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Michelin L, Bellei N, Ferreira da Costa Gomes M, Raboni SM, Kairalla M, Correa RA, Levi M, Chebabo A, Ballalai I, Cimerman S, Roteli-Martins CM, Aidé S, Dalcolmo MP, de Veras BMG, De Ávila Kfouri R, Cintra O. Respiratory syncytial virus: challenges in diagnosis and impact on the elderly: Recommendations from a multidisciplinary panel. Hum Vaccin Immunother 2024; 20:2388943. [PMID: 39161095 PMCID: PMC11340750 DOI: 10.1080/21645515.2024.2388943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Respiratory syncytial virus (RSV) is an important cause of respiratory illness. While most attention is paid to childhood infection, the RSV burden in adults ≥60 y should also be considered. In Brazil, this is generally underrecognized, where greater focus is toward other respiratory pathogens. This article presents insights from a multidisciplinary panel gathered to review epidemiologic data and current diagnostic approaches to RSV in Brazil (and their limitations) and develop communication strategies to improve knowledge and awareness. National surveillance data indicate a steady increase in cases of RSV-related severe acute respiratory illness (RSV-SARI) in those aged ≥60 y in recent years, with high fatality rates (>30%). Routine RSV testing in older individuals with respiratory symptoms is relatively low. Educational activities targeted toward health-care professionals and the general public are critical to raising awareness of the importance of RSV in older individuals, particularly as protective vaccines are now available.
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Affiliation(s)
| | - Nancy Bellei
- Laboratório de Virologia Clínica, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Disciplina de Infectologia, São Paulo, Brazil
| | | | - Sonia M Raboni
- Molecular Virology Research Laboratory, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Ricardo Amorim Correa
- Departamento de Clínica Médica, Serviço de Pneumologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Monica Levi
- Sociedade Brasileira de Imunizações (SBim), São Paulo, Brazil
| | - Alberto Chebabo
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Isabela Ballalai
- Sociedade Brasileira de Imunizações (SBim), Rio de Janeiro, Brazil
| | - Sergio Cimerman
- Sociedade Brasileira de Imunizações (SBim), São Paulo, Brazil
- Instituto de Infectologia Emílio Ribas, São Paulo, Brazil
- Universidade Paulista (UNIP) - Campus Alphaville, São Paulo, Brazil
| | | | - Susana Aidé
- Maternal and Child Department, Faculty of Medicine, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | | | | | - Renato De Ávila Kfouri
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Sociedade Brasileira de Imunizações (SBim), São Paulo, Brazil
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Patel DA, Marcum ZA, Chansakul A, Toyip A, Nerney K, Panozzo CA, St Laurent S, Mehta D, Ghaswalla P. Economic burden of cardiorespiratory hospitalizations associated with respiratory syncytial virus among United States adults in 2017-2019. Hum Vaccin Immunother 2024; 20:2364493. [PMID: 38982719 PMCID: PMC11238920 DOI: 10.1080/21645515.2024.2364493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/02/2024] [Indexed: 07/11/2024] Open
Abstract
Morbidity and mortality caused by respiratory syncytial virus (RSV) in older adults and those with underlying health conditions can be potentially alleviated through vaccination. To assist vaccine policy decision-makers and payers, we estimated the annual economic burden of RSV-associated cardiorespiratory hospitalizations among insured US adults aged ≥18 y in the Merative MarketScan claims database from September through August of 2017-2018 and 2018-2019. Negative binomial regression models were used to estimate the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. This number was multiplied by mean cardiorespiratory hospitalization costs to estimate total costs for RSV-associated cardiorespiratory hospitalizations. Number and cost for International Classification of Diseases (ICD)-coded RSV hospitalizations were quantified from MarketScan. In 2017-2018 and 2018-2019, respectively, 18,515,878 and 16,462,120 adults with commercial or Medicare supplemental benefits were assessed. In 2017-2018, 301,248 cardiorespiratory hospitalizations were observed; 0.32% had RSV-specific ICD codes, costing $44,916,324, and 5.52% were RSV-associated cardiorespiratory hospitalizations, costing $734,078,602 (95% CI: $460,826,580-$1,103,358,799). In 2018-2019, 215,525 cardiorespiratory hospitalizations were observed; 0.34% had RSV-specific ICD codes, costing $33,053,105, and 3.14% were RSV-associated cardiorespiratory hospitalizations, costing $287,549,472 (95% CI: $173,377,778-$421,884,259). RSV contributes to substantial economic burden of cardiorespiratory hospitalizations among US adults. Modeling excess risk using viral positivity data provides a comprehensive estimation of RSV hospitalization burden and associated costs, compared with relying on ICD diagnosis codes alone.
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Affiliation(s)
| | | | | | | | | | - Catherine A Panozzo
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Samantha St Laurent
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Darshan Mehta
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
| | - Parinaz Ghaswalla
- Department of Health Economics and Outcomes Research, Moderna, Inc ., Cambridge, MA, USA
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Hutton DW, Prosser LA, Rose AM, Mercon K, Ortega-Sanchez IR, Leidner AJ, Havers FP, Prill MM, Whitaker M, Roper LE, Pike J, Britton A, Melgar M. Cost-effectiveness of vaccinating adults aged 60 years and older against respiratory syncytial virus. Vaccine 2024; 42:126294. [PMID: 39241353 DOI: 10.1016/j.vaccine.2024.126294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two subunit RSV vaccines (Arexvy [GSK] and Abrysvo [Pfizer]) received approval from the U.S. Food and Drug Administration (FDA). In June 2023, ACIP recommended that adults aged ≥60 years may receive a single dose of RSV vaccine, using shared clinical decision-making. In support of development of this policy, our objective was to assess the cost-effectiveness of RSV vaccination in the general population in this age group. We used a decision-analytical model of RSV over a two-year timeframe using data from published literature, FDA documents, epidemiological databases, and manufacturer data. We tracked RSV-associated outpatient, emergency department, inpatient healthcare utilization, RSV-attributable deaths, quality-adjusted life-years lost (QALYs), and societal costs. The societal cost per QALY saved from RSV vaccination depended on age group and product: adults aged ≥60 years, $196,842 for GSK's vaccine and $176,557 for Pfizer's vaccine; adults ≥65 years, $162,138 for GSK and $146,543 for Pfizer; adults 60- <65 years, $385,829 for GSK and $331,486 for Pfizer. Vaccine efficacy, incidence of RSV hospitalization, and vaccine cost had the greatest influence on cost per QALY. Cost per QALY saved decreased as the age of those vaccinated increased. Inputs such as long-term efficacy are uncertain. RSV vaccination in adults aged ≥60 years may be cost-effective, particularly in those of more advanced age. Lower vaccine acquisition costs and persistent efficacy beyond two RSV seasons would render RSV vaccination more cost-effective for a broader target population. PRIMARY FUNDING SOURCE: US Centers for Disease Control and Prevention.
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Affiliation(s)
- David W Hutton
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Lisa A Prosser
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Angela M Rose
- Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Kerra Mercon
- Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew J Leidner
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fiona P Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mila M Prill
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Whitaker
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren E Roper
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jamison Pike
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amadea Britton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Melgar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Tuite AR, Simmons AE, Rudd M, Cernat A, Gebretekle GB, Yeung MW, Killikelly A, Siu W, Buchan SA, Brousseau N, Tunis M. Respiratory syncytial virus vaccination strategies for older Canadian adults: a cost-utility analysis. CMAJ 2024; 196:E989-E1005. [PMID: 39251240 PMCID: PMC11383547 DOI: 10.1503/cmaj.240452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) vaccines could reduce disease burden and costs in older Canadian adults, but vaccination program cost-effectiveness is unknown. We evaluated the cost-effectiveness of different age cut-offs for RSV adult vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions. METHODS We developed a static individual-based model of medically attended RSV disease to compare alternative age-, medical risk-, and age-plus medical risk-based vaccination policies. The model followed a multiage population of 100 000 people aged 50 years and older. Vaccine characteristics were based on RSV vaccines authorized in Canada as of May 2024, with vaccine protection assumed to last 2 years (or 3 years in scenario analyses). We calculated sequential incremental cost-effectiveness ratios in 2023 Canadian dollars per quality-adjusted life year (QALY) from the health-system and societal perspectives, discounted at 1.5%. RESULTS Although all vaccination strategies averted medically attended RSV disease, universal age-based strategies were not an efficient use of resources compared with medical risk-based strategies. Vaccinating adults aged 70 years and older with 1 or more chronic medical condition was the optimal strategy for a cost-effectiveness threshold of $50 000 per QALY. Results were sensitive to assumptions about vaccine price, but medical risk-based approaches remained optimal compared with age-based strategies, even when vaccine prices were low. Findings were robust to a range of alternative assumptions. INTERPRETATION Vaccination programs for RSV in some groups of older Canadians with underlying medical conditions are likely cost-effective. These findings can inform the design of vaccination programs.
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Affiliation(s)
- Ashleigh R Tuite
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que.
| | - Alison E Simmons
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Monica Rudd
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Alexandra Cernat
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Gebremedhin B Gebretekle
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Man Wah Yeung
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - April Killikelly
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Winnie Siu
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Sarah A Buchan
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Nicholas Brousseau
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
| | - Matthew Tunis
- Centre for Immunization Programs (Tuite, Simmons, Rudd, Cernat, Gebretekle, Yeung, Killikelly, Siu, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Dalla Lana School of Public Health (Tuite, Simmons, Rudd, Buchan), University of Toronto, Toronto, Ont.; Health Policy PhD Program (Cernat), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Epidemiology and Public Health (Siu), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Health Protection (Buchan), Public Health Ontario, Toronto, Ont.; Direction des risques biologiques (Brousseau), Institut national de santé publique du Québec, Québec, Que
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Mitratza M, Elsobky M, Liang C, Bruyndonckx R, Polkowska-Kramek A, Ewnetu WB, Peerawaranun P, Tran TMP, Nuttens C, Grajales AG, Nzula S, Gessner BD, Begier E. Estimated Incidence of Hospitalizations Attributable to RSV Infection Among Adults in Ontario, Canada, Between 2013 and 2019. Infect Dis Ther 2024; 13:1949-1962. [PMID: 39004648 PMCID: PMC11343949 DOI: 10.1007/s40121-024-01018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Adult respiratory syncytial virus (RSV) burden is underestimated due to non-specific symptoms, limited standard-of-care and delayed testing, reduced diagnostic test sensitivity-particularly when using single diagnostic specimen-when compared to children, and variable test sensitivity based on the upper airway specimen source. We estimated RSV-attributable hospitalization incidence among adults aged ≥ 18 years in Ontario, Canada, using a retrospective time-series model-based approach. METHODS The Institute for Clinical Evaluative Sciences data repository provided weekly numbers of hospitalizations (from 2013 to 2019) for respiratory, cardiovascular, and cardiorespiratory disorders. The number of hospitalizations attributable to RSV was estimated using a quasi-Poisson regression model that considered probable overdispersion and was based on periodic and aperiodic time trends and viral activity. As proxies for viral activity, weekly counts of RSV and influenza hospitalizations in children under 2 years and adults aged 60 years and over, respectively, were employed. Models were stratified by age and risk group. RESULTS In patients ≥ 60 years, RSV-attributable incidence rates were high for cardiorespiratory hospitalizations (range [mean] in 2013-2019: 186-246 [215] per 100,000 person-years, 3‒4% of all cardiorespiratory hospitalizations), and subgroups including respiratory hospitalizations (144-192 [167] per 100,000 person-years, 5‒7% of all respiratory hospitalizations) and cardiovascular hospitalizations (95-126 [110] per 100,000 person-years, 2‒3% of all cardiovascular hospitalizations). RSV-attributable cardiorespiratory hospitalization incidence increased with age, from 14-18 [17] hospitalizations per 100,000 person-years (18-49 years) to 317-411 [362] per 100,000 person-years (≥ 75 years). CONCLUSIONS Estimated RSV-attributable respiratory hospitalization incidence among people ≥ 60 years in Ontario, Canada, is comparable to other incidence estimates from high-income countries, including model-based and pooled prospective estimates. Recently introduced RSV vaccines could have a substantial public health impact.
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Affiliation(s)
| | | | - Caihua Liang
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
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6
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Osei-Yeboah R, Amankwah S, Begier E, Adedze M, Nyanzu F, Appiah P, Ansah JOB, Campbell H, Sato R, Jodar L, Gessner BD, Nair H. Burden of Respiratory Syncytial Virus (RSV) Infection Among Adults in Nursing and Care Homes: A Systematic Review. Influenza Other Respir Viruses 2024; 18:e70008. [PMID: 39284784 PMCID: PMC11405123 DOI: 10.1111/irv.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/20/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Older adults in nursing and care homes (NCHs) are vulnerable to severe respiratory syncytial virus (RSV) infection, hospitalization, and death. This study aimed to gather data on RSV disease among older adults in NCHs and identify reported risk factors for RSV hospitalization and case fatality. METHODS The study protocol was registered in PROSPERO (CRD42022371908). We searched MEDLINE, EMBASE, and Global Health databases to identify articles published between 2000 and 2023. Observational and experimental studies conducted among older adults in NCHs requiring assistive care and reporting RSV illness were included and relevant data were extracted. RESULTS Of 18,690 studies screened, 32 were selected for full-text review, and 20 were included. Overall, the number of NCH residents ranged from 42 to 1459 with a mean age between 67.6 and 85 years. Attack rates ranged from 6.7% to 47.6% and annual incidence ranged from 0.5% to 14%. Case fatality rates ranged from 7.7% to 23.1%. We found similar annual incidence rates of RSV-positive acute respiratory infection (ARI) of 4582 (95% CI: 3259-6264) and 4785 (95% CI: 2258-10,141) per 100,000 reported in two studies. Annual incidence rate of RSV-positive lower respiratory tract infection was 3040 (95% CI: 1986-4454) cases per 100,000 adults. Annual RSV-ARI hospital admission rates were between 600 (95% CI: 190-10,000) and 1104 (95% CI: 350-1930) per 100,000 person-years. Among all RSV disease cases, commonly reported chronic medical conditions included chronic obstructive pulmonary disease (COPD), heart failure, ischemic heart disease, coronary artery disease, hypertension, diabetes, kidney dysfunction, cerebrovascular accident, malignancies, dementia, and those with a Charlson comorbidity score > 6.5. CONCLUSION Data on RSV infection among NCH residents are limited and largely heterogeneous but document a high risk of illness, frequent hospitalization, and high mortality. Preventive interventions, such as vaccination, should be considered for this high-risk population. Nationally representative epidemiologic studies and NCH-based viral pathogen surveillance could more precisely assess the burden on NCH residents.
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Affiliation(s)
- Richard Osei-Yeboah
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen Amankwah
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Dublin, Ireland
| | - Miranda Adedze
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Franklin Nyanzu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Pious Appiah
- Department of Medical Microbiology, Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Reiko Sato
- Value & Evidence, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Luis Jodar
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
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7
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Carrico J, Hicks KA, Wilson E, Panozzo CA, Ghaswalla P. The Annual Economic Burden of Respiratory Syncytial Virus in Adults in the United States. J Infect Dis 2024; 230:e342-e352. [PMID: 38060972 PMCID: PMC11326840 DOI: 10.1093/infdis/jiad559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/05/2023] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Current estimates of the economic burden of respiratory syncytial virus (RSV) are needed for policymakers to evaluate adult RSV vaccination strategies. METHODS A cost-of-illness model was developed to estimate the annual societal burden of RSV in US adults aged ≥60 years. Additional analyses were conducted to estimate the burden of hospitalized RSV in all adults aged 50-59 years and in adults aged 18-49 years with potential RSV risk factors. RESULTS Among US adults aged ≥60 years, the model estimated 4.0 million annual RSV cases (95% uncertainty interval [UI], 2.7-5.6 million) and an annual economic burden of $6.6 billion (95% UI, $3.1-$12.9 billion; direct medical costs, $2.9 billion; indirect costs, $3.7 billion). The 4% of RSV cases that were hospitalized contributed to 94% of direct medical costs. Additional analyses estimated $422 million in annual hospitalization costs among all adults aged 50-59 years. Among adults aged 18-49 years with RSV risk factors, annual per capita burden was highest among people with congestive heart failure at $51 100 per 1000 people. DISCUSSION The economic burden of RSV is substantial among adults aged ≥50 years and among adults aged 18-49 years with RSV risk factors, underscoring the need for preventive interventions for these populations.
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Gómez JA, Cintra O, Berzanskis A, Pacheco S, Jaswantlal H, Hasnaoui AE, van Oorschot DAM, Guzman-Holst A. Burden of Disease Due to Respiratory Syncytial Virus in Adults in Five Middle-Income Countries. Infect Dis Rep 2024; 16:750-762. [PMID: 39195008 DOI: 10.3390/idr16040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/26/2024] [Accepted: 08/08/2024] [Indexed: 08/29/2024] Open
Abstract
Respiratory syncytial virus (RSV) is an important cause of severe respiratory disease in older adults. Understanding the disease burden is crucial for guiding vaccination policy and raising disease awareness. We estimated the burden of RSV hospitalizations and deaths in adults in five middle-income countries: Argentina, Brazil, Chile, Mexico, and Malaysia. Hospital discharge and death statistics due to any respiratory disease (ICD-10 codes: J00-99) from 2010 to 2022 were obtained. The RSV attributable burden on hospitalizations and deaths by age group was determined for 2019 using previously published estimates. Latin American countries showed distinct annual peaks in respiratory-related hospitalizations and deaths during winter months that were absent in Malaysia. Among ≥20-year-olds in 2019, there were 14,604 RSV-attributable hospitalizations nationally in Argentina, 44,323 in Brazil, 4529 in Chile, 7416 in Malaysia, and 8651 in Mexico, and 60-74% in ≥65-year-olds. There were also 3518 RSV-attributable deaths in Argentina, 9115 in Brazil, 801 in Chile, 704 in Malaysia, and 3806 in Mexico 79-88% in ≥65-year-olds. Incidences of RSV-attributable hospitalizations in ≥75-year-olds ranged between 256.3 and 294.3 per 100,000 population, and deaths between 33.6 and 112.9 per 100,000 population. RSV is associated with a substantial disease burden beyond pediatric age groups, and preventive vaccines could have a major impact on this burden, especially in older adults.
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Affiliation(s)
- Jorge A Gómez
- Value Evidence & Outcomes, Vaccines, Emerging Markets, GSK, Buenos Aires 1429, Argentina
| | - Otavio Cintra
- Medical Affairs, Vaccines, Emerging Markets, GSK, Sao Paulo 04001-083, Brazil
| | - Arnas Berzanskis
- Medical Affairs, Vaccines, Emerging Markets, GSK, London WC1A 1DG, UK
| | - Salma Pacheco
- Medical Affairs, Vaccines, Emerging Markets, GSK, Mexico City 03330, Mexico
| | - Henny Jaswantlal
- Medical Affairs, Vaccines, Emerging Markets, GSK, Petaling Jaya 47800, Selangor, Malaysia
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Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, Ortega-Sanchez IR, Broder KR, Talbot HK, Long SS, Havers FP, Melgar M. Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2024. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:696-702. [PMID: 39146277 DOI: 10.15585/mmwr.mm7332e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory illness and hospitalization in older adults during fall and winter in the United States. The 2023-2024 RSV season was the first during which RSV vaccination was recommended for U.S. adults aged ≥60 years, using shared clinical decision-making. On June 26, 2024, the Advisory Committee on Immunization Practices voted to update this recommendation as follows: a single dose of any Food and Drug Administration-approved RSV vaccine (Arexvy [GSK]; Abrysvo [Pfizer]; or mResvia [Moderna]) is now recommended for all adults aged ≥75 years and for adults aged 60-74 years who are at increased risk for severe RSV disease. Adults who have previously received RSV vaccine should not receive another dose. This report summarizes the evidence considered for these updated recommendations, including postlicensure data on vaccine effectiveness and safety, and provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years. These updated recommendations are intended to maximize RSV vaccination coverage among persons most likely to benefit, by clarifying who is at highest risk and by reducing implementation barriers associated with the previous shared clinical decision-making recommendation. Continued postlicensure monitoring will guide future recommendations.
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Ferguson M, Schwarz TF, Núñez SA, Rodríguez-García J, Mital M, Zala C, Schmitt B, Toursarkissian N, Mazarro DO, Großkopf J, Voors-Pette C, Mehta H, Hailemariam HA, de Heusch M, Salaun B, Damaso S, David MP, Descamps D, Hill J, Vandermeulen C, Hulstrøm V. Noninferior Immunogenicity and Consistent Safety of Respiratory Syncytial Virus Prefusion F Protein Vaccine in Adults 50-59 Years Compared to ≥60 Years of Age. Clin Infect Dis 2024:ciae364. [PMID: 39099093 DOI: 10.1093/cid/ciae364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND The adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVPreF3 OA) is approved in adults aged ≥60 years. We evaluated RSVPreF3 OA immunogenicity and safety in adults aged 50-59 years without or with increased risk for RSV disease due to specific chronic medical conditions. METHODS This observer-blind, phase 3, noninferiority trial included adults aged 50-59 years, stratified into 2 subcohorts: those with and those without predefined, stable, chronic medical conditions leading to an increased risk for RSV disease. Participants in both subcohorts were randomized 2:1 to receive RSVPreF3 OA or placebo. A control group of adults aged ≥60 years received RSVPreF3 OA. Primary outcomes were RSV-A and RSV-B neutralization titers (geometric mean titer ratios and sero-response rate differences) 1 month post-vaccination in 50-59-year-olds versus ≥60-year-olds. Cell-mediated immunity and safety were also assessed. RESULTS The exposed population included 1152 participants aged 50-59 years and 381 participants aged ≥60 years. RSVPreF3 OA was immunologically noninferior in 50-59-year-olds versus ≥60-year-olds; noninferiority criteria were met for RSV-A and RSV-B neutralization titers in those with and those without increased risk for RSV disease. Frequencies of RSVPreF3-specific polyfunctional CD4+ T cells increased substantially from pre- to 1 month post-vaccination. Most solicited adverse events had mild-to-moderate intensity and were transient. Unsolicited and serious adverse event rates were similar in all groups. CONCLUSIONS RSVPreF3 OA was immunologically noninferior in 50-59-year-olds compared to ≥60-year-olds, in whom efficacy was previously demonstrated. The safety profile in 50-59-year-olds was consistent with that in ≥60-year-olds. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT05590403.
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Affiliation(s)
| | - Tino F Schwarz
- Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg Mitte, Würzburg, Germany
| | | | - Juan Rodríguez-García
- Preventive Medicine Department, Immunocompromised Patient Immunization Unit, Son Espases University Hospital, Palma de Mallorca, Mallorca, Balearic Islands, Spain
| | - Marek Mital
- Agnieszka Mital Centrum Badan Clinic, Elblag, Poland
| | - Carlos Zala
- Vacunar, Sede Las Cañitas, Buenos Aires, Argentina
| | | | | | - Dolores Ochoa Mazarro
- Clinical Pharmacology Department, Hospital Universitario De La Princesa, Instituto de Investigación Sanitaria La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Hemalini Mehta
- Clinical Research Institute, Minneapolis, Minnesota, USA
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Nuttens C, Moyersoen J, Curcio D, Aponte-Torres Z, Baay M, Vroling H, Gessner BD, Begier E. Differences Between RSV A and RSV B Subgroups and Implications for Pharmaceutical Preventive Measures. Infect Dis Ther 2024; 13:1725-1742. [PMID: 38971918 PMCID: PMC11266343 DOI: 10.1007/s40121-024-01012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/21/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Understanding the differences between respiratory syncytial virus (RSV) subgroups A and B provides insights for the development of prevention strategies and public health interventions. We aimed to describe the structural differences of RSV subgroups, their epidemiology, and genomic diversity. The associated immune response and differences in clinical severity were also investigated. METHODS A literature review from PubMed and Google Scholar (1985-2023) was performed and extended using snowballing from references in captured publications. RESULTS RSV has two major antigenic subgroups, A and B, defined by the G glycoprotein. The RSV F fusion glycoprotein in the prefusion conformation is a major target of virus neutralizing antibodies and differs in surface exposed regions between RSV A and RSV B. The subgroups co-circulate annually, but there is considerable debate as to whether clinical severity is impacted by the subgroup of the infecting RSV strain. Large variations between the studies reporting RSV subgroup impact on clinical severity were observed. A tendency for higher disease severity may be attributed to RSV A but no consensus could be reached as to whether infection by one of the subgroup caused more severe outcomes. RSV genotype diversity decreased over the last two decades, and ON and BA have become the sole lineages detected for RSV A and RSV B, since 2014. No studies with data obtained after 2014 reported a difference in disease severity between the two subgroups. RSV F is relatively well conserved and highly similar between RSV A and B, but changes in the amino acid sequence have been observed. Some of these changes led to differences in F antigenic sites compared to reference F sequences (e.g., RSV/A Long strain), which are more pronounced in antigenic sites of the prefusion conformation of RSV B. Initial results from the second season after vaccination suggest specific RSV B efficacy wanes more rapidly than RSV A for RSV PreF-based monovalent vaccines. CONCLUSIONS RSV A and RSV B both contribute substantially to the global RSV burden. Both RSV subgroups cause severe disease and none of the available evidence to date suggests any differences in clinical severity between the subgroups. Therefore, it is important to implement measures effective at preventing disease due to both RSV A and RSV B to ensure impactful public health interventions. Monitoring overtime will be needed to assess the impact of waning antibody levels on subgroup-specific efficacy.
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Affiliation(s)
| | | | | | | | - Marc Baay
- Epidemiology & Pharmacovigilance, P95, Louvain, Belgium
| | - Hilde Vroling
- Epidemiology & Pharmacovigilance, P95, Louvain, Belgium
| | | | - Elizabeth Begier
- Scientific Affairs, Older Adult RSV Vaccine Program, Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Dublin, Ireland.
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Wang Y, Wei X, Liu Y, Li S, Pan W, Dai J, Yang Z. Towards broad-spectrum protection: the development and challenges of combined respiratory virus vaccines. Front Cell Infect Microbiol 2024; 14:1412478. [PMID: 38903942 PMCID: PMC11188343 DOI: 10.3389/fcimb.2024.1412478] [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: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
In the post-COVID-19 era, the co-circulation of respiratory viruses, including influenza, SARS-CoV-2, and respiratory syncytial virus (RSV), continues to have significant health impacts and presents ongoing public health challenges. Vaccination remains the most effective measure for preventing viral infections. To address the concurrent circulation of these respiratory viruses, extensive efforts have been dedicated to the development of combined vaccines. These vaccines utilize a range of platforms, including mRNA-based vaccines, viral vector vaccines, and subunit vaccines, providing opportunities in addressing multiple pathogens at once. This review delves into the major advancements in the field of combined vaccine research, underscoring the strategic use of various platforms to tackle the simultaneous circulation of respiratory viruses effectively.
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Affiliation(s)
- Yang Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Laboratory, Guangzhou, China
| | - Xiaotong Wei
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Customs Technology Center, Guangzhou, China
| | - Shengfeng Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqi Pan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Jun Dai
- Guangzhou National Laboratory, Guangzhou, China
- Guangzhou Customs Technology Center, Guangzhou, China
| | - Zifeng Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Laboratory, Guangzhou, China
- Respiratory Disease AI Laboratory on Epidemic and Medical Big Data Instrument Applications, Faculty of Innovation Engineering, Macau University of Science and Technology, Macao, Macao SAR, China
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13
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Gennattasio A. Adjuvanted Vaccine to Prevent Respiratory Syncytial Virus in Adults Ages 60 Years and Older. Nurs Womens Health 2024; 28:242-246. [PMID: 38702040 DOI: 10.1016/j.nwh.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 05/06/2024]
Abstract
Respiratory syncytial virus (RSV) is a prevalent cause of acute lower respiratory tract illness that disproportionately affects older adults, young children, and infants, which can lead to hospitalizations and death. The health impact on the elderly and infants accentuates the need for effective preventive strategies. Arexvy is the first approved vaccine to prevent lower respiratory tract illness caused by RSV in older adults ages 60 and older. It contains recombinant respiratory syncytial virus glycoprotein F stabilized in the prefusion conformation. Arexvy offers approximately 83% protection in adults and appears to maintain effectiveness for up to two RSV seasons. The vaccine was generally well tolerated in clinical trials, with the most frequently observed and reported adverse events being mild to moderate injection site pain, fatigue, myalgia, headache, and arthralgia. This article includes a description of Arexvy, the target population, contraindications, side effects, and clinical implications when considering the use of this vaccine.
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14
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Alfano F, Bigoni T, Caggiano FP, Papi A. Respiratory Syncytial Virus Infection in Older Adults: An Update. Drugs Aging 2024; 41:487-505. [PMID: 38713299 PMCID: PMC11193699 DOI: 10.1007/s40266-024-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
Respiratory syncytial virus (RSV) infection represents one of the most common infections during childhood, with significant morbidity and mortality in newborns and in the early years of life. RSV is a common infection throughout all age groups, largely undetected and underestimated in adults, with a disproportionately high impact in older individuals. RSV infection has a wide range of clinical presentations, from asymptomatic conditions to acute pneumonia and severe life-threatening respiratory distress, including exacerbations of underlying chronic conditions. Overall, the incidence of RSV infections requiring medical attention increases with age, and it is highest among persons ≥ 70 years of age. As a consequence of a combination of an aging population, immunosenescence, and the related increased burden of comorbidities, high-income countries are at risk of developing RSV epidemics. The standard of care for RSV-infected patients remains supportive, including fluids, antipyretics, and oxygen support when needed. There is an urgent need for antivirals and preventive strategies in this population, particularly in individuals at higher risk of severe outcomes following RSV infection. In this review, we describe prevention and treatment strategies for RSV illnesses, with a deep focus on the novel data on vaccination that has become available (Arexvy, GSK, and Abrysvo, Pfizer) for older adults.
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Affiliation(s)
- Franco Alfano
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Tommaso Bigoni
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Francesco Paolo Caggiano
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Alberto Papi
- Respiratory Unit, Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Via Aldo Moro, 8, 44124, Ferrara, Italy.
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15
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Woodruff RC, Melgar M, Pham H, Sperling LS, Loustalot F, Kirley PD, Austin E, Yousey-Hindes K, Openo KP, Ryan P, Brown C, Lynfield R, Davis SS, Barney G, Tesini B, Sutton M, Talbot HK, Zahid H, Kim L, Havers FP. Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection. JAMA Intern Med 2024; 184:602-611. [PMID: 38619857 PMCID: PMC11019447 DOI: 10.1001/jamainternmed.2024.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 04/16/2024]
Abstract
Importance Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection. Objective To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection. Design, Setting, and Participants This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events. Exposures Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review. Main Outcomes and Measures Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events. Results The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31). Conclusions and Relevance In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.
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Affiliation(s)
- Rebecca C. Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Huong Pham
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurence S. Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | | | | | | | - Kyle P. Openo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
- Research, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Patricia Ryan
- Emerging Infections Program, Maryland Department of Health, Baltimore
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing
| | - Ruth Lynfield
- Health Protection Bureau, Minnesota Department of Health, St. Paul
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque
| | - Grant Barney
- Division of Epidemiology, New York State Department of Health, Albany
| | - Brenda Tesini
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland
| | - H. Keipp Talbot
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hafsa Zahid
- Epidemiology Bureau, Salt Lake County Health Department, Salt Lake City, Utah
| | - Lindsay Kim
- US Public Health Service Commissioned Corps, Rockville, Maryland
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fiona P. Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
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Hause AM, Moro PL, Baggs J, Zhang B, Marquez P, Melgar M, Britton A, Stroud E, Myers TR, Rakickas J, Blanc PG, Welsh K, Broder KR, Su JR, Shay DK. Early Safety Findings Among Persons Aged ≥60 Years Who Received a Respiratory Syncytial Virus Vaccine - United States, May 3, 2023-April 14, 2024. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:489-494. [PMID: 38814851 PMCID: PMC11152365 DOI: 10.15585/mmwr.mm7321a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
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17
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Moghadas SM, Shoukat A, Bawden CE, Langley JM, Singer BH, Fitzpatrick MC, Galvani AP. Cost-effectiveness of Prefusion F Protein-based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States. Clin Infect Dis 2024; 78:1328-1335. [PMID: 38035791 PMCID: PMC11093660 DOI: 10.1093/cid/ciad658] [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: 07/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. METHODS We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the United States. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained as a measure of effectiveness and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. RESULTS Using a willingness-to-pay of $95 000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD up to $127 with Arexvy and $118 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the United States, the budget impact of these programs at the maximum PPD ranged from $6.48 to $6.78 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $235 for Arexvy and $245 for Abrysvo, with 2-year budget impacts of $11.78 and $12.25 billion, respectively. CONCLUSIONS Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
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Affiliation(s)
- Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Affan Shoukat
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Carolyn E Bawden
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, USA
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Qin H, Luo J, Zhao N, Lou W, Chen P, Wang H, Pan Z, Xiong X. Xuanfei Formula inhibited RSV infection by normalizing the SREBP2-mediated cholesterol synthesis process. Front Microbiol 2024; 15:1387062. [PMID: 38765687 PMCID: PMC11100329 DOI: 10.3389/fmicb.2024.1387062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 05/22/2024] Open
Abstract
Background and aims Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in children and the elderly, often progressing to pneumonia and severe sequelae. However, there are currently no feasible and cost-effective interventions with proven efficacy for children, making medications with anti-RSV activity urgently needed. Traditional Chinese medicine has shown promising therapeutic efficacy in alleviating viral infection symptoms. Therefore, we aimed to develop effective strategies for RSV treatment based on traditional Chinese medicine. Methods and results The infection status was assessed in BALB/c mice with or without Xuanfei Formula (XFF) treatment over a one-week period using H&E staining, cytokine assays and RSV titer testing after RSV challenge. Remarkably, on the first day of XFF intervention, both the pro-inflammation cytokine levels in the serum and RSV-N gene copies in the lung of mice were plummeted, compared to the RSV-infected group. This implied that XFF might possess the immune-independent anti-RSV capability. To elucidate the underlying mechanism, we employed transcriptome analysis followed by k-means analysis. The reversal effects of XFF against RSV primarily focused on the processes of innate and adaptive immunity. Additionally, we found that XFF administration corrected the disordered fatty acid and cholesterol metabolism processes during RSV infection. Lipidomics profiling indicated consistent cholesterol abundance with transcriptional changes but not fatty acids. Cholesterol synthesis-related genes mRNA levels and cholesterol synthesis intermediates detection supported XFF's repression upon cholesterol biosynthesis. Aberrantly increased cholesterol production has been reported as necessary for RSV infection. To mimic that, we observed lovastatin treatment inhibited RSV replication and pro-inflammation cytokine expression in vitro. Transcription factor prediction of differentially expressed genes (DEGs) involved in cholesterol synthesis implicated SREBP2. Through network pharmacology, stigmasterol and β-sitosterol were identified as the effective active ingredients within the XFF, with the help of further molecular docking and mass spectrum detection. In vitro experiments demonstrated β-sitosterol and stigmasterol reinforced the bonding between SREBP cleavage-activation protein (SCAP) and insulin-induced gene proteins (INSIGs) to inhibit SREBP2 cleavage maturation and consequent RSV infection. Conclusion Xuanfei Formula (XFF) exhibits excellent anti-RSV efficacy by inhibiting SREBP2-mediated cholesterol synthesis to reduce RSV replication and ameliorate inflammation in the lung of infected mice.
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Affiliation(s)
- Huan Qin
- College of Life Sciences, State Key Laboratory of Virology, Wuhan University, Wuhan, China
- Department of Integrated Chinese and Western Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University and Technology, Wuhan, China
| | - Jin Luo
- Institute of Maternal and Child Health, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University and Technology, Wuhan, China
| | - Nan Zhao
- College of Life Sciences, State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Wange Lou
- College of Life Sciences, State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Peng Chen
- Department of Respiratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University and Technology, Wuhan, China
| | - Huihao Wang
- Information Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University and Technology, Wuhan, China
| | - Zishu Pan
- College of Life Sciences, State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Xiaoli Xiong
- Clinical Laboratory, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Levy M, Chen JW, Kaiser JA, Park HS, Liu X, Yang L, Santos C, Buchholz UJ, Le Nouën C. Intranasal respiratory syncytial virus vaccine attenuated by codon-pair deoptimization of seven open reading frames is genetically stable and elicits mucosal and systemic immunity and protection against challenge virus replication in hamsters. PLoS Pathog 2024; 20:e1012198. [PMID: 38739647 PMCID: PMC11115275 DOI: 10.1371/journal.ppat.1012198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/23/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Respiratory syncytial virus (RSV) is the most important viral agent of severe pediatric respiratory illness worldwide, but there is no approved pediatric vaccine. Here, we describe the development of the live-attenuated RSV vaccine candidate Min AL as well as engineered derivatives. Min AL was attenuated by codon-pair deoptimization (CPD) of seven of the 11 RSV open reading frames (ORFs) (NS1, NS2, N, P, M, SH and L; 2,073 silent nucleotide substitutions in total). Min AL replicated efficiently in vitro at the permissive temperature of 32°C but was highly temperature sensitive (shut-off temperature of 36°C). When serially passaged at increasing temperatures, Min AL retained greater temperature sensitivity compared to previous candidates with fewer CPD ORFs. However, whole-genome deep-sequencing of passaged Min AL revealed mutations throughout its genome, most commonly missense mutations in the polymerase cofactor P and anti-termination transcription factor M2-1 (the latter was not CPD). Reintroduction of selected mutations into Min AL partially rescued its replication in vitro at temperatures up to 40°C, confirming their compensatory effect. These mutations restored the accumulation of positive-sense RNAs to wild-type (wt) RSV levels, suggesting increased activity by the viral transcriptase, whereas viral protein expression, RNA replication, and virus production were only partly rescued. In hamsters, Min AL and derivatives remained highly restricted in replication in the upper and lower airways, but induced serum IgG and IgA responses to the prefusion form of F (pre F) that were comparable to those induced by wt RSV, as well as robust mucosal and systemic IgG and IgA responses against RSV G. Min AL and derivatives were fully protective against challenge virus replication. The derivatives had increased genetic stability compared to Min AL. Thus, Min AL and derivatives with selected mutations are stable, attenuated, yet highly-immunogenic RSV vaccine candidates that are available for further evaluation.
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Affiliation(s)
- Megan Levy
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Jessica W. Chen
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Jaclyn A. Kaiser
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Hong-Su Park
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Xueqiao Liu
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Lijuan Yang
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Celia Santos
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Ursula J. Buchholz
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Cyril Le Nouën
- RNA Viruses Section, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, Maryland, United States of America
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20
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Sullivan K, Sullivan B. Does nirsevimab prevent lower respiratory infections caused by respiratory syncytial virus? J Perinatol 2024; 44:767-769. [PMID: 38637681 DOI: 10.1038/s41372-024-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Kelsey Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
| | - Brynne Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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21
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Lauring AS, Gaglani M, Ghamande S, Peltan ID, Brown SM, Ginde AA, Martinez A, Mohr NM, Gibbs KW, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Bendall EE, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Mosier JM, Safdar B, Casey JD, Talbot HK, Rice TW, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Swan SA, Johnson CA, Lwin CT, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults. JAMA Netw Open 2024; 7:e244954. [PMID: 38573635 PMCID: PMC11192181 DOI: 10.1001/jamanetworkopen.2024.4954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
Importance On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making. Objective To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status. Design, Setting, and Participants In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023. Exposures RSV, SARS-CoV-2, or influenza infection. Main Outcomes and Measures Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death. Results Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001). Conclusions and Relevance Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine A. Yuengling
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S. Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Ithan D. Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Samuel M. Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Amanda Martinez
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | | | - Kevin W. Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N. Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E. Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michelle N. Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicholas J. Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | | | - Jay S. Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Aleda M. Leis
- School of Public Health, University of Michigan, Ann Arbor
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland
| | | | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Emily E. Bendall
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Jennifer G. Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California, Los Angeles
| | - Steven Y. Chang
- Department of Medicine, University of California, Los Angeles
| | | | - Jennie H. Kwon
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cristie Columbus
- Baylor Scott &White Health, Dallas, Texas
- Texas A&M University College of Medicine, Dallas
| | - Ivana A. Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan
| | | | - Basmah Safdar
- Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan D. Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H. Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W. Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N. Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney A. Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra A. Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cara T. Lwin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathaniel M. Lewis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith L. McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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22
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Molnar D, La EM, Verelst F, Poston S, Graham J, Van Bellinghen LA, Curran D. Public Health Impact of the Adjuvanted RSVPreF3 Vaccine for Respiratory Syncytial Virus Prevention Among Older Adults in the United States. Infect Dis Ther 2024; 13:827-844. [PMID: 38507143 PMCID: PMC11058166 DOI: 10.1007/s40121-024-00939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract disease in older adults, resulting in substantial morbidity and mortality. METHODS This study estimates the public health impact of vaccination with the adjuvanted RSVPreF3 vaccine among adults aged ≥ 60 years in the United States (US). A static, multi-cohort Markov model was used to estimate RSV-related outcomes over a 3-year time horizon for scenarios with and without one-time RSV vaccination. The base-case analysis assumed the same vaccination coverage as for influenza vaccines, with key epidemiology and vaccine inputs obtained from the published literature and phase 3 clinical trial results for the adjuvanted RSVPreF3 vaccine. Model outcomes included the clinical burden of RSV (symptomatic RSV acute respiratory illness [RSV-ARI] cases [classified as upper or lower respiratory tract disease], pneumonia complications, and mortality) and RSV-related healthcare resource use (hospitalizations, emergency department visits, outpatient visits, and antibiotic prescriptions). RESULTS In the base-case analysis, approximately 56.7 million adults aged ≥ 60 years received the vaccine, resulting in 2,954,465 fewer symptomatic RSV-ARI cases over 3 years compared with no vaccination, including 321,019 fewer X-ray confirmed pneumonia cases and 16,660 fewer RSV-related deaths. Vaccination also prevented a substantial number of RSV-related hospitalizations (203,891), emergency department visits (164,060), outpatient visits (1,577,586), and antibiotic prescriptions (1,343,915) over the 3-year period. A considerable public health impact was observed across a range of sensitivity analyses. CONCLUSIONS These findings highlight the potential of the adjuvanted RSVPreF3 vaccine to substantially reduce RSV disease burden among US older adults aged ≥ 60 years.
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23
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Bruyndonckx R, Polkowska-Kramek A, Liang C, Nuttens C, Tran TMP, Gessner BD, Begier E. Estimation of Symptomatic Respiratory Syncytial Virus Infection Incidence in Adults in Multiple Countries: A Time-Series Model-Based Analysis Protocol. Infect Dis Ther 2024; 13:953-963. [PMID: 38499832 PMCID: PMC11058168 DOI: 10.1007/s40121-024-00948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Estimating respiratory syncytial virus (RSV) burden in adults is challenging because of non-specific symptoms, infrequent standard-of-care testing, resolution of viral shedding before seeking medical care, test positivity that varies by specimen site in the upper airway and lower diagnostic test sensitivity compared to children. Conducting prospective observational studies to assess RSV burden in adults is time- and resource-intensive. Thus, model-based approaches can be applied using existing data to obtain more accurate estimates of RSV burden. This protocol establishes essential elements for estimating RSV incidence rate in adults using a time series model-based approach. It can be tailored to specific databases and applied globally across countries, enabling estimation of local RSV disease burden to inform public health decision-making, including immunization policy. METHODS Data are analysed using a quasi-Poisson regression model, considering the effect of baseline trends and pathogen co-circulation, stratified by age and risk status. Pathogen co-circulation is represented by viral proxies defined based on ICD code groupings indicating RSV and influenza-specific hospitalizations, lagged 0 up to 4 weeks based on the model selection. A final model is constructed in two steps: optimization of the time trend (using p-values) and selection of the viral proxy lag time (using test statistics, to prioritize the most biologically plausible option). The yearly incidence rate and percentage of events attributable to RSV are estimated from the final model. Confidence intervals are calculated using residual bootstrapping. PLANNED OUTCOMES Outcomes to be modelled are based on administrative ICD code groupings and include the number of cardiorespiratory, respiratory and cardiovascular events in a specific care setting (e.g., general practitioner visit, emergency department visit, hospitalization and death). Cardiovascular events are limited to those for which existing evidence suggests an association with RSV infection. Additional secondary outcomes are constructed as a subset of the primary outcomes based on specific ICD code groups.
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Affiliation(s)
| | | | | | | | | | | | - Elizabeth Begier
- Pfizer Inc, Dublin, Republic of Ireland.
- Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Republic of Ireland.
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24
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Polkowska-Kramek A, Begier E, Bruyndonckx R, Liang C, Beese C, Brestrich G, Tran TMP, Nuttens C, Casas M, Bayer LJ, Huebbe B, Ewnetu WB, Agudelo JLR, Gessner BD, von Eiff C, Rohde G. Estimated Incidence of Hospitalizations and Deaths Attributable to Respiratory Syncytial Virus Infections Among Adults in Germany Between 2015 and 2019. Infect Dis Ther 2024; 13:845-860. [PMID: 38520629 PMCID: PMC11058748 DOI: 10.1007/s40121-024-00951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) burden in adults is underestimated mainly due to unspecific symptoms and limited standard-of-care testing. We estimated the population-based incidence of hospitalization and mortality attributable to RSV among adults with and without risk factors in Germany. METHODS Weekly counts of hospitalizations and deaths for respiratory, cardiovascular, and cardiorespiratory diseases were obtained (Statutory Health Insurance database, 2015-2019). A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends, and viral activity while allowing for potential overdispersion. Weekly counts of RSV and influenza hospitalizations in children < 2 years and adults ≥ 60 years, respectively, were used as viral activity indicators. Models were stratified by age group and risk status (defined as presence of selected comorbidities). RESULTS Population-based RSV-attributable hospitalization incidence rates were high among adults ≥ 60 years: respiratory hospitalizations (236-363 per 100,000 person-years) and cardiorespiratory hospitalizations (584-912 per 100,000 person-years). RSV accounted for 2-3% of all cardiorespiratory hospitalizations in this age group. The increase in cardiorespiratory hospitalization risk associated with underlying risk factors was greater in 18-44 year old persons (five to sixfold higher) than in ≥ 75 year old persons (two to threefold higher). CONCLUSIONS This is a first model-based study to comprehensively assess adult RSV burden in Germany. Estimated cardiorespiratory RSV hospitalization rates increased with age and were substantially higher in people with risk factors compared to those without risk factors. Our study indicates that RSV, like other respiratory viruses, contributes to both respiratory and cardiovascular hospitalizations. Effective prevention strategies are needed, especially among older adults ≥ 60 years and among adults with underlying risk factors.
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Affiliation(s)
| | | | | | - Caihua Liang
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
| | | | | | | | | | - Maribel Casas
- P95 Pharmacovigilance and Epidemiology Services, Leuven, Belgium
| | | | | | | | | | | | | | - Gernot Rohde
- Medical Clinic I, Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
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25
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Domnich A, Calabrò GE. Epidemiology and burden of respiratory syncytial virus in Italian adults: A systematic review and meta-analysis. PLoS One 2024; 19:e0297608. [PMID: 38442123 PMCID: PMC10914269 DOI: 10.1371/journal.pone.0297608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Respiratory syncytial virus (RSV) is a common respiratory pathogen not only in children, but also in adults. In view of a recent authorization of adult RSV vaccines in Italy, our research question was to quantify the epidemiology and burden of RSV in Italian adults. METHODS Observational studies on the epidemiology and clinical burden of laboratory-confirmed or record-coded RSV infection in Italian adults of any age were eligible. Studies with no separate data for Italian adults, modeling and other secondary publications were excluded. A literature search was performed in MEDLINE, Biological Abstracts, Global Health, Scopus and Web of Science on 22 November 2023. Critical appraisal was performed by means of a Joanna Briggs Institute checklist. Random-effects (RE) meta-analysis was performed to obtain pooled estimates and the observed heterogeneity was investigated by subgroup and meta-regression analyses. The protocol was prospectively registered (doi.org/10.17504/protocols.io.5qpvo32odv4o/v1). RESULTS Thirty-five studies were identified, most of which had at least one possible quality concern. RSV seasonal attack rates ranged from 0.8 ‰ in community-dwelling older adults to 10.9% in hematological outpatients. In the RE model, 4.5% (95% CI: 3.2-5.9%) of respiratory samples tested positive for RSV. This positivity prevalence was higher in older adults (4.4%) than in working-age adults (3.5%) and in outpatient (4.9%) than inpatient (2.9%) settings. According to the meta-regression, study location and sample size were also significant predictors of RSV detection frequency. The pooled estimate of in-hospital mortality was as high as 7.2% (95% CI: 4.7-10.3%). Data on other indicators of the diseases burden, such as complication and hospitalization rates, were unavailable. CONCLUSION RSV poses a measurable burden on Italian adults, especially those of older age and with some co-morbidities. However, several data on the natural history of RSV disease are missing and should be established by future large-scale studies.
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Affiliation(s)
- Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Giovanna Elisa Calabrò
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Correa RA, Arancibia F, De Ávila Kfouri R, Chebabo A, García G, Gutiérrez Robledo LM, Lopardo G, Nemerovsky J, Pérez CM, Rendon A, Ruiz-Palacios GM, Aggarwal B, Berzanskis A, Cintra O. Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps. Pulm Ther 2024; 10:1-20. [PMID: 38358618 PMCID: PMC10881952 DOI: 10.1007/s41030-024-00253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.
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Affiliation(s)
- Ricardo Amorim Correa
- Medical School, Pulmonology and Thoracic Surgery Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Arancibia
- Pulmonary Department, Instituto Nacional del Tórax and Clínica Santa María, Santiago de Chile, Chile
| | - Renato De Ávila Kfouri
- Pediatric Infectious Disease Specialist, Brazilian Pediatric Society and Brazilian Immunization, São Paulo, Brazil
| | - Alberto Chebabo
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luis Miguel Gutiérrez Robledo
- National Institute of Medical Sciences and Nutrition "S Zubiran" and National Institute of Geriatric Medicine, Mexico City, Mexico
| | - Gustavo Lopardo
- Infectious Diseases Department, Hospital Bernardo Houssay, Buenos Aires, Argentina
| | - Julio Nemerovsky
- Geriatrician Physician, Argentine Society of Gerontology and Geriatrics, Buenos Aires, Argentina
| | - Carlos M Pérez
- Faculty of Medicine and Science, Universidad San Sebastian, Santiago, Chile
| | - Adrian Rendon
- Universidad Autonoma de Nuevo León, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Monterrey, Mexico
| | - Guillermo M Ruiz-Palacios
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
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Averin A, Atwood M, Sato R, Yacisin K, Begier E, Shea K, Curcio D, Houde L, Weycker D. Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase. Open Forum Infect Dis 2024; 11:ofae097. [PMID: 38486815 PMCID: PMC10939437 DOI: 10.1093/ofid/ofae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
Background Estimates of the cost of medically attended lower respiratory tract illness (LRTI) due to respiratory syncytial virus (RSV) in adults, especially beyond the acute phase, is limited. This study was undertaken to estimate the attributable costs of RSV-LRTI among US adults during, and up to 1 year after, the acute phase of illness. Methods A retrospective observational matched-cohort design and a US healthcare claims repository (2016-2019) were employed. The study population comprised adults aged ≥18 years with RSV-LRTI requiring hospitalization (RSV-H), an emergency department visit (RSV-ED), or physician office/hospital outpatient visit (RSV-PO/HO), as well as matched comparison patients. All-cause healthcare expenditures were tallied during the acute phase of illness (RSV-H: from admission through 30 days postdischarge; ambulatory RSV: during the episode) and long-term phase (end of acute phase to end of following 1-year period). Results The study population included 4526 matched pairs of RSV-LRTI and comparison patients (RSV-H: n = 970; RSV-ED: n = 590; RSV-PO/HO: n = 2966). Mean acute-phase expenditures were $42 179 for RSV-H (vs $5154 for comparison patients), $4409 for RSV-ED (vs $377), and $922 for RSV-PO/HO (vs $201). By the end of the 1-year follow-up period, mean expenditures-including acute and long-term phases-were $101 532 for RSV-H (vs $36 302), $48 701 for RSV-ED (vs $27 131), and $28 851 for RSV-PO/HO (vs $20 523); overall RSV-LRTI attributable expenditures thus totaled $65 230, $21 570, and $8327, respectively. Conclusions The cost of RSV-LRTI requiring hospitalization or ambulatory care among US adults is substantial, and the economic impact of RSV-LTRI may extend well beyond the acute phase of illness.
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Affiliation(s)
| | - Mark Atwood
- Policy Analysis Inc, Boston, Massachusetts, USA
| | - Reiko Sato
- Pfizer Inc, Collegeville, Pennsylvania, USA
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Gerber MA, Burke MK, Brodeur MR. Respiratory Syncytial Virus Vaccination in Older Adults: Considerations for Use and Shared Clinical Decision-Making. J Gerontol Nurs 2024; 50:7-12. [PMID: 38417072 DOI: 10.3928/00989134-20240207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
PURPOSE To evaluate the impact of two newly U.S. Food and Drug Administration-approved respiratory syncytial virus (RSV) vaccines, RSVpreF3 (Arexvy™, GSK) and RSVpreF (Abrysvo™, Pfizer), on morbidity in older adults. RSV is known to cause significant health issues in this demographic. METHOD The current article reviews Phases 1 and 2 and Phase 3 published clinical trials, the recommendations for immunization practices outlined in the Morbidity and Mortality Weekly Report, and other relevant literature on RSV infection and vaccine coadministration. A case vignette is also included to illustrate an example of the shared clinical decision-making process for vaccination. RESULTS Findings suggest that RSVpreF3 and RSVpreF vaccines effectively reduce health complications of RSV in older adults. Successful integration of these vaccines with other immunizations is also highlighted, emphasizing the role of an interprofessional team in this process. CONCLUSION The introduction of RSVpreF3 and RSVpreF vaccines represents a significant advancement in the management of RSV in older adults. This article underscores the importance of shared clinical decision-making in vaccine administration and the effective coordination of an interprofessional team for coadministration with other vaccines. [Journal of Gerontological Nursing, 50(3), 7-12.].
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Haeberer M, Bruyndonckx R, Polkowska-Kramek A, Torres A, Liang C, Nuttens C, Casas M, Lemme F, Ewnetu WB, Tran TMP, Atwell JE, Diez CM, Gessner BD, Begier E. Estimated Respiratory Syncytial Virus-Related Hospitalizations and Deaths Among Children and Adults in Spain, 2016-2019. Infect Dis Ther 2024; 13:463-480. [PMID: 38319540 DOI: 10.1007/s40121-024-00920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes a substantial disease burden among infants. In older children and adults, incidence is underestimated due to nonspecific symptoms and limited standard-of-care testing. We aimed to estimate RSV-attributable hospitalizations and deaths in Spain during 2016-2019. METHODS Nationally representative hospitalization and mortality databases were obtained from the Ministry of Health and the National Statistical Office. A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends and viral activity, while allowing for potential overdispersion. RESULTS In children, the RSV-attributable respiratory hospitalization incidence was highest among infants aged 0-5 months (3998-5453 cases/100,000 person-years, representing 72% of all respiratory hospitalizations) and decreased with age. In 2019, estimated rates in children 0-5, 6-11, 12-23 months and 6-17 years were approximately 1.3, 1.4, 1.5, and 6.5 times higher than those based on standard-of-care RSV-specific codes. In adults, the RSV-attributable cardiorespiratory hospitalization rate increased with age and was highest among persons ≥ 80 years (1325-1506 cases/100,000, 6.5% of all cardiorespiratory hospitalizations). In 2019, for persons aged 18-49, 50-59, 60-79, and ≥ 80 years, estimated rates were approximately 8, 6, 8, and 16 times higher than those based on standard-of-care RSV-specific codes. The RSV-attributable cardiorespiratory mortality rate was highest among ≥ 80 age group (126-150 deaths/100,000, 3.5-4.1% of all cardiorespiratory deaths), when reported mortality rate ranged between 0 and 0.5/100,000. CONCLUSIONS When accounting for under-ascertainment, estimated RSV-attributable hospitalizations were higher than those reported based on standard-of-care RSV-specific codes in all age groups but particularly among older children and older adults. Like other respiratory viruses, RSV contributes to both respiratory and cardiovascular complications. Efficacious RSV vaccines could have a high public health impact in these age and risk groups.
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Affiliation(s)
| | | | | | | | | | | | - Maribel Casas
- Epidemiology and Pharmacovigilance, P95, Leuven, Belgium
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Redondo E, Rivero-Calle I, Mascarós E, Ocaña D, Jimeno I, Gil Á, Linares M, Onieva-García MÁ, González-Romo F, Yuste J, Martinón-Torres F. Respiratory Syncytial Virus Vaccination Recommendations for Adults Aged 60 Years and Older: The NeumoExperts Prevention Group Position Paper. Arch Bronconeumol 2024; 60:161-170. [PMID: 38311509 DOI: 10.1016/j.arbres.2024.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.
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Affiliation(s)
- Esther Redondo
- Infectious, Migrant, Vaccines and Preventive Activities Group of SEMERGEN, International Healthcare Centre of the City Council of Madrid, Madrid, Spain
| | - Irene Rivero-Calle
- Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Mascarós
- Health Department, Hospital la Fe, Primary Care Centre Arquitecto Tolsá, Valencia, Spain
| | - Daniel Ocaña
- Primary Care, Health Care Centre Algeciras, Algeciras, Spain
| | - Isabel Jimeno
- Primary Care Health Centre Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain
| | - Ángel Gil
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Manuel Linares
- Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación io, Madrid, Spain
| | - María Ángeles Onieva-García
- Preventive Medicine and Public Health Unit, Hospital Universitario Reina Sofía, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
| | - Fernando González-Romo
- Clinical Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - José Yuste
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Balbi H. Nirsevimab: A Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2024; 37:3-6. [PMID: 38484270 DOI: 10.1089/ped.2024.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in people of all ages and is the leading cause of hospitalization among infants in the United States. The year 2023 was exciting for RSV prevention. The Food and Drug Administration (FDA) approved 3 new tools for preventing severe lower respiratory tract RSV infections in infants, young children, and elderly persons. In May 2023, the FDA approved 2 vaccines, RSVpreF3 (Arexvy™, GSK) and RSVpreF (Abrysvo™, Pfizer), for adults ages 60 years or older to be given as a single-dose intramuscular injection. July 2023 brought the approval of the first long-acting monoclonal antibody nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV disease in infants and young children. Then in August, the FDA approved a vaccine (Abrysvo™, Pfizer) to be given to pregnant women to protect their newborns through passive immunity. This article focuses on nirsevemab that has been recommended by the Advisory Committee on Immunization Practices (ACIP) and American Academy of Pediatrics (AAP) to be administered for all infants <8 months of age and for children 8 to 19 months of age who are at increased risk for severe RSV disease.
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Affiliation(s)
- Howard Balbi
- Department of Pediatrics, Good Samaritan University Hospital, West Islip, New York, USA
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Schaerlaekens S, Jacobs L, Stobbelaar K, Cos P, Delputte P. All Eyes on the Prefusion-Stabilized F Construct, but Are We Missing the Potential of Alternative Targets for Respiratory Syncytial Virus Vaccine Design? Vaccines (Basel) 2024; 12:97. [PMID: 38250910 PMCID: PMC10819635 DOI: 10.3390/vaccines12010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Respiratory Syncytial Virus (RSV) poses a significant global health concern as a major cause of lower respiratory tract infections (LRTIs). Over the last few years, substantial efforts have been directed towards developing vaccines and therapeutics to combat RSV, leading to a diverse landscape of vaccine candidates. Notably, two vaccines targeting the elderly and the first maternal vaccine have recently been approved. The majority of the vaccines and vaccine candidates rely solely on a prefusion-stabilized conformation known for its highly neutralizing epitopes. Although, so far, this antigen design appears to be successful for the elderly, our current understanding remains incomplete, requiring further improvement and refinement in this field. Pediatric vaccines still have a long journey ahead, and we must ensure that vaccines currently entering the market do not lose efficacy due to the emergence of mutations in RSV's circulating strains. This review will provide an overview of the current status of vaccine designs and what to focus on in the future. Further research into antigen design is essential, including the exploration of the potential of alternative RSV proteins to address these challenges and pave the way for the development of novel and effective vaccines, especially in the pediatric population.
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Affiliation(s)
- Sofie Schaerlaekens
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
| | - Lotte Jacobs
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
| | - Kim Stobbelaar
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
- Pediatrics Department, Antwerp University Hospital (UZA), Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
- Infla-Med Centre of Excellence, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium; (S.S.); (L.J.); (K.S.); (P.C.)
- Infla-Med Centre of Excellence, University of Antwerp (UA), Universiteitsplein 1 S.7, 2610 Antwerp, Belgium
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33
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Mehta D, Kimball-Carroll S, Clark DR, Fossati S, Hunger M, Pahwa A, Malmenäs M, Hille B, Van de Velde N. Vaccine preparation time, errors, satisfaction, and preference of prefilled syringes versus RSV vaccines requiring reconstitution: randomized, time and motion study. J Med Econ 2024; 27:887-896. [PMID: 38896438 DOI: 10.1080/13696998.2024.2370177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024]
Abstract
AIM The current study compared preparation time, errors, satisfaction, and preference for a prefilled syringe (PFS) versus two RSV vaccines requiring reconstitution (VRR1 and VRR2) in a randomized, single-blinded time and motion study. METHODS Pharmacists, nurses, and pharmacy technicians were randomized to a preparation sequence of the three vaccines. Participants read instructions, then consecutively prepared the three vaccines with a 3-5-min washout period in between. Preparations were video recorded and reviewed by a trained pharmacist for preparation time and errors using predefined, vaccine-specific checklists. Participant demographics, satisfaction with vaccine preparation, and vaccine preference were recorded. Within-subjects analysis of variance was used to compare preparation time. Mixed-effects Poisson and ordered logistic regression models were used to compare the number of preparation errors and satisfaction scores, respectively. RESULTS Sixty-three pharmacists (60%), nurses (35%), and pharmacy technicians (5%) participated at four sites in the United States. The least squares mean preparation time per dose for PFS was 141.8 s (95% CI = 156.8-126.7; p <.0001) faster than for VRR1, 103.6 s (95% CI = 118.7-88.5; p <.0001) faster than for VRR2, and 122.7 s (95% CI = 134.2-111.2; p <.0001) faster than the pooled VRRs. Overall satisfaction (combined "Very" and "Extremely") was 87.3% for PFS, 28.6% for VRR1, and 47.6% for VRR2. Most participants (81.0%) preferred the PFS vaccine. LIMITATIONS The study is limited by the inability to completely blind observers. To minimize the effects of order, we utilized a 3-sequence block design; however, the order in which the vaccines were prepared may have affected outcomes. Participants were assessed once, whereas if repeated preparations were performed there may have been trained efficiencies gained for each vaccine. CONCLUSION PFS vaccines can greatly simplify the vaccine preparation process, allowing administrators to prepare almost four times more doses per hour than with vial and syringe systems.
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Affiliation(s)
| | | | - Dayna R Clark
- ICON plc, Insights, Evidence & Value - Health Economics & Epidemiology, Dublin, Ireland
| | - Serena Fossati
- ICON plc, Insights, Evidence & Value - Health Economics & Epidemiology, Dublin, Ireland
| | - Matthias Hunger
- ICON plc, Insights, Evidence & Value - Health Economics & Epidemiology, Dublin, Ireland
| | - Ankit Pahwa
- ICON plc, Insights, Evidence & Value - Health Economics & Epidemiology, Dublin, Ireland
| | - Mia Malmenäs
- ICON plc, Insights, Evidence & Value - Health Economics & Epidemiology, Dublin, Ireland
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Cusi K, Ekhlaspour L, Fleming TK, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Napoli N, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Verduzco-Gutierrez M, Younossi ZM, Gabbay RA. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S52-S76. [PMID: 38078591 PMCID: PMC10725809 DOI: 10.2337/dc24-s004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Weycker D, Averin A, Houde L, Ottino K, Shea K, Sato R, Gessner BD, Yacisin K, Curcio D, Begier E, Rozenbaum M. Rates of Lower Respiratory Tract Illness in US Adults by Age and Comorbidity Profile. Infect Dis Ther 2024; 13:207-220. [PMID: 38236516 PMCID: PMC10828164 DOI: 10.1007/s40121-023-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION While it is widely recognized that older adults, adults with chronic medical conditions (CMC), and adults with immunocompromising conditions (IC) are at increased risk of lower respiratory tract illness (LRTI), evidence of the magnitude of increased risk is limited. This study was thus undertaken to characterize rates of hospitalized and ambulatory LRTI among United States (US) adults by age and comorbidity profile. METHODS A retrospective cohort design and US healthcare claims database (2016-2019) were employed. Study population included adults aged ≥ 18 years and was stratified by age and comorbidity profile (CMC-, CMC+ , IC). LRTI was ascertained overall and by pathogen pathogen (e.g., respiratory syncytial virus [RSV]), and was classified by care setting (hospital, emergency department [ED], physician office/hospital outpatient [PO/HO]). RESULTS Relative rates (RR) of LRTI generally increased with older age across care settings (vs. 18-49 years), with the most marked increase for hospitalizations: for LRTI-hospitalized, RRs ranged from 3.3 for 50-64 years to 46.6 for ≥ 85 years; for LRTI-ED and LRTI-PO/HO, RRs ranged from 1.0 to 2.7 and from 1.3 to 1.5, respectively. Within age groups, LRTI rates were also consistently higher among CMC+ and IC adults (vs. CMC- adults). Age-specific RRs of LRTI patients hospitalized due to RSV were largely comparable to overall LRTI; age-specific RRs for other care settings, and RRs for CMC+ and IC adults (vs. CMC- adults), were generally higher for LRTI due to RSV. CONCLUSIONS Incidence of LRTI, including that due to RSV, especially for events requiring acute inpatient care, is markedly higher among older adults and adults of all ages with CMC or IC.
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Kurai D, Mizukami A, Preckler V, Verelst F, Molnar D, Matsuki T, Ho Y, Igarashi A. The potential public health impact of the respiratory syncytial virus prefusion F protein vaccine in people aged ≥60 years in Japan: results of a Markov model analysis. Expert Rev Vaccines 2024; 23:303-311. [PMID: 38426479 DOI: 10.1080/14760584.2024.2323128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV), a common respiratory pathogen, can lead to severe symptoms, especially in older adults (OA). A recently developed RSV prefusion F protein (RSVPreF3 OA) vaccine confers high protection against RSV lower respiratory tract disease (LRTD) over two full RSV seasons. The aim of this study was to assess the potential public health impact of RSVPreF3 OA vaccination in the Japanese OA population. RESEARCH DESIGN AND METHODS A static Markov model was used to estimate the number of symptomatic RSV cases, hospitalizations and deaths in the Japanese population aged ≥ 60 years over a 3-year time horizon. Japan-specific RSV epidemiology and healthcare resource use parameters were used; vaccine efficacy was derived from a phase 3 randomized study (AReSVi-006, NCT04886596). Vaccination coverage was set to 50%. RESULTS Without vaccination, >5 million RSV acute respiratory illness (ARI) would occur (2.5 million LRTD and 2.8 million upper respiratory tract infections) leading to ~ 3.5 million outpatient visits, >534,000 hospitalizations and ~ 25,500 RSV-related deaths over 3 years. Vaccination could prevent > 1 million RSV-ARI cases, 728,000 outpatient visits, 143,000 hospitalizations and 6,840 RSV-related deaths. CONCLUSIONS RSVPreF3 OA vaccination is projected to have a substantial public health impact by reducing RSV-related morbidity and mortality in the OA population.
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Affiliation(s)
- Daisuke Kurai
- Department of General Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | - Ataru Igarashi
- Department of Public Health, Yokohama City University, Kanagawa, Japan
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Wilson E, Goswami J, Baqui AH, Doreski PA, Perez-Marc G, Zaman K, Monroy J, Duncan CJA, Ujiie M, Rämet M, Pérez-Breva L, Falsey AR, Walsh EE, Dhar R, Wilson L, Du J, Ghaswalla P, Kapoor A, Lan L, Mehta S, Mithani R, Panozzo CA, Simorellis AK, Kuter BJ, Schödel F, Huang W, Reuter C, Slobod K, Stoszek SK, Shaw CA, Miller JM, Das R, Chen GL. Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults. N Engl J Med 2023; 389:2233-2244. [PMID: 38091530 DOI: 10.1056/nejmoa2307079] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) can cause substantial morbidity and mortality among older adults. An mRNA-based RSV vaccine, mRNA-1345, encoding the stabilized RSV prefusion F glycoprotein, is under clinical investigation. METHODS In this ongoing, randomized, double-blind, placebo-controlled, phase 2-3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive one dose of mRNA-1345 (50 μg) or placebo. The two primary efficacy end points were the prevention of RSV-associated lower respiratory tract disease with at least two signs or symptoms and with at least three signs or symptoms. A key secondary efficacy end point was the prevention of RSV-associated acute respiratory disease. Safety was also assessed. RESULTS Overall, 35,541 participants were assigned to receive the mRNA-1345 vaccine (17,793 participants) or placebo (17,748). The median follow-up was 112 days (range, 1 to 379). The primary analyses were conducted when at least 50% of the anticipated cases of RSV-associated lower respiratory tract disease had occurred. Vaccine efficacy was 83.7% (95.88% confidence interval [CI], 66.0 to 92.2) against RSV-associated lower respiratory tract disease with at least two signs or symptoms and 82.4% (96.36% CI, 34.8 to 95.3) against the disease with at least three signs or symptoms. Vaccine efficacy was 68.4% (95% CI, 50.9 to 79.7) against RSV-associated acute respiratory disease. Protection was observed against both RSV subtypes (A and B) and was generally consistent across subgroups defined according to age and coexisting conditions. Participants in the mRNA-1345 group had a higher incidence than those in the placebo group of solicited local adverse reactions (58.7% vs. 16.2%) and of systemic adverse reactions (47.7% vs. 32.9%); most reactions were mild to moderate in severity and were transient. Serious adverse events occurred in 2.8% of the participants in each trial group. CONCLUSIONS A single dose of the mRNA-1345 vaccine resulted in no evident safety concerns and led to a lower incidence of RSV-associated lower respiratory tract disease and of RSV-associated acute respiratory disease than placebo among adults 60 years of age or older. (Funded by Moderna; ConquerRSV ClinicalTrials.gov number, NCT05127434.).
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Affiliation(s)
- Eleanor Wilson
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jaya Goswami
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Abdullah H Baqui
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Pablo A Doreski
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Gonzalo Perez-Marc
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Khalequ Zaman
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jorge Monroy
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Christopher J A Duncan
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Mugen Ujiie
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Mika Rämet
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Lina Pérez-Breva
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Ann R Falsey
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Edward E Walsh
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Rakesh Dhar
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Lauren Wilson
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jiejun Du
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Parinaz Ghaswalla
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Archana Kapoor
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Lan Lan
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Shraddha Mehta
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Runa Mithani
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Catherine A Panozzo
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Alana K Simorellis
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Barbara J Kuter
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Florian Schödel
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Wenmei Huang
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Caroline Reuter
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Karen Slobod
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Sonia K Stoszek
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Christine A Shaw
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Jacqueline M Miller
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Rituparna Das
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
| | - Grace L Chen
- From Moderna, Cambridge, MA (E.W., J.G., R. Dhar, L.W., J.D., P.G., A.K., L.L., S.M., R.M., C.A.P., A.K.S., B.J.K., F.S., W.H., C.R., K.S., S.K.S., C.A.S., J.M.M., R. Das, G.L.C.); Johns Hopkins Bloomberg School of Public Health, Baltimore (A.H.B.); Fundación Respirar-Vaccine Research Division (P.A.D.) and Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich (G.P.-M.) - both in Buenos Aires; International Center for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z.); Clinical Site Partners, Winter Park, FL (J.M.); Translational and Clinical Research Institute, Newcastle University, and the National Institute for Health and Care Research Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust - both in Newcastle upon Tyne, United Kingdom (C.J.A.D.); Center Hospital of the National Center for Global Health and Medicine, Tokyo (M.U.); Rokotetutkimusklinikka, Järvenpää, and Finnish Vaccine Research, Tampere - both in Finland (M.R.); Vaccine Research-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO) Public Health, Valencia, Spain (L.P.-B.); and the University of Rochester, Rochester, NY (A.R.F., E.E.W.)
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Affiliation(s)
- Amanda C Cohn
- From the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta
| | - Aron J Hall
- From the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta
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Smith RA, Desai A, Hashash JG, Hayney MS, Farraye FA, Caldera F. Addressing the Risks of Respiratory Syncytial Virus for Patients With Inflammatory Bowel Disease in the Era of Novel Vaccines. Inflamm Bowel Dis 2023; 29:1842-1845. [PMID: 37816231 DOI: 10.1093/ibd/izad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Indexed: 10/12/2023]
Affiliation(s)
- Ryan A Smith
- Division of Gastroenterology and WI, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aakash Desai
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Jana G Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Freddy Caldera
- Division of Gastroenterology and WI, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Ruckwardt TJ. The road to approved vaccines for respiratory syncytial virus. NPJ Vaccines 2023; 8:138. [PMID: 37749081 PMCID: PMC10519952 DOI: 10.1038/s41541-023-00734-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
After decades of work, several interventions to prevent severe respiratory syncytial virus (RSV) disease in high-risk infant and older adult populations have finally been approved. There were many setbacks along the road to victory. In this review, I will discuss the impact of RSV on human health and how structure-based vaccine design set the stage for numerous RSV countermeasures to advance through late phase clinical evaluation. While there are still many RSV countermeasures in preclinical and early-stage clinical trials, this review will focus on products yielding long-awaited efficacy results. Finally, I will discuss some challenges and next steps needed to declare a global victory against RSV.
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Affiliation(s)
- Tracy J Ruckwardt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, 20892, USA.
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Moghadas SM, Shoukat A, Bawden CE, Langley JM, Singer BH, Fitzpatrick MC, Galvani AP. Cost-Effectiveness of Prefusion F Protein-Based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.14.23294076. [PMID: 37645896 PMCID: PMC10462221 DOI: 10.1101/2023.08.14.23294076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against Respiratory Syncytial Virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. Methods We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the US. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-years (QALY) gained as a measure of effectiveness, and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. Results Using a willingness-to-pay of $95,000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD under $120 with Arexvy and $111 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the US, the budget impact of these programs at the maximum PPD ranged from $5.74 to $6.10 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $250 for Arexvy and $233 for Abrysvo, with two-year budget impacts of $11.59 and $10.89 billion, respectively. Conclusions Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
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Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, Havers FP. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:793-801. [PMID: 37471262 PMCID: PMC10360650 DOI: 10.15585/mmwr.mm7229a4] [Citation(s) in RCA: 94] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Respiratory syncytial virus (RSV) is a cause of severe respiratory illness in older adults. In May 2023, the Food and Drug Administration approved the first vaccines for prevention of RSV-associated lower respiratory tract disease in adults aged ≥60 years. Since May 2022, the Advisory Committee on Immunization Practices (ACIP) Respiratory Syncytial Virus Vaccines Adult Work Group met at least monthly to review available evidence regarding the safety, immunogenicity, and efficacy of these vaccines among adults aged ≥60 years. On June 21, 2023, ACIP voted to recommend that adults aged ≥60 years may receive a single dose of an RSV vaccine, using shared clinical decision-making. This report summarizes the body of evidence considered for this recommendation and provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years. RSV vaccines have demonstrated moderate to high efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults; postmarketing surveillance will direct future guidance.
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Abstract
Respiratory syncytial virus (RSV) is the most common cause of serious respiratory infection in infants. Reinfections occur commonly, including in older adults. For six decades, effective vaccines remained elusive. Stabilization of the prefusion conformation of the RSV glycoprotein F was critical for development of effective vaccines to prevent RSV in older adults. To view this Bench to Bedside, open or download the PDF.
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Affiliation(s)
- Ann R Falsey
- Department of Medicine, University of Rochester, Rochester, NY, USA.
| | - Edward E Walsh
- Department of Medicine, University of Rochester, Rochester, NY, USA
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Onwuchekwa C, Moreo LM, Menon S, Machado B, Curcio D, Kalina W, Atwell JE, Gessner BD, Siapka M, Agarwal N, Rubbrecht M, Nair H, Rozenbaum M, Aponte-Torres Z, Vroling H, Begier E. Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis. J Infect Dis 2023; 228:173-184. [PMID: 36661222 PMCID: PMC10345483 DOI: 10.1093/infdis/jiad012] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Most observational population-based studies identify respiratory syncytial virus (RSV) by nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR) only. We conducted a systematic review and meta-analyses to quantify specimen and diagnostic testing-based underascertainment of adult RSV infection. METHODS EMBASE, PubMed, and Web of Science were searched (January 2000-December 2021) for studies including adults using/comparing >1 RSV testing approach. We quantified test performance and RSV detection increase associated with using multiple specimen types. RESULTS Among 8066 references identified, 154 met inclusion. Compared to RT-PCR, other methods were less sensitive: rapid antigen detection test (RADT; pooled sensitivity, 64%), direct fluorescent antibody (DFA; 83%), and viral culture (86%). Compared to singleplex PCR, multiplex PCR's sensitivity was lower (93%). Compared to nasal/nasopharyngeal swab RT-PCR alone, adding another specimen type increased detection: sputum RT-PCR, 52%; 4-fold rise in paired serology, 44%; and oropharyngeal swab RT-PCR, 28%. Sensitivity was lower in estimates limited to only adults (for RADT, DFA, and viral culture), and detection rate increases were largely comparable. CONCLUSIONS RT-PCR, particularly singleplex testing, is the most sensitive RSV diagnostic test in adults. Adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection. Synergistic effects of using ≥3 specimen types should be assessed, as this approach may improve the accuracy of adult RSV burden estimates.
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Affiliation(s)
| | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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Cong B, Dighero I, Zhang T, Chung A, Nair H, Li Y. Understanding the age spectrum of respiratory syncytial virus associated hospitalisation and mortality burden based on statistical modelling methods: a systematic analysis. BMC Med 2023; 21:224. [PMID: 37365569 DOI: 10.1186/s12916-023-02932-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Statistical modelling studies based on excess morbidity and mortality are important for understanding RSV disease burden for age groups that are less frequently tested for RSV. We aimed to understand the full age spectrum of RSV morbidity and mortality burden based on statistical modelling studies, as well as the value of modelling studies in RSV disease burden estimation. METHODS The databases Medline, Embase and Global Health were searched to identify studies published between January 1, 1995, and December 31, 2021, reporting RSV-associated excess hospitalisation or mortality rates of any case definitions using a modelling approach. All reported rates were summarised using median, IQR (Interquartile range) and range by age group, outcome and country income group; where applicable, a random-effects meta-analysis was conducted to combine the reported rates. We further estimated the proportion of RSV hospitalisations that could be captured in clinical databases. RESULTS A total of 32 studies were included, with 26 studies from high-income countries. RSV-associated hospitalisation and mortality rates both showed a U-shape age pattern. Lowest and highest RSV acute respiratory infection (ARI) hospitalisation rates were found in 5-17 years (median: 1.6/100,000 population, IQR: 1.3-18.5) and < 1 year (2235.7/100,000 population, 1779.1-3552.5), respectively. Lowest and highest RSV mortality rates were found in 18-49 years (0.1/100,000 population, 0.06-0.2) and ≥ 75 years (80.0/100,000 population, 70.0-90.0) for high-income countries, respectively, and in 18-49 years (0.3/100,000 population, 0.1-2.4) and < 1 year (143.4/100,000 population, 143.4-143.4) for upper-middle income countries. More than 70% of RSV hospitalisations in children < 5 years could be captured in clinical databases whereas less than 10% of RSV hospitalisations could be captured in adults, especially for adults ≥ 50 years. Using pneumonia and influenza (P&I) mortality could potentially capture half of all RSV mortality in older adults but only 10-30% of RSV mortality in children. CONCLUSIONS Our study provides insights into the age spectrum of RSV hospitalisation and mortality. RSV disease burden using laboratory records alone could be substantially severely underreported for age groups ≥ 5 years. Our findings confirm infants and older adults should be prioritised for RSV immunisation programmes. TRIAL REGISTRATION PROSPERO CRD42020173430.
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Affiliation(s)
- Bingbing Cong
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Izzie Dighero
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tiantian Zhang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Alexandria Chung
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - You Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Grace M, Colosia A, Wolowacz S, Panozzo C, Ghaswalla P. Economic burden of respiratory syncytial virus infection in adults: a systematic literature review. J Med Econ 2023:1-60. [PMID: 37167068 DOI: 10.1080/13696998.2023.2213125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIMS Capture the economic and healthcare resource utilization (HCRU) burden in older adults due to respiratory syncytial virus (RSV) infection. METHODS An electronic literature search of PubMed, Embase, the Cochrane Library, PsycINFO, and EconLit was conducted for studies of the cost and HCRU outcomes of RSV infection in adult patients, with no language or country restrictions. Search dates for primary studies were January 1, 2002-May 18, 2022. The methodological quality of included studies was assessed using a modification of the Critical Appraisal Skills Programme (CASP) checklist for economic studies and the Drummond checklist. RESULTS 42 studies were identified that reported cost or HCRU data associated with RSV infections, with geographic locations across North America, South America, Europe, Asia, and Oceania. Generally, hospitalization costs were highest in the United States (US). Driving factors of increased cost included older age, comorbidities, and length of stay. US studies found that the national direct cost burden of RSV hospitalizations was $1.3 billion for all adults and $1.5-$4.0 billion for adults aged ≥60 years (estimates for other countries were not identified). Studies estimating incremental costs for RSV cases versus controls and costs pre- and post-RSV infection demonstrated higher costs for RSV cases. Hospitalizations accounted for the majority of total costs.
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Affiliation(s)
- Mei Grace
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Ann Colosia
- RTI Health Solutions, Research Triangle Park, NC, USA
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Ramirez J, Carrico R, Wilde A, Junkins A, Furmanek S, Chandler T, Schulz P, Hubler R, Peyrani P, Liu Q, Trivedi S, Uppal S, Kalina WV, Falsey AR, Walsh EE, Yacisin K, Jodar L, Gessner BD, Begier E. Diagnosis of Respiratory Syncytial Virus in Adults Substantially Increases When Adding Sputum, Saliva, and Serology Testing to Nasopharyngeal Swab RT-PCR. Infect Dis Ther 2023:10.1007/s40121-023-00805-1. [PMID: 37148463 PMCID: PMC10163290 DOI: 10.1007/s40121-023-00805-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/06/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Nearly all existing respiratory syncytial virus (RSV) incidence estimates are based on real-time polymerase chain reaction (RT-PCR) testing of nasal or nasopharyngeal (NP) swabs. Adding testing of additional specimen types to NP swab RT-PCR increases RSV detection. However, prior studies only made pairwise comparisons and the synergistic effect of adding multiple specimen types has not been quantified. We compared RSV diagnosis by NP swab RT-PCR alone versus NP swab plus saliva, sputum, and serology. METHODS This was a prospective cohort study over two study periods (27 December 2021 to 1 April 2022 and 22 August 2022 to 11 November 2022) of patients aged ≥ 40 years hospitalized for acute respiratory illness (ARI) in Louisville, KY. NP swab, saliva, and sputum specimens were collected at enrollment and PCR tested (Luminex ARIES platform). Serology specimens were obtained at acute and convalescent timepoints (enrollment and 30-60-day visit). RSV detection rate was calculated for NP swab alone and for NP swab plus all other specimen type/test. RESULTS Among 1766 patients enrolled, 100% had NP swab, 99% saliva, 34% sputum, and 21% paired serology specimens. RSV was diagnosed in 56 (3.2%) patients by NP swab alone, and in 109 (6.2%) patients by NP swab plus additional specimens, corresponding to a 1.95 times higher rate [95% confidence interval (CI) 1.62, 2.34]. Limiting the comparison to the 150 subjects with all four specimen types available (i.e., NP swab, saliva, sputum, and serology), there was a 2.60-fold increase (95% CI 1.31, 5.17) compared to NP swab alone (3.3% versus 8.7%). Sensitivities by specimen type were: NP swab 51%, saliva 70%, sputum 72%, and serology 79%. CONCLUSIONS Diagnosis of RSV in adults was several-fold greater when additional specimen types were added to NP swab, even with a relatively low percentage of subjects with sputum and serology results available. Hospitalized RSV ARI burden estimates in adults based solely on NP swab RT-PCR should be adjusted for underestimation.
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Affiliation(s)
- Julio Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA.
| | - Ruth Carrico
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Ashley Wilde
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Alan Junkins
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | - Paul Schulz
- Norton Infectious Diseases Institute, Norton Healthcare, 601 S Floyd St, Louisville, KY, 40202, USA
| | | | | | - Qing Liu
- Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - Ann R Falsey
- Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Edward E Walsh
- Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Hamid S, Winn A, Parikh R, Jones JM, McMorrow M, Prill MM, Silk BJ, Scobie HM, Hall AJ. Seasonality of Respiratory Syncytial Virus - United States, 2017-2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:355-361. [PMID: 37022977 PMCID: PMC10078848 DOI: 10.15585/mmwr.mm7214a1] [Citation(s) in RCA: 75] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the United States, respiratory syncytial virus (RSV) infections cause an estimated 58,000-80,000 hospitalizations among children aged <5 years (1,2) and 60,000-160,000 hospitalizations among adults aged ≥65 years each year (3-5). U.S. RSV epidemics typically follow seasonal patterns, peaking in December or January (6,7), but the COVID-19 pandemic disrupted RSV seasonality during 2020-2022 (8). To describe U.S. RSV seasonality during prepandemic and pandemic periods, polymerase chain reaction (PCR) test results reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS)* during July 2017-February 2023 were analyzed. Seasonal RSV epidemics were defined as the weeks during which the percentage of PCR test results that were positive for RSV was ≥3% (9). Nationally, prepandemic seasons (2017-2020) began in October, peaked in December, and ended in April. During 2020-21, the typical winter RSV epidemic did not occur. The 2021-22 season began in May, peaked in July, and ended in January. The 2022-23 season started (June) and peaked (November) later than the 2021-22 season, but earlier than prepandemic seasons. In both prepandemic and pandemic periods, epidemics began earlier in Florida and the Southeast and later in regions further north and west. With several RSV prevention products in development,† ongoing monitoring of RSV circulation can guide the timing of RSV immunoprophylaxis and of clinical trials and postlicensure effectiveness studies. Although the timing of the 2022-23 season suggests that seasonal patterns are returning toward those observed in prepandemic years, clinicians should be aware that off-season RSV circulation might continue.
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Walsh EE, Pérez Marc G, Zareba AM, Falsey AR, Jiang Q, Patton M, Polack FP, Llapur C, Doreski PA, Ilangovan K, Rämet M, Fukushima Y, Hussen N, Bont LJ, Cardona J, DeHaan E, Castillo Villa G, Ingilizova M, Eiras D, Mikati T, Shah RN, Schneider K, Cooper D, Koury K, Lino MM, Anderson AS, Jansen KU, Swanson KA, Gurtman A, Gruber WC, Schmoele-Thoma B. Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults. N Engl J Med 2023; 388:1465-1477. [PMID: 37018468 DOI: 10.1056/nejmoa2213836] [Citation(s) in RCA: 155] [Impact Index Per Article: 155.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection causes considerable illness in older adults. The efficacy and safety of an investigational bivalent RSV prefusion F protein-based (RSVpreF) vaccine in this population are unknown. METHODS In this ongoing, phase 3 trial, we randomly assigned, in a 1:1 ratio, adults (≥60 years of age) to receive a single intramuscular injection of RSVpreF vaccine at a dose of 120 μg (RSV subgroups A and B, 60 μg each) or placebo. The two primary end points were vaccine efficacy against seasonal RSV-associated lower respiratory tract illness with at least two or at least three signs or symptoms. The secondary end point was vaccine efficacy against RSV-associated acute respiratory illness. RESULTS At the interim analysis (data-cutoff date, July 14, 2022), 34,284 participants had received RSVpreF vaccine (17,215 participants) or placebo (17,069 participants). RSV-associated lower respiratory tract illness with at least two signs or symptoms occurred in 11 participants in the vaccine group (1.19 cases per 1000 person-years of observation) and 33 participants in the placebo group (3.58 cases per 1000 person-years of observation) (vaccine efficacy, 66.7%; 96.66% confidence interval [CI], 28.8 to 85.8); 2 cases (0.22 cases per 1000 person-years of observation) and 14 cases (1.52 cases per 1000 person-years of observation), respectively, occurred with at least three signs or symptoms (vaccine efficacy, 85.7%; 96.66% CI, 32.0 to 98.7). RSV-associated acute respiratory illness occurred in 22 participants in the vaccine group (2.38 cases per 1000 person-years of observation) and 58 participants in the placebo group (6.30 cases per 1000 person-years of observation) (vaccine efficacy, 62.1%; 95% CI, 37.1 to 77.9). The incidence of local reactions was higher with vaccine (12%) than with placebo (7%); the incidences of systemic events were similar (27% and 26%, respectively). Similar rates of adverse events through 1 month after injection were reported (vaccine, 9.0%; placebo, 8.5%), with 1.4% and 1.0%, respectively, considered by the investigators to be injection-related. Severe or life-threatening adverse events were reported in 0.5% of vaccine recipients and 0.4% of placebo recipients. Serious adverse events were reported in 2.3% of participants in each group through the data-cutoff date. CONCLUSIONS RSVpreF vaccine prevented RSV-associated lower respiratory tract illness and RSV-associated acute respiratory illness in adults (≥60 years of age), without evident safety concerns. (Funded by Pfizer; RENOIR ClinicalTrials.gov number, NCT05035212; EudraCT number, 2021-003693-31.).
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Affiliation(s)
- Edward E Walsh
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Gonzalo Pérez Marc
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Agnieszka M Zareba
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Ann R Falsey
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Qin Jiang
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Michael Patton
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Fernando P Polack
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Conrado Llapur
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Pablo A Doreski
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kumar Ilangovan
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Mika Rämet
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Yasushi Fukushima
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Nazreen Hussen
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Louis J Bont
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Jose Cardona
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Elliot DeHaan
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Giselle Castillo Villa
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Marinela Ingilizova
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Daniel Eiras
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Tarek Mikati
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Rupal N Shah
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Katherine Schneider
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - David Cooper
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kenneth Koury
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Maria-Maddalena Lino
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Annaliesa S Anderson
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kathrin U Jansen
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kena A Swanson
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Alejandra Gurtman
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - William C Gruber
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Beate Schmoele-Thoma
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
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