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Sanchez Clemente N, Coles C, Paixao ES, Brickley EB, Whittaker E, Alfven T, Rulisa S, Agudelo Higuita N, Torpiano P, Agravat P, Thorley EV, Drysdale SB, Le Doare K, Muyembe Tamfum JJ. Paediatric, maternal, and congenital mpox: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e572-e588. [PMID: 38401556 DOI: 10.1016/s2214-109x(23)00607-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Although mpox has been detected in paediatric populations in central and west Africa for decades, evidence synthesis on paediatric, maternal, and congenital mpox, and the use of vaccines and therapeutics in these groups, is lacking. A systematic review is therefore indicated to set the research agenda. METHODS We conducted a systematic review and meta-analysis, searching articles in Embase, Global Health, MEDLINE, CINAHL, Web of Science, Scopus, SciELO, and WHO databases from inception to April 17, 2023. We included studies reporting primary data on at least one case of confirmed, suspected, or probable paediatric, maternal, or congenital mpox in humans or the use of third-generation smallpox or mpox vaccines, targeted antivirals, or immune therapies in at least one case in our population of interest. We included clinical trials and observational studies in humans and excluded reviews, commentaries, and grey literature. A pooled estimate of the paediatric case fatality ratio was obtained using random-effects meta-analysis. This study is registered with PROSPERO (CRD420223336648). FINDINGS Of the 61 studies, 53 reported paediatric outcomes (n=2123 cases), seven reported maternal or congenital outcomes (n=32 cases), two reported vaccine safety (n=28 recipients), and three reported transmission during breastfeeding (n=4 cases). While a subset of seven observational studies (21 children and 12 pregnant individuals) reported uneventful treatment with tecovirimat, there were no randomised trials reporting safety or efficacy for any therapeutic agent. Among children, the commonest clinical features included rash (86 [100%] of 86), fever (63 [73%] of 86), and lymphadenopathy (40 [47%] of 86). Among pregnant individuals, rash was reported in 23 (100%) of 23; fever and lymphadenopathy were less common (six [26%] and three [13%] of 23, respectively). Most paediatric complications (12 [60%] of 20) arose from secondary bacterial infections. The pooled paediatric case fatality ratio was 11% (95% CI 4-20), I2=75%. Data from 12 pregnancies showed half resulted in fetal death. Research on vaccine and immune globulin safety remains scarce for children and absent for pregnant individuals. INTERPRETATION Our review highlights critical knowledge gaps in the epidemiology, prevention, and treatment of mpox in children and pregnant individuals, especially those residing in endemic countries. Increased funding, international collaboration, and equitable research is needed to inform mpox control strategies tailored for at-risk communities in endemic countries. FUNDING None. TRANSLATIONS For the French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nuria Sanchez Clemente
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK; Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Charlotte Coles
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Enny S Paixao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK; Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University of Rwanda and University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Nelson Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Paul Torpiano
- Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Malta
| | - Priyesh Agravat
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Emma V Thorley
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Simon B Drysdale
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK; Centre of Excellence in Maternal Vaccination, Makerere University, John Hopkins University, Kampala, Uganda; Pathogen Immunology Group, UK Health Security Agency, Porton Down, UK
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Faust SN, Drysdale SB, Vassilouthis NC. Nirsevimab for Prevention of RSV Hospitalizations in Infants. Reply. N Engl J Med 2024; 390:1152-1153. [PMID: 38507766 DOI: 10.1056/nejmc2400983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Saul N Faust
- University of Southampton, Southampton, United Kingdom
| | - Simon B Drysdale
- St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
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Lin GL, Drysdale SB, Snape MD, O'Connor D, Brown A, MacIntyre-Cockett G, Mellado-Gomez E, de Cesare M, Ansari MA, Bonsall D, Bray JE, Jolley KA, Bowden R, Aerssens J, Bont L, Openshaw PJM, Martinon-Torres F, Nair H, Golubchik T, Pollard AJ. Targeted metagenomics reveals association between severity and pathogen co-detection in infants with respiratory syncytial virus. Nat Commun 2024; 15:2379. [PMID: 38493135 PMCID: PMC10944482 DOI: 10.1038/s41467-024-46648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/23/2024] [Indexed: 03/18/2024] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of hospitalisation for respiratory infection in young children. RSV disease severity is known to be age-dependent and highest in young infants, but other correlates of severity, particularly the presence of additional respiratory pathogens, are less well understood. In this study, nasopharyngeal swabs were collected from two cohorts of RSV-positive infants <12 months in Spain, the UK, and the Netherlands during 2017-20. We show, using targeted metagenomic sequencing of >100 pathogens, including all common respiratory viruses and bacteria, from samples collected from 433 infants, that burden of additional viruses is common (111/433, 26%) but only modestly correlates with RSV disease severity. In contrast, there is strong evidence in both cohorts and across age groups that presence of Haemophilus bacteria (194/433, 45%) is associated with higher severity, including much higher rates of hospitalisation (odds ratio 4.25, 95% CI 2.03-9.31). There is no evidence for association between higher severity and other detected bacteria, and no difference in severity between RSV genotypes. Our findings reveal the genomic diversity of additional pathogens during RSV infection in infants, and provide an evidence base for future causal investigations of the impact of co-infection on RSV disease severity.
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Affiliation(s)
- Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
- NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Anthony Brown
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | | | - Esther Mellado-Gomez
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Human Technopole, Milan, Italy
| | - M Azim Ansari
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - David Bonsall
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James E Bray
- Department of Biology, University of Oxford, Oxford, UK
| | | | - Rory Bowden
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Jeroen Aerssens
- Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Louis Bont
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- ReSViNET Foundation, Zeist, Netherlands
| | | | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Genetics, Vaccines, Infectious Diseases and Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanya Golubchik
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Sydney Infectious Diseases Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Johnson M, Chelysheva I, Öner D, McGinley J, Lin GL, O'Connor D, Robinson H, Drysdale SB, Gammin E, Vernon S, Muller J, Wolfenden H, Westcar S, Anguvaa L, Thwaites RS, Bont L, Wildenbeest J, Martinón-Torres F, Aerssens J, Openshaw PJM, Pollard AJ. A Genome-Wide Association Study of Respiratory Syncytial Virus Infection Severity in Infants. J Infect Dis 2024; 229:S112-S119. [PMID: 38271230 DOI: 10.1093/infdis/jiae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a significant cause of infant morbidity and mortality worldwide. Most children experience at least one 1 RSV infection by the age of two 2 years, but not all develop severe disease. However, the understanding of genetic risk factors for severe RSV is incomplete. Consequently, we conducted a genome-wide association study of RSV severity. METHODS Disease severity was assessed by the ReSVinet scale, in a cohort of 251 infants aged 1 week to 1 year. Genotyping data were collected from multiple European study sites as part of the RESCEU Consortium. Linear regression models were used to assess the impact of genotype on RSV severity and gene expression as measured by microarray. RESULTS While no SNPs reached the genome-wide statistical significance threshold (P < 5 × 10-8), we identified 816 candidate SNPs with a P-value of <1 × 10-4. Functional annotation of candidate SNPs highlighted genes relevant to neutrophil trafficking and cytoskeletal functions, including LSP1 and RAB27A. Moreover, SNPs within the RAB27A locus significantly altered gene expression (false discovery rate, FDR P < .05). CONCLUSIONS These findings may provide insights into genetic mechanisms driving severe RSV infection, offering biologically relevant information for future investigations.
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Affiliation(s)
- Mari Johnson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Irina Chelysheva
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Deniz Öner
- Biomarkers Infectious Diseases, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Joseph McGinley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Emma Gammin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Sophie Vernon
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Jill Muller
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | | | | | | | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Louis Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - Joanne Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela
- Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Jeroen Aerssens
- Biomarkers Infectious Diseases, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, United Kingdom
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Sheikh Z, Potter E, Li Y, Drysdale SB, Wildenbeest JG, Robinson H, McGinley J, Lin GL, Öner D, Aerssens J, Justicia-Grande AJ, Martinón-Torres F, Pollard AJ, Bont L, Nair H. External Validation of the Discriminative Validity of the ReSVinet Score and Development of Simplified ReSVinet Scores in Secondary Care. J Infect Dis 2024; 229:S18-S24. [PMID: 37712125 DOI: 10.1093/infdis/jiad388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND There is no consensus on how to best quantify disease severity in infants with respiratory syncytial virus (RSV) and/or bronchiolitis; this lack of a sufficiently validated score complicates the provision of clinical care and, the evaluation of trials of therapeutics and vaccines. The ReSVinet score appears to be one of the most promising; however, it is too time consuming to be incorporated into routine clinical care. We aimed to develop and externally validate simplified versions of this score. METHODS Data from a multinational (the Netherlands, Spain, and United Kingdom) multicenter case-control study of infants with RSV were used to develop simplified versions of the ReSVinet score by conducting a grid search to determine the best combination of equally weighted parameters to maximize for the discriminative ability (measured by area under the receiver operating characteristic curve [AUROC]) across a range of outcomes (hospitalization, intensive care unit admission, ventilation requirement). Subsequently discriminative validity of the score for a range of secondary care outcomes was externally validated by secondary analysis of datasets from Rwanda and Colombia. RESULTS Three candidate simplified scores were identified using the development dataset; they were excellent (AUROC >0.9) at discriminating for a range of outcomes, and their performance was not significantly different from the original ReSVinet score despite having fewer parameters. In the external validation datasets, the simplified scores were moderate to excellent (AUROC, 0.7-1) across a range of outcomes. In all outcomes, except in a single dataset for predicting admission to the high-dependency unit, they performed at least as well as the original ReSVinet score. CONCLUSIONS The candidate simplified scores developed require further external validation in larger datasets, ideally from resource-limited settings before any recommendation regarding their use.
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Affiliation(s)
- Zakariya Sheikh
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Ellie Potter
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - You Li
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Simon B Drysdale
- Centre for Neonatal & Paediatric Infection, St George's, University of London, London, United Kingdom
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Joseph McGinley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Deniz Öner
- Infectious Diseases Translational Biomarkers, Janssen Pharmaceutica, Beerse, Belgium
| | - Jeroen Aerssens
- Infectious Diseases Translational Biomarkers, Janssen Pharmaceutica, Beerse, Belgium
| | - Antonio José Justicia-Grande
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Department of Pediatrics, Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Louis Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harish Nair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Gkentzi D, Blázquez-Gamero D, Buxmann H, Drysdale SB, Papaevangelou V, Lyall H. Congenital CMV Monthly International Virtual Clinics: A cCMVnet European Initiative. Pediatr Infect Dis J 2024; 43:e26-e27. [PMID: 37922475 DOI: 10.1097/inf.0000000000004133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
- Despoina Gkentzi
- Department of Pediatrics, Patras Medical School, University General Hospital of Patras, Rio, Greece
| | | | - Horst Buxmann
- Department of Pediatrics and Neonatology, Main-Kinzig Clinics, Gelnhausen, Germany
| | - Simon B Drysdale
- Centre for Neonatal and Paediatric Infections, St George's, University of London, London, United Kingdom, Department of Paediatrics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vassiliki Papaevangelou
- Third Department of Paediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Hermione Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
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Drysdale SB, Cathie K, Flamein F, Knuf M, Collins AM, Hill HC, Kaiser F, Cohen R, Pinquier D, Felter CT, Vassilouthis NC, Jin J, Bangert M, Mari K, Nteene R, Wague S, Roberts M, Tissières P, Royal S, Faust SN. Nirsevimab for Prevention of Hospitalizations Due to RSV in Infants. N Engl J Med 2023; 389:2425-2435. [PMID: 38157500 DOI: 10.1056/nejmoa2309189] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The safety of the monoclonal antibody nirsevimab and the effect of nirsevimab on hospitalizations for respiratory syncytial virus (RSV)-associated lower respiratory tract infection when administered in healthy infants are unclear. METHODS In a pragmatic trial, we randomly assigned, in a 1:1 ratio, infants who were 12 months of age or younger, had been born at a gestational age of at least 29 weeks, and were entering their first RSV season in France, Germany, or the United Kingdom to receive either a single intramuscular injection of nirsevimab or standard care (no intervention) before or during the RSV season. The primary end point was hospitalization for RSV-associated lower respiratory tract infection, defined as hospital admission and an RSV-positive test result. A key secondary end point was very severe RSV-associated lower respiratory tract infection, defined as hospitalization for RSV-associated lower respiratory tract infection with an oxygen saturation of less than 90% and the need for supplemental oxygen. RESULTS A total of 8058 infants were randomly assigned to receive nirsevimab (4037 infants) or standard care (4021 infants). Eleven infants (0.3%) in the nirsevimab group and 60 (1.5%) in the standard-care group were hospitalized for RSV-associated lower respiratory tract infection, which corresponded to a nirsevimab efficacy of 83.2% (95% confidence interval [CI], 67.8 to 92.0; P<0.001). Very severe RSV-associated lower respiratory tract infection occurred in 5 infants (0.1%) in the nirsevimab group and in 19 (0.5%) in the standard-care group, which represented a nirsevimab efficacy of 75.7% (95% CI, 32.8 to 92.9; P = 0.004). The efficacy of nirsevimab against hospitalization for RSV-associated lower respiratory tract infection was 89.6% (adjusted 95% CI, 58.8 to 98.7; multiplicity-adjusted P<0.001) in France, 74.2% (adjusted 95% CI, 27.9 to 92.5; multiplicity-adjusted P = 0.006) in Germany, and 83.4% (adjusted 95% CI, 34.3 to 97.6; multiplicity-adjusted P = 0.003) in the United Kingdom. Treatment-related adverse events occurred in 86 infants (2.1%) in the nirsevimab group. CONCLUSIONS Nirsevimab protected infants against hospitalization for RSV-associated lower respiratory tract infection and against very severe RSV-associated lower respiratory tract infection in conditions that approximated real-world settings. (Funded by Sanofi and AstraZeneca; HARMONIE ClinicalTrials.gov number, NCT05437510).
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Affiliation(s)
- Simon B Drysdale
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Katrina Cathie
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Florence Flamein
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Markus Knuf
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Andrea M Collins
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Helen C Hill
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Friedrich Kaiser
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Robert Cohen
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Didier Pinquier
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Christian T Felter
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Natalya C Vassilouthis
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Jing Jin
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Mathieu Bangert
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Karine Mari
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Rapi Nteene
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Sophie Wague
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Michelle Roberts
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Pierre Tissières
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Simon Royal
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Saul N Faust
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
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8
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Zivanovic N, Öner D, Abraham Y, McGinley J, Drysdale SB, Wildenbeest JG, Crabbe M, Vanhoof G, Thys K, Thwaites RS, Robinson H, Bont L, Openshaw PJM, Martinón‐Torres F, Pollard AJ, Aerssens J. Single-cell immune profiling reveals markers of emergency myelopoiesis that distinguish severe from mild respiratory syncytial virus disease in infants. Clin Transl Med 2023; 13:e1507. [PMID: 38115705 PMCID: PMC10731116 DOI: 10.1002/ctm2.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
Whereas most infants infected with respiratory syncytial virus (RSV) show no or only mild symptoms, an estimated 3 million children under five are hospitalized annually due to RSV disease. This study aimed to investigate biological mechanisms and associated biomarkers underlying RSV disease heterogeneity in young infants, enabling the potential to objectively categorize RSV-infected infants according to their medical needs. Immunophenotypic and functional profiling demonstrated the emergence of immature and progenitor-like neutrophils, proliferative monocytes (HLA-DRLow , Ki67+), impaired antigen-presenting function, downregulation of T cell response and low abundance of HLA-DRLow B cells in severe RSV disease. HLA-DRLow monocytes were found as a hallmark of RSV-infected infants requiring hospitalization. Complementary transcriptomics identified genes associated with disease severity and pointed to the emergency myelopoiesis response. These results shed new light on mechanisms underlying the pathogenesis and development of severe RSV disease and identified potential new candidate biomarkers for patient stratification.
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Affiliation(s)
- Nevena Zivanovic
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
| | - Deniz Öner
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
| | - Yann Abraham
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
| | - Joseph McGinley
- Department of PaediatricsOxford Vaccine Group, NIHR Oxford Biomedical Research Centre, University of OxfordLondonUK
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of LondonLondonUK
| | - Joanne G. Wildenbeest
- Department of Pediatric Infectious Diseases and ImmunologyWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
| | - Marjolein Crabbe
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
| | - Greet Vanhoof
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
| | - Kim Thys
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
| | - Ryan S. Thwaites
- Department of Respiratory MedicineNational Heart and Lung Institute, Imperial College LondonLondonUK
| | - Hannah Robinson
- Department of PaediatricsOxford Vaccine Group, NIHR Oxford Biomedical Research Centre, University of OxfordLondonUK
| | - Louis Bont
- Department of Pediatric Infectious Diseases and ImmunologyWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
| | - Peter J. M. Openshaw
- Department of Respiratory MedicineNational Heart and Lung Institute, Imperial College LondonLondonUK
| | - Federico Martinón‐Torres
- Pediatrics DepartmentTranslational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de CompostelaGaliciaSpain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de CompostelaGaliciaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos IIIMadridSpain
| | | | - Andrew J. Pollard
- Department of PaediatricsOxford Vaccine Group, NIHR Oxford Biomedical Research Centre, University of OxfordLondonUK
| | - Jeroen Aerssens
- Discovery Sciences & Translational Biomarkers Infectious DiseasesJanssen Research and DevelopmentBeerseBelgium
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9
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Salaun B, De Smedt J, Vernhes C, Moureau A, Öner D, Bastian AR, Janssens M, Balla-Jhagjhoorsingh S, Aerssens J, Lambert C, Coenen S, Butler CC, Drysdale SB, Wildenbeest JG, Pollard AJ, Openshaw PJM, Bont L. T cells, more than antibodies, may prevent symptoms developing from respiratory syncytial virus infections in older adults. Front Immunol 2023; 14:1260146. [PMID: 37936699 PMCID: PMC10627235 DOI: 10.3389/fimmu.2023.1260146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction The immune mechanisms supporting partial protection from reinfection and disease by the respiratory syncytial virus (RSV) have not been fully characterized. In older adults, symptoms are typically mild but can be serious in patients with comorbidities when the infection extends to the lower respiratory tract. Methods This study formed part of the RESCEU older-adults prospective-cohort study in Northern Europe (2017-2019; NCT03621930) in which a thousand participants were followed over an RSV season. Peripheral-blood samples (taken pre-season, post-season, during illness and convalescence) were analyzed from participants who (i) had a symptomatic acute respiratory tract infection by RSV (RSV-ARTI; N=35) or (ii) asymptomatic RSV infection (RSV-Asymptomatic; N=16). These analyses included evaluations of antibody (Fc-mediated-) functional features and cell-mediated immunity, in which univariate and machine-learning (ML) models were used to explore differences between groups. Results Pre-RSV-season peripheral-blood biomarkers were predictive of symptomatic RSV infection. T-cell data were more predictive than functional antibody data (area under receiver operating characteristic curve [AUROC] for the models were 99% and 76%, respectively). The pre-RSV season T-cell phenotypes which were selected by the ML modelling and which were more frequent in RSV-Asymptomatic group than in the RSV-ARTI group, coincided with prominent phenotypes identified during convalescence from RSV-ARTI (e.g., IFN-γ+, TNF-α+ and CD40L+ for CD4+, and IFN-γ+ and 4-1BB+ for CD8+). Conclusion The evaluation and statistical modelling of numerous immunological parameters over the RSV season suggests a primary role of cellular immunity in preventing symptomatic RSV infections in older adults.
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Affiliation(s)
| | | | | | | | - Deniz Öner
- Biomarkers Infectious Diseases, Janssen Pharmaceutica NV, Beerse, Belgium
| | | | | | | | - Jeroen Aerssens
- Biomarkers Infectious Diseases, Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Samuel Coenen
- Centre for General Practice, Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon B. Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health and care Research (NIHR) Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Joanne G. Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health and care Research (NIHR) Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Peter J. M. Openshaw
- National Heart and Lung Institute , Imperial College London, London, United Kingdom
| | - Louis Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- ReSViNET Foundation, Julius Clinical, Zeist, Netherlands
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10
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Kujawski SA, Banks V, Casey CS, Drysdale SB, Patel A, Massey O, Holbrook T, Pawaskar M. The Clinical and Economic Burden of Antibiotic Use in Pediatric Patients with Varicella Infection: a Retrospective Cohort Analysis of Real-World Data in England. J Infect Dis 2023:jiad420. [PMID: 37795662 DOI: 10.1093/infdis/jiad420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/18/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Varicella is a highly infectious disease, particularly affecting children, that can lead to complications requiring antibiotics or hospitalization. Antibiotic use for varicella management is poorly documented. This study assessed antibiotic use for varicella and its complications in a pediatric population in England. METHODS Data were drawn from medical records in the Clinical Practice Research Datalink and Hospital Episode Statistics datasets. Patients <18 years old diagnosed with varicella during 2014-2018 with 3-month follow-up available were included. We described varicella-related complications, medication use, healthcare resource utilization, and costs from diagnosis until 3-month post-diagnosis. RESULTS We identified 114,578 children with a primary varicella diagnosis. 7.7% (n = 8,814) had a varicella-related complication, the most common being ear, nose, and throat related (37.1%, n = 3,271). In all, 25.9% (n = 29,706/114,578) were prescribed antibiotics. A higher proportion of patients with complications than those without complications were prescribed antibiotics (64.3%, n = 5,668/8,814 vs. 22.7%, n = 24,038/105,764). Mean annualized varicella-related costs were £2,231,481 for the study cohort. Overall, antibiotic prescriptions cost ∼£262,007. CONCLUSIONS This study highlights high antibiotic use and healthcare resource utilization associated with varicella management, particularly in patients with complications. A national varicella vaccination program in England may reduce varicella burden and related complications, medication use, and costs.
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Affiliation(s)
- Stephanie A Kujawski
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey, United States
| | | | | | - Simon B Drysdale
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
- Centre for Neonatal and Paediatric Infection, St George's, University of London, London, United Kingdom
| | | | | | | | - Manjiri Pawaskar
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey, United States
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11
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Channon-Wells S, Elmes J, Muller-Pebody B, McGarrity O, Chappell F, Drysdale SB, Ashiru-Oredope D, Patel S, Demirjian A. National point-prevalence survey of healthcare-associated infections and antimicrobial use: UK-PAS/UKHSA joint call to action for all paediatric services. J Antimicrob Chemother 2023; 78:2392-2394. [PMID: 37611224 PMCID: PMC10805576 DOI: 10.1093/jac/dkad265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
The negative impact of high antimicrobial use (AMU), antimicrobial resistance and healthcare-associated infections (HCAIs) on children is concerning. However, a lack of available paediatric data makes it challenging to design and implement interventions that would improve health outcomes in this population, and impedes efforts to secure additional resources. The upcoming 2023 national point-prevalence survey of HCAIs and AMU in hospitals, led by the UK Health Security Agency, is an opportunity to collect valuable information, which will enable healthcare providers and policy makers to optimize antimicrobial stewardship and infection prevention practices in all populations, including children. These data will facilitate benchmarking and sharing of best practice, internally, nationally and internationally. This is a joint call to action asking all healthcare professionals-particularly in paediatrics-to nominate a lead for their institution and participate in this survey, to ensure appropriate paediatric representation, and help protect children from these growing threats.
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Affiliation(s)
- Samuel Channon-Wells
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
| | - Jocelyn Elmes
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Orlagh McGarrity
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Department of Pharmacy, Great Ormond Street Hospital, London, UK
| | - Faye Chappell
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
| | - Simon B Drysdale
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Centre for Paediatric and Neonatal Infection, St George’s, University of London, London, UK
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Sanjay Patel
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Alicia Demirjian
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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12
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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13
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Petrunin Y, Payne H, Blázquez-Gamero D, Buxmann H, Drysdale SB, Gkentzi D, Papaevangelou V, Lyall H. Discrepancies in Management of Congenital Cytomegalovirus in Preterm Infants: An International Survey. Pediatr Infect Dis J 2023; 42:801-803. [PMID: 37310886 DOI: 10.1097/inf.0000000000003995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We performed an international survey regarding management of infants with congenital cytomegalovirus (cCMV) born at less than 32 weeks gestation or with birth weight under 1500 g. Replies from 51 level 3 neonatal intensive care units across 13 countries demonstrated striking discrepancies in screening practices, testing for cCMV, further investigations of confirmed cases, indications for initiation, and duration of treatment.
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Affiliation(s)
- Yury Petrunin
- From the Neonatal Intensive Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helen Payne
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Daniel Blázquez-Gamero
- Hospital Universitario 12 De Octubre, Pediatric Infectious Diseases Unit, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (imas12) Madrid, Madrid, Spain
| | - Horst Buxmann
- Department of Neonatology, Main-Kinzig-Kliniken, Gelnhausen, Germany
| | - Simon B Drysdale
- Department of Paediatric Infectious Diseases, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, University of Patras, Patras, Greece
| | - Vana Papaevangelou
- Third Department of Paediatrics, General University Hospital "Attikon," Athens, Greece
| | - Hermione Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
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14
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Mammas IN, Drysdale SB, Charalampous C, Koletsi P, Papatheodoropoulou A, Koutsaftiki C, Sergentanis T, Merakou K, Kornarou H, Papaioannou G, Kramvis A, Greenough A, Theodoridou M, Spandidos DA. Navigating paediatric virology through the COVID‑19 era (Review). Int J Mol Med 2023; 52:83. [PMID: 37503745 PMCID: PMC10555476 DOI: 10.3892/ijmm.2023.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
The present review article presents the key messages of the 8th Workshop on Paediatric Virology organised virtually by the Institute of Paediatric Virology based on the island of Euboea in Greece. The major topics covered during the workshop were the following: i) New advances in antiviral agents and vaccines against cytomegalovirus; ii) hantavirus nephropathy in children; iii) human rhinovirus infections in children requiring paediatric intensive care; iv) complications and management of human adenovirus infections; v) challenges of post‑coronavirus disease 2019 (COVID‑19) syndrome in children and adolescents; and vi) foetal magnetic resonance imaging in viral infections involving the central nervous system. The COVID‑19 era requires a more intensive, strategic, global scientific effort in the clinic and in the laboratory, focusing on the diagnosis, management and prevention of viral infections in neonates and children.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London SW17 0RE
- Department of Paediatrics, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | | | - Patra Koletsi
- Department of Paediatrics, 'Penteli' Children's Hospital, 15236 Palaia Penteli
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 15236 Palaia Penteli
| | | | - Chryssie Koutsaftiki
- COVID-19 Reference Centre, 'Rafina' Health Care Centre, 19009 Rafina
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Theodoros Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Kyriakoula Merakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Helen Kornarou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 15123 Athens, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, 2193 Johannesburg, South Africa
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Maria Theodoridou
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
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15
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Mammas IN, Drysdale SB, Theodoridou M, Spandidos DA. Exploring medical terminology inexpediencies: Tripledemic vs. triple epidemic. Exp Ther Med 2023; 26:334. [PMID: 37346400 PMCID: PMC10280319 DOI: 10.3892/etm.2023.12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
Accurate and consistent medical terminology has a fundamental value in medicine. It enables medical students to understand the meaning of each term, medical physicians to communicate with each other, and it also enables science to adopt a logical language of high-level understanding and scientific regularity. Medical terminology inexpediencies caused by the adoption of etymologically illogical or linguistically false terms lead to misunderstanding and confusion among clinicians. The medical terms epidemic and pandemic are as old as Hippocrates and Sophocles, respectively. The present article evaluates the new medical terms tripledemic and triple epidemic, which were introduced during the recent COVID-19 pandemic.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens, Greece
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London SW17 0RE, UK
- Department of Paediatrics, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Maria Theodoridou
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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16
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Barr RS, Drysdale SB. Viral Respiratory Tract Infections in the Immunocompromised Child. Pediatr Infect Dis J 2023; 42:e170-e172. [PMID: 36795556 PMCID: PMC10097468 DOI: 10.1097/inf.0000000000003855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Rachael S. Barr
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
- Department of Paediatrics, St George’s University Hospitals NHS Foundation Trust, London, UK
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17
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Drysdale SB, Broadbent L. Respiratory syncytial virus (RSV): over 60 years of research but
still so many unanswered questions. Ther Adv Infect Dis 2023; 10:20499361231159991. [PMID: 36968553 PMCID: PMC10031616 DOI: 10.1177/20499361231159991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
- Simon B. Drysdale
- Department of Paediatrics, St George’s
University Hospitals NHS Foundation Trust, London, UK
- Centre for Neonatal and Paediatric Infection,
St George’s, University of London, London, UK
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18
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Jayawardena-Thabrew H, Warris A, Ferreras-Antolin L, Demirjian A, Drysdale SB, Emonts M, McMaster P, Paulus S, Patel S, Kinsey S, Vergnano S, Whittaker E, Ferreras-Antolin L. Nystatin is commonly prescribed as prophylaxis in children beyond the neonatal age. Med Mycol 2022; 61:6969424. [PMID: 36610724 DOI: 10.1093/mmy/myac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
The indications for nystatin as prophylaxis or treatment are limited. In the PASOAP (Pediatric Antifungal Stewardship Optimizing Antifungal Prescription) study, high use of nystatin in hospitalized children beyond the neonatal age was observed. In this report, we present the data on nystatin use in infants and children ≥ 3 months who participated in the PASOAP study. Nystatin was prescribed mainly for prophylaxis. Congenital heart disease, cystic fibrosis, and chronic renal disease were the most commonly reported conditions in children receiving prophylactic nystatin. There is sparse evidence supporting the use of nystatin prophylaxis beyond neonates; trials in specific pediatric patient groups are required.
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Affiliation(s)
| | - Adilia Warris
- Medical Research Council Center for Medical Mycology, University of Exeter, Exeter, United Kingdom.,Department of Pediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Laura Ferreras-Antolin
- Medical Research Council Center for Medical Mycology, University of Exeter, Exeter, United Kingdom.,Pediatric Infectious Diseases and Immunology Unit, St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Laura Ferreras-Antolin
- Medical Research Council Centre for Medical Mycology. University of Exeter , UK
- Paediatric Infectious Diseases and Immunology Unit. St George's University Hospitals NHS Foundation Trust , London , UK
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19
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Jones CE, Bailey H, Bamford A, Calvert A, Dorey RB, Drysdale SB, Khalil A, Heath PT, Lyall H, Ralph KMI, Sapuan S, Vandrevala T, Walter S, Whittaker E, Wood S. Managing challenges in congenital CMV: current thinking. Arch Dis Child 2022:archdischild-2022-323809. [PMID: 36442957 DOI: 10.1136/archdischild-2022-323809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
Congenital human cytomegalovirus (CMV) infection is the most common congenital infection, affecting around 1 in 200 infants in high-income settings. It can have life-long consequences for up to one in four children, including sensorineural hearing loss and neurodisability. Despite the frequency of congenital CMV and the severity for some children, it is a little-known condition by pregnant women, families and healthcare providers. Timely diagnosis of CMV infection in pregnancy is important to facilitate consideration of treatment with valaciclovir, which may reduce the risk of transmission to the fetus or reduce the severity of the outcomes for infected infants. Recognition of features of congenital CMV is important for neonatologists, paediatricians and audiologists to prompt testing for congenital CMV within the first 21 days of life. Early diagnosis gives the opportunity for valganciclovir treatment, where appropriate, to improve outcomes for affected infants. Further research is urgently needed to inform decisions about antenatal and neonatal screening, long-term outcomes for asymptomatic and symptomatic infants, predictors of these outcomes and optimal treatment for women and infants.
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Affiliation(s)
- Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK .,Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heather Bailey
- Institute for Global Health, University College London, London, UK
| | - Alasdair Bamford
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anna Calvert
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Robert B Dorey
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon B Drysdale
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Hermione Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | | | - Shari Sapuan
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education, Kingston University, Kingston-Upon-Thames, UK
| | - Simone Walter
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
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20
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Wildenbeest JG, Billard MN, Zuurbier RP, Korsten K, Langedijk AC, van de Ven PM, Snape MD, Drysdale SB, Pollard AJ, Robinson H, Heikkinen T, Cunningham S, O'Neill T, Rizkalla B, Dacosta-Urbieta A, Martinón-Torres F, van Houten MA, Bont LJ, Billard MN, Zuurbier R, Korsten K, van Houten M, Langedijk A, van de Ven P, Bont L, Drysdale S, McGinley J, Lin GL, Snape M, Pollard A, Ives A, Wolfenden H, Salgia S, Shetty R, Dacosta-Urbieta A, Rivero-Calle I, Gómez-Carballa A, Pischedda S, Rodriguez-Tenreiro C, Martinón-Torres F, Heikkinen T, Cunningham S, Nair H, Campbell H, O'Neill T, Miller M, Baggott J, Beveridge C, McKernan R, Rizkalla B, Beutels P, Openshaw P, Meijer A, Kølsen Fischer T, van den Berge M, Giaquinto C, Abram M, Swanson K, Aerssens J, Vernhes C, Gallichan S, Kumar V, Molero E. The burden of respiratory syncytial virus in healthy term-born infants in Europe: a prospective birth cohort study. Lancet Respir Med 2022; 11:341-353. [PMID: 36372082 PMCID: PMC9764871 DOI: 10.1016/s2213-2600(22)00414-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of hospitalisation in infants. The burden of RSV infection in healthy term infants has not yet been established. Accurate health-care burden data in healthy infants are necessary to determine RSV immunisation policy when RSV immunisation becomes available. METHODS We performed a multicentre, prospective, observational birth cohort study in healthy term-born infants (≥37 weeks of gestation) in five sites located in different European countries to determine the health-care burden of RSV. The incidence of RSV-associated hospitalisations in the first year of life was determined by parental questionnaires and hospital chart reviews. We performed active RSV surveillance in a nested cohort to determine the incidence of medically attended RSV infections. The study is registered with ClinicalTrials.gov, NCT03627572. FINDINGS In total, 9154 infants born between July 1, 2017, and April 1, 2020, were followed up during the first year of life and 993 participated in the nested active surveillance cohort. The incidence of RSV-associated hospitalisations in the total cohort was 1·8% (95% CI 1·6-2·1). There were eight paediatric intensive care unit admissions, corresponding to 5·5% of 145 RSV-associated hospitalisations and 0·09% of the total cohort. Incidence of RSV infection in the active surveillance cohort confirmed by any diagnostic assay was 26·2% (24·0-28·6) and that of medically attended RSV infection was 14·1% (12·3-16·0). INTERPRETATION RSV-associated acute respiratory infection causes substantial morbidity, leading to the hospitalisation of one in every 56 healthy term-born infants in high-income settings. Immunisation of pregnant women or healthy term-born infants during their first winter season could have a major effect on the health-care burden caused by RSV infections. FUNDING Innovative Medicines Initiative 2 Joint Undertaking, with support from the EU's Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations.
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Affiliation(s)
- Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marie-Noëlle Billard
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roy P Zuurbier
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Spaarne Gasthuis Academy, Hoofddorp and Haarlem, Netherlands
| | - Koos Korsten
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centre, Amsterdam University, Amsterdam, Netherlands
| | - Annefleur C Langedijk
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter M van de Ven
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK,Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Thomas O'Neill
- Children's Clinical Research Facility, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
| | | | - Ana Dacosta-Urbieta
- Translational Paediatrics and Infectious Diseases, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain,Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain,Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Correspondence to: Prof Louis J Bont, Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584EA Utrecht, Netherlands
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21
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Geier CB, Ellison M, Cruz R, Pawar S, Leiss-Piller A, Zmajkovicova K, McNulty SM, Yilmaz M, Evans MO, Gordon S, Ujhazi B, Wiest I, Abolhassani H, Aghamohammadi A, Barmettler S, Bhar S, Bondarenko A, Bolyard AA, Buchbinder D, Cada M, Cavieres M, Connelly JA, Dale DC, Deordieva E, Dorsey MJ, Drysdale SB, Ehl S, Elfeky R, Fioredda F, Firkin F, Förster-Waldl E, Geng B, Goda V, Gonzalez-Granado L, Grunebaum E, Grzesk E, Henrickson SE, Hilfanova A, Hiwatari M, Imai C, Ip W, Jyonouchi S, Kanegane H, Kawahara Y, Khojah AM, Kim VHD, Kojić M, Kołtan S, Krivan G, Langguth D, Lau YL, Leung D, Miano M, Mersyanova I, Mousallem T, Muskat M, Naoum FA, Noronha SA, Ouederni M, Ozono S, Richmond GW, Sakovich I, Salzer U, Schuetz C, Seeborg FO, Sharapova SO, Sockel K, Volokha A, von Bonin M, Warnatz K, Wegehaupt O, Weinberg GA, Wong KJ, Worth A, Yu H, Zharankova Y, Zhao X, Devlin L, Badarau A, Csomos K, Keszei M, Pereira J, Taveras AG, Beaussant-Cohen SL, Ong MS, Shcherbina A, Walter JE. Disease Progression of WHIM Syndrome in an International Cohort of 66 Pediatric and Adult Patients. J Clin Immunol 2022; 42:1748-1765. [PMID: 35947323 PMCID: PMC9700649 DOI: 10.1007/s10875-022-01312-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome (WS) is a combined immunodeficiency caused by gain-of-function mutations in the C-X-C chemokine receptor type 4 (CXCR4) gene. We characterize a unique international cohort of 66 patients, including 57 (86%) cases previously unreported, with variable clinical phenotypes. Of 17 distinct CXCR4 genetic variants within our cohort, 11 were novel pathogenic variants affecting 15 individuals (23%). All variants affect the same CXCR4 region and impair CXCR4 internalization resulting in hyperactive signaling. The median age of diagnosis in our cohort (5.5 years) indicates WHIM syndrome can commonly present in childhood, although some patients are not diagnosed until adulthood. The prevalence and mean age of recognition and/or onset of clinical manifestations within our cohort were infections 88%/1.6 years, neutropenia 98%/3.8 years, lymphopenia 88%/5.0 years, and warts 40%/12.1 years. However, we report greater prevalence and variety of autoimmune complications of WHIM syndrome (21.2%) than reported previously. Patients with versus without family history of WHIM syndrome were diagnosed earlier (22%, average age 1.3 years versus 78%, average age 5 years, respectively). Patients with a family history of WHIM syndrome also received earlier treatment, experienced less hospitalization, and had less end-organ damage. This observation reinforces previous reports that early treatment for WHIM syndrome improves outcomes. Only one patient died; death was attributed to complications of hematopoietic stem cell transplantation. The variable expressivity of WHIM syndrome in pediatric patients delays their diagnosis and therapy. Early-onset bacterial infections with severe neutropenia and/or lymphopenia should prompt genetic testing for WHIM syndrome, even in the absence of warts.
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Affiliation(s)
- Christoph B Geier
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maryssa Ellison
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Rachel Cruz
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sumit Pawar
- X4 Pharmaceuticals (Austria) GmbH, Vienna, Austria
| | | | | | - Shannon M McNulty
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melis Yilmaz
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Sumai Gordon
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Boglarka Ujhazi
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Ivana Wiest
- X4 Pharmaceuticals (Austria) GmbH, Vienna, Austria
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Barmettler
- Allergy and Clinical Immunology Unit, Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Saleh Bhar
- Department of Pediatrics, Section of Hematology/Oncology and Critical Care Medicine, Bone Marrow Transplantation, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Audrey Anna Bolyard
- Severe Chronic Neutropenia International Registry, University of Washington, Seattle, WA, USA
| | - David Buchbinder
- Division of Hematology, CHOC Children's Hospital, Orange, CA, USA
| | - Michaela Cada
- Division of Hematology and Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mirta Cavieres
- Hematology Unit, Dr Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | | | - David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ekaterina Deordieva
- Immunology, the Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Morna J Dorsey
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Simon B Drysdale
- Paediatric Infectious Diseases Research Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reem Elfeky
- Department of Clinical Immunology, Royal Free Hospital, London, UK
| | | | - Frank Firkin
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Vic, Fitzroy, Australia
- Department of Clinical Haematology, St Vincent's Hospital, Vic, Fitzroy, Australia
| | - Elizabeth Förster-Waldl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Division of Neonatology, Pediatric Intensive Care & Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Center for Congenital Immunodeficiencies, Medical University of Vienna & Jeffrey Modell Diagnostic and Research Center, Vienna, Austria
| | - Bob Geng
- Divisions of Adult and Pediatric Allergy and Immunology, University of California, San Diego, CA, USA
| | - Vera Goda
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Luis Gonzalez-Granado
- Immunodeficiencies Unit, Department of Pediatrics, University Hospital 12 de Octubre, Research Institute Hospital 12 Octubre, Madrid, Spain
| | - Eyal Grunebaum
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Immunology and Allergy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elzbieta Grzesk
- Department of Pediatrics, Hematology and Oncology Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Hilfanova
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Mitsuteru Hiwatari
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihaya Imai
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Winnie Ip
- Great Ormond Street Hospital for Children, London, UK
| | - Soma Jyonouchi
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Amer M Khojah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vy Hong-Diep Kim
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Immunology and Allergy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marina Kojić
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sylwia Kołtan
- Department of Pediatrics, Hematology and Oncology Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Gergely Krivan
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Daman Langguth
- Department of Immunology, Sullivan and Nicolaides Pathology, Brisbane, Australia
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China
| | - Daniel Leung
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China
| | - Maurizio Miano
- Haematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Irina Mersyanova
- Immunology, the Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Talal Mousallem
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Mica Muskat
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Flavio A Naoum
- Academia de Ciência e Tecnologia, Sao Jose do Rio Preto, Brazil
| | - Suzie A Noronha
- Department of Pediatrics, Division of Hematology-Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Monia Ouederni
- Faculty of Médecine, University Tunis El Manar, Tunis, Tunisia
- Department of Pediatrics: Immuno-Hematology and Stem Cell Transplantation, Bone Marrow Transplantation Center of Tunisia, Tunis, Tunisia
| | - Shuichi Ozono
- Department of Pediatrics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - G Wendell Richmond
- Section of Allergy and Immunology, Rush University Medical Center, Chicago, IL, USA
| | - Inga Sakovich
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Filiz Odabasi Seeborg
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Svetlana O Sharapova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Katja Sockel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Malte von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany
| | - Klaus Warnatz
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Wegehaupt
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Golisano Children's Hospital, Rochester, NY, USA
| | - Ke-Juin Wong
- Sabah Women and Children's Hospital, Sabah, Malaysia
| | - Austen Worth
- Great Ormond Street Hospital for Children, London, UK
| | - Huang Yu
- National Clinical Research Center for Child Health and disorders, Children Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Yulia Zharankova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Xiaodong Zhao
- National Clinical Research Center for Child Health and disorders, Children Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Lisa Devlin
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | | | - Krisztian Csomos
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Marton Keszei
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Joao Pereira
- Department of Immunobiology, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | | | | | - Mei-Sing Ong
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anna Shcherbina
- Immunology, the Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Jolan E Walter
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.
- Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, USA.
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22
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Rallapalli S, Razai MS, Majeed A, Drysdale SB. Diagnosis and management of monkeypox in primary care. J R Soc Med 2022; 115:384-389. [PMID: 36342045 PMCID: PMC9720287 DOI: 10.1177/01410768221131914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The monkeypox virus outbreak continues to evolve worldwide. While most people recover without treatment, primary care clinicians may be the first point of contact for those affected. Prompt assessment, diagnosis, isolation, treatment and prophylaxis will reduce the risk of community transmission. The current public health advice is to test suspected cases and monitor close contacts. If individuals test positive for the monkeypox virus, self-isolation at home is recommended for most people with mild symptoms. If patients report severe symptoms, referral and admission to hospital will be needed, where further interventions such as antivirals may be administered. The infection can spread through close contact; therefore, healthcare professionals must take precautions, such as using appropriate personal protective equipment for possible or probable cases.
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Affiliation(s)
- Smrithi Rallapalli
- Institute of Medical and Biomedical Education, St George's University of London, London, SW17 0RE, UK
| | - Mohammad S Razai
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Simon B Drysdale
- Department of Paediatric Infectious Diseases, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.,Centre for Neonatal and Paediatric Infection, St George's University of London, London, SW17 0RE, UK
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23
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McGinley JP, Lin GL, Öner D, Golubchik T, O'Connor D, Snape MD, Gruselle O, Langedijk AC, Wildenbeest J, Openshaw P, Nair H, Aerssens J, Bont L, Martinón-Torres F, Drysdale SB, Pollard AJ. Clinical and Viral Factors Associated With Disease Severity and Subsequent Wheezing in Infants With Respiratory Syncytial Virus Infection. J Infect Dis 2022; 226:S45-S54. [PMID: 35902389 DOI: 10.1093/infdis/jiac163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in infants and young children worldwide. Here we evaluated host demographic and viral factors associated with RSV disease severity in 325 RSV-infected infants under 1 year of age from 3 European countries during 2017-2020. Younger infants had a higher clinical severity (ReSViNET) score and were more likely to require hospitalization, intensive care, respiratory support, and/or mechanical ventilation than older infants (<3 months vs 3 to <6 months and 3 to <6 months vs ≥6 months). Older age (≥6 months vs <3 months), higher viral load, and RSV-A were associated with a greater probability of fever. RSV-A and RSV-B caused similar disease severity and had similar viral dynamics. Infants with a more severe RSV infection, demonstrated by having a higher ReSViNET score, fever, and requiring hospitalization and intensive care, were more likely to have developed subsequent wheezing at 1 year of age. CLINICAL TRIALS REGISTRATION NCT03756766.
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Affiliation(s)
- Joseph P McGinley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gu Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Deniz Öner
- Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Tanya Golubchik
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joanne Wildenbeest
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Jeroen Aerssens
- Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Louis Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Simon B Drysdale
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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24
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Barr RS, Drysdale SB, Boullier M, Lyall H, Cook L, Collins GP, Kelly DF, Phelan L, Taylor GP. A Review of the Prevention of Mother-to-Child Transmission of Human T-Cell Lymphotrophic Virus Type 1 (HTLV-1) With a Proposed Management Algorithm. Front Med (Lausanne) 2022; 9:941647. [PMID: 35872787 PMCID: PMC9304803 DOI: 10.3389/fmed.2022.941647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/10/2022] [Indexed: 01/06/2023] Open
Abstract
Human T cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that is endemic in a number of regions across the world. There are an estimated 5–10 million people infected worldwide. Japan is currently the only country with a national antenatal screening programme in place. HTLV-1 is primarily transmitted sexually in adulthood, however it can be transmitted from mother-to-child perinatally. This can occur transplacentally, during the birth process or via breastmilk. If HTLV-1 is transmitted perinatally then the lifetime risk of adult T cell leukemia/lymphoma rises from 5 to 20%, therefore prevention of mother-to-child transmission of HTLV-1 is a public health priority. There are reliable immunological and molecular tests available for HTLV-1 diagnosis during pregnancy and screening should be considered on a country by country basis. Further research on best management is needed particularly for pregnancies in women with high HTLV-1 viral load. A first step would be to establish an international registry of cases and to monitor outcomes for neonates and mothers. We have summarized key risk factors for mother-to-child transmission of HTLV-1 and subsequently propose a pragmatic guideline for management of mothers and infants in pregnancy and the perinatal period to reduce the risk of transmission. This is clinically relevant in order to reduce mother-to-child transmission of HTLV-1 and it's complications.
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Affiliation(s)
- Rachael S. Barr
- Department of Paediatrics, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- *Correspondence: Rachael S. Barr
| | - Simon B. Drysdale
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
- Oxford Vaccine Group and NIHR Oxford Biomedical Research Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Mary Boullier
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Hermione Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Lucy Cook
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Graham P. Collins
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dominic F. Kelly
- Oxford Vaccine Group and NIHR Oxford Biomedical Research Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Level 2, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lorna Phelan
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Graham P. Taylor
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
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25
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Ferreras-Antolín L, Irwin A, Atra A, Chapelle F, Drysdale SB, Emonts M, McMaster P, Paulus S, Patel S, Rompola M, Vergnano S, Whittaker E, Warris A. Pediatric Antifungal Prescribing Patterns Identify Significant Opportunities to Rationalize Antifungal Use in Children. Pediatr Infect Dis J 2022; 41:e69-e74. [PMID: 34784303 PMCID: PMC8826618 DOI: 10.1097/inf.0000000000003402] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The need for pediatric antifungal stewardship programs has been driven by an increasing consumption of antifungals for prophylactic and empirical use. Drivers and rational of antifungal prescribing need to be identified to optimize prescription behaviors. METHODS A prospective modified weekly Point Prevalence Survey capturing antifungal prescriptions for children (> 90 days to < 18 years of age) in 12 centers in England during 26 consecutive weeks was performed. Demographic, diagnostic and treatment information was collected for each patient. Data were entered into an online REDCap database. RESULTS One thousand two hundred fifty-eight prescriptions were included for 656 pediatric patients, 44.9% were girls, with a median age of 6.4 years (interquartile range, 2.5-11.3). Most common underlying condition was malignancy (55.5%). Four hundred nineteen (63.9%) received antifungals for prophylaxis, and 237 (36.1%) for treatment. Among patients receiving antifungal prophylaxis, 40.2% did not belong to a high-risk group. In those receiving antifungal treatment, 45.9%, 29.4%, 5.1% and 19.6% had a diagnosis of suspected, possible, probable of proven invasive fungal disease (IFD), respectively. Proven IFD was diagnosed in 78 patients, 84.6% (n = 66) suffered from invasive candidiasis and 15.4% (n = 12) from an invasive mold infection. Liposomal amphotericin B was the most commonly prescribed antifungal for both prophylaxis (36.6%) and empiric and preemptive treatment (47.9%). Throughout the duration of the study, 72 (11.0%) patients received combination antifungal therapy. CONCLUSIONS Antifungal use in pediatric patients is dominated by liposomal amphotericin B and often without evidence for the presence of IFD. A significant proportion of prophylactic and empiric antifungal use was seen in pediatric patients not at high-risk for IFD.
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Affiliation(s)
- Laura Ferreras-Antolín
- From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Adam Irwin
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Ayad Atra
- Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton, London, United Kingdom
| | - Faye Chapelle
- Department of Infectious Diseases and Immunology, Evelina Children Hospital, London, United Kingdom
| | - Simon B. Drysdale
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Marieke Emonts
- Department of Paediatric Immunology, Infectious Diseases and Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paddy McMaster
- Department of Paediatric Infectious Diseases, Royal Manchester Childrens´ Hospital, Manchester, United Kingdom
| | - Stephane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Menie Rompola
- Dept. of Paediatric Haematology and Oncology, Leeds General Infirmary, Leeds, United Kingdom
| | - Stefania Vergnano
- Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust and Section of Paediatrics, Department of Infectious Diseases, Imperial College, London, United Kingdom
| | - Adilia Warris
- From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
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26
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Lin GL, Drysdale SB, Snape MD, O'Connor D, Brown A, MacIntyre-Cockett G, Mellado-Gomez E, de Cesare M, Bonsall D, Ansari MA, Öner D, Aerssens J, Butler C, Bont L, Openshaw P, Martinón-Torres F, Nair H, Bowden R, Golubchik T, Pollard AJ. Publisher Correction: Distinct patterns of within-host virus populations between two subgroups of human respiratory syncytial virus. Nat Commun 2021; 12:5971. [PMID: 34620863 PMCID: PMC8497499 DOI: 10.1038/s41467-021-26291-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. .,NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Anthony Brown
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | | | | | | | - David Bonsall
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.,Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M Azim Ansari
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Deniz Öner
- Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jeroen Aerssens
- Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Bont
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,ReSViNET Foundation, Zeist, Netherlands
| | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Rory Bowden
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.,Division of Advanced Technology and Biology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | | | - Tanya Golubchik
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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27
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Takata J, Kelly DF, Sadarangani M, Jeffery K, Drysdale SB. 14-year trends and resistance patterns of blood and cerebrospinal fluid cultures in children under three years old. J Infect 2021; 83:533-541. [PMID: 34534564 DOI: 10.1016/j.jinf.2021.08.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/27/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Bacterial infections are a major cause of UK paediatric hospitalisations, yet longitudinal data on causative organisms or antimicrobial resistance are scarce. This retrospective analysis describes trends in blood and cerebrospinal fluid (CSF) cultures and resistance patterns in children under three years old from a large UK centre. METHODS All culture results, and resistance data for Gram-negative rods (GNR) in blood cultures, collected between January 2005 and December 2018 were extracted from Oxford University Hospitals NHS Foundation Trust microbiology database. RESULTS Of 49,298 samples, 6.7% of blood and 3.1% of CSF cultures were positive for bacterial growth; 2.3% and 1.1%, respectively grew pathogens. Number of cultures taken increased over time; the proportion growing pathogens declined. Resistance of GNR to first-line antimicrobials was 9.3% to gentamicin (neonatal units), and 17.1% and 25.8% to ceftriaxone (paediatric ED and wards respectively). Resistance to any two of ceftriaxone, ciprofloxacin, gentamicin, or meropenem was ≤ 6% in both areas. CONCLUSIONS The proportion of positive cultures declined over time. Resistance of GNR to empirical antimicrobials were observed, but resistance to a second agent were lower. Our study informs clinician decisions on when, and to which antimicrobials, to escalate if a child is not improving on empirical therapy.
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Affiliation(s)
- Junko Takata
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dominic F Kelly
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Paediatrics, Oxford Vaccine Group, University of Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford, United Kingdom
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Canada; Department of Paediatrics, University of British Columbia, Canada
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Simon B Drysdale
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Paediatrics, Oxford Vaccine Group, University of Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford, United Kingdom; Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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28
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Lin GL, Drysdale SB, Snape MD, O’Connor D, Brown A, MacIntyre-Cockett G, Mellado-Gomez E, de Cesare M, Bonsall D, Ansari MA, Öner D, Aerssens J, Butler C, Bont L, Openshaw P, Martinón-Torres F, Nair H, Bowden R, Golubchik T, Pollard AJ. Distinct patterns of within-host virus populations between two subgroups of human respiratory syncytial virus. Nat Commun 2021; 12:5125. [PMID: 34446722 PMCID: PMC8390747 DOI: 10.1038/s41467-021-25265-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
Human respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children globally, but little is known about within-host RSV diversity. Here, we characterised within-host RSV populations using deep-sequencing data from 319 nasopharyngeal swabs collected during 2017-2020. RSV-B had lower consensus diversity than RSV-A at the population level, while exhibiting greater within-host diversity. Two RSV-B consensus sequences had an amino acid alteration (K68N) in the fusion (F) protein, which has been associated with reduced susceptibility to nirsevimab (MEDI8897), a novel RSV monoclonal antibody under development. In addition, several minor variants were identified in the antigenic sites of the F protein, one of which may confer resistance to palivizumab, the only licensed RSV monoclonal antibody. The differences in within-host virus populations emphasise the importance of monitoring for vaccine efficacy and may help to explain the different prevalences of monoclonal antibody-escape mutants between the two subgroups.
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Affiliation(s)
- Gu-Lung Lin
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK ,grid.454382.cNIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Simon B. Drysdale
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK ,grid.454382.cNIHR Oxford Biomedical Research Centre, Oxford, UK ,grid.4464.20000 0001 2161 2573Present Address: Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Matthew D. Snape
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK ,grid.454382.cNIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel O’Connor
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK ,grid.454382.cNIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Anthony Brown
- grid.4991.50000 0004 1936 8948Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Esther Mellado-Gomez
- grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - David Bonsall
- grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M. Azim Ansari
- grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Deniz Öner
- grid.419619.20000 0004 0623 0341Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jeroen Aerssens
- grid.419619.20000 0004 0623 0341Translational Biomarkers, Infectious Diseases Therapeutic Area, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Christopher Butler
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Bont
- grid.7692.a0000000090126352Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,ReSViNET Foundation, Zeist, Netherlands
| | - Peter Openshaw
- grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College London, London, UK
| | - Federico Martinón-Torres
- grid.411048.80000 0000 8816 6945Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain ,grid.488911.d0000 0004 0408 4897Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Harish Nair
- grid.4305.20000 0004 1936 7988Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Rory Bowden
- grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,grid.1042.7Present Address: Division of Advanced Technology and Biology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC Australia
| | | | - Tanya Golubchik
- grid.4991.50000 0004 1936 8948Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew J. Pollard
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK ,grid.454382.cNIHR Oxford Biomedical Research Centre, Oxford, UK
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29
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Drysdale SB, Barr RS, Rollier CS, Green CA, Pollard AJ, Sande CJ. Priorities for developing respiratory syncytial virus vaccines in different target populations. Sci Transl Med 2021; 12:12/535/eaax2466. [PMID: 32188721 DOI: 10.1126/scitranslmed.aax2466] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/25/2019] [Indexed: 01/13/2023]
Abstract
The development of an effective vaccine against respiratory syncytial virus (RSV) has been hampered by major difficulties that occurred in the 1960s when a formalin-inactivated vaccine led to increased severity of RSV disease after acquisition of the virus in the RSV season after vaccination. Recent renewed efforts to develop a vaccine have resulted in about 38 candidate vaccines and monoclonal antibodies now in clinical development. The target populations for effective vaccination are varied and include neonates, young children, pregnant women, and older adults. The reasons for susceptibility to infection in each of these groups may be different and, therefore, could require different vaccine types for induction of protective immune responses, adding a further challenge for vaccine development. Here, we review the current knowledge of RSV vaccine development for these target populations and propose a view and rationale for prioritizing RSV vaccine development.
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Affiliation(s)
- Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK. .,Institute of Infection and Immunity, St George's, University of London, London SW17 0RE, UK
| | - Rachael S Barr
- Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Christine S Rollier
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
| | - Christopher A Green
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Charles J Sande
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7LE, UK. .,KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya
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30
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Zuurbier RP, Bont LJ, Langedijk AC, Hamer M, Korsten K, Drysdale SB, Snape MD, Robinson H, Pollard AJ, Martinón-Torres F, Rodríguez-Tenreiro Sánchez C, Gómez-Carballa A, Dacosta-Urbieta AI, Heikkinen T, Cunningham S, van Houten MA, Wildenbeest JG. Low Sensitivity of BinaxNOW RSV in Infants. J Infect Dis 2021; 222:S640-S647. [PMID: 32227106 DOI: 10.1093/infdis/jiaa050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of hospitalization in infants. Early detection of RSV can optimize clinical management and minimize use of antibiotics. BinaxNOW RSV (BN) is a rapid antigen detection test that is widely used. We aimed to validate the sensitivity of BN in hospitalized and nonhospitalized infants against the gold standard of molecular diagnosis. METHODS We evaluated the performance of BN in infants with acute respiratory tract infections with different degrees of disease severity. Diagnostic accuracy of BN test results were compared with molecular diagnosis as reference standard. RESULTS One hundred sixty-two respiratory samples from 148 children from October 2017 to February 2019 were studied. Sixty-six (40.7%) samples tested positive for RSV (30 hospitalizations, 31 medically attended episodes not requiring hospitalization, and 5 nonmedically attended episodes). Five of these samples tested positive with BN, leading to an overall sensitivity of BN of 7.6% (95% confidence interval [CI], 3.3%-16.5%) and a specificity of 100% (95% CI, 96.2%-100%). Sensitivity was low in all subgroups. CONCLUSIONS We found a low sensitivity of BN for point-of-care detection of RSV infection. BinaxNOW RSV should be used and interpreted with caution.
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Affiliation(s)
- Roy P Zuurbier
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands.,Spaarne Gasthuis Academy, Hoofddorp and Haarlem, Hoofddorp, Netherlands
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Mirjam Hamer
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Koos Korsten
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Gómez-Carballa
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Ana Isabel Dacosta-Urbieta
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Joanne G Wildenbeest
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
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31
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Jefferies K, Drysdale SB, Robinson H, Clutterbuck EA, Blackwell L, McGinley J, Lin GL, Galal U, Nair H, Aerssens J, Öner D, Langedijk A, Bont L, Wildenbeest JG, Martinon-Torres F, Rodríguez-Tenreiro Sánchez C, Nadel S, Openshaw P, Thwaites R, Widjojoatmodjo M, Zhang L, Nguyen TLA, Giaquinto C, Giordano G, Baraldi E, Pollard AJ. Presumed Risk Factors and Biomarkers for Severe Respiratory Syncytial Virus Disease and Related Sequelae: Protocol for an Observational Multicenter, Case-Control Study From the Respiratory Syncytial Virus Consortium in Europe (RESCEU). J Infect Dis 2021; 222:S658-S665. [PMID: 32794560 DOI: 10.1093/infdis/jiaa239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading viral pathogen associated with acute lower respiratory tract infection and hospitalization in children < 5 years of age worldwide. While there are known clinical risk factors for severe RSV infection, the majority of those hospitalized are previously healthy infants. There is consequently an unmet need to identify biomarkers that predict host response, disease severity, and sequelae. The primary objective is to identify biomarkers of severe RSV acute respiratory tract infection (ARTI) in infants. Secondary objectives include establishing biomarkers associated with respiratory sequelae following RSV infection and characterizing the viral load, RSV whole-genome sequencing, host immune response, and transcriptomic, proteomic, metabolomic and epigenetic signatures associated with RSV disease severity. Six hundred thirty infants will be recruited across 3 European countries: the Netherlands, Spain, and the United Kingdom. Participants will be recruited into 2 groups: (1) infants with confirmed RSV ARTI (includes upper and lower respiratory tract infections), 500 without and 50 with comorbidities; and (2) 80 healthy controls. At baseline, participants will have nasopharyngeal, blood, buccal, stool, and urine samples collected, plus complete a questionnaire and 14-day symptom diary. At convalescence (7 weeks ± 1 week post-ARTI), specimen collection will be repeated. Laboratory measures will be correlated with symptom severity scores to identify corresponding biomarkers of disease severity. CLINICAL TRIALS REGISTRATION NCT03756766.
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Affiliation(s)
| | - Simon B Drysdale
- Department of Paediatrics, Oxford Vaccine Group, Oxford, United Kingdom.,Department of Paediatrics, St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - Hannah Robinson
- Department of Paediatrics, Oxford Vaccine Group, Oxford, United Kingdom
| | | | - Luke Blackwell
- Department of Paediatrics, Oxford Vaccine Group, Oxford, United Kingdom
| | - Joseph McGinley
- Department of Paediatrics, Oxford Vaccine Group, Oxford, United Kingdom
| | - Gu-Lung Lin
- Department of Paediatrics, Oxford Vaccine Group, Oxford, United Kingdom
| | - Ushma Galal
- Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Harish Nair
- Usher Institute, University of Edinburgh, Old Medical School, Edinburgh, United Kingdom
| | - Jeroen Aerssens
- Infectious Diseases, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Deniz Öner
- Infectious Diseases, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Annefleur Langedijk
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Louis Bont
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joanne G Wildenbeest
- Department of Paediatrics, Immunology and Infectious Disease, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Federico Martinon-Torres
- Translational Paediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,Genetics, Vaccines, Infections and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Paediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,Genetics, Vaccines, Infections and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Simon Nadel
- Department of Paediatrics, Imperial College, London, United Kingdom
| | - Peter Openshaw
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ryan Thwaites
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Carlo Giaquinto
- Fondazione Penta Onlus, Torre di Ricerca Pediatrica, Padova, Italy
| | | | - Eugenio Baraldi
- Fondazione Penta Onlus, Torre di Ricerca Pediatrica, Padova, Italy
| | - Andrew J Pollard
- Department of Paediatrics, Oxford Vaccine Group, Oxford, United Kingdom
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32
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Wildenbeest JG, Zuurbier RP, Korsten K, van Houten MA, Billard MN, Derksen-Lazet N, Snape MD, Drysdale SB, Robinson H, Pollard AJ, Heikkinen T, Cunningham S, Leach A, Martinón-Torres F, Rodríguez-Tenreiro Sánchez C, Gómez-Carballa A, Bont LJ. Respiratory Syncytial Virus Consortium in Europe (RESCEU) Birth Cohort Study: Defining the Burden of Infant Respiratory Syncytial Virus Disease in Europe. J Infect Dis 2021; 222:S606-S612. [PMID: 32794574 DOI: 10.1093/infdis/jiaa310] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes significant morbidity and mortality in infants worldwide. Although prematurity and cardiopulmonary disease are risk factors for severe disease, the majority of infants hospitalized with RSV are previously healthy. Various vaccines and therapeutics are under development and expected to be available in the near future. To inform the use of these new vaccines and therapeutics, it is necessary to determine the burden of RSV disease in Europe. We will prospectively follow-up a birth cohort to obtain incidence data on RSV acute respiratory tract infection (ARTI). METHODS Multicenter prospective study of a birth cohort consisting of 10 000 healthy infants, recruited during 3 consecutive years. RSV associated hospitalization in the first year of life will be determined by questionnaires and hospital chart reviews. A nested cohort of 1000 infants will be actively followed. In case of ARTI, a respiratory sample will be collected for RSV molecular diagnosis. RESULTS The primary outcome is the incidence rate of RSV-associated hospitalization in the first year of life. In the active cohort the primary outcome is RSV associated ARTI and MA-ARTI. CONCLUSIONS We will provide key information to fill the gaps in knowledge about the burden of RSV disease in healthy infants. CLINICAL TRIALS REGISTRATION NCT03627572.
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Affiliation(s)
- Joanne G Wildenbeest
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roy P Zuurbier
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.,Spaarne Gasthuis Academy, Hoofddorp and Haarlem, The Netherlands
| | - Koos Korsten
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marie N Billard
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicole Derksen-Lazet
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Gómez-Carballa
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
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33
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Öner D, Drysdale SB, McPherson C, Lin GL, Janet S, Broad J, Pollard AJ, Aerssens J. Biomarkers for Disease Severity in Children Infected With Respiratory Syncytial Virus: A Systematic Literature Review. J Infect Dis 2021; 222:S648-S657. [PMID: 32794555 DOI: 10.1093/infdis/jiaa208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Clinical manifestations of respiratory syncytial virus (RSV) infection vary widely from mild, self-limiting illness to severe life-threatening disease. There are gaps in knowledge of biomarkers to objectively define severe disease and predict clinical outcomes. METHODS A systematic search was performed, 1945-March 2019 in databases Ovid Medline, Embase, Global health, Scopus, and Web of Science. Risk of bias was assessed using the Cochrane tool. RESULTS A total of 25 132 abstracts were screened and studies were assessed for quality, risk of bias, and extracted data; 111 studies met the inclusion criteria. RSV severity was correlated with antibody titers, reduced T and B cells, dysregulated innate immunity, neutrophil mobilization to the lungs and blood, decreased Th1 response, and Th2 weighted shift. Microbial exposures in respiratory tract may contribute to neutrophil mobilization to the lungs of the infants with severe RSV compared with mild RSV disease. CONCLUSIONS Although a wide range of biomarkers have been associated with RSV disease severity, robust validated biomarkers are lacking. This review illustrates the broad heterogeneity of study designs and high variability in the definition of severe RSV disease. Prospective studies are required to validate biomarkers. Additional research investigating epigenetics, metabolomics, and microbiome holds promise for novel biomarkers.
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Affiliation(s)
- Deniz Öner
- Infectious Diseases Translational Biomarkers, Janssen Pharmaceutica, Beerse, Belgium
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Calum McPherson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Sophie Janet
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Jonathan Broad
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Jeroen Aerssens
- Infectious Diseases Translational Biomarkers, Janssen Pharmaceutica, Beerse, Belgium
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34
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Motedayen Aval L, Boullier M, Lyall H, Collins GP, Ayto R, Kelly DF, Tedder RS, Drysdale SB, Taylor GP, Cook LB. Adult T cell leukaemia/lymphoma (ATL) in pregnancy: A UK case series. eJHaem 2021; 2:131-135. [PMID: 35846087 PMCID: PMC9175930 DOI: 10.1002/jha2.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 01/17/2023]
Abstract
Introduction Chronic infection with human T‐cell lymphotropic virus type‐1 (HTLV‐1) may result in aggressive adult T‐cell leukaemia/lymphoma (ATL) in 4‐6% carriers. The majority of this risk arises in carriers infected during infancy, and so each infant has ∼25% lifetime risk. Other risk factors include a family history of ATL. Antenatal HTLV‐1 screening is not undertaken in the UK. Methods Here we describe four cases of ATL diagnosed during pregnancy and describe strategies to minimise HTLV‐1 transmission to neonates. Results/conclusion These cases highlight undiagnosed HTLV‐1 in pregnancy which allows ongoing mother to child vertical transmission and risk of future ATL. We recommend the UK National Screening Committee incorporate HTLV‐1 serology into antenatal screening.
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Affiliation(s)
| | - Mary Boullier
- Department of PaediatricsSt George's University Hospitals NHS Foundation TrustLondonUK
| | - Hermione Lyall
- Department of Paediatric Infectious DiseasesImperial College Healthcare NHS TrustLondonUK
| | - Graham P. Collins
- Department of HaematologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Robert Ayto
- Department of HaematologyPortsmouth Hospitals NHS TrustHampshireUK
| | - Dominic F. Kelly
- Oxford Vaccine GroupDepartment of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxfordUK
| | | | - Simon B. Drysdale
- Department of PaediatricsSt George's University Hospitals NHS Foundation TrustLondonUK
- Oxford Vaccine GroupDepartment of PaediatricsUniversity of OxfordOxfordUK
| | - Graham P. Taylor
- Section of Virology, Imperial CollegeLondonUK
- National Centre for Human RetrovirologyImperial College Healthcare NHS TrustLondonUK
| | - Lucy B. Cook
- Section of Virology, Imperial CollegeLondonUK
- Centre for HaematologyImperial College Healthcare NHS TrustLondonUK
- National Centre for Human RetrovirologyImperial College Healthcare NHS TrustLondonUK
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35
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Drysdale SB, Bennett AM, Greenough A. Training in paediatric virology in the UK: A brief overview (Review). Exp Ther Med 2020; 20:290. [PMID: 33209134 PMCID: PMC7668129 DOI: 10.3892/etm.2020.9420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/06/2022] Open
Abstract
Paediatric virology is a bold, new scientific field, where paediatrics focuses on the newly acquired knowledge from clinical virology, enriched with current advances in epidemiology, molecular medicine, evidence-based medicine, clinical governance, quality improvement, pharmacology and immunology. Although there are several methods with which to obtain training in paediatric viral infections in the UK, paediatric virology does not currently exist as a specific subspecialty. The aim of the present article was to present the existing educational platforms and training options in paediatric virology in the UK available to trainees wanting to pursue a clinical and/or academic career in paediatric virology.
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Affiliation(s)
- Simon B Drysdale
- St. George's, University of London, London SW17 0RE, UK.,Department of Paediatric Infectious Diseases, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Aisleen M Bennett
- St. George's, University of London, London SW17 0RE, UK.,Department of Paediatric Infectious Diseases, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE5 9RS, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London SE1 9RT, UK
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Mammas IN, Drysdale SB, Theodoridou M, Greenough A, Spandidos DA. Viruses, vaccinations and RSV: Exploring terminology in paediatric virology. Exp Ther Med 2020; 20:300. [PMID: 33209144 PMCID: PMC7668151 DOI: 10.3892/etm.2020.9430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ioannis N Mammas
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Simon B Drysdale
- St. George's, University of London, London SW17 0RE, UK.,Department of Paediatric Infectious Diseases, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Maria Theodoridou
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences and Medicine, King's College London, London SE5 9RS, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London SE1 9RT, UK
| | - Demetrios A Spandidos
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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37
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Mammas IN, Drysdale SB, Theodoridou M, Greenough A, Spandidos DA. Paediatric virology and medical terminology. Exp Ther Med 2020; 20:301. [PMID: 33209145 PMCID: PMC7668148 DOI: 10.3892/etm.2020.9431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ioannis N Mammas
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Simon B Drysdale
- St. George's, University of London, London SW17 0RE, UK.,Department of Paediatric Infectious Diseases, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Maria Theodoridou
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences and Medicine, King's College London, London SE5 9RS, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London SE1 9RT, UK
| | - Demetrios A Spandidos
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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38
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Drysdale SB, Kelly DF, Morgan M, Peto T, Crook D, Matthews PC, Walker TM. Case Report: Disseminated, rifampicin resistant Mycobacterium bovis (BCG) infection in an immunocompromised child. Wellcome Open Res 2020; 5:242. [PMID: 33283057 PMCID: PMC7682502 DOI: 10.12688/wellcomeopenres.16280.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Bacillus Calmette-Guérin (BCG) is a live-attenuated vaccine used world-wide for prevention of tuberculosis disease. In some immunocompromised hosts it has the potential to cause disease. As with other members of the M. tuberculosis complex it has the potential for acquiring drug resistance. Methods: We reviewed 10 years of paediatric clinical BCG strains referred to our clinical microbiology laboratory in Oxford where they underwent whole genome sequencing. We present a case series comparing clinical, pathogen genetic and pathogen phenotypic data, and consider the clinical implications. Results: We identified 15 BCG isolates from 8 children under 16 years old. Only one child had clinical disease with the other seven reported as local inoculation-site reactions. Case 1 suffered disseminated disease secondary to an undiagnosed IL-12/IFNγ receptor defect and the BCG isolates evolved two different rifampicin resistance mutations. Across all 15 isolates, phenotypic resistance to each first line drug was seen. Conclusions: BCG is a safe and effective vaccine in children. Most clinical specimens in our series were not related to disease. However, in the context of rare pathogen-specific immunocompromise, BCG can cause pathology and acquire drug resistance under selection from therapy.
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Affiliation(s)
- Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University, Oxford, UK.,Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - Dominic F Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University, Oxford, UK
| | - Marcus Morgan
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tim Peto
- NIHR Oxford Biomedical Research Centre, Oxford University, Oxford, UK.,Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Derrick Crook
- NIHR Oxford Biomedical Research Centre, Oxford University, Oxford, UK.,Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philippa C Matthews
- NIHR Oxford Biomedical Research Centre, Oxford University, Oxford, UK.,Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Timothy M Walker
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
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39
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Wiseman DJ, Thwaites RS, Drysdale SB, Janet S, Donaldson GC, Wedzicha JA, Openshaw PJ. Immunological and Inflammatory Biomarkers of Susceptibility and Severity in Adult Respiratory Syncytial Virus Infections. J Infect Dis 2020; 222:S584-S591. [PMID: 32227102 DOI: 10.1093/infdis/jiaa063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in young infants. However, it is also a significant pathogen in older adults. Validated biomarkers of RSV disease severity would benefit diagnostics, treatment decisions, and prophylactic interventions. This review summarizes knowledge of biomarkers for RSV disease in adults. METHODS A literature review was performed using Ovid Medline, Embase, Global health, Scopus, and Web of Science for articles published 1946-October 2016. Nine articles were identified plus 9 from other sources. RESULTS From observational studies of natural infection and challenge studies in volunteers, biomarkers of RSV susceptibility or disease severity in adults were: (1) lower anti-RSV neutralizing antibodies, where neutralizing antibody (and local IgA) may be a correlate of susceptibility/severity; (2) RSV-specific CD8+ T cells in bronchoalveolar lavage fluid preinfection (subjects with higher levels had less severe illness); and (3) elevated interleukin-6 (IL-6), IL-8, and myeloperoxidase levels in the airway are indicative of severe infection. CONCLUSIONS Factors determining susceptibility to and severity of RSV disease in adults have not been well defined. Respiratory mucosal antibodies and CD8+ T cells appear to contribute to preventing infection and modulation of disease severity. Studies of RSV pathogenesis in at-risk populations are needed.
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Affiliation(s)
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College, London, UK
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Children's Hospital, Oxford, UK.,Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Sophie Janet
- National Institute for Health Research Oxford Biomedical Research Centre, Children's Hospital, Oxford, UK
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40
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Mammas IN, Drysdale SB, Rath B, Theodoridou M, Papaioannou G, Papatheodoropoulou A, Koutsounaki E, Koutsaftiki C, Kozanidou E, Achtsidis V, Korovessi P, Chrousos GP, Spandidos DA. Update on current views and advances on RSV infection (Review). Int J Mol Med 2020; 46:509-520. [PMID: 32626981 PMCID: PMC7307844 DOI: 10.3892/ijmm.2020.4641] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood.
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Affiliation(s)
- Ioannis N Mammas
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | | | - Barbara Rath
- Vienna Vaccine Safety Initiative, D‑10437 Berlin, Germany
| | - Maria Theodoridou
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 15123 Athens, Greece
| | | | - Eirini Koutsounaki
- Neonatal Department, 'Alexandra' Maternity Hospital, 15123 Athens, Greece
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 15236 Penteli, Greece
| | - Eleftheria Kozanidou
- 2nd Department of Internal Medicine, 'St Panteleimon' General Hospital of Nikaia, 18454 Piraeus, Greece
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals, Cornwall TR1 3LQ, UK
| | - Paraskevi Korovessi
- Department of Paediatrics, 'Penteli' Children's Hospital, 15236 Penteli, Greece
| | - George P Chrousos
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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41
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Green CA, Drysdale SB, Pollard AJ, Sande CJ. Vaccination against Respiratory Syncytial Virus. Interdiscip Top Gerontol Geriatr 2020; 43:182-192. [PMID: 32305982 DOI: 10.1159/000504477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/24/2019] [Indexed: 06/11/2023]
Abstract
Respiratory syncytial virus (RSV) causes infection throughout life, with infants, adults who are severely immunocompromised, and the elderly at special risk of developing lower respiratory tract disease, hospitalisation, and death. The burden of severe disease in the elderly is comparable to seasonal influenza, and there remains no effective anti-viral drugs or vaccine for any target population. The development of a vaccine to confer immunity against severe disease is a major global health priority. A multitude of safe and immunogenic vaccine candidates have failed to induce the protective immunity needed for licensure, and in recent years this has included the largest clinical trials of RSV vaccines in history. The obstacles to vaccine development in elderly populations include an incomplete understanding of the immune responses needed for protection, the effect of aging on induction and maintenance of immunity (natural and vaccine induced immunity), and the high rate of co-morbid disease in older adults. Recent advances in structural biology, new biological platforms for antigen delivery, and insights from experimental challenge models mark the latest developments in over 50 years of research. This continues to be an active and evolving field of scientific discovery with renewed hope for a vaccine in the future.
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Affiliation(s)
- Christopher A Green
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom,
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom,
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St George's, University of London, London, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Charles J Sande
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Abstract
Viral respiratory tract infections are the most common infections of childhood. They result in clinical syndromes ranging from mild upper respiratory tract infection to severe lower respiratory tract disease requiring intensive care. Respiratory viruses are most commonly identified from a respiratory swab or nasopharyngeal aspirate by real-time PCR, which has a very high sensitivity and specificity. In this article, we review when and how children should be tested for viral respiratory tract infections and how to interpret the result in context of the clinical picture.
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Affiliation(s)
- Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford, UK
| | - Dominic F Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford, UK
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MacBean V, Drysdale SB, Zivanovic S, Peacock JL, Greenough A. Participant retention in follow-up studies of prematurely born children. BMC Public Health 2019; 19:1233. [PMID: 31492117 PMCID: PMC6729033 DOI: 10.1186/s12889-019-7575-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 08/30/2019] [Indexed: 12/21/2022] Open
Abstract
Background Follow-up studies of infants born prematurely are essential to understand the long-term consequences of preterm birth and the efficacy of interventions delivered in the neonatal period. Retention of participants for follow-up studies, however, is challenging, with attrition rates of up to 70%. Our aim was to examine retention rates in two follow-up studies of prematurely born children and identify participant or study characteristics that were associated with higher attrition, and to discuss retention strategies with regard to the literature. Methods Data from children recruited at birth to one of two studies of prematurely born infants were assessed. The two studies were the United Kingdom Oscillation Study (UKOS, a randomised study comparing two modes of neonatal ventilation in infants born less than 29 weeks of gestational age (GA)), and an observational study examining the impact of viral lower respiratory tract infections in infancy in those born less than 36 weeks of GA (virus study). The UKOS participants, but not those in the virus study, had regularly been contacted throughout the follow-up period. UKOS subjects were followed up at 11 to 14 years of age and subjects in the virus study at 5–7 years of age. At follow up in both studies, pulmonary function and respiratory morbidity were assessed. Retention rates to follow-up in the two studies and baseline characteristics of those who were and were not retained were assessed. Results Retention was significantly higher in UKOS than the virus study (61% versus 35%, p < 0.0001). Subjects lost to UKOS follow up had greater deprivation scores (p < 0.001), a greater likelihood of intrauterine tobacco exposure (p = 0.001) and were more likely to be of non-white ethnicity (p < 0.001). In the virus study, those lost to follow-up had higher birth weights (p = 0.036) and were less likely to be oxygen dependent at hospital discharge (p = 0.003) or be part of a multiple birth (p = 0.048). Conclusions Higher retention was demonstrated when there was regular contact in the follow-up period. Both social factors and initial illness severity affected the retention into follow-up studies of prematurely born infants, though these factors were not consistent across the two studies.
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Affiliation(s)
- Victoria MacBean
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, London, UK
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Janet L Peacock
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Anne Greenough
- NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK. .,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK. .,The Asthma UK Centre for Allergic Mechanisms of Asthma, King's College London, London, UK.
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44
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Johnstone PD, Jayamohan J, Kelly DF, Drysdale SB. Does appendicitis in a child with a ventriculoperitoneal shunt necessitate shunt revision? Arch Dis Child 2019; 104:607-609. [PMID: 30770382 DOI: 10.1136/archdischild-2018-316265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/04/2022]
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Sande CJ, Njunge JM, Mwongeli Ngoi J, Mutunga MN, Chege T, Gicheru ET, Gardiner EM, Gwela A, Green CA, Drysdale SB, Berkley JA, Nokes DJ, Pollard AJ. Airway response to respiratory syncytial virus has incidental antibacterial effects. Nat Commun 2019; 10:2218. [PMID: 31101811 PMCID: PMC6525170 DOI: 10.1038/s41467-019-10222-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/26/2019] [Indexed: 01/01/2023] Open
Abstract
RSV infection is typically associated with secondary bacterial infection. We hypothesise that the local airway immune response to RSV has incidental antibacterial effects. Using coordinated proteomics and metagenomics analysis we simultaneously analysed the microbiota and proteomes of the upper airway and determined direct antibacterial activity in airway secretions of RSV-infected children. Here, we report that the airway abundance of Streptococcus was higher in samples collected at the time of RSV infection compared with samples collected one month later. RSV infection is associated with neutrophil influx into the airway and degranulation and is marked by overexpression of proteins with known antibacterial activity including BPI, EPX, MPO and AZU1. Airway secretions of children infected with RSV, have significantly greater antibacterial activity compared to RSV-negative controls. This RSV-associated, neutrophil-mediated antibacterial response in the airway appears to act as a regulatory mechanism that modulates bacterial growth in the airways of RSV-infected children.
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Affiliation(s)
- Charles J Sande
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya.
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxford, OX3 7LE, UK.
| | - James M Njunge
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Joyce Mwongeli Ngoi
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Martin N Mutunga
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Timothy Chege
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Elijah T Gicheru
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Elizabeth M Gardiner
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Agnes Gwela
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
| | - Christopher A Green
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxford, OX3 7LE, UK
| | - Simon B Drysdale
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxford, OX3 7LE, UK
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7FZ, Oxford, UK
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, - P.O. Box 43640-00100, Kenya
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, Bofa Rd, Kilifi, - P.O. Box 230 - 80108, Kenya
- School of Life Sciences and Zeeman Institute (SBIDER), University of Warwick, CV4 7AL, Coventry, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxford, OX3 7LE, UK
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46
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Barr R, McGalliard R, Drysdale SB. Human metapneumovirus in paediatric intensive care unit (PICU) admissions in the United Kingdom (UK) 2006-2014. J Clin Virol 2019; 112:15-19. [PMID: 30669024 PMCID: PMC7106375 DOI: 10.1016/j.jcv.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/27/2018] [Accepted: 01/15/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human metapneumovirus (HMPV) is a pneumovirus known to cause respiratory disease in children. It was identified as a pathogen in 2001 and its healthcare burden and associated costs are not fully understood. OBJECTIVES This study aimed to assess the clinical characteristics of children with HMPV infection admitted to paediatric intensive care units (PICUs) across the United Kingdom (UK) over a nine-year period and to estimate the associated costs of care. STUDY DESIGN Data were collected from the UK paediatric intensive care audit network (PICANet) and costs calculated using the National Health Service (NHS) reference costing scheme. RESULTS There were 114 admissions in which HMPV was detected. The number of admissions associated with a code of HMPV rose steadily over the study period (three in 2006 to 28 in 2014) and showed significant seasonal variability, with the peak season being from November to May. Children required varying levels of intensive care support from minimal to complex support including invasive ventilation, inotropes, renal replacement therapy and extracorporeal membrane oxygenation (ECMO). HMPV was associated with five deaths during the study period. The associated costs of PICU admissions were estimated to be between £2,256,823 and £3,997,823 over the study period, with estimated annual costs rising over the study period due to increasing HMPV admissions. CONCLUSIONS HMPV is associated with a significant healthcare burden and associated cost of care in PICUs in the UK.
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Affiliation(s)
- Rachael Barr
- Oxford University Hospitals NHS Foundation Trust, Children's Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom; Taunton and Somerset NHS Foundation Trust, Children's Hospital, Parkfield Drive, Taunton, TA1 5DA, United Kingdom.
| | - Rachel McGalliard
- Oxford University Hospitals NHS Foundation Trust, Children's Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom
| | - Simon B Drysdale
- Oxford University Hospitals NHS Foundation Trust, Children's Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, OX3 9DU, United Kingdom; NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford, OX3 9DU, United Kingdom
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47
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Barr R, Green CA, Sande CJ, Drysdale SB. Respiratory syncytial virus: diagnosis, prevention and management. Ther Adv Infect Dis 2019; 6:2049936119865798. [PMID: 31384456 PMCID: PMC6664627 DOI: 10.1177/2049936119865798] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022] Open
Abstract
Respiratory syncytial virus (RSV) is responsible for a large burden of disease globally and can present as a variety of clinical syndromes in children of all ages. Bronchiolitis in infants under 1 year of age is the most common clinical presentation hospitalizing 24.2 per 1000 infants each year in the United Kingdom. RSV has been shown to account for 22% of all episodes of acute lower respiratory tract infection in children globally. RSV hospitalization, that is, RSV severe disease, has also been associated with subsequent chronic respiratory morbidity. Routine viral testing in all children is not currently recommended by the United Kingdom National Institute for Health and Care Excellence (NICE) or the American Academy of Pediatrics (AAP) guidance and management is largely supportive. There is some evidence for the use of ribavirin in severely immunocompromised children. Emphasis is placed on prevention of RSV infection through infection control measures both in hospital and in the community, and the use of the RSV-specific monoclonal antibody, palivizumab, for certain high-risk groups of infants. New RSV antivirals and vaccines are currently in development. Ongoing work is needed to improve the prevention of RSV infection, not only because of the acute morbidity and mortality, but also to reduce the associated chronic respiratory morbidity after severe infection.
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Affiliation(s)
- Rachael Barr
- Musgrove Park Hospital, Taunton and Somerset NHS
Foundation Trust, Taunton, UK
| | | | - Charles J. Sande
- Oxford Vaccine Group, Department of Paediatrics,
University of Oxford, UK
| | - Simon B. Drysdale
- Institute for Infection and Immunity, St
George’s, University of London, Cranmer Terrance, London, SW17 0RE, UK
- Oxford Vaccine Group, Department of Paediatrics,
University of Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre, Level 2,
Children’s Hospital, Oxford OX3 9DU, UK
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48
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Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis can be caused by a broad range of pathogens; however, bacterial infections represent the majority of sepsis cases. Up to 42% of sepsis presentations are culture negative, suggesting a non-bacterial cause. Despite this, diagnosis of viral sepsis remains very rare. Almost any virus can cause sepsis in vulnerable patients (e.g., neonates, infants, and other immunosuppressed groups). The prevalence of viral sepsis is not known, nor is there enough information to make an accurate estimate. The initial standard of care for all cases of sepsis, even those that are subsequently proven to be culture negative, is the immediate use of broad-spectrum antibiotics. In the absence of definite diagnostic criteria for viral sepsis, or at least to exclude bacterial sepsis, this inevitably leads to unnecessary antimicrobial use, with associated consequences for antimicrobial resistance, effects on the host microbiome and excess healthcare costs. It is important to understand non-bacterial causes of sepsis so that inappropriate treatment can be minimised, and appropriate treatments can be developed to improve outcomes. In this review, we summarise what is known about viral sepsis, its most common causes, and how the immune responses to severe viral infections can contribute to sepsis. We also discuss strategies to improve our understanding of viral sepsis, and ways we can integrate this new information into effective treatment.
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Affiliation(s)
- Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Joseph P McGinley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom.,Department of Paediatrics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
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MacBean V, Lunt A, Drysdale SB, Yarzi MN, Rafferty GF, Greenough A. Predicting healthcare outcomes in prematurely born infants using cluster analysis. Pediatr Pulmonol 2018; 53:1067-1072. [PMID: 29790677 DOI: 10.1002/ppul.24050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/25/2018] [Indexed: 11/10/2022]
Abstract
AIMS Prematurely born infants are at high risk of respiratory morbidity following neonatal unit discharge, though prediction of outcomes is challenging. We have tested the hypothesis that cluster analysis would identify discrete groups of prematurely born infants with differing respiratory outcomes during infancy. METHODS A total of 168 infants (median (IQR) gestational age 33 (31-34) weeks) were recruited in the neonatal period from consecutive births in a tertiary neonatal unit. The baseline characteristics of the infants were used to classify them into hierarchical agglomerative clusters. Rates of viral lower respiratory tract infections (LRTIs) were recorded for 151 infants in the first year after birth. RESULTS Infants could be classified according to birth weight and duration of neonatal invasive mechanical ventilation (MV) into three clusters. Cluster one (MV ≤5 days) had few LRTIs. Clusters two and three (both MV ≥6 days, but BW ≥or <882 g respectively), had significantly higher LRTI rates. Cluster two had a higher proportion of infants experiencing respiratory syncytial virus LRTIs (P = 0.01) and cluster three a higher proportion of rhinovirus LRTIs (P < 0.001) CONCLUSIONS: Readily available clinical data allowed classification of prematurely born infants into one of three distinct groups with differing subsequent respiratory morbidity in infancy.
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Affiliation(s)
- Victoria MacBean
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Alan Lunt
- MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, London, United Kingdom
| | - Muska N Yarzi
- Cellular and Molecular Medicine, University of Bristol, London, United Kingdom
| | - Gerrard F Rafferty
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Anne Greenough
- MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
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50
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Barr R, Carande EJ, Pollard AJ, Drysdale SB. Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline. J Clin Virol 2018; 105:84-87. [DOI: 10.1016/j.jcv.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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