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Respiratory syncytial virus (RSV) infection remains a major public health problem, especially in younger children and the elderly. But several monoclonal antibodies, antivirals and vaccines, either recently launched or in development, offer new hope for RSV prevention and treatment.Copyright © 2023 Wiley Interface Ltd.
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And FDA has committed to deciding by August whether to allow use of the Pfizer vaccine in pregnant people, who pass protective antibodies to their newborns. INFECTIOUS DISEASES ;A decadeslong effort to develop a vaccine against respiratory syncytial virus (RSV), a respiratory pathogen that targets infants and the elderly, succeeded last week when the U.S. Food and Drug Administration (FDA) green-lighted one made by manufacturer GlaxoSmithKline. [Extracted from the article] Copyright of Science is the property of American Association for the Advancement of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background: Data on respiratory syncytial virus (RSV) disease burden in adults remain scarce. We assessed the burden of confirmed RSV-acute respiratory infections (cRSV-ARIs) in community-dwelling (CD) adults and those in long-term care facilities (LTCFs). Methods: In this prospective cohort study covering 2 RSV seasons (October 2019-March 2020 and October 2020-June 2021), RSV-ARIs were identified through active surveillance, in medically stable CD-adults ≥50 years (Europe) or adults ≥65 years in LTCFs (Europe and the United States). RSV infection was confirmed by polymerase chain reaction from combined nasal and throat swabs. Results: Of 1981 adults enrolled, 1251 adults in CD and 664 LTCFs (season 1) and 1223 adults in CD and 494 LTCFs (season 2) were included in the analyses. During season 1, overall incidence rates ([IRs] cases/1000 person-years) and attack rates (ARs) for cRSV-ARIs were 37.25 (95% confidence interval [CI], 22.62-61.35) and 1.84% in adults in CD and 47.85 (CI, 22.58-101.4) and 2.26% in adults in LTCFs. Complications occurred for 17.4% (CD) and 13.3% (LTCFs) of cRSV-ARIs. One cRSV-ARI occurred in season 2 (IR = 2.91 [CI, 0.40-20.97]; AR = 0.20%), without complications. No cRSV-ARIs led to hospitalization or death. Viral pathogens were codetected in ≤17.4% of cRSV-ARIs. Conclusions: RSV is an important cause of disease burden in adults in CD and LTCFs. Despite the observed low severity of cRSV-ARI, our results support the need for RSV prevention strategies among adults ≥50 years old.
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Respiratory viral infections are important cause of morbidity and mortality in early life. The relative influence of host and viral factors possibly contribute to the disease pathogenesis. Predisposing conditions like prematurity, Low birth weight and congenital heart diseases etc. have been incriminated in the disease progression. The development of cough, wheezing, and tachypnea, usually peaking on days 4 to 5, go parallel with host cytokine responses and viral load. Various host cytokines, chemokines and molecules involved in the immune response against RSV infection might be responsible for the outcome of the disease process. Nasopharyngeal aspirates (NPAs) from children (n = 349) between 2013-2017 were subjected for IL-17A, IFN-gamma, TNF-alpha, IL-10, IL-6 levels by CBA and MMP-9 and TIMP-1 levels by ELISA. The viral load in RSV positive samples and cytokine levels were correlated with the WHO criteria for acute lower respiratory tract illness (ALRTI). RSV viral load, Pro-inflammatory cytokine (TNF-alpha) levels in severe ALRTI patients were significantly higher than the ALRTI patients [p<0.001]. Whereas Th17 cytokine (IL-17) was found to be significantly higher (p<0.05) in ALRTI patients than severe patients. MMP-9 is secreted in higher levels in severe ALRTI patients (n = 77) in comparison to Acute LRTI patients (n = 35) with an increase of thirty seven fold (p<0.001). Thus, the study highlights the role of TNF -alpha, IL-17 and Th2 cytokine biasness in the pathogenesis of RSV disease with the possible contribution of higher MMP-9/TIMP-1 ratio as a bad prognostic marker towards disease severity. To study the gene expression of autophagy and mTOR signalling pathways in RSV infected children with ALRTI. Nasopharyngeal aspirate (NPA) samples (n = 145) from children suffering from ALRTI were subjected for detection of RSV (Oct 2019 to March 2020). Semi-quantitative gene expression analysis for 5 representative genes each of mTOR signalling and autophagy pathway were performed in respiratory tract epithelial cells using 25 RSV positive cases and 10 healthy controls subjects. Autophagy gene expression analysis revealed significant upregulation in NPC1 and ATG3 autophagy genes. mTOR, AKT1 and TSC1 genes of mTOR pathway were significantly down-regulated in RSV positive patients except RICTOR gene which was significantly upregulated. Thus, survival of RSV within autophagosome might have been facilitated by upregulation of autophagy and downregulation of mTOR signalling genes. To assess the impact of SARS-CoV2 pandemic on RSV, samples were collected from children with ALRTIs admitted to emergency, PICU and indoor admissions during pre-pandemic period (October 2019 to February 2020;n = 166) and during COVID-19 Pandemic (July 2021 to July 2022;n = 189, SARS-CoV2 negative). These NP swabs were analyzed for pdm InfA H1N1, InfA H3N2, Inf B, RSV, hMPV, hBoV, hRV, PIV-2 and PIV-3 by PCR. Higher proportion of children with ALRTIs have had virus/es isolated during pre-pandemic period than during pandemic period (p<0.001). During pre-pandemic period, significantly higher proportion of children had RSV positivity (p<0.001);and significantly lower positivity for hRV (p<0.05), hMPV (p<0.05), and hBoV (p <= 0.005). The occurrence of COVID-19 pandemic has significantly impacted the frequency and pattern of detection of RSV among hospitalized children with LRTIs. RSV Fusion protein plays a critical role in the entry of the virus into the host cell by initiating the fusion of host and viral membranes. It happens to be a target of neutralizing antibodies paving the way as a vaccine candidate. Hence effort was made to introduce point mutation in hRSV fusion protein which can confer stability in its prefusion form. In-silico a stable structure of RSV fusion protein was generated making it a potential vaccine candidate. The timely diagnosis of RSV infection in this population is important for initiating therapy and instituting appropriate infection prevention measures. Serological testing is not widely used for the diagnosis of RSV. C ll Cultures including shell vial culture were used for RSV diagnosis. However, culture approaches lack sensitivity, often quite significantly, compared to nucleic acid amplification assays for the diagnosis of RSV infections. Molecular multiplex assays now offer increased sensitivity for a more accurate diagnosis. However issues with the use of these types of commercial panel assays include the requirement for substantial training, quality systems, and infrastructure to maintain and run these assays and many a times identification of viruses where the true pathogenic potential of those multiple viruses are debatable. Studies are available with laboratory- developed nucleic acid amplification test systems for the detection of RSVA and RSVB in clinical specimens either by PCRbased technologies or RT-LAMP. Gene targets of laboratory-developed molecular assays point towards M gene and the N gene in RSVA and -B with the benefits of flexibility to modify assays when targets are under evolutionary pressure to change, as well as a perceived initial low cost to carry out testing.
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Herein, we establish a novel isothermal digital amplification system termed digital nicking and extension chain reaction system-based amplification (dNESBA) by utilizing the isothermal NESBA technique and the newly developed miniaturized fluorescence monitoring system (mFMS). dNESBA enables parallel isothermal NESBA reactions in more than 10,000 localized droplet microreactors and read the fluorescence signals rapidly in 150 s by mFMS. This system could identify the genomic RNA (gRNA) extracted from target respiratory syncytial virus A (RSV A) as low as 10 copies with remarkable specificity. The practical applicability of dNESBA was also successfully verified by reliably detecting the gRNA in the artificial sputum samples with excellent reproducibility and accuracy. Due to the intrinsic advantages of isothermal amplifying technique including the elimination of the requirement of thermocycling device and the enhanced portability of the miniaturized read-out equipment, the dNESBA technique equipped with mFMS could serve as a promising platform system to achieve point-of-care (POC) digital molecular diagnostics, enabling absolute and ultra-sensitive quantification of various infectious pathogens even in an early stage.Copyright © 2023
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Introduction: The COVID-19 pandemic forced taking measures to restrain viral transmission. Our aim was to describe the changes in the patterns of childhood respiratory viral infections in admitted patients during the COVID19 pandemic. Method(s): We performed an observational study. Trends in respiratory PCR results, from all children admitted to the pediatric departments between Jan. 2015 to Aug. 2021 were evaluated using time series models. Weekly patterns were compared between pre-COVID era and COVID-19 era. Result(s): A total of 7322 pediatric admissions with respiratory viral panel PCR results from 43,466 admissions were evaluated. When comparing Pre-COVID-19 to the COVID-19 era, there was a significant decrease in the number of admissions in which a respiratory viral panel was performed (18% vs. 12%, p<0.001) and a decrease in the number of panels positive for a respiratory viral pathogen (47% vs. 36%, p<0.001). We observed a change in the circulation pattern of respiratory viruses during the COVID-19 era, with marked differences between different respiratory viruses;Influenza viruses completely disappeared;The peak in RSV infection was delayed from the 1st week of 2021 to the 25th week;HMPV had an attenuated peak in 2020 and peaked normally in 2021;parainfluenza viruses did not peak during 2020 with an early peak in the 1st week of 2021;Adenovirus circulation pattern was only minimally affected. Conclusion(s): This study offers a detailed picture of the change in respiratory viruses in children during the COVID19 pandemic, compared to previous years. The changes in patterns are probably related to the application of measures taken to control the SARS-CoV-2 transmission.
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Currently, the disease caused by the new coronavirus (COVID-19) and the possibility of co-infection with SARS-CoV-2 and other pathogens in the current epidemic situation continues to be of particular interest. The review, based on the analysis of literature and own materials, outlines the features of the relationship between SARS-CoV-2 and pathogens of acute respiratory viral infections (ARVI). Particular attention is paid to the combined course of COVID-19 and influenza, a comparative characteristic of the severity of the clinical picture. An assessment of the epidemic situation against the backdrop of the COVID-19 pandemic in foreign countries and the Russian Federation (RF) revealed the presence of the phenomenon of SARS-CoV-2 interference with other viral respiratory agents, based on the facts of a sharp suppression of the circulation of influenza viruses, respiratory syncytial virus (RSV) and other ARVI pathogens during the period of active spread of pandemic coronavirus. The main epidemiological indicators of the course of coronavirus infection were compared and the contribution of various pathogens to the etiology of acute respiratory viral infections during the development of the second wave of COVID-19 in the RF was assessed. It was noted that the decrease in the number of new cases by 11.4 and deaths by 2.1 times due to COVID-19 at 6 and 13 weeks in 2022 occurred with unchanged laboratory detection of the influenza virus (0.8%) and an increase in the frequency detection of pathogens of other SARS. The results of observations showed that against the background of a decrease in the incidence of COVID-19, there was no increase in the proportion of diagnosed cases of infections caused by other pathogens, especially influenza. The results obtained confirm the need to ensure effective epidemiological surveillance and additional application of pathogen identification methods for monitoring various ARVI, which can significantly affect the approach to differential diagnosis, patient management tactics and the decision on appropriate preventive measures.Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
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The article presents an overview of current trends in the epidemiology of respiratory syncytial viral (RSV) infection, including its seasonality, under the impact of the COVID-19 pandemic, both according to world literature and taking into account monitoring epidemiological studies conducted in the Russian Federation. A detailed description of the dynamics of RSV detection in the period 2020-2021 and the beginning of 2022 in Russia according to the results of the all-Russian epidemiological monitoring is given. Epidemiological studies in different regions of the world, including Russia, have revealed the absence of seasonal rises in the incidence of RSV infection, characteristic of previous years, in 2020 and winter-spring in 2021 under the influence of the COVID-19 pandemic. In 2021-2022, a sharp increase in the incidence and hospitalization of children was noted against the backdrop of a decrease in cases of a new coronavirus infection in all countries of the world, while the start time and duration of respiratory syncytial virus infection, typical for the prepandemic period, changed. Our previous studies have shown that in different years and in different regions of Russia, the start and end times of the epidemiological season may also not coincide, which makes it difficult to predict seasonal peaks in incidence, their duration and severity only on the basis of previously obtained data. This makes it expedient to extend the terms of passive specific prophylaxis with palivizumab for a year if there are indications for its use, including taking into account the data of epidemiological monitoring conducted in the Russian Federation.Copyright © 2022 Authors. All rights reserved.
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The article presents an overview of current trends in the epidemiology of respiratory syncytial viral (RSV) infection, including its seasonality, under the impact of the COVID-19 pandemic, both according to world literature and taking into account monitoring epidemiological studies conducted in the Russian Federation. A detailed description of the dynamics of RSV detection in the period 2020-2021 and the beginning of 2022 in Russia according to the results of the all-Russian epidemiological monitoring is given. Epidemiological studies in different regions of the world, including Russia, have revealed the absence of seasonal rises in the incidence of RSV infection, characteristic of previous years, in 2020 and winter-spring in 2021 under the influence of the COVID-19 pandemic. In 2021-2022, a sharp increase in the incidence and hospitalization of children was noted against the backdrop of a decrease in cases of a new coronavirus infection in all countries of the world, while the start time and duration of respiratory syncytial virus infection, typical for the prepandemic period, changed. Our previous studies have shown that in different years and in different regions of Russia, the start and end times of the epidemiological season may also not coincide, which makes it difficult to predict seasonal peaks in incidence, their duration and severity only on the basis of previously obtained data. This makes it expedient to extend the terms of passive specific prophylaxis with palivizumab for a year if there are indications for its use, including taking into account the data of epidemiological monitoring conducted in the Russian Federation.Copyright © 2022 Authors. All rights reserved.
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The regulation of inflammation is a complex pathophysiological process that depends on the production of oxygenated lipid derivatives essential polyunsaturated fatty acids, like omega-3 and omega-6, among which are the lipoxins resolvins and protectins, called specialized pro-resolving lipid mediators (SPM). Their activity is associated with the control of respiratory infection processes to modulate the production of proinflammatory cytokines, avoiding damage due to inflammation-associated necrosis, reducing microbial loads, and promoting tissue remodeling. Therefore, we review some of the biochemical, physiological and immunological aspects of SPM in the regulation of inflammation in respiratory infections.Copyright © 2022, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.
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Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.
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Objectives: To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. Methods: A retrospective chart review of children 0–14 years old admitted to PICU with a viral infection. Results: Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). Conclusion: Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
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Aims Respiratory syncytial virus (RSV) causes annual winter epidemics that usually peak in December in the UK and Ireland. Infants are disproportionately affected, with infection leading to lower respiratory tract disease, most commonly bronchiolitis, that often result in emergency department visits and hospitalisations. Non-pharmaceutical interventions (NPIs) introduced globally to limit the spread of SARS-CoV-2 led to disruption of the typical RSV seasonality. Studies examining the aseasonal resurgence of RSV have been limited by sample size, and lack of information on secondary care episodes and clinical features. The BronchStart study is a prospective multicentre cohort study with the objective to monitor RSV disease in children under two years of age attending emergency departments (EDs) across the UK and Ireland and examine the impact on timing, age and severity of clinical presentations as NPI restrictions are reduced throughout the UK and Ireland in 2021. Methods Paediatric emergency departments (PED) within PERUKI (Paediatric Emergency Research in the UK and Ireland) submit data on all children under 2 years of age who visit a PED with symptoms of an acute lower respiratory tract infection (diagnosed as bronchiolitis, lower respiratory tract infection, or first episode of acute wheeze), to a secure online Research Electronic Data Capture (REDCap) database. Followup information is submitted 7 days later. Here we present initial data for 10,347 infants and children from 44 study sites for the period 1st June to 5th December 2021. Results At the time of submission the aseasonal 2021 RSV epidemic in the UK has now come to an end, with infections having peaked in August (figure 1A). Comparing the age distribution of hospitalised infants <12 months to previous years at two large paediatric centres currently participating in the BronchStart Study (Leicester Children's Hospital and Bristol Royal Hospital for Children), we observed a similar age distribution (figure 1B). This suggests reduced community exposure to RSV during the 15 months preceding the start of the season did not result in a clinically significant lack of protective maternal antibody transfer to those <3 months of age, or that the NPIs introduced were not strong enough to prevent low level transmission. Disease severe enough to require intensive care was 2.5% in our cohort (for those aged 6 weeks to one year), comparable to 4.2% reported in previous studies. We also observed a substantial number of PED visits and admissions for RSV positive 12-23 month old children in BronchStart: 362 out of 1,468 (24.7%) admissions were in this age group. Conclusion We found that the 2021 summer lower respiratory tract infection peak in the UK and Ireland, although temporally disrupted and with an attenuated disease burden, predominantly affected younger age groups as in previous years The overall lower burden of disease in 2021 suggests incomplete infection by RSV of its usual susceptible population, probably due to the effect of ongoing non-pharmaceutical interventions over the study time period, and raises the strong possibility of a further wave of infection in the coming months.
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Background: Influenza and bronchiolitis are serious infections especially among vulnerable pediatric populations. Earlier studies have suggested that the transmission of influenza viruses can be reduced by face masking and social distancing measures. In response to the COVID-19 pandemic, Ohio adopted various measures including school closing, travel restrictions, social distancing, and face masking in March, 2020. These measures have created a unique opportunity to study the impact of social distancing measures on the spread of potentially serious viral infections such as influenza and respiratory syncytial viral (RSV) infections of children in our locality. Methods: This is a retrospective cohort study conducted at Akron Children's hospital in Northeast Ohio where the peak respiratory season extends from October to April. The primary outcome was to evaluate the prevalence of influenza A and B and RSV infections before and after implementation of social distancing measures. Prevalence of SARS-CoV-2 was also tracked for comparison. Viral assay data were collected between October 1, 2020 through April 30th, 2021 (during the pandemic and social distancing implementation) and compared with two pre-COVID19 respiratory seasons: 2018-19 and 2019-20. Results from all patients who received viral testing as a part of their medical care were included. Viral tests included rapid antigen tests for Influenza A/B and RSV (Quidel SoFIA), Respiratory Film Array (BioFire, includes flu, RSV, and SARS-CoV-2 targets), and single target tests for SARS-CoV-2 from multiple vendors (see Table 1). Results: There was a dramatic increase in viral testing in the 2020-2021 respiratory season. With most of the new test targeting SARS-CoV-2, Flu and RSV antigen tests decreased significantly but were replaced in part by Respiratory FilmArray use (Table 1). Pre-COVID-19, the peak incidence of RSV occurred in December for the 2018-19 (28.9%, average of 8.8%) and 2019- 20 (24.7%, average of 8.8%) seasons. After social distancing measures, the incidence and positivity rate for RSV was 0% until March 14, 2021 when the first RSV case was detected in our locality, concurrent with relaxation of social distancing measures. Pre-COVID 19, the peak incidence of Influenza A virus occurred during February in the seasons 2018-19 (40.9%;average of 13.6%) and 2019-20 (24.1%, average of 6.1%). Influenza B had a low incidence throughout 2018-2019 (average of 0.3%) with a peak during January in the 2019-2020 season (24.0%, average of 6.8%). During the 2020-2021 season, we detected only two isolated cases of Influenza B virus and no cases of Influenza A virus through April 30, 2021 (Figure-1). Conclusion: Social distancing and mask mandates can be effective tools to decrease the rates of potentially serious infections such as Influenza and RSV in the pediatric population. Travel restrictions and school closures likely had an affect but were not evaluated during this study.
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Purpose of the study: Respiratory syncytial virus (RSV) is a wellknown pathogen in pediatric patients. (1) However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. (2). Methods:We reviewed a patient suffering from cardiac arrest (CA) and acute RSV infection who was admitted to the Department of Emergency Medicine, Medical University of Vienna, Austria. Results: A 74-year-old male patient complained about dyspnea and later went into CA. Bystander BLS was conducted for 7 minutes, and arriving EMS performed advanced life support (ALS). The initial rhythm check showed pulseless electrical activity. After further 6 minutes of ALS, sustained return of spontaneous circulation (ROSC) was achieved, and the patient was transported to the emergency department (ED). At the ED, the ECG showed no ischemia-like patterns, and point-of-care ultrasound revealed a highly reduced left ventricular function. Laboratory results showed signs of inflammation, and a routine PCR turned out positive for RSV. Awhole body computed tomography revealed no acute pathology, and before a background of chronic pulmonary disease, the CA event was deemed as hypoxic caused by exacerbation of the chronic pulmonary pathologies either parallel to- or directly through an acute RSV infection. Conclusion: An RSV infection should be considered during post- ROSC in adult patients with presumed hypoxic etiology of CA. From a public health perspective, an immune-naivety for RSV caused by the COVID-19 pandemic may potentially induce a rise in cases, morbidity, and mortality in the future.