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

SLIDE 1

Respiratory Syncytial Virus and Bronchiolitis

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

SLIDE 2

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

SLIDE 3

Paramyxoviridae

Avian MPV Human MPV Human RSV Bovine RSV Ovine RSV Pneumovirus of mice Metapneumovirus Pneumovirus Human PIV 1-4 Sendai Parainfluenza Paramyxoviridae Paramyxovirinae Pneumovirinae

Piedimonte & Perez, PIR 2014

SLIDE 4

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% Streptococcus pneumoniae 8% H parainfluenzae 2% Haemophilus influenzae 6% Chlamydia pneumoniae 0% Mycoplasma pneumoniae 9% Piedimonte & Perez, PIR 2014

SLIDE 5

Global Seasonality of RSV

RSV Seasonality in NL

Positive Results from Registratie virologische laboratoria (1996-98)

300 600 900 1200

4 1

• 4

4 4 9

• 5

2 5

• 8

1 3

• 1

6 2 1

• 2

4 2 9

• 3

2 3 7

• 4

4 5

• 4

8 1

• 4

9

• 1

2 1 7

• 2

2 5

• 2

8 3 3

• 3

6 4 1

• 4

4 4 9

• 5

2 5

• 8

1 3

• 1

6 2 1

• 2

4 2 9

• 3

2 3 7

• 4

4 5

• 4

8 1

• 4

RSV Cases Reported

RSV Seasonality in UK

Cases Reported by UK Centre for Disease Control (1996-98)

1000 2000 3000 4000 5000 RSV Cases Reported

RSV Seasonality in Belgium

Cases Reported by Institut Pasteur, Bruxelles (1996-99)

300 600 900 1200

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

Cases Reported

200 400 600 800 1000 RSV Cases Reported

RSV Seasonality in Norway

National Institute of Public Health - Dept. of Virology 1996-98) 1996 1997 1998

Piedimonte & Perez, PIR 2014

SLIDE 6

Annual Bronchiolitis Hospitalizations Among US Children

Shay DK, JAMA 1999; 282:1440

1 10 100 YEAR # of Bronchiolitis Hospitalizations (000's) <6 mo 6-11mo 12-23mo 24-59mo

Piedimonte & Perez, PIR 2014

SLIDE 7

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

SLIDE 8

RSV: Radiologic Findings

Piedimonte & Perez, PIR 2014

SLIDE 9

Time Course of Post-RSV Recurrent 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 Patients Affected (%)

20 40 60 80 100

2 3.5 82%1 69%2 55%3 31%3 4-5 6-8

Piedimonte & Perez, PIR 2014

SLIDE 10

Current Bronchiolitis Management

Inconclusive Bronchodilators Corticosteroids Ribavirin Vaccines Proven Efficacy Fluid Intake Oxygen Palivizumab Future?

THERAPY PROPHYLAXIS

Antivirals DNAse Surfactant Heliox New Monoclonals New Vaccines EVIDENCE

Piedimonte & Perez, PIR 2014