Clinical and Epidemiologic Features of Respiratory Syncytial Virus

Abstract

Since its discovery in 1955, respiratory syncytial virus (RSV) has consistently been noted to be the single most important cause of lower respiratory tract illness in infants <1 year of age. RSV also causes repeat infections and significant disease throughout life. In addition to the young child, persons with compromised immune, pulmonary or cardiac systems, and the elderly have significant risk from infection. Though RSV causes the full spectrum of acute respiratory illnesses, it is most notably associated with signs and symptoms of increased airway resistance manifested as wheezing and, in the young child, diagnosed as bronchiolitis. In temperate climates, RSV occurs as yearly outbreaks usually between late fall and early spring lasting 3-4 months in a community. The timing of outbreaks varies between years and in the same year between regions and even between nearby communities. RSV can be a serious nosocomial pathogen in high risk individuals but nosocomial transmission that can often be prevented with meticulous attention to good infection control practices. High risk groups include the premature infants and persons of any age with compromised cardiac, pulmonary, or immune systems. Risk factors for infection include increased number of children in the household and day care center attendance. There are reasonable estimates of the sizable burden of RSV disease in infants and young children and the elderly but less data on disease in older children, the role of RSV in later reactive airway disease (see chapter by M.T. Lotz et al. , this volume), and RSV-associated mortality in developing countries. The available data on burden of disease suggests there are at least four potential target populations for a vaccine, the young infant, young children >4-6 months of age, pregnant women, and the elderly. A link between infection in the young infant and later reactive airway disease and mortality in developing countries is needed. Each target population has different vaccine safety and efficacy concerns and may warrant a different type of vaccine.

Respiratory Syncytial Virus–Associated Mortality in Hospitalized Infants and Young Children

“…Infants with CCC represent a vulnerable population who, along with the elderly, experience the greatest mortality burden from RSV. 3,30 These populations should be prioritized if a safe and effective RSV vaccine is developed. Our findings may help to inform policy makers as they model the costs associated with RSV prevention and treatment strategies, including palivizumab and investigational therapeutics and vaccines under development.…”

Recombinant Subgroup B Human Respiratory Syncytial Virus Expressing Enhanced Green Fluorescent Protein Efficiently Replicates in Primary Human Cells and Is Virulent in Cotton Rats

“…HRSV infections are observed during seasonal outbreaks in winter or during the rainy season in the tropics (2). The virus usually causes a self-limiting upper respiratory tract (URT) infection, resulting in rhinorrhea and other common cold-like clinical signs (3). However, in a minority of cases the infection can also spread to the lower respiratory tract (LRT), resulting in severe pneumonia or bronchiolitis.…”

Population-based Incidence and Etiology of Community-acquired Neonatal Viral Infections in Bangladesh

“…25,26 The global burden of RSV on neonatal morbidity and mortality has not been well elucidated. 27,28 In the CHW surveillance area, we identified 6 cases of neonatal RSV infection presenting as URTI on the first or second day of life. In addition, RSV was isolated in over half of all cases presenting with pneumonia (see Table, Supplemental Digital Content 3, http://links.lww.com/INF/C118).…”