Respiratory Syncytial Virus: New Challenges for Molecular Epidemiology Surveillance and Vaccination Strategy in Patients with ILI/SARI

Several respiratory pathogens are responsible for influenza-like illness (ILI) and severe respiratory infections (SARI), among which human respiratory syncytial virus (hRSV) represents one of the most common aetiologies. We analysed the hRSV prevalence among subjects with ILI or SARI during the five influenza seasons before the emergence of SARS-CoV-2 epidemic in Sicily (Italy). Respiratory specimens from ILI outpatients and SARI inpatients were collected in the framework of the Italian Network for the Influenza Surveillance and molecularly tested for hRSV-A and hRSV-B. Overall, 8.1% of patients resulted positive for hRSV. Prevalence peaked in the age-groups <5 years old (range: 17.6–19.1%) and ≥50 years old (range: 4.8–5.1%). While the two subgroups co-circulated throughout the study period, hRSV-B was slightly predominant over hRSV-A, except for the season 2019–2020 when hRSV-A strongly prevailed (82.9%). In the community setting, the distribution of hRSV subgroups was balanced (47.8% vs. 49.7% for hRSV-A and hRSV-B, respectively), while most infections identified in the hospital setting were caused by hRSV-B (69.5%); also, this latter one was more represented among hRSV cases with underlying diseases, as well as among those who developed a respiratory complication. The molecular surveillance of hRSV infections may provide a valuable insight into the epidemiological features of ILI/SARI. Our findings add new evidence to the existing knowledge on viral aetiology of ILI and SARI in support of public health strategies and may help to define high-risk categories that could benefit from currently available and future vaccines.

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Use of the moving epidemic method (MEM) to assess national surveillance data for respiratory syncytial virus (RSV) in the Netherlands, 2005 to 2017

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.20.1800469 ◽

2019 ◽

Vol 24 (20) ◽

Cited By ~ 4

Author(s):

Laura M Vos ◽

Anne C Teirlinck ◽

José E Lozano ◽

Tomás Vega ◽

Gé A Donker ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

The Netherlands ◽

Respiratory Infections ◽

Laboratory Data ◽

Age Distribution ◽

Age Groups ◽

Surveillance Data ◽

Cumulative Number ◽

Laboratory Surveillance ◽

Syncytial Virus

Background To control respiratory syncytial virus (RSV), which causes acute respiratory infections, data and methods to assess its epidemiology are important. Aim We sought to describe RSV seasonality, affected age groups and RSV-type distribution over 12 consecutive seasons in the Netherlands, as well as to validate the moving epidemic method (MEM) for monitoring RSV epidemics. Methods We used 2005−17 laboratory surveillance data and sentinel data. For RSV seasonality evaluation, epidemic thresholds (i) at 1.2% of the cumulative number of RSV-positive patients per season and (ii) at 20 detections per week (for laboratory data) were employed. We also assessed MEM thresholds. Results In laboratory data RSV was reported 25,491 times (no denominator). In sentinel data 5.6% (767/13,577) of specimens tested RSV positive. Over 12 seasons, sentinel data showed percentage increases of RSV positive samples. The average epidemic length was 18.0 weeks (95% confidence intervals (CI): 16.3–19.7) and 16.5 weeks (95% CI: 14.0–18.0) for laboratory and sentinel data, respectively. Epidemics started on average in week 46 (95% CI: 45–48) and 47 (95% CI: 46–49), respectively. The peak was on average in the first week of January in both datasets. MEM showed similar results to the other methods. RSV incidence was highest in youngest (0–1 and >1–2 years) and oldest (>65–75 and > 75 years) age groups, with age distribution remaining stable over time. RSV-type dominance alternated every one or two seasons. Conclusions Our findings provide baseline information for immunisation advisory groups. The possibility of employing MEM to monitor RSV epidemics allows prospective, nearly real-time use of surveillance data.

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The rapid reemergence of seasonal respiratory viruses in Houston, Texas, after relaxing COVID-19 restrictions

10.1101/2021.05.27.21257940 ◽

2021 ◽

Author(s):

Parsa Hodjat ◽

Paul Christensen ◽

Sishir Subedi ◽

Randall James Olsen ◽

David W Bernard ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

State Level ◽

Complete Removal ◽

Respiratory Viruses ◽

Rapid Decrease ◽

The State ◽

Respiratory Pathogens ◽

Containment Measures ◽

Syncytial Virus

Implementation of measures to limit the spread of the SARS-CoV-2 virus at the start of the COVID-19 pandemic resulted in a rapid decrease in all other respiratory pathogens. As COVID-19 containment measures were relaxed, the first non-COVID respiratory viruses to return to prepandemic levels were members of the rhinovirus/enterovirus, followed by the rapid return of seasonal coronaviruses, parainfluenza, and respiratory syncytial virus after the complete removal of COVID-19 precautions at the state level, including an end to mask mandates. Inasmuch as COVID-19 has dominated the landscape of respiratory infections since early 2020, it is important for clinicians to recognize the return of non-COVID respiratory pathogens may be rapid and significant when COVID-19 containment measures are removed.

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Performance of surveillance case definitions for respiratory syncytial virus infections through the sentinel influenza surveillance system, Portugal, 2010 to 2018

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.45.1900140 ◽

2019 ◽

Vol 24 (45) ◽

Cited By ~ 2

Author(s):

Emma Sáez-López ◽

Pedro Pechirra ◽

Inês Costa ◽

Paula Cristóvão ◽

Patrícia Conde ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Characteristic Curve ◽

Age Groups ◽

Case Definition ◽

Influenza Surveillance ◽

Surveillance Systems ◽

The European Union ◽

Case Definitions ◽

Rsv Infection ◽

Syncytial Virus

Background Well-established influenza surveillance systems (ISS) can be used for respiratory syncytial virus (RSV) surveillance. In Portugal, RSV cases are detected through the ISS using the European Union (EU) influenza-like illness (ILI) case definition. Aim To investigate clinical predictors for RSV infection and how three case definitions (EU ILI, a modified EU acute respiratory infection, and one respiratory symptom) performed in detecting RSV infections in Portugal. Methods This observational retrospective study used epidemiological and laboratory surveillance data (October 2010–May 2018). Associations between clinical characteristics and RSV detection were analysed using logistic regression. Accuracy of case definitions was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A 0.05 significance level was accepted. Results The study involved 6,523 persons, including 190 (2.9%) RSV cases. Among 183 cases with age information, RSV infection was significantly more frequent among individuals < 5 years (n = 23; 12.6%) and ≥ 65 years (n = 45; 24.6%) compared with other age groups (p < 0.0001). Cough (odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2–6.5) was the best RSV-infection predictor considering all age groups, while shortness of breath was particularly associated with RSV-positivity among ≤ 14 year olds (OR: 6.7; 95% CI: 2.6–17.4 for 0–4 year olds and OR: 6.7; 95% CI: 1.5–28.8 for 5–14 year olds). Systemic symptoms were significantly associated with RSV-negative and influenza-positive cases. None of the case definitions were suitable to detect RSV infections (AUC = 0.51). Conclusion To avoid underestimating the RSV disease burden, RSV surveillance within the Portuguese sentinel ISS would require a more sensitive case definition than ILI and, even a different case definition according to age.

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Evaluation of Human Respiratory Syncytial Virus and Human Parainfluenza Virus Type 3 among Hospitalized Children in Northwest of Iran

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2021/2270307 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Zahra Ramezannia ◽

Javid Sadeghi ◽

Shahram Abdoli Oskouie ◽

Mohammad Ahangarzadeh Rezaee ◽

Hossein Bannazadeh Baghi ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Respiratory Infections ◽

Winter Season ◽

Human Respiratory Syncytial Virus ◽

Respiratory Pathogens ◽

Limited Information ◽

Syncytial Virus ◽

Tract Infections

Background. Acute respiratory tract infections (ARTIs) are the leading cause of illnesses in children. Human respiratory syncytial virus (HRSV) and human parainfluenza viruses (HPIVs) are among the most common etiologic agents associated with viral respiratory tract infections in children worldwide. Nevertheless, limited information is available on the spread of infections of these two viruses in northwest Iran. Objective. The purpose of the current study is to evaluate the frequency of RSV and HPIV-3 and clinical features among Iranian children with confirmed respiratory infections between April 2019 and March 2020. Methods. 100 nasopharyngeal swabs were collected from hospitalized patients (under 5 years old) with ARTI from Tabriz Children’s Hospital. Detection of respiratory viruses was performed using the nested RT-PCR method. Results. Respiratory syncytial virus and HPIV-3 were recognized in 18% (18/100) and 2% (2/100) of children, respectively. Ten (55.6%) of the RSV-positive samples were male, while 8 (44.4%) were female. HPIV‐3 was found only among 2 male patients (100%). Most patients (61.1%) with RSV infection were less than 12 months old. Additionally, samples that were positive for HPIV-3 were less than 12 months old. RSV infections had occurred mainly during the winter season. Conclusions. This study confirms that RSV can be one of the important respiratory pathogens in children in northwestern Iran. However, according to this study, HPIV-3 has a lower prevalence among children in this area than RSV. Therefore, implementing a routine diagnosis for respiratory pathogens can improve the management of respiratory infections in children.

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Etiology of Coinfections in Children with Influenza during 2015/16 Winter Season in Nepal

International Journal of Microbiology ◽

10.1155/2018/8945142 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Bishnu Prasad Upadhyay ◽

Megha Raj Banjara ◽

Ram Krishna Shrestha ◽

Masato Tashiro ◽

Prakash Ghimire

Keyword(s):

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Influenza A ◽

Antimicrobial Agents ◽

Respiratory Infections ◽

Winter Season ◽

Parainfluenza Virus ◽

Respiratory Pathogen ◽

Respiratory Pathogens ◽

Syncytial Virus

Acute respiratory infections (ARIs) are one of the major public health problems in developing countries like Nepal. Besides the influenza, several other pathogens are responsible for acute respiratory infection in children. Etiology of infections is poorly characterized at the course of clinical management, and hence empirical antimicrobial agents are used. The objective of this study was to characterize the influenza and other respiratory pathogens by real-time PCR assay. A total of 175 throat swab specimens of influenza-positive cases collected at National Influenza Center, Nepal, during the 2015/16 winter season were selected for detecting other respiratory copathogens. Total nucleic acid was extracted using Pure Link viral RNA/DNA mini kit (Invitrogen), and multiplex RT-PCR assays were performed. Influenza A and B viruses were found in 120 (68.6%) and 55 (31.4%) specimens, respectively, among which coinfections were found in 106 (60.6%) specimens. Among the influenza A-positive cases, 25 (20.8%) were A/H1N1 pdm09 and 95 (79.2%) were A/H3 subtypes. Viruses coinfected frequently with influenza virus in children were rhinovirus (26; 14.8%), respiratory syncytial virus A/B (19; 10.8%), adenovirus (14; 8.0%), coronavirus (CoV)-HKU1 (14; 8.0%), CoV-OC43 (5; 2.9%), CoV-229E (2; 1.1%), metapneumovirus A/B (5; 2.9%), bocavirus (6; 3.4%), enterovirus (5; 2.9%), parainfluenza virus-1 (3; 1.7%), and parainfluenza virus-3 (2; 1.1%). Coinfection of Mycoplasma pneumoniae with influenza virus was found in children (5; 2.8%). Most of the viral infection occurred in young children below 5 years of age. In addition to influenza virus, nine different respiratory pathogens were detected, of which coinfections of rhinovirus and respiratory syncytial virus A/B were predominantly found in children. This study gives us better information on the respiratory pathogen profile and coinfection combinations which are important for diagnosis and treatment of ARIs.

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Role of Respiratory Syncytial Virus in Pediatric Pneumonia

Microorganisms ◽

10.3390/microorganisms8122048 ◽

2020 ◽

Vol 8 (12) ◽

pp. 2048

Author(s):

Sonia Bianchini ◽

Ettore Silvestri ◽

Alberto Argentiero ◽

Valentina Fainardi ◽

Giovanna Pisi ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Young Children ◽

Respiratory Infections ◽

Clinical Signs ◽

Supportive Therapy ◽

Respiratory Pathogens ◽

Single Polymerase Chain Reaction ◽

Rsv Infection ◽

Syncytial Virus ◽

Tract Infections

Respiratory viral infections represent the leading cause of hospitalization in infants and young children worldwide and the second leading cause of infant mortality. Among these, Respiratory Syncytial Virus (RSV) represents the main cause of lower respiratory tract infections (LRTIs) in young children worldwide. RSV manifestation can range widely from mild upper respiratory infections to severe respiratory infections, mainly bronchiolitis and pneumonia, leading to hospitalization, serious complications (such as respiratory failure), and relevant sequalae in childhood and adulthood (wheezing, asthma, and hyperreactive airways). There are no specific clinical signs or symptoms that can distinguish RSV infection from other respiratory pathogens. New multiplex platforms offer the possibility to simultaneously identify different pathogens, including RSV, with an accuracy similar to that of single polymerase chain reaction (PCR) in the majority of cases. At present, the treatment of RSV infection relies on supportive therapy, mainly consisting of oxygen and hydration. Palivizumab is the only prophylactic method available for RSV infection. Advances in technology and scientific knowledge have led to the creation of different kinds of vaccines and drugs to treat RSV infection. Despite the good level of these studies, there are currently few registered strategies to prevent or treat RSV due to difficulties related to the unpredictable nature of the disease and to the specific target population.

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Influenza and Respiratory Syncytial Virus during the COVID-19 pandemic: time for a new paradigm?

10.22541/au.162321850.03771992/v1 ◽

2021 ◽

Author(s):

Emma Binns ◽

marianne koenraads ◽

Lidia Hristeva ◽

Alix Flamant ◽

Sebastián Baier Grabner ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

Current Knowledge ◽

Age Groups ◽

Population Level ◽

Lessons Learned ◽

New Paradigm ◽

Current Scenario ◽

Community Transmission ◽

Syncytial Virus

Seasonal epidemics of influenza and the respiratory syncytial virus are the cause of substantial morbidity and mortality among children. During the global COVID-19 pandemic, the epidemiology of these viruses seems to have changed dramatically. In Australia and New Zealand, a significant decrease in both influenza and bronchiolities have been noticed during usual peak seasons. Data from early months of winter seasons in Europe are showing similar trends. This current scenario imposes a reconsideration of the paradigm that toddlers and young schoolchildren are the main drivers of seasonal RSV outbreaks and respiratory epidemics in general. In this paper, we summarize current literature, address current knowledge or role of adults in the respiratory syncitial virus epidemiology, describe the lessons learned from pertussis epidemics and call the international community to better understand the community transmission dynamics of respiratory infections in all age-groups. This can allow the establishment of better and more affordable preventive measures in the whole population level, which can ultimately save millions of child lives.

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Influenza, RSV, and Other Respiratory Infections among Children in Qatar

University of the Future: Re-Imagining Research and Higher Education ◽

10.29117/quarfe.2020.0133 ◽

2020 ◽

Author(s):

Maria K. Smatti ◽

Hamad E. Al-Romaihi ◽

Hebah A. Al-Khatib ◽

Peter V. Coyle ◽

Asmaa A Al Thani ◽

...

Keyword(s):

Respiratory Infections ◽

Control Strategies ◽

Age Groups ◽

Influenza Viruses ◽

Respiratory Pathogen ◽

Infection Prevention And Control ◽

Respiratory Pathogens ◽

Gulf Region ◽

Mortality And Morbidity ◽

Syncytial Virus

Background: Acute respiratory infections (ARIs) lead to high rates of mortality and morbidity among children. However, studies on the etiology of respiratory infections among children in Qatar and surrounding countries are still limited. Objectives: To describe the prevalence and seasonality of RSV, influenza, and other respiratory pathogens among children in Qatar. Methods: We retrospectively collected data of 33,404 patients <15 years old presented with Influenza-like illness (ILI) from 2012 to 2017. All samples were tested for influenza viruses, while 30,946 were tested for a complete panel of 21 respiratory pathogens. Results: At least one respiratory pathogen was detected in 26,138 (78%) of patients. Together, human rhinoviruses (HRV), respiratory syncytial virus (RSV), and influenza viruses comprised nearly two-thirds of all ILI cases, detected in 24%, 19.7%, and 18.5%, respectively. A detection rate of 5-10% was recorded for adenovirus, human parainfluenza viruses (HPIVs), bocavirus (HboV), and human coronaviruses (HCoVs). Other pathogens such as human metapneumovirus (HMPV), enteroviruses, mycoplasma pneumonia, and parechovirus had prevalence rates below 5%. ILI positive cases were detected throughout the year. RSV, influenza, HMPV exhibited strong seasonal activity in the winter, while HRV was primarily active during low RSV and influenza activity. The burden of RSV exceeds that of influenza among young age groups (<5 years), affecting 17-30% of ILI cases. Prevalence of influenza, on the other hand, correlated positively with age, ranging from 23% to 32% in age groups above five years. Further, male patients had higher rates of HRV (26%) and adenovirus (9%), whereas females showed a higher prevalence of influenza (22%), and RSV (20%) infections. Conclusion: This comprehensive report provides insights into the etiology of ILI among children in Qatar, which represents the Gulf region. Our results reinforce the significance of active surveillance of respiratory pathogens to improve infection prevention and control strategies, particularly among children.

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Epidemiology and prevention of respiratory syncytial virus infections in children in Italy

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01148-8 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Chiara Azzari ◽

Eugenio Baraldi ◽

Paolo Bonanni ◽

Elena Bozzola ◽

Alessandra Coscia ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

Unmet Need ◽

Respiratory Pathogens ◽

Virus Infections ◽

New Agents ◽

Epidemic Season ◽

Case Identification ◽

Syncytial Virus ◽

Neonates And Infants

AbstractRespiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.

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1718. Respiratory Syncytial Virus (RSV) Surveillance in the Department of Veterans Affairs (VA), 2010-2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1896 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S843-S843

Author(s):

Cynthia Lucero-Obusan ◽

Patricia Schirmer ◽

Gina Oda ◽

Mark Holodniy

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

Diagnostic Testing ◽

Fold Increase ◽

Respiratory Illness ◽

Veterans Affairs ◽

Department Of Veterans Affairs ◽

Management And Development ◽

Syncytial Virus ◽

National Trends

Abstract Background Respiratory Syncytial Virus (RSV) is an increasingly recognized cause of acute respiratory illness in older adults, leading to an estimated 177,000 hospitalizations and 14,000 deaths each year in the US. In adult populations, diagnostic testing for RSV has historically been underutilized. Herein, we examine national trends in RSV testing and infection across the Veterans Affairs (VA) healthcare system. Methods Electronic RSV laboratory testing results, ICD-coded hospitalizations and outpatient encounters were obtained from VA’s Praedico Surveillance System (1/1/2010-12/31/2018). Patients were reviewed for positive results, repeat testing, and demographics. Antibody tests were excluded. Results A total of 102,251 RSV results were included. Overall, 4,372 (4.3%) specimens from 4,263 unique individuals were positive with a median age of 67 years (range 0-101) and 90% were male. 1,511 individuals (35.4%) also had an RSV-coded hospitalization. RSV type was specified for only 7.8% of positives (Table). During 2010-2018 there were 2,522 RSV-coded hospitalizations (median length of stay = 4 days) among 2,444 unique individuals, which included 413 ICU stays (16.4%) and 98 deaths (3.9%) during the RSV-coded hospitalization. Approximately 78% of RSV-coded hospitalizations within VA (excluding all non-VA hospitalizations) had a documented positive test result. A greater than 15-fold increase in RSV tests performed, hospitalizations and outpatient encounters was observed from 2010-2018, although the percent testing positive remained relatively stable (Figure, Table). Figure. Testing for Respiratory Syncytial Virus (RSV), Department of Veterans Affairs, 2010-2018. Table. Select RSV Surveillance Metrics, Department of Veterans Affairs, 2010-2018 Conclusion RSV testing and identification of patients with RSV infection increased dramatically during the time period analyzed, likely due to increased availability of PCR-based multi-pathogen panels and duplex assays. While the percentage of tests positive for RSV remained relatively stable, the rise in coded hospitalizations may be due to increased testing for RSV among hospitalized Veterans with severe respiratory infections. These surveillance data may allow for further characterization of RSV disease burden estimates which can help inform clinical management and development of interventions for adults, such as vaccines and antiviral therapies. Disclosures All Authors: No reported disclosures

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