The Burden and Long-term Respiratory Morbidity Associated with Respiratory Syncytial Virus Infection in Early Childhood

Abstract

IntroductionThe REGAL (RSV Evidence—a Geographical Archive of the Literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. The objective of this fifth publication was to determine the long-term respiratory morbidity associated with RSV lower respiratory tract infection (RSV LRTI) in early life.MethodsA systematic review was undertaken for articles published between January 1, 1995 and December 31, 2015. This was supplemented by inclusion of papers published whilst drafting the manuscript. Studies reporting data on the incidence and long-term wheezing and asthma following RSV LRTI in early life were included. Study quality and strength of evidence (SOE) were graded using recognized criteria.ResultsA total of 2337 studies were identified of which 74 were included. Prospective, epidemiologic studies consistently demonstrated that RSV LRTI is a significant risk factor for on-going respiratory morbidity characterized by transient early wheezing and recurrent wheezing and asthma within the first decade of life and possibly into adolescence and adulthood (high SOE). RSV LRTI was also associated with impaired lung function in these children (high SOE). Respiratory morbidity has been shown to result in reduced quality of life and increased healthcare resource use (moderate SOE). The mechanisms through which RSV contributes to wheezing/asthma development are not fully understood, but appear to relate to the viral injury, preexisting abnormal lung function and/or other factors that predispose to wheezing/asthma, including genetic susceptibility, altered immunology, eosinophilia, and associated risk factors such as exposure to environmental tobacco smoke (high SOE).ConclusionThere is growing evidence that RSV LRTI in early childhood is associated with long-term wheezing and asthma and impaired lung function. Future research should aim to fully elucidate the pathophysiological mechanisms through which RSV causes recurrent wheezing/asthma.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-017-0151-4) contains supplementary material, which is available to authorized users.

Association of early viral lower respiratory infections and subsequent development of atopy, a systematic review and meta-analysis of cohort studies

“…Technical differences in the handling of skin and serum tests may also be involved in the differences observed between the two methods [57]. The systematic review by Fauroux et al reported for studies conducted between 1995 and 2015 in industrialized countries the controversial nature of the results on the association between infantile hospitalizations for HRSV LRTI and subsequent atopy [58]. Pérez-Yarza in a systematic review including children younger than 3 years with HRSV respiratory infection from 1985 to 2006 also suggested controversial findings about the subsequent risk of allergic sensitization development defined by positive skin or serum tests specific for common allergens [11].…”

Assessing the association between bronchiolitis in infancy and recurrent wheeze: a whole English birth cohort case–control study

“…While the link between RSV bronchiolitis and later respiratory pathology has been consistently demonstrated, the strength and details of the association vary between populations and has not been previously described in a UK cohort 7. Studies have also linked rhinovirus, human meta-pneumovirus and parainfluenzae as associated with later wheeze, with some suggesting a stronger effect for non-RSV bronchiolitis 8.…”

Hospitalizations associated with respiratory syncytial virus (RSV) and influenza in children, including children having a diagnosis of asthma

“…While the connection between RSV infection in early childhood and the subsequent risk of developing asthma has received a lot of attention in the literature [31][32][33][34], the contribution of RSV to the hospitalization burden in children having a diagnosis of asthma is less studied [35]. This fact might partly stem from the uncertainty in the etiology behind asthma diagnoses in very young children [23], with the resulting ambiguity about the criteria that would validate such a diagnosis [36].…”