respiratory syncytial virus and bronchiolitis · 2014-11-19 · respiratory syncytial virus...

Respiratory Syncytial Virus and Bronchiolitis

Giovanni Piedimonte, M.D.Miriam K. Perez, M.D.

Respiratory Syncytial Virus

Envelope Spikes

Inner Envelope

Nuecleocapsid Surface ofInfected Cells

Electron photomicrograph of budding virion(Adapted from: Peter Collins, 1989; Fields Virology 2nd Edition, 1990).

Piedimonte & Perez, PIR 2014

Paramyxoviridae

Avian MPV

Human MPV

Human RSVBovine RSVOvine RSV

Pneumovirus of mice

MetapneumovirusPneumovirus

Human PIV 1-4

Sendai

Parainfluenza

Paramyxoviridae

Paramyxovirinae Pneumovirinae

Piedimonte & Perez, PIR 2014

RSV: The Most Common Respiratory Pathogen in Children Worldwide

RSV accounts for:

• >60% of ARIs during entire respiratory season

• 90% of ARIs at peak of respiratory season

• 80% of ARIs in infants <1 year old during entire respiratory season

ARI = acute respiratory infection.

RSV 63%

Adenovirus 7%

Influenza A 3%

Influenza B 2%

Streptococcuspneumoniae 8%

H parainfluenzae 2%

Haemophilus influenzae 6%

Chlamydia pneumoniae 0%

Mycoplasma pneumoniae 9%

Piedimonte & Perez, PIR 2014

Global Seasonality of RSVRSV Seasonality in NL

Positive Results from Registratie virologische laboratoria (1996-98)

0

300

600

900

1200

41-4449-5

25-8

13-1621-2

429-3

237-4

045-4

81-4

9-1217-2

025-2

833-3

641-4

449-5

25-8

13-1621-2

429-3

237-4

045-4

81-4

RS

V C

ases

Rep

ort

ed

RSV Seasonality in UKCases Reported by UK Centre for Disease Control (1996-98)

0

1000

2000

3000

4000

5000

RS

V C

ases R

ep

orte

d

RSV Seasonality in BelgiumCases Reported by Institut Pasteur, Bruxelles (1996-99)

0

300

600

900

1200

1-49-1

217-2

025-2

833-3

641-4

449-5

25-8

13-16

21-24

29-32

37-40

45-48

1-49-1

217-2

025-2

833-3

641-4

449-5

25-8

Cas

es R

epor

ted

0

200

400

600

800

1000

RS

V C

ases R

ep

ort

ed

RSV Seasonality in NorwayNational Institute of Public Health - Dept. of Virology 1996-98)

1996 1997 1998

Piedimonte & Perez, PIR 2014

Annual Bronchiolitis Hospitalizations Among US Children

Shay DK, JAMA 1999; 282:1440

1

10

100

YEAR

# o

f B

ro

nch

ioliti

s

Ho

sp

italizati

on

s (

00

0's

)

<6 mo

6-11mo

12-23mo

24-59mo

Piedimonte & Perez, PIR 2014

RSV Epidemiology

• >120,000 annual hospitalizations in US

• Peak incidence of severe illness 2-3 months

• Illness severity related to:

– Age <12 weeks

– Absence of breastfeeding

– History of prematurity

– Underlying heart or lung disease

– Immune deficit

Piedimonte & Perez, PIR 2014

RSV: Radiologic Findings

Piedimonte & Perez, PIR 2014

Time Course of Post-RSVRecurrent Respiratory Symptoms

1. Henry RL et al. Arch Dis Child 1983; 58:713-716.2. Webb MS et al. Arch Dis Child 1985; 60:1064-1067.3. Hall CB et al. J Pediatr 1984;105:358-364.

Years After Initial RSV Infection

Pati

en

ts A

ffecte

d

(%

)

0

20

40

60

80

100

2 3.5

82%1

69%2

55%3

31%3

4-5 6-8

Piedimonte & Perez, PIR 2014

Current Bronchiolitis Management

InconclusiveBronchodilatorsCorticosteroids

RibavirinVaccines

Proven EfficacyFluid Intake

OxygenPalivizumab

Future?

THERAPY PROPHYLAXIS

AntiviralsDNAse

SurfactantHeliox

New MonoclonalsNew Vaccines

EVIDENCE

Piedimonte & Perez, PIR 2014