Respiratory Syncytial Virus and Bronchiolitis · 2014-11-19 · Respiratory Syncytial Virus...
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Respiratory Syncytial Virus and Bronchiolitis Giovanni Piedimonte, M.D. Miriam K. Perez, M.D.
Transcript of 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
