Respiratory syncytial virus in influenza‐like illness cases: Epidemiology and molecular analyses of four consecutive winter seasons (2014‐2015/2017‐2018) in Lombardy (Northern Italy)
Abstract:Background
Besides seasonal influenza viruses (IV), several other pathogens—including respiratory syncytial virus (RSV)—are involved in clinically undistinguished influenza‐like illnesses (ILIs). This study aimed at investigating the contribution of RSV in ILI cases in Lombardy (Northern Italy) during four consecutive winter seasons.
Materials and Methods
In the framework of influenza surveillance, respiratory samples from ILI outpatients were collected from 2014‐2015 to 2017‐2018 season. IV‐negative swabs wer… Show more
“…During the study period, RSV circulated from mid-November until the end of April, peaking in mid-February (median: week 8; range: 6–10); the duration of RSV circulation was about 4 months (median: 15.5 weeks; range: 13–19 weeks). This is consistent with the results of a previous analysis of data from 15 European countries, which did not include Italy [ 41 ]. Fig.…”
Section: Epidemiological Surveillancesupporting
confidence: 93%
“…RSV was detected in all age groups; however, the RSV positivity rate among ILI cases was highest in the pediatric age group ≤5 years (27.8%; 51/183) (Table 2 ) [ 41 ].…”
Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.
“…During the study period, RSV circulated from mid-November until the end of April, peaking in mid-February (median: week 8; range: 6–10); the duration of RSV circulation was about 4 months (median: 15.5 weeks; range: 13–19 weeks). This is consistent with the results of a previous analysis of data from 15 European countries, which did not include Italy [ 41 ]. Fig.…”
Section: Epidemiological Surveillancesupporting
confidence: 93%
“…RSV was detected in all age groups; however, the RSV positivity rate among ILI cases was highest in the pediatric age group ≤5 years (27.8%; 51/183) (Table 2 ) [ 41 ].…”
Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.
“…As the regional reference laboratory for influenza and other respiratory viruses in Lombardy, we collaborate closely with the national COVID-19 surveillance system coordinated by the National Institute of Health (Istituto Superiore di Sanità, ISS), and soon after the global spread of SARS-CoV-2 was announced, we implemented SARS-CoV-2 molecular detection as part of the ILI sentinel surveillance program [8]. In fact, since ILI clinical manifestations are similar to mild symptoms of SARS-CoV-2 infection, the Italian Influenza Surveillance Network (InfluNet) was used to monitor the epidemiological and virological characteristics of SARS-CoV-2, which had previously been employed successfully for respiratory viruses other than influenza, such as respiratory syncytial virus (RSV) [9], enteroviruses, and parechoviruses [10]. Recently, it has been demonstrated that ILI outpatient surveillance data could be used to estimate the baseline prevalence of SARS-CoV-2 and to identify surges of excess ILIs correlated with SARS-CoV-2, with the broader potential to use this syndromic surveillance for early detection and molecular-epidemiological characterization [11,12].…”
This paper outlines the role of Lombardy’s regional influenza reference laboratory (Northern Italy) in the surveillance of influenza-like illnesses (ILIs) in monitoring SARS-CoV-2 circulation by analyzing 631 consecutive nasopharyngeal swabs (NPSs) collected from ILI outpatients by sentinel physicians during the 2019–2020 season. The samples were tested by specific real-time RT-PCRs targeting SARS-CoV-2, influenza viruses, and RSVs. Results: Of these NPSs, 31% tested positive for influenza viruses, 10% for SARS-CoV-2, and 7% for RSV. No coinfections were detected. Influenza viruses and RSVs circulated throughout the surveillance period until the end of February (week 9-2020), when they suddenly ceased to circulate seven weeks earlier than during the previous five influenza seasons. After the first detection of SARS-CoV-2 in our ILI outpatients at the beginning of March (week 10-2020), SARS-CoV-2 remained the only virus identified throughout the surveillance period. Patients ≥ 65 years had a 3.2-fold greater risk of being infected with SARS-CoV-2, while school-age children (5–14 years) and children < 5 years proved to be the age groups most at risk of contracting influenza viruses and RSV, respectively. Our experience demonstrates that laboratory-based ILI surveillance networks are essential for identifying SARS-CoV-2 cases that would otherwise remain undetected, in order to stop their spread within our communities.
“…Respiratory syncytial virus (RSV) is a single-stranded RNA virus that belongs to the Paramyxoviridae family, affecting respiratory epithelial cells and presenting two subtypes, RSV A (the most severe form of presentation) and RSV B [ 1 ].…”
A respiratory syncytial virus (RSV) is the major cause of respiratory tract infection in children under 5 years. However, RSV infection in the European Region of the World Health Organization has not been systematically reviewed. The aim was to determine the prevalence and factors associated with RSV in children under 5 years of age in European regions. A systematic review and meta-analysis was performed. CINAHL, Medline, LILACS, ProQuest, SciELO, and Scopus databases were consulted for studies published in the last 5 years, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search equation was “respiratory syncytial virus AND (newborn OR infant OR child) AND (prevalence OR risk factors)”. Studies reporting the prevalence of RSV were eligible for inclusion in the meta-analysis. A total of 20 articles were included. The meta-analytic prevalence estimation of RSV, with a sample of n = 16,115 children, was 46% (95% CI 34–59%). The main risk factors were age, male gender, winter season, and environmental factors such as cold temperatures, higher relative humidity, high concentrations of benzene, exposure to tobacco, and living in urban areas. Robust age-specific estimates of RSV infection in healthy children should be promoted in order to determine the optimal age for immunization. In addition, it is necessary to analyse in greater depth the potentially predictive factors of RSV infection, to be included in prevention strategies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
