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Giannini F, Hogan AB, Sarna M, Glass K, Moore HC. Modelling respiratory syncytial virus age-specific risk of hospitalisation in term and preterm infants. BMC Infect Dis 2024; 24:510. [PMID: 38773455 PMCID: PMC11110433 DOI: 10.1186/s12879-024-09400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infections in children worldwide. The highest incidence of severe disease is in the first 6 months of life, with infants born preterm at greatest risk for severe RSV infections. The licensure of new RSV therapeutics (a long-acting monoclonal antibody and a maternal vaccine) in Europe, USA, UK and most recently in Australia, has driven the need for strategic decision making on the implementation of RSV immunisation programs. Data driven approaches, considering the local RSV epidemiology, are critical to advise on the optimal use of these therapeutics for effective RSV control. METHODS We developed a dynamic compartmental model of RSV transmission fitted to individually-linked population-based laboratory, perinatal and hospitalisation data for 2000-2012 from metropolitan Western Australia (WA), stratified by age and prior exposure. We account for the differential risk of RSV-hospitalisation in full-term and preterm infants (defined as < 37 weeks gestation). We formulated a function relating age, RSV exposure history, and preterm status to the risk of RSV-hospitalisation given infection. RESULTS The age-to-risk function shows that risk of hospitalisation, given RSV infection, declines quickly in the first 12 months of life for all infants and is 2.6 times higher in preterm compared with term infants. The hospitalisation risk, given infection, declines to < 10% of the risk at birth by age 7 months for term infants and by 9 months for preterm infants. CONCLUSIONS The dynamic model, using the age-to-risk function, characterises RSV epidemiology for metropolitan WA and can now be extended to predict the impact of prevention measures. The stratification of the model by preterm status will enable the comparative assessment of potential strategies in the extended model that target this RSV risk group relative to all-population approaches. Furthermore, the age-to-risk function developed in this work has wider relevance to the epidemiological characterisation of RSV.
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Affiliation(s)
- Fiona Giannini
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands, WA, 6009, Australia.
| | - Alexandra B Hogan
- School of Population Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mohinder Sarna
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands, WA, 6009, Australia
- School of Population Health, Curtin University, Perth, WA, 6002, Australia
| | - Kathryn Glass
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands, WA, 6009, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, 62 Mills Rd, Acton ACT, 2601, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands, WA, 6009, Australia
- School of Population Health, Curtin University, Perth, WA, 6002, Australia
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Petat H, Corbet S, Leterrier B, Vabret A, Ar Gouilh M. Unravelling the acute respiratory infection landscape: virus type, viral load, health status and coinfection do matter. Front Cell Infect Microbiol 2024; 14:1380855. [PMID: 38803572 PMCID: PMC11128575 DOI: 10.3389/fcimb.2024.1380855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Acute respiratory infections (ARI) are the most common infections in the general population and are mainly caused by respiratory viruses. Detecting several viruses in a respiratory sample is common. To better understand these viral codetections and potential interferences, we tested for the presence of viruses and developed quantitative PCR (Polymerase Chain Reaction) for the viruses most prevalent in coinfections: human rhinovirus (HRV) and respiratory syncytial virus (RSV), and quantified their viral loads according to coinfections and health status, age, cellular abundance and other variables. Materials and methods Samples from two different cohorts were analyzed: one included hospitalized infants under 12 months of age with acute bronchiolitis (n=719) and the other primary care patients of all ages with symptoms of ARI (n=685). We performed Multiplex PCR on nasopharyngeal swabs, and quantitative PCR on samples positive for HRV or/and RSV to determine viral loads (VL). Cellular abundance (CA) was also estimated by qPCR targeting the GAPDH gene. Genotyping was performed either directly from first-line molecular panel or by PCR and sequencing for HRV. Results The risks of viral codetection were 4.1 (IC95[1.8; 10.0]) and 93.9 1 (IC95[48.7; 190.7]) higher in infants hospitalized for bronchiolitis than in infants in primary care for RSV and HRV respectively (p<0.001). CA was higher in samples positive for multiple viruses than in mono-infected or negative samples (p<0.001), and higher in samples positive for RSV (p<0.001) and HRV (p<0.001) than in negative samples. We found a positive correlation between CA and VL for both RSV and HRV. HRV VL was higher in children than in the elderly (p<0.05), but not RSV VL. HRV VL was higher when detected alone than in samples coinfected with RSV-A and with RSV-B. There was a significant increase of RSV-A VL when codetecting with HRV (p=0.001) and when co-detecting with RSV-B+HRV versus RSV-A+ RSV-B (p=0.02). Conclusions Many parameters influence the natural history of respiratory viral infections, and quantifying respiratory viral loads can help disentangle their contributions to viral outcome.
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Affiliation(s)
- Hortense Petat
- University of Rouen Normandy, Dynamicure INSERM UMR 1311, CHU Rouen, Department of Pediatrics and Adolescent Medicine, Rouen, France
- University of Caen Normandy, Dynamicure INSERM UMR 1311, Centre hospitalo-universitaire (CHU) Caen, Department of Virology, Caen, France
| | - Sandrine Corbet
- University of Caen Normandy, Dynamicure INSERM UMR 1311, Centre hospitalo-universitaire (CHU) Caen, Department of Virology, Caen, France
| | - Bryce Leterrier
- University of Caen Normandy, Dynamicure INSERM UMR 1311, Centre hospitalo-universitaire (CHU) Caen, Department of Virology, Caen, France
| | - Astrid Vabret
- University of Caen Normandy, Dynamicure INSERM UMR 1311, Centre hospitalo-universitaire (CHU) Caen, Department of Virology, Caen, France
| | - Meriadeg Ar Gouilh
- University of Caen Normandy, Dynamicure INSERM UMR 1311, Centre hospitalo-universitaire (CHU) Caen, Department of Virology, Caen, France
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Self A, Van Buskirk J, Clark J, Cochrane JE, Knibbs L, Cass-Verco J, Gupta L. Respiratory syncytial virus disease morbidity in Australian infants aged 0 to 6 months: a systematic review with narrative synthesis. BMC Public Health 2023; 23:2560. [PMID: 38129854 PMCID: PMC10740277 DOI: 10.1186/s12889-023-17474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND A significant proportion of the global respiratory syncytial virus (RSV) associated morbidity is accounted for by infants aged 0 to 6 months, who are particularly vulnerable to severe disease. In 2015, 44% of global hospitalisations in infants in this age group were secondary to RSV. The objective of this systematic review is to appraise and synthesise the local evidence of RSV infection morbidity among Australian infants aged 0 to 6 months and to assess the implications for future immunisation strategies. METHODS Electronic databases (Medline, Embase, Pubmed and Global Health) were searched for full-text articles published between 2000 and 2023 in English language. Studies that examined markers of RSV disease morbidity in infants aged 0 to 6 months in Australia who had laboratory confirmed RSV infection were eligible for inclusion. The outcomes of interest were incidence, prevalence, testing rate, positivity rate, mortality, emergency department visits, community health visits, hospitalisation, intensive care unit admission, supplementary oxygen use, mechanical ventilation, risk factors for disease severity and monoclonal antibody use. RESULTS The database search identified 469 studies. After removal of duplicates and full-text review, 17 articles were eligible for inclusion. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis without meta-analysis guidelines. CONCLUSIONS Qualitative analysis of the included studies showed that Australian infants aged 0 to 6 months have higher rates of RSV testing, positivity and incidence; and more likely to develop severe disease that requires hospitalisation, intensive care unit admission or respiratory support, compared to children and adults of all ages. Aboriginal and Torres Strait Islander infants aged 0 to 6 months demonstrated higher rates of RSV infection and hospitalisation, compared to non-Indigenous infants. Age-related trends persisted in geographic areas with varying seasonal transmission of RSV, and during the SARS-CoV-2 pandemic. Passive immunisation strategies targeting infants in their first 6 months of life, either via vaccination of pregnant women or administration of long-acting monoclonal antibody during infancy, could effectively reduce RSV disease burden in Australia.
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Affiliation(s)
- Alice Self
- Sydney Local Health District, Sydney, NSW, Australia.
| | - Joseph Van Buskirk
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Jayden Clark
- Sydney Local Health District, Sydney, NSW, Australia
| | | | - Luke Knibbs
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - John Cass-Verco
- Department of Paediatrics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Leena Gupta
- Sydney Local Health District, Sydney, NSW, Australia
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4
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Stevenson PG, Cooper MN, Billingham W, de Klerk N, Simpson SJ, Strunk T, Moore HC. Health service utilisation for acute respiratory infections in infants graduating from the neonatal intensive care unit: a population-based cohort study. BMC Pediatr 2023; 23:335. [PMID: 37393229 PMCID: PMC10314380 DOI: 10.1186/s12887-023-04152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Despite advances in neonatal intensive care, babies admitted to Neonatal Intensive Care Units (NICU) suffer from adverse outcomes. We aim to describe the longer-term respiratory infectious morbidity of infants discharged from NICU using state-wide population-based linked data in Western Australia. STUDY DESIGN We used probabilistically linked population-based administrative data to analyse respiratory infection morbidity in a cohort of 23,784 infants admitted to the sole tertiary NICU, born 2002-2013 with follow up to 2015. We analysed incidence rates of secondary care episodes (emergency department presentations and hospitalisations) by acute respiratory infection (ARI) diagnosis, age, gestational age and presence of chronic lung disease (CLD). Poisson regression was used to investigate the differences in rates of ARI hospital admission between gestational age groups and those with CLD, after adjusting for age at hospital admission. RESULTS From 177,367 child-years at risk (i.e., time that a child could experience an ARI outcome), the overall ARI hospitalisation rate for infants and children aged 0-8 years was 71.4/1000 (95% confidence interval, CI: 70.1, 72.6), with the highest rates in infants aged 0-5 months (242.9/1000). For ARI presentations to emergency departments, equivalent rates were 114/1000 (95% CI: 112.4, 115.5) and 337.6/1000, respectively. Bronchiolitis was the most common diagnosis among both types of secondary care, followed by upper respiratory tract infections. Extremely preterm infants (< 28 weeks gestation at birth) were 6.5 (95% CI: 6.0, 7.0) times more likely and those with CLD were 5.0 (95% CI: 4.7, 5.4) times more likely to be subsequently admitted for ARI than those in NICU who were not preterm or had CLD after adjusting for age at hospital admission. CONCLUSIONS There is an ongoing burden of ARI in children who graduate from the NICU, especially those born extremely preterm, that persists into early childhood. Early life interventions to prevent respiratory infections in these children and understanding the lifelong impact of early ARI on later lung health are urgent priorities.
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Affiliation(s)
- Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, WA, Australia
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
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Le H, Gidding H, Blyth CC, Richmond P, Moore HC. Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study. Open Forum Infect Dis 2023; 10:ofad199. [PMID: 37125230 PMCID: PMC10135427 DOI: 10.1093/ofid/ofad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023] Open
Abstract
Background Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomized clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalizations among Western Australian infants. Methods We conducted a population-based cohort study of births during 2000-2012, using probabilistically linked individual-level immunization, hospitalization, respiratory microbiology testing, and perinatal data. We performed Cox proportional hazard models with time-varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalization 0-12 months adjusted for perinatal and sociodemographic factors. Results From 360 994 children, 3-dose PCV coverage in Aboriginal infants ranged from 29% to 51% in 2001-2004 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalization rates were highest in young infants aged 0-5 months (22.5/1000 child-years) and >2 times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of ≥3 PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalization in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46-1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63-0.99]) compared with unvaccinated infants. Conclusions Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and may be important for countries that are yet to consider PCV programs.
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Affiliation(s)
- Huong Le
- Correspondence: Hannah Moore, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia (); Huong Le, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia ()
| | - Heather Gidding
- Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
- Women and Babies Research, Kolling Institute, St Leonards, New South Wales, Australia
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- PathWest Laboratory Medicine, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Peter Richmond
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Hannah C Moore
- Correspondence: Hannah Moore, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia (); Huong Le, PhD, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855 West Perth, Perth, WA 6872, Australia ()
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6
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Anderson J, Oeum M, Verkolf E, Licciardi PV, Mulholland K, Nguyen C, Chow K, Waller G, Costa AM, Daley A, Crawford NW, Babl FE, Duke T, Do LAH, Wurzel D. Factors associated with severe respiratory syncytial virus disease in hospitalised children: a retrospective analysis. Arch Dis Child 2022; 107:359-364. [PMID: 34526293 DOI: 10.1136/archdischild-2021-322435] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early recognition of children at risk of severe respiratory syncytial virus (RSV) lower respiratory tract infection is important as it informs management decisions. We aimed to evaluate factors associated with severe disease among young children hospitalised with RSV infection. METHODS We conducted a retrospective cohort study of all children <2 years of age hospitalised for RSV lower respiratory tract infection at a single tertiary paediatric hospital over three RSV seasons (January 2017-December 2019). We classified children as having 'moderate' or 'severe' disease based on the level of respiratory intervention and used univariable and multivariable regression models to determine factors associated with severe disease. RESULTS Of 970 hospitalised children, 386 (40%) were classified as having 'severe' and 584 (60%) as having 'moderate' RSV disease. On multivariable analyses, age <2 months (OR: 2.3, 95% CI 1.6 to 3.3, p<0.0001), prematurity (OR: 1.6, 95% CI 1.1 to 2.4, p=0.02) and RSV-parainfluenza virus type 3 (PIV3) codetection (OR: 2.6, 95% CI 1.05 to 6.5, p=0.04) were independently associated with severe disease. CONCLUSION Younger age, prematurity and PIV3 codetection were associated with severe RSV disease in children <2 years of age hospitalised with RSV infection. The association between PIV3 and severe RSV disease is a novel finding and warrants further investigation.
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Affiliation(s)
- Jeremy Anderson
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Michelle Oeum
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Eva Verkolf
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,London School of Hygiene & Tropical Medicine, London, UK
| | - Cattram Nguyen
- The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Kim Chow
- Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Gregory Waller
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Anna-Maria Costa
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Andrew Daley
- Microbiology and Infection Control, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel W Crawford
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Trevor Duke
- Intensive Care Unit and Department of Paediatrics, The Royal Children's Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Lien Anh Ha Do
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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7
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Foley DA, Phuong LK, Peplinski J, Lim SM, Lee WH, Farhat A, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Hoeppner T, Borland ML, Hazelton B, Moore HC, Blyth C, Yeoh DK, Bowen AC. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child 2022; 107:e7. [PMID: 34433552 PMCID: PMC8390145 DOI: 10.1136/archdischild-2021-322507] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Following a relative absence in winter 2020, a large resurgence of respiratory syncytial virus (RSV) detections occurred during the 2020/2021 summer in Western Australia. This seasonal shift was linked to SARS-CoV-2 public health measures. We examine the epidemiology and RSV testing of respiratory-coded admissions, and compare clinical phenotype of RSV-positive admissions between 2019 and 2020. METHOD At a single tertiary paediatric centre, International Classification of Diseases, 10th edition Australian Modification-coded respiratory admissions longer than 12 hours were combined with laboratory data from 1 January 2019 to 31 December 2020. Data were grouped into bronchiolitis, other acute lower respiratory infection (OALRI) and wheeze, to assess RSV testing practices. For RSV-positive admissions, demographics and clinical features were compared between 2019 and 2020. RESULTS RSV-positive admissions peaked in early summer 2020, following an absent winter season. Testing was higher in 2020: bronchiolitis, 94.8% vs 89.2% (p=0.01); OALRI, 88.6% vs 82.6% (p=0.02); and wheeze, 62.8% vs 25.5% (p<0.001). The 2020 peak month, December, contributed almost 75% of RSV-positive admissions, 2.5 times the 2019 peak. The median age in 2020 was twice that observed in 2019 (16.4 vs 8.1 months, p<0.001). The proportion of RSV-positive OALRI admissions was greater in 2020 (32.6% vs 24.9%, p=0.01). There were no clinically meaningful differences in length of stay or disease severity. INTERPRETATION The 2020 RSV season was in summer, with a larger than expected peak. There was an increase in RSV-positive non-bronchiolitis admissions, consistent with infection in older RSV-naïve children. This resurgence raises concern for regions experiencing longer and more stringent SARS-CoV-2 public health measures.
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Affiliation(s)
- David Anthony Foley
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Linny Kimly Phuong
- Murdoch Children's Research Institute, Infection and Immunity, Parkville, Victoria, Australia
| | - Joseph Peplinski
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Selina Mei Lim
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Asifa Farhat
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Cara A Minney-Smith
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chisha T Sikazwe
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Huong Le
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Avram Levy
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Hoeppner
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Briony Hazelton
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christopher Blyth
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
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8
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Gebremedhin AT, Hogan AB, Blyth CC, Glass K, Moore HC. Developing a prediction model to estimate the true burden of respiratory syncytial virus (RSV) in hospitalised children in Western Australia. Sci Rep 2022; 12:332. [PMID: 35013434 PMCID: PMC8748465 DOI: 10.1038/s41598-021-04080-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of childhood morbidity, however there is no systematic testing in children hospitalised with respiratory symptoms. Therefore, current RSV incidence likely underestimates the true burden. We used probabilistically linked perinatal, hospital, and laboratory records of 321,825 children born in Western Australia (WA), 2000-2012. We generated a predictive model for RSV positivity in hospitalised children aged < 5 years. We applied the model to all hospitalisations in our population-based cohort to determine the true RSV incidence, and under-ascertainment fraction. The model's predictive performance was determined using cross-validated area under the receiver operating characteristic (AUROC) curve. From 321,825 hospitalisations, 37,784 were tested for RSV (22.8% positive). Predictors of RSV positivity included younger admission age, male sex, non-Aboriginal ethnicity, a diagnosis of bronchiolitis and longer hospital stay. Our model showed good predictive accuracy (AUROC: 0.87). The respective sensitivity, specificity, positive predictive value and negative predictive values were 58.4%, 92.2%, 68.6% and 88.3%. The predicted incidence rates of hospitalised RSV for children aged < 3 months was 43.7/1000 child-years (95% CI 42.1-45.4) compared with 31.7/1000 child-years (95% CI 30.3-33.1) from laboratory-confirmed RSV admissions. Findings from our study suggest that the true burden of RSV may be 30-57% higher than current estimates.
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Affiliation(s)
- Amanuel Tesfay Gebremedhin
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia.
| | - Alexandra B Hogan
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, WA, Australia
| | - Kathryn Glass
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
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Moore HC, Le H, Mace A, Blyth CC, Yeoh D, Foley D, Martin A. Interrupted time-series analysis showed unintended consequences of non-pharmaceutical interventions on pediatric hospital admissions. J Clin Epidemiol 2021; 143:1-10. [PMID: 34801694 PMCID: PMC8600916 DOI: 10.1016/j.jclinepi.2021.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE COVID-19-associated non-pharmaceutical interventions (NPI) have disrupted respiratory viral transmission. We quantified the changes in pediatric hospital admissions in 2020 from five different NPI phases in Western Australia for acute lower respiratory infections (ALRI) in children in the context of all-cause admissions. STUDY DESIGN AND SETTING We assessed anonymised hospitalization data from Perth Children's Hospital (Jan 2015-Dec 2020) for all-cause admissions, ALRI, febrile illnesses and trauma (negative control) in those <17 years. We evaluated absolute changes in admissions and the weekly change estimated from interrupted time-series models. RESULTS The absolute number of admissions was comparable in 2020 (15,678) vs. 2015 to 2019 average (15,310). Following the introduction of strict NPIs, all-cause admissions declined by 35%, recovered to pre-pandemic levels, then increased by 24% following NPI cessation. ALRI admissions in children <5 years initially declined by 89%, which was sustained throughout the gradual easing of NPI until an increase of 579% (997% in <3 months) following the final easing of NPI. Admissions for trauma showed minimal changes in 2020 compared to preceding years. CONCLUSION COVID-19-associated NPI had significant unintended consequences in health service utilization, especially for ALRI and infants <3 months, prompting the need to understand viral transmission dynamics in young children.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Huong Le
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Ariel Mace
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of General Paediatrics, Perth Children's Hospital, Perth, Australia; Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; PathWest Laboratory Medicine, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - Daniel Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria
| | - David Foley
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; PathWest Laboratory Medicine, Perth, Australia
| | - Andrew Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Australia
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Greiff DRL, Patterson-Robert A, Blyth CC, Glass K, Moore HC. Epidemiology and seasonality of human parainfluenza serotypes 1-3 in Australian children. Influenza Other Respir Viruses 2021; 15:661-669. [PMID: 33491337 PMCID: PMC8404051 DOI: 10.1111/irv.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 01/03/2023] Open
Abstract
Background Parainfluenza viruses are significant contributors to childhood respiratory illness worldwide, although detailed epidemiological studies are lacking. Few recent Australian studies have investigated serotype‐specific PIV epidemiology, and there is a paucity of southern hemisphere PIV reports. We report age‐stratified PIV hospitalisation rates and a mathematical model of PIV seasonality and dynamics in Western Australia (WA). Methods We used linked perinatal, hospital admission and laboratory diagnostic data of 469 589 children born in WA between 1996 and 2012. Age‐specific rates of viral testing and PIV detection in hospitalised children were determined using person time‐at‐risk analysis. PIV seasonality was modelled using a compartmental SEIRS model and complex demodulation methods. Results From 2000 to 2012, 9% (n = 43 627) of hospitalised children underwent PIV testing, of which 5% (n = 2218) were positive for PIV‐1, 2 or 3. The highest incidence was in children aged 1‐5 months (PIV‐1:62.6 per 100 000 child‐years, PIV‐2:26.3/100 000, PIV‐3:256/100 000), and hospitalisation rates were three times higher for Aboriginal children compared with non‐Aboriginal children overall (IRR: 2.93). PIV‐1 peaked in the autumn of even‐numbered years, and PIV‐3 annually in the spring, whereas PIV‐2 had inconsistent peak timing. Fitting models to the higher incidence serotypes estimated reproduction numbers of 1.24 (PIV‐1) and 1.72 (PIV‐3). Conclusion PIV‐1 and 3 are significant contributors towards infant respiratory hospitalisations. Interventions should prioritise children in the first 6 months of life, with respect to the observed autumn PIV‐1 and spring PIV‐3 activity peaks. Continued surveillance of all serotypes and investigation into PIV‐1 and 3 interventions should be prioritised.
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Affiliation(s)
- Daniel R L Greiff
- Wesfarmers Centre for Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Alice Patterson-Robert
- Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Kathryn Glass
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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