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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
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