Alegre, Brazil
| | - Letícia G Martins
- Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul-CEVS/SES-RS, Porto Alegre, Brazil
| | | | - Richard S Salvato
- Centro de Desenvolvimento Científico e Tecnológico, Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul-CDCT/CEVS/SES-RS, Porto Alegre, Brazil
| | - Elisa C Pereira
- Laboratório Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais - LVRE/FIOCRUZ-RJ, Porto Alegre, Brazil
| | - Victor Guimarães-Ribeiro
- Laboratório Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais - LVRE/FIOCRUZ-RJ, Porto Alegre, Brazil
| | - Letícia de Paula Scalioni
- Laboratório Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais - LVRE/FIOCRUZ-RJ, Porto Alegre, Brazil
| | - Marilda M Siqueira
- Laboratório Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais - LVRE/FIOCRUZ-RJ, Porto Alegre, Brazil
| | - Paola C Resende
- Laboratório Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais - LVRE/FIOCRUZ-RJ, Porto Alegre, Brazil
| | - Ana B G Veiga
- Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brazil
| |
Collapse
|
26
|
Pisuttinusart N, Shanmugaraj B, Srisaowakarn C, Ketloy C, Prompetchara E, Thitithanyanont A, Phoolcharoen W. Immunogenicity of a recombinant plant-produced respiratory syncytial virus F subunit vaccine in mice. BIOTECHNOLOGY REPORTS (AMSTERDAM, NETHERLANDS) 2024; 41:e00826. [PMID: 38234330 PMCID: PMC10793081 DOI: 10.1016/j.btre.2023.e00826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
Respiratory syncytial virus (RSV) is a highly infectious respiratory virus that causes serious illness, particularly in young children, elderly people, and those with immunocompromised individuals. RSV infection is the leading cause of infant hospitalization and can lead to serious complications such as pneumonia and bronchiolitis. Currently, there is an RSV vaccine approved exclusively for the elderly population, but no approved vaccine specifically designed for infants or any other age groups. Therefore, it is crucial to continue the development of an RSV vaccine specifically tailored for these populations. In this study, the immunogenicity of the two plant-produced RSV-F Fc fusion proteins (Native construct and structural stabilized construct) were examined to assess them as potential vaccine candidates for RSV. The RSV-F Fc fusion proteins were transiently expressed in Nicotiana benthamiana and purified using protein A affinity column chromatography. The recombinant RSV-F Fc fusion protein was recognized by the monoclonal antibody Motavizumab specific against RSV-F protein. Moreover, the immunogenicity of the two purified RSV-F Fc proteins were evaluated in mice by formulating with different adjuvants. According to our results, the plant-produced RSV-F Fc fusion protein is immunogenic in mice. These preliminary findings, demonstrate the immunogenicity of plant-based RSV-F Fc fusion protein, however, further preclinical studies such as antigen dose and adjuvant optimization, safety, toxicity, and challenge studies in animal models are necessary in order to prove the vaccine efficacy.
Collapse
Affiliation(s)
- Nuttapat Pisuttinusart
- Center of Excellence in Plant-produced Pharmaceuticals, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Balamurugan Shanmugaraj
- Department of Biotechnology, Bharathiar University, Coimbatore - 641046, Tamil Nadu, India
- Baiya Phytopharm Co., Ltd, Bangkok 10330, Thailand
| | - Chanya Srisaowakarn
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Chutitorn Ketloy
- Center of Excellence in Vaccine Research and Development (Chula VRC), Chulalongkorn University, Bangkok 10330, Thailand
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Eakachai Prompetchara
- Center of Excellence in Vaccine Research and Development (Chula VRC), Chulalongkorn University, Bangkok 10330, Thailand
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Waranyoo Phoolcharoen
- Center of Excellence in Plant-produced Pharmaceuticals, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
27
|
Ferrante G, Piacentini G, Piazza M, Boner AL, Bellanti JA. Addressing global health disparities in the management of RSV infection in infants and children: Strategies for preventing bronchiolitis and post-bronchiolitis recurrent wheezing. Allergy Asthma Proc 2024; 45:84-91. [PMID: 38449013 DOI: 10.2500/aap.2024.45.230089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background: The topic of equitable access to health care and its impact on exacerbating worldwide inequities in child health not only strikes at the heart of our health-care delivery systems but also deeply resonates with our collective social consciences. Nowhere is this better seen on a global scale than in the burden of illness caused by respiratory syncytial virus (RSV) infection, which extracts the most severe morbidity and mortality in infants and children in low- and middle-income countries (LMIC). This report addresses global health disparities that exist in the management of RSV infection in infants and children, and offers strategies for preventing bronchiolitis and postbronchiolitis recurrent wheezing in LMICs. Methods: A systematic literature review was conducted across the PubMed data bases of RSV infection and the socioeconomic impact of bronchiolitis and postbronchiolitis recurrent wheezing in LMICs. Results: The results of the present study address the many issues that deal with the question if prevention of RSV bronchiolitis can mitigate recurrent wheezing episodes and links RSV risks, downstream effects, prevention, malnutrition, and socioeconomic restraints of developing countries with a call for possible global action. Conclusion: The present study stresses the importance of considering the linkage between malnutrition and disease susceptibility because of the known relationships between undernutrition and greater vulnerability to infectious diseases, including RSV infection. These complex interactions between infectious disease and undernutrition also raise issues on the longer-term sequelae of postbronchiolitis recurrent wheezing. This prompts a discussion on whether industrialized countries should prioritize the provision of newly developed monoclonal antibodies and RSV vaccines to LMICs or whether vital nutritional needs should be a first focus. The resolution of these issues will require research and greater international discourse.
Collapse
Affiliation(s)
- Giuliana Ferrante
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Michele Piazza
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Attilio L Boner
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | | |
Collapse
|
28
|
Brenes-Chacon H, Eisner M, Acero-Bedoya S, Ramilo O, Mejias A. Age-specific predictors of disease severity in children with respiratory syncytial virus infection beyond infancy and through the first 5 years of age. Pediatr Allergy Immunol 2024; 35:e14083. [PMID: 38363050 DOI: 10.1111/pai.14083] [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: 08/02/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection is associated with significant morbidity in infants. Risk factors for severe disease beyond the first 2 years of life have not been fully defined. METHODS Children <5 years hospitalized with virologically confirmed RSV infection were identified over six respiratory seasons (10/2012-4/2018) and their medical records manually reviewed. Multivariable analyses were performed to define the age-specific (<6, 6-24, and >24-59 months) risk factors associated with oxygen administration, PICU admission, mechanical ventilation, and duration of hospitalization. RESULTS We identified 5143 children hospitalized with RSV infection: 53.5% (n = 2749) <6 months; 31.7% (n = 1631) 6-24 months; and 14.8% (n = 763) >24-59 months. Rates of ICU admission were high (35%-36%) and comparable across age groups, while children >24-59 and 6-24 versus those <6 months required supplemental oxygen more frequently (73%; 71%; 68%, respectively; p = .003). The presence of comorbidities increased with age (25%, <6 months; 46%, 6-24 months; 70%, >24-59 months; p < .001). Specifically, neuromuscular disorders, chronic lung disease, and reactive airway disease/asthma were predictive of worse clinical outcomes in children aged 6-24 and >24-59 months, while RSV-viral codetections increased the risk of severe outcomes in children aged <6 and 6-24 months of age. CONCLUSIONS Almost half of children hospitalized with RSV infection were >6 months. Underlying comorbidities increased with age and remained associated with severe disease in older children, while RSV-viral codetections were predictive of worse clinical outcomes in the youngest age groups. These data suggest the importance of defining the clinical phenotype associated with severe RSV according to age, and the persistent burden associated with RSV beyond infancy.
Collapse
Affiliation(s)
- Helena Brenes-Chacon
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Division of Infectious Diseases, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Mariah Eisner
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Santiago Acero-Bedoya
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
29
|
Cantais A, Annino N, Thuiller C, Tripodi L, Cesana P, Seigle-Ferrand E, Zekre F, Pillet S, Pozzetto B. First RSV epidemic with nirsevimab. Older children than previous epidemics, even when hospitalized. J Med Virol 2024; 96:e29483. [PMID: 38375933 DOI: 10.1002/jmv.29483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Aymeric Cantais
- Paediatric Emergency Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Nadine Annino
- Paediatric Emergency Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Charlotte Thuiller
- Paediatric Emergency Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Louise Tripodi
- Paediatric Emergency Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Philippine Cesana
- Paediatric Emergency Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Eloise Seigle-Ferrand
- Paediatric Emergency Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Franck Zekre
- Paediatric Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Sylvie Pillet
- Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Bruno Pozzetto
- Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Étienne, Saint-Étienne, France
| |
Collapse
|
30
|
Gauthier TW, Ping XD, Harris FL, Brown LAS. Liposomal Glutathione Augments Immune Defenses against Respiratory Syncytial Virus in Neonatal Mice Exposed in Utero to Ethanol. Antioxidants (Basel) 2024; 13:137. [PMID: 38397736 PMCID: PMC10886408 DOI: 10.3390/antiox13020137] [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: 12/29/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
We previously reported that maternal alcohol use increased the risk of sepsis in premature and term newborns. In the neonatal mouse, fetal ethanol (ETOH) exposure depleted the antioxidant glutathione (GSH), which promoted alveolar macrophage (AM) immunosuppression and respiratory syncytial virus (RSV) infections. In this study, we explored if oral liposomal GSH (LGSH) would attenuate oxidant stress and RSV infections in the ETOH-exposed mouse pups. C57BL/6 female mice were pair-fed a liquid diet with 25% of calories from ethanol or maltose-dextrin. Postnatal day 10 pups were randomized to intranasal saline, LGSH, and RSV. After 48 h, we assessed oxidant stress, AM immunosuppression, pulmonary RSV burden, and acute lung injury. Fetal ETOH exposure increased oxidant stress threefold, lung RSV burden twofold and acute lung injury threefold. AMs were immunosuppressed with decreased RSV clearance. However, LGSH treatments of the ETOH group normalized oxidant stress, AM immune phenotype, the RSV burden, and acute lung injury. These studies suggest that the oxidant stress caused by fetal ETOH exposure impaired AM clearance of infectious agents, thereby increasing the viral infection and acute lung injury. LGSH treatments reversed the oxidative stress and restored AM immune functions, which decreased the RSV infection and subsequent acute lung injury.
Collapse
Affiliation(s)
- Theresa W. Gauthier
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, GA 30322, USA; (X.-D.P.); (F.L.H.); (L.A.S.B.)
| | | | | | | |
Collapse
|
31
|
Foley DA, Minney-Smith CA, Lee WH, Oakes DB, Hazelton B, Ford TJ, Wadia U, Sikazwe C, Moore HC, Nicol MP, Levy A, Blyth CC. Respiratory Syncytial Virus Reinfections in Children in Western Australia. Viruses 2023; 15:2417. [PMID: 38140658 PMCID: PMC10747877 DOI: 10.3390/v15122417] [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: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Respiratory syncytial virus (RSV) reinfection in children is poorly understood. We examined the incidence, characteristics, and outcomes of hospital-attended RSV reinfections in children <16 years in Western Australia between 2012 and 2022. Individuals with repeat RSV detections ≥56 days apart were identified using laboratory data. The incidence of reinfection in the first five years of life was estimated using the total birth population from 2012 to 2017. Clinical data on a subset of reinfection episodes were obtained from two metropolitan pediatric centers. A total of 466 children with hospital-attended reinfections were identified. The median interval between RSV detections was 460 days (interquartile range: 324, 812), with a reinfection rate of 95 per 100,000 individuals (95% confidence interval: 82, 109). Reinfection was most common in children who experienced their first RSV detection <6 months of age. Predisposing factors were identified in 56% of children; children with predisposing factors were older at first and second detections, were more likely to be admitted, and had a longer length of stay. This study highlights the significant burden of hospital-attended RSV reinfections in children with and without predisposing factors. Expanded surveillance with in-depth clinical data is required to further characterize the impact of RSV reinfection.
Collapse
Affiliation(s)
- David A. Foley
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Cara A. Minney-Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
| | - Wei Hao Lee
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of General Paediatrics, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Daniel B. Oakes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
| | - Briony Hazelton
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Timothy J. Ford
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Ushma Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Department of General Paediatrics, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Marshall Centre for Infectious Diseases, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Population Health, Curtin University, Perth, WA 6009, Australia
| | - Mark P. Nicol
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Marshall Centre for Infectious Diseases, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Christopher C. Blyth
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia (A.L.); (C.C.B.)
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia (H.C.M.); (M.P.N.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| |
Collapse
|
32
|
Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, Campbell OMR. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. Arch Dis Child 2023; 108:956-969. [PMID: 37339859 PMCID: PMC11474254 DOI: 10.1136/archdischild-2022-324884] [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: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps. METHODS We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association. FINDINGS We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting. INTERPRETATION Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations. PROSPERO REGISTRATION NUMBER CRD42021268843.
Collapse
Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Eman Sharara
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine El Rashidi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
33
|
Wick M, Poshtiban A, Kramer R, Bangert M, Lange M, Wetzke M, Damm O. Inpatient burden of respiratory syncytial virus in children ≤2 years of age in Germany: A retrospective analysis of nationwide hospitalization data, 2019-2022. Influenza Other Respir Viruses 2023; 17:e13211. [PMID: 38019702 PMCID: PMC10667831 DOI: 10.1111/irv.13211] [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: 05/24/2023] [Revised: 08/31/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes respiratory tract disease in seasonal waves, primarily in infants and young children. This study aims to quantify the number of RSV-related hospitalizations in children ≤2 years of age and to determine corresponding resource use and costs in Germany. METHODS We retrospectively analyzed population-wide hospital data from the Institute for the Hospital Remuneration System (InEK) from 2019 to 2022. RSV cases were identified using the RSV-specific 10th revision of the International Classification of Diseases (ICD-10) codes J12.1, J20.5, and J21.0. The RSV-associated proportion of all hospitalizations caused by severe acute respiratory infections (SARIs), clinical manifestations, length of stay (LOS), intensive care unit (ICU) admissions, ventilation rates, and hospitalization costs were retrieved. RESULTS We identified 98,220 hospitalizations (26,052, 15,407, 31,362, and 25,399 in 2019, 2020, 2021, and 2022, respectively) with a principal RSV diagnosis in children aged ≤2 years in Germany. The majority of RSV hospitalizations (73,178) occurred in infants (<1 year), with annual incidence rates ranging from 14.9 to 28.6 per 1000 population. Fifty-eight percent of all SARI hospitalizations in this age group were attributable to RSV. In children aged ≤2 years, mean LOS was 4.5 days, 6.1% of cases were admitted to ICU, and 5.3% of cases were ventilated. Mean hospitalization costs per case ranged from €3001 to €3961 over the study period. CONCLUSIONS RSV causes substantial disease burden and is a leading cause of SARI-related hospital admissions of children ≤2 years of age in Germany. Our results confirm the need to explore and evaluate strategies to prevent RSV in infants and young children.
Collapse
Affiliation(s)
- Moritz Wick
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | | | - Rolf Kramer
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| | | | - Matthias Lange
- Department of Pediatric Pneumology and AllergologyUniversitätsklinik für Kinder‐ und Jugendmedizin OldenburgOldenburgGermany
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology and NeonatologyHannover Medical SchoolHannoverGermany
- Biomedical Research in End‐Stage and Obstructive Lung Disease Hannover (BREATH)HannoverGermany
| | - Oliver Damm
- Sanofi‐Aventis Deutschland GmbHBerlinGermany
| |
Collapse
|
34
|
Hayashida S, Nagano N, Morohashi T, Momoki E, Nezu K, Shimozawa K, Ishii W, Okahashi A, Morioka I. Clinical factors associated with extended hospitalization in pediatric patients ≥3 years of age with respiratory syncytial virus or human metapneumovirus infection: A Japanese single-center, retrospective study. Medicine (Baltimore) 2023; 102:e35565. [PMID: 37861549 PMCID: PMC10589578 DOI: 10.1097/md.0000000000035565] [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: 03/10/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) infections are common in children worldwide. However, the clinical factors related to extended hospitalization in Japanese patients aged ≥3 years remain elusive. We aimed to elucidate the clinical risk factors contributing to hospital stays ≥7 days in patients with RSV and hMPV infections. Patients ≥3 years of age who were hospitalized due to RSV or hMPV infection between 2014 to 2020 were included. Twenty-one RSV- and 27 hMPV-infected patients were enrolled. Patients were divided into 2 groups: hospitalization for ≥ and <7 days. Univariate and multivariate analyses determined the clinical risk factors contributing to hospital stay ≥7 days. The RSV- and hMPV-infected patients had similar clinical characteristics. The clinical risk factors contributing to extended hospitalization were analyzed in the 48 infected patients of the 2 groups. The presence of prophylactic antibiotics usage, co-bacterial colonization, and underlying diseases were extracted by univariate analysis (P < .05). In multivariate analysis, underlying diseases were determined as an independent clinical risk factor (odds ratio 8.09, P = .005). Underlying diseases contributed to extended hospitalization in RSV- or hMPV-infected patients ≥3 years of age.
Collapse
Affiliation(s)
- Shingo Hayashida
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tamaki Morohashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Emiko Momoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Keiko Nezu
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuyoshi Shimozawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Wakako Ishii
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Aya Okahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
35
|
Munro AP, Martinón-Torres F, Drysdale SB, Faust SN. The disease burden of respiratory syncytial virus in Infants. Curr Opin Infect Dis 2023; 36:379-384. [PMID: 37610444 PMCID: PMC10487373 DOI: 10.1097/qco.0000000000000952] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW To describe the current global burden of respiratory syncytial virus (RSV) in infants and its implications for morbidity, health resources and economic costs. RECENT FINDINGS New prophylactic therapies are on the horizon for RSV in the form of long-acting monoclonal antibodies suitable for healthy infants and maternal immunizations. SUMMARY Despite being responsible for significant global infant morbidity and mortality, until recently there have been no effective therapeutics available for healthy infants to protect them from RSV. Several new drugs are likely to be available within the next few years which could help relieve a huge burden on healthcare systems over the coming winters.
Collapse
Affiliation(s)
- Alasdair P.S. Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela
- Genetics, Vaccines and Paediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London
- Department of Paediatrics, St George's University Hospital NHS Foundation Trust, London, UK
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
36
|
Tian J, Wang XY, Zhang LL, Liu MJ, Ai JH, Feng GS, Zeng YP, Wang R, Xie ZD. Clinical epidemiology and disease burden of bronchiolitis in hospitalized children in China: a national cross-sectional study. World J Pediatr 2023; 19:851-863. [PMID: 36795317 PMCID: PMC9933022 DOI: 10.1007/s12519-023-00688-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Bronchiolitis is a common acute lower respiratory tract infection (ALRTI) and the most frequent cause of hospitalization of infants and young children with ALRTI. Respiratory syncytial virus is the main pathogen that leads to severe bronchiolitis. The disease burden is relatively high. To date, few descriptions of the clinical epidemiology and disease burden of children hospitalized for bronchiolitis are available. This study reports the general clinical epidemiological characteristics and disease burden of bronchiolitis in hospitalized children in China. METHODS This study included the face sheet of discharge medical records collected from 27 tertiary children's hospitals from January 2016 to December 2020 that were aggregated into the FUTang Update medical REcords (FUTURE) database. The sociodemographic variables, length of stay (LOS) and disease burden of children with bronchiolitis were analyzed and compared using appropriate statistical tests. RESULTS In total, 42,928 children aged 0-3 years were hospitalized due to bronchiolitis from January 2016 to December 2020, accounting for 1.5% of the total number of hospitalized children of the same age in the database during the period and 5.31% of the hospitalizations for ALRTI. The male to female ratio was 2.01:1. Meanwhile, more boys than girls were observed in different regions, age groups, years, and residences. The 1-2 year age group had the greatest number of hospitalizations for bronchiolitis, while the 29 days-6 months group had the largest proportion of the total inpatients and inpatients with ALRTI in the same age group. In terms of region, the hospitalization rate of bronchiolitis was the highest in East China. Overall, the number of hospitalizations from 2017 to 2020 showed a decreasing trend from that in 2016. Seasonally, the peak hospitalizations for bronchiolitis occurred in winter. Hospitalization rates in North China in autumn and winter were higher than those in South China, while hospitalization rates in South China were higher in spring and summer. Approximately, half of the patients with bronchiolitis had no complications. Among the complications, myocardial injury, abnormal liver function and diarrhea were more common. The median LOS was 6 days [interquartile range (IQR) = 5-8], and the median hospitalization cost was 758 United States dollars (IQR = 601.96-1029.53). CONCLUSIONS Bronchiolitis is a common respiratory disease in infants and young children in China, and it accounts for a higher proportion of both total hospitalizations and hospitalizations due to ALRTI in children. Among them, children aged 29 days-2 years are the main hospitalized population, and the hospitalization rate of boys is significantly higher than that of girls. The peak season for bronchiolitis is winter. Bronchiolitis causes few complications and has a low mortality rate, but the burden of this disease is heavy.
Collapse
Affiliation(s)
- Jiao Tian
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu 56#, Beijing, 100045, China
| | - Xin-Yu Wang
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin-Lin Zhang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu 56#, Beijing, 100045, China
| | - Meng-Jia Liu
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu 56#, Beijing, 100045, China
| | - Jun-Hong Ai
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu 56#, Beijing, 100045, China
| | - Guo-Shuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue-Ping Zeng
- Medical Record Management Office, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ran Wang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu 56#, Beijing, 100045, China.
| | - Zheng-De Xie
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu 56#, Beijing, 100045, China.
| |
Collapse
|
37
|
von Ash T, Alikhani A, Sharkey KM, Solano P, Morales Aquino M, Markham Risica P. Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs. Nutrients 2023; 15:3435. [PMID: 37571371 PMCID: PMC10421484 DOI: 10.3390/nu15153435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.
Collapse
Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02903, USA
| | - Anna Alikhani
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
| | - Katherine M. Sharkey
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA;
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Paola Solano
- Brown University, Providence, RI 02912, USA; (P.S.); (M.M.A.)
| | | | - Patricia Markham Risica
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02903, USA
| |
Collapse
|
38
|
Lloyd CM, Saglani S. Early-life respiratory infections and developmental immunity determine lifelong lung health. Nat Immunol 2023; 24:1234-1243. [PMID: 37414905 DOI: 10.1038/s41590-023-01550-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Respiratory infections are common in infants and young children. However, the immune system develops and matures as the child grows, thus the effects of infection during this time of dynamic change may have long-term consequences. The infant immune system develops in conjunction with the seeding of the microbiome at the respiratory mucosal surface, at a time that the lungs themselves are maturing. We are now recognizing that any disturbance of this developmental trajectory can have implications for lifelong lung health. Here, we outline our current understanding of the molecular mechanisms underlying relationships between immune and structural cells in the lung with the local microorganisms. We highlight the importance of gaining greater clarity as to what constitutes a healthy respiratory ecosystem and how environmental exposures influencing this network will aid efforts to mitigate harmful effects and restore lung immune health.
Collapse
Affiliation(s)
- Clare M Lloyd
- National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK.
| | - Sejal Saglani
- National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK.
| |
Collapse
|
39
|
Halasa N, Zambrano LD, Amarin JZ, Stewart LS, Newhams MM, Levy ER, Shein SL, Carroll CL, Fitzgerald JC, Michaels MG, Bline K, Cullimore ML, Loftis L, Montgomery VL, Jeyapalan AS, Pannaraj PS, Schwarz AJ, Cvijanovich NZ, Zinter MS, Maddux AB, Bembea MM, Irby K, Zerr DM, Kuebler JD, Babbitt CJ, Gaspers MG, Nofziger RA, Kong M, Coates BM, Schuster JE, Gertz SJ, Mack EH, White BR, Harvey H, Hobbs CV, Dapul H, Butler AD, Bradford TT, Rowan CM, Wellnitz K, Staat MA, Aguiar CL, Hymes SR, Randolph AG, Campbell AP. Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak. JAMA Netw Open 2023; 6:e2328950. [PMID: 37581884 PMCID: PMC10427947 DOI: 10.1001/jamanetworkopen.2023.28950] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023] Open
Abstract
Importance Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide. Objective To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission. Design, Setting, and Participants This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection. Exposure Respiratory syncytial virus. Main Outcomes and Measures Data were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity. Results The first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days. Conclusions and Relevance In this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.
Collapse
Affiliation(s)
- Natasha Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura D. Zambrano
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Justin Z. Amarin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S. Stewart
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Emily R. Levy
- Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | | | - Julie C. Fitzgerald
- Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Marian G. Michaels
- Division of Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Bline
- Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Melissa L. Cullimore
- Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Laura Loftis
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Houston
| | - Vicki L. Montgomery
- Department of Pediatrics, University of Louisville and Norton Children’s Hospital, Louisville, Kentucky
| | - Asumthia S. Jeyapalan
- Division of Pediatric Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Pia S. Pannaraj
- Division of Infectious Diseases, Children’s Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles
| | - Adam J. Schwarz
- Division of Critical Care Medicine, Children’s Hospital Orange County, Orange, California
| | - Natalie Z. Cvijanovich
- Division of Critical Care, Department of Pediatrics, University of California, San Francisco Benioff Children’s Hospital Oakland, Oakland
| | - Matt S. Zinter
- Division of Critical Care, Department of Pediatrics, University of California, San Francisco Benioff Children’s Hospital San Francisco, San Francisco
| | - Aline B. Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Melania M. Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Irby
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock
| | - Danielle M. Zerr
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Joseph D. Kuebler
- Division of Pediatric Critical Care, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York
| | - Christopher J. Babbitt
- Division of Pediatric Critical Care, Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California
| | - Mary Glas Gaspers
- Division of Critical Care, Department of Pediatrics, Banner Children’s at Diamond Children’s Medical Center, Tucson, Arizona
| | - Ryan A. Nofziger
- Division of Critical Care Medicine, Akron Children’s Hospital, Akron, Ohio
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Bria M. Coates
- Division of Pediatric Critical Care Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Shira J. Gertz
- Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey
| | - Elizabeth H. Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Benjamin R. White
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City
| | - Helen Harvey
- Division of Pediatric Critical Care, Rady Children’s Hospital-San Diego, San Diego, California
| | - Charlotte V. Hobbs
- Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson
| | - Heda Dapul
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Andrew D. Butler
- Division of Pediatric Critical Care, St Christopher’s Hospital for Children, Philadelphia, Pennsylvania
| | - Tamara T. Bradford
- Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans, New Orleans
| | - Courtney M. Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City
| | - Mary Allen Staat
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cassyanne L. Aguiar
- Division of Pediatric Rheumatology, Children’s Hospital of The King’s Daughters, Eastern Virginia Medical School, Norfolk
| | - Saul R. Hymes
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Bernard and Millie Duker Children’s Hospital, Albany Med Health System, Albany, New York
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Angela P. Campbell
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
40
|
Singh S, Maheshwari A, Namazova I, Benjamin JT, Wang Y. Respiratory Syncytial Virus Infections in Neonates: A Persisting Problem. NEWBORN (CLARKSVILLE, MD.) 2023; 2:222-234. [PMID: 38348152 PMCID: PMC10860331 DOI: 10.5005/jp-journals-11002-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in young infants. It is an enveloped, single-stranded, nonsegmented, negative-strand RNA virus, a member of the family Pneumoviridae. Globally, RSV is responsible for 2.3% of deaths among neonates 0-27 days of age. Respiratory syncytial virus infection is most common in children aged below 24 months. Neonates present with cough and fever. Respiratory syncytial virus-associated wheezing is seen in 20% infants during the first year of life of which 2-3% require hospitalization. Reverse transcriptase polymerase chain reaction (RT-PCR) gives fast results and has higher sensitivity compared with culture and rapid antigen tests and are not affected by passively administered antibody to RSV. Therapy for RSV infection of the LRT is mainly supportive, and preventive measures like good hygiene and isolation are the mainstay of management. Standard precautions, hand hygiene, breastfeeding and contact isolation should be followed for RSV-infected newborns. Recent AAP guidelines do not recommend pavilizumab prophylaxis for preterm infants born at 29-35 weeks without chronic lung disease, hemodynamically significant congenital heart disease and coexisting conditions. RSV can lead to long-term sequelae such as wheezing and asthma, associated with increased healthcare costs and reduced quality of life.
Collapse
Affiliation(s)
- Srijan Singh
- Neonatologist, Kailash Hospital, Noida, Uttar Pradesh, India
- Global Newborn Society (https://www.globalnewbornsociety.org/)
| | - Akhil Maheshwari
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Pediatrics, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Ilhama Namazova
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Pediatrics, Azerbaijan Tibb Universiteti, Baku, Azerbaijan
| | - John T Benjamin
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Yuping Wang
- Department of Obstetrics and Gynaecology, Louisiana State University, Shreveport, Louisiana, United States of America
| |
Collapse
|
41
|
Divarathna MVM, Rafeek RAM, Morel AJ, Aththanayake C, Noordeen F. Epidemiology and risk factors of respiratory syncytial virus associated acute respiratory tract infection in hospitalized children younger than 5 years from Sri Lanka. Front Microbiol 2023; 14:1173842. [PMID: 37434712 PMCID: PMC10330818 DOI: 10.3389/fmicb.2023.1173842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is the leading cause of acute respiratory tract infections (ARTI) and a major cause of morbidity and mortality in children worldwide. Aim This study aimed to describe the prevalence and seasonal patterns of RSV and to determine the actual and predictive association of RSV-associated ARTI and clinical, socio-demographic, and climatic risk factors in children < 5 years. Methods Nasopharyngeal aspirates were collected from 500 children < 5 years admitted to the Kegalle General Hospital, Sri Lanka between May 2016 to July 2018. RSV and RSV subtypes were detected using immunofluorescence assay and real time RT-PCR, respectively. Descriptive and inferential statistics were done for the data analysis using Chi-square, Fisher's exact, Kruskal-Wallis test, and multiple binary logistic regression in the statistical package for social sciences (SPSS), version 16.0. Results Prevalence of RSV-associated ARTI was 28% in children < 5 years. Both RSV subtypes were detected throughout the study period. RSV-B was the dominant subtype detected with a prevalence of 72.14%. RSV infection in general caused severe respiratory disease leading to hypoxemia. Compared to RSV-B, RSV-A infection had more symptoms leading to hypoxemia. Factors increasing the risk of contracting RSV infection included number of people living (n > 6), having pets at home and inhaling toxic fumes. The inferential analysis predicts RSV infection in children < 5 years with ARTI, with a 75.4% probability with clinical and socio-demographic characteristics like age < 1 year, fever for > 4 days, cough, conjunctivitis, stuffiness, fatigue, six or more people at home, having pets at home and inhaling toxic fumes. Climatic factors like increases in temperature (°C), wind speed (Km/h), wind gust (Km/h), rainfall (mm) and atmospheric pressure (mb) showed a strong correlation with the RSV infection in children.
Collapse
Affiliation(s)
- Maduja V. M. Divarathna
- Department of Microbiology, Faculty of Medicine, Diagnostic and Research Virology Laboratory, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rukshan A. M. Rafeek
- Department of Microbiology, Faculty of Medicine, Diagnostic and Research Virology Laboratory, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, Diagnostic and Research Virology Laboratory, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
42
|
Trautmannsberger I, Bösl S, Tischer C, Kostenzer J, Mader S, Zimmermann LJI. ResQ Family: Respiratory Syncytial Virus (RSV) Infection in Infants and Quality of Life of Families-Study Protocol of a Multi-Country Family Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5917. [PMID: 37297526 PMCID: PMC10252710 DOI: 10.3390/ijerph20115917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/25/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
(1) Respiratory syncytial virus (RSV) infection in infants not only affects the child itself, but also their families. Nevertheless, information on the overall impact is scarce. A comprehensive caregiver-specific approach covering essential (health) dimensions and relevant stakeholders was initiated under the ResQ Family study conducted in Germany, France, Italy and Sweden. The primary objective is to investigate the health-related quality of life of parents and/or caregivers of children (<24 months) hospitalised for RSV. (2) Each participant completes an online questionnaire disseminated via social media and printed material in hospitals. Using the PedsQLTM FIM as well as further self-designed questions, parent and patient characteristics as well as potential stressors and preventive factors are recorded at baseline and after six weeks. Multivariate regression models with health-related quality of life as main outcome parameter will be conducted. (3) The study is currently in the recruitment process. A full analysis will be performed once the data collection phase is complete. First results are to be expected in late 2023. (4) Publishing the results in the form of scientific papers but also non-scientific (information) material will help us raise awareness for RSV and the importance of prevention among healthcare professionals, patient representatives and decision-makers.
Collapse
Affiliation(s)
| | - Sabina Bösl
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
| | - Christina Tischer
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
- Department of Health Security, Finnish Institute for Health and Welfare, FIN-70701 Kuopio, Finland
| | - Johanna Kostenzer
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
| | - Luc J. I. Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
- Department of Paediatrics, Research School for Oncology and Reproduction, Maastricht UMC+, 6229 ER Maastricht, The Netherlands
| | | |
Collapse
|
43
|
Sun YL, Zhao PP, Zhu CB, Jiang MC, Li XM, Tao JL, Hu CC, Yuan B. Integrating metabolomics and network pharmacology to assess the effects of quercetin on lung inflammatory injury induced by human respiratory syncytial virus. Sci Rep 2023; 13:8051. [PMID: 37198253 DOI: 10.1038/s41598-023-35272-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/15/2023] [Indexed: 05/19/2023] Open
Abstract
Quercetin (QR) has significant anti-respiratory syncytial virus (RSV) effects. However, its therapeutic mechanism has not been thoroughly explored. In this study, a lung inflammatory injury model caused by RSV was established in mice. Untargeted lung tissue metabolomics was used to identify differential metabolites and metabolic pathways. Network pharmacology was used to predict potential therapeutic targets of QR and analyze biological functions and pathways modulated by QR. By overlapping the results of the metabolomics and the network pharmacology analyses, the common targets of QR that were likely to be involved in the amelioration of RSV-induced lung inflammatory injury by QR were identified. Metabolomics analysis identified 52 differential metabolites and 244 corresponding targets, while network pharmacology analysis identified 126 potential targets of QR. By intersecting these 244 targets with the 126 targets, hypoxanthine-guanine phosphoribosyltransferase (HPRT1), thymidine phosphorylase (TYMP), lactoperoxidase (LPO), myeloperoxidase (MPO), and cytochrome P450 19A1 (CYP19A1) were identified as the common targets. The key targets, HPRT1, TYMP, LPO, and MPO, were components of purine metabolic pathways. The present study demonstrated that QR effectively ameliorated RSV-induced lung inflammatory injury in the established mouse model. Combining metabolomics and network pharmacology showed that the anti-RSV effect of QR was closely associated with purine metabolism pathways.
Collapse
Affiliation(s)
- Ya-Lei Sun
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Pei-Pei Zhao
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng-Bi Zhu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | | | - Xin-Min Li
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Jia-Lei Tao
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
| | - Chan-Chan Hu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
| |
Collapse
|
44
|
Uwak I, Johnson N, Mustapha T, Rahman M, Tonpay T, Regan AK, Mendoza-Sanchez I. Quantifying changes in respiratory syncytial virus-associated hospitalizations among children in Texas during COVID-19 pandemic using records from 2006 to 2021. Front Pediatr 2023; 11:1124316. [PMID: 36994433 PMCID: PMC10040829 DOI: 10.3389/fped.2023.1124316] [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: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
Aim To quantify changes on RSV- associated hospitalizations during COVID-19 pandemic, among children four years of age or younger at the state and county levels of Texas using routinely acquired hospital admission records. Methods We used the Texas Public Use Data Files (PUDF) of the Department of State Human Services (DSHS) to obtain hospital admissions and healthcare outcomes from 2006 to 2021. We used the 2006-2019 period to estimate a long-term temporal trend and predict expected values for 2020-2021. Actual and predicted values were used to quantify changes in seasonal trends of the number of hospital admissions and mean length of hospital stay. Additionally, we calculated hospitalization rates and assessed their similarity to rates reported in the RSV Hospitalization Surveillance Network (RSV-NET). Results An unusually low number of hospitalizations in 2020 was followed by an unusual peak in the third quarter of 2021. Hospital admissions in 2021 were approximately twice those in a typical year. The mean length of hospital stay typically followed a seasonal trend before COVID-19, but increased by a factor of ∼6.5 during the pandemic. Spatial distribution of hospitalization rates revealed localized healthcare infrastructure overburdens during COVID-19. RSV associated hospitalization rates were, on average, two times higher than those of RSV-NET. Conclusion Hospital admission data can be used to estimate long-term temporal and spatial trends and quantify changes during events that exacerbate healthcare systems, such as pandemics. Using the mean difference between hospital rates calculated with hospital admissions and hospital rates obtained from RSV-NET, we speculate that state-level hospitalization rates for 2022 could be at least twice those observed in the two previous years, and the highest in the last 17 years.
Collapse
Affiliation(s)
- Inyang Uwak
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, United States
| | - Natalie Johnson
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, United States
| | - Toriq Mustapha
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, United States
| | - Mariya Rahman
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, United States
| | - Tanaya Tonpay
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, United States
| | - Annette K. Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States
| | - Itza Mendoza-Sanchez
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, United States
| |
Collapse
|
45
|
Cocchio S, Prandi GM, Furlan P, Venturato G, Saia M, Marcon T, Tremolada G, Baldo V. Respiratory Syncytial Virus in Veneto Region: Analysis of Hospital Discharge Records from 2007 to 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4565. [PMID: 36901576 PMCID: PMC10002215 DOI: 10.3390/ijerph20054565] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Respiratory Syncytial Virus (RSV) is a known cause of acute lower respiratory infections in infants and young children. The present study aims to analyze the temporal trends and characteristics of hospitalization related to RSV in the Veneto region (Italy) in the period between 2007 and 2021. The analysis is performed on all the hospital discharge records (HDRs) of public and accredited private hospitals corresponding to hospitalizations occurring in the Veneto region (Italy). HDRs are considered if they included at least one of the following ICD9-CM codes: 079.6-Respiratory Syncytial Virus (RSV); 466.11-acute bronchiolitis due to RSV; and 480.1-pneumonia due to RSV. Total annual cases, sex, and age-specific rates and trends are evaluated. Overall, an increasing trend in the number of hospitalizations due to RSV was observed between 2007 and 2019, with a slight drop in RSV seasons 2013-2014 and 2014-2015. From March 2020 to September 2021, almost no hospitalization was registered, but in the last quarter of 2021, the number of hospitalizations reached its highest value in the series. Our data confirm the preponderance of RSV hospitalizations in infants and young children, the seasonality of RSV hospitalizations, and acute bronchiolitis as the most frequent diagnosis. Interestingly, the data also show the existence of a significant burden of disease and a non-negligible number of deaths also in older adults. The present study confirms RSV is associated with high rates of hospitalization in infants and sheds light on the burden in the 70+ age group in which a considerable number of deaths was observed, as well as the parallelism with other countries, which is consistent with a wide underdiagnoses issue.
Collapse
Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Gian Marco Prandi
- Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Patrizia Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giovanni Venturato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Mario Saia
- “Azienda Zero” of Veneto Region, 35100 Padua, Italy
| | | | - Giulia Tremolada
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| |
Collapse
|
46
|
Belachew AB, Rantala AK, Jaakkola MS, Hugg TT, Jaakkola JJK. Asthma and Respiratory Infections From Birth to Young Adulthood. Am J Epidemiol 2023; 192:408-419. [PMID: 36516986 PMCID: PMC9985109 DOI: 10.1093/aje/kwac210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/22/2022] [Accepted: 12/07/2022] [Indexed: 12/16/2022] Open
Abstract
We applied data from a population-based prospective study, the Espoo Cohort Study (n = 2,568), to identify the potential susceptibility of persons with asthma to respiratory tract infections (RTIs). Information on the occurrence of asthma and both upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs) was collected with a questionnaire at baseline and at the 6-year and 20-year follow-up studies, and from the Finnish national health registries. We estimated age- and sex-specific incidence rate differences (IRDs) and incidence rate ratios (IRRs) by applying negative binomial regression. Meta-regression was used to summarize the age-specific IRRs from childhood to 27 years of age. Individuals with asthma at any age during the follow-up period had increased risks of both URTIs (adjusted IRD = 72.6 (95% confidence interval (CI): 50.6, 94.7) per 100 person-years; adjusted IRR = 1.27 (95% CI: 1.20, 1.35)) and LRTIs (adjusted IRD = 25.5 (95% CI: 17.9, 33.1); adjusted IRR = 2.87 (95% CI: 2.33, 3.53)) from childhood to young adulthood. In young adulthood, the association between asthma and URTIs was stronger in women than in men, while such an association was not detected for LRTIs. This analysis provides strong evidence that persons with asthma experience more RTIs from preschool age to young adulthood than do those without asthma. Thus, they constitute a susceptible population for RTIs. Women with asthma are at especially high risk.
Collapse
Affiliation(s)
| | | | | | | | - Jouni J K Jaakkola
- Correspondence to Prof. Jouni J. K. Jaakkola, Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu FI-90014, Finland ()
| |
Collapse
|
47
|
Noppert GA, Hegde ST, Kubale JT. Exposure, Susceptibility, and Recovery: A Framework for Examining the Intersection of the Social and Physical Environments and Infectious Disease Risk. Am J Epidemiol 2023; 192:475-482. [PMID: 36255177 PMCID: PMC10372867 DOI: 10.1093/aje/kwac186] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023] Open
Abstract
Despite well-documented evidence that structurally disadvantaged populations are disproportionately affected by infectious diseases, our understanding of the pathways that connect structural disadvantage to the burden of infectious diseases is limited. We propose a conceptual framework to facilitate more rigorous examination and testing of hypothesized mechanisms through which social and environmental factors shape the burden of infectious diseases and lead to persistent inequities. Drawing upon the principles laid out by Link and Phelan in their landmark paper on social conditions (J Health Soc Behav. 1995;(spec no.):80-94), we offer an explication of potential pathways through which structural disadvantage (e.g., racism, sexism, and economic deprivation) operates to produce infectious disease inequities. Specifically, we describe how the social environment affects an individual's risk of infectious disease by 1) increasing exposure to infectious pathogens and 2) increasing susceptibility to infection. This framework will facilitate both the systematic examination of the ways in which structural disadvantage shapes the burden of infectious disease and the design of interventions that can disrupt these pathways.
Collapse
Affiliation(s)
- Grace A Noppert
- Survey Research Center, Institute for Social Research, University of Michigan
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins University
| | - John T Kubale
- ICPSR, Institute for Social Research, University of Michigan
| |
Collapse
|
48
|
Muckian MD, Wilson JF, Taylor GS, Stagg HR, Pirastu N. Mendelian randomisation identifies priority groups for prophylactic EBV vaccination. BMC Infect Dis 2023; 23:65. [PMID: 36737699 PMCID: PMC9896437 DOI: 10.1186/s12879-023-08031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Epstein Barr virus (EBV) infects ~ 95% of the population worldwide and is known to cause adverse health outcomes such as Hodgkin's, non-Hodgkin's lymphomas, and multiple sclerosis. There is substantial interest and investment in developing infection-preventing vaccines for EBV. To effectively deploy such vaccines, it is vital that we understand the risk factors for infection. Why particular individuals do not become infected is currently unknown. The current literature, describes complex, often conflicting webs of intersecting factors-sociodemographic, clinical, genetic, environmental-, rendering causality difficult to decipher. We aimed to use Mendelian randomization (MR) to overcome the issues posed by confounding and reverse causality to determine the causal risk factors for the acquisition of EBV. METHODS We mapped the complex evidence from the literature prior to this study factors associated with EBV serostatus (as a proxy for infection) into a causal diagram to determine putative risk factors for our study. Using data from the UK Biobank of 8422 individuals genomically deemed to be of white British ancestry between the ages of 40 and 69 at recruitment between the years 2006 and 2010, we performed a genome wide association study (GWAS) of EBV serostatus, followed by a Two Sample MR to determine which putative risk factors were causal. RESULTS Our GWAS identified two novel loci associated with EBV serostatus. In MR analyses, we confirmed shorter time in education, an increase in number of sexual partners, and a lower age of smoking commencement, to be causal risk factors for EBV serostatus. CONCLUSIONS Given the current interest and likelihood of a future EBV vaccine, these factors can inform vaccine development and deployment strategies by completing the puzzle of causality. Knowing these risk factors allows identification of those most likely to acquire EBV, giving insight into what age to vaccinate and who to prioritise when a vaccine is introduced.
Collapse
Affiliation(s)
- Marisa D. Muckian
- grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - James F. Wilson
- grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK ,grid.4305.20000 0004 1936 7988MRC Human Genetics Unit, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road, Edinburgh, EH4 2XU UK
| | - Graham S. Taylor
- grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT UK
| | - Helen R. Stagg
- grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Nicola Pirastu
- grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK ,grid.510779.d0000 0004 9414 6915Human Technopole, Viale Rita Levi-Montalcini, 1, Area MIND–Cargo 6, 20157 Milan, Italy
| |
Collapse
|
49
|
Ebersjö C, Berggren Broström E, Kull I, Lindholm Olinder A. Home Immunization with Palivizumab-A Randomized Pilot Study Describing Safety Aspects and Parents' Preferences. CHILDREN (BASEL, SWITZERLAND) 2023; 10:198. [PMID: 36832327 PMCID: PMC9955059 DOI: 10.3390/children10020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Among prematurely born infants and newborns with chronic conditions, a respiratory syncytial virus (RSV) infection may cause (re-)admission and later respiratory complications. Therapeutic protection is possible with monthly injections of a specific monoclonal antibody, palivizumab, during RSV season. Standard care is giving up to five injections in clinic-based settings. Immunization at home could be an alternative to standard care for vulnerable infants to reduce the number of revisits and associated risk of RSV infection. The aim of this randomized pilot trial was to evaluate safety aspects and explore parents' preferences of home versus hospital immunization with palivizumab during one RSV season. Immediate adverse events (AEs) were observed and registered by a pediatric specialist nurse. Late-onset AEs were reported by parents. Parents' perceptions were collected through a questionnaire and analyzed using content analysis. The study population consisted of 43 infants in 38 families. No immediate AEs occurred. Three late-onset AEs were reported in two infants in the intervention group. Three categories emerged in the content analysis: (1) protect and watch over the infant, (2) optimal health and well-being for the whole family, and (3) avoid suffering for the infant. The study results show that home immunization with palivizumab is feasible if safety aspects are considered and that parental involvement in the choice of place for immunization after a neonatal intensive care experience can be important.
Collapse
Affiliation(s)
- Christina Ebersjö
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 171 77 Stockholm, Sweden
- Sach’s Children and Youth Hospital, Södersjukhuset AB, 118 83 Stockholm, Sweden
| | - Eva Berggren Broström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 171 77 Stockholm, Sweden
- Sach’s Children and Youth Hospital, Södersjukhuset AB, 118 83 Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 171 77 Stockholm, Sweden
- Sach’s Children and Youth Hospital, Södersjukhuset AB, 118 83 Stockholm, Sweden
| |
Collapse
|
50
|
Regassa BT, Gebrewold LA, Mekuria WT, Kassa NA. Molecular epidemiology of respiratory syncytial virus in children with acute respiratory illnesses in Africa: A systematic review and meta-analysis. J Glob Health 2023; 13:04001. [PMID: 36637855 PMCID: PMC9840062 DOI: 10.7189/jogh.13.04001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Globally, the respiratory syncytial virus (RSV) is the most common etiologic agent of acute respiratory illnesses in children. However, its burden has not been well addressed in developing countries. We aimed to estimate the molecular epidemiology of RSV in children less than 18 years of age with acute respiratory infections in Africa by conducting a systematic review and meta-analysis. Methods We systematically searched PubMed, Scopus, CINAHL, and Global Index Medicus databases to identify studies published from January 1, 2002, to April 27, 2022, following the PRISMA 2020 guideline. We assessed the study quality using the Joanna Brigg's Institute (JBI) critical appraisal checklists. We conducted a qualitative synthesis by describing the characteristics of included studies and performed the quantitative synthesis with random effects model using STATA-14. We checked for heterogeneity with Q statistics, quantified by I2, and determined the prediction interval. We performed subgroup analyses to explain the sources of heterogeneity and assessed publication biases by funnel plots augmented with Egger's test. Results Eighty-eight studies with 105 139 participants were included in the review. The overall pooled prevalence of RSV in children <18 years of age was 23% (95% confidence interval (CI) = 20, 25%). Considerable heterogeneity was present across the included studies. The adjusted prediction interval was found to be 19%-27%. Heterogeneities were explained by subgroups analyses. The highest prevalence of RSV was found among inpatients, 28% (95% CI = 25, 31%) compared with inpatients/outpatients and outpatients, with statistically significant differences (P < 0.01). The RSV estimate was also highest among those with acute lower respiratory tract illnesses (ALRTIs), 28% (95% CI = 25, 31%) compared with acute upper respiratory tract illnesses (AURTIs) and both acute upper/lower respiratory manifestations, with statistically different prevalence (P < 0.01). RSV infection estimates in each sub-region of Africa were statistically different (P < 0.01). There were no statistically significant differences in RSV infections by designs, specimen types, and specimen conditions, despite them contributing to heterogeneity. Conclusions We found a high prevalence of RSV in pediatric populations with acute respiratory tract illnesses in Africa, highlighting that the prevention and control of RSV infections in children deserve more attention. Registration PROSPERO CRD42022327054.
Collapse
Affiliation(s)
- Belay Tafa Regassa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ethiopia
| | - Lami Abebe Gebrewold
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ethiopia
| | - Wagi Tosisa Mekuria
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ethiopia
| | - Nega Assefa Kassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Ethiopia
| |
Collapse
|