Respiratory Syncytial Virus and Bronchiolitis Giovanni Piedimonte, - PowerPoint PPT Presentation

Respiratory Syncytial Virus and Bronchiolitis Giovanni Piedimonte, M.D. Miriam K. Perez, M.D.

Respiratory Syncytial Virus Envelope Spikes Inner Envelope Nuecleocapsid Surface of Infected Cells Electron photomicrograph of budding virion (Adapted from: Peter Collins, 1989; Fields Virology 2nd Edition, 1990). Piedimonte & Perez, PIR 2014

Paramyxoviridae Paramyxoviridae Paramyxovirinae Pneumovirinae Pneumovirus Metapneumovirus Parainfluenza Human RSV Human PIV 1-4 Avian MPV Bovine RSV Ovine RSV Sendai Human MPV Pneumovirus of mice Piedimonte & Perez, PIR 2014

RSV: The Most Common Respiratory Pathogen in Children Worldwide Chlamydia pneumoniae 0% Adenovirus 7% Mycoplasma pneumoniae 9% RSV accounts for: Haemophilus • >60% of ARIs during influenzae 6% entire respiratory season H parainfluenzae 2% • 90% of ARIs at peak of Influenza B 2% respiratory season RSV • 80% of ARIs in infants Influenza A 3% 63% <1 year old during entire respiratory season Streptococcus pneumoniae 8% ARI = acute respiratory infection. Piedimonte & Perez, PIR 2014

Global Seasonality of RSV RSV Seasonality in NL RSV Seasonality in Belgium Positive Results from Registratie virologische laboratoria (1996-98) Cases Reported by Institut Pasteur, Bruxelles (1996-99) 1200 1200 900 900 RSV Cases Reported Cases Reported 600 600 300 300 0 4 2 8 6 4 2 0 8 4 2 0 8 6 4 2 8 6 4 2 0 8 4 4 5 - 1 2 3 4 4 - 1 2 2 3 4 5 - 1 2 3 4 4 - 5 1 5 1 - - - - - - - - - - - - - - - - - - 1 9 3 1 9 7 5 9 7 5 3 1 9 3 1 9 7 5 4 4 1 2 2 3 4 1 2 3 4 4 1 2 2 3 4 0 1-4 9-12 17-20 25-28 33-36 41-44 49-52 5-8 13-16 21-24 29-32 37-40 45-48 1-4 9-12 17-20 25-28 33-36 41-44 49-52 5-8 RSV Seasonality in UK RSV Seasonality in Norway Cases Reported by UK Centre for Disease Control (1996-98) National Institute of Public Health - Dept. of Virology 1996-98) 1000 5000 RSV Cases Reported 800 4000 RSV Cases Reported 600 3000 400 2000 200 1000 0 0 1996 1998 1997 Piedimonte & Perez, PIR 2014

Annual Bronchiolitis Hospitalizations Among US Children Hospitalizations (000's) 100 # of Bronchiolitis <6 mo 6-11mo 10 12-23mo 24-59mo 1 YEAR Shay DK, JAMA 1999; 282:1440 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-RSV Recurrent Respiratory Symptoms 100 82% 1 Patients Affected 80 69% 2 60 55% 3 (%) 40 31% 3 20 0 4-5 6-8 2 3.5 Years After Initial RSV Infection 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. Piedimonte & Perez, PIR 2014

Current Bronchiolitis Management THERAPY PROPHYLAXIS EVIDENCE Bronchodilators Inconclusive Corticosteroids Vaccines Ribavirin Fluid Intake Proven Efficacy Palivizumab Oxygen Antivirals DNAse New Monoclonals Future? Surfactant New Vaccines Heliox Piedimonte & Perez, PIR 2014