1
|
Langedijk AC, Bont LJ. Respiratory syncytial virus infection and novel interventions. Nat Rev Microbiol 2023; 21:734-749. [PMID: 37438492 DOI: 10.1038/s41579-023-00919-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
The large global burden of respiratory syncytial virus (RSV) respiratory tract infections in young children and older adults has gained increased recognition in recent years. Recent discoveries regarding the neutralization-specific viral epitopes of the pre-fusion RSV glycoprotein have led to a shift from empirical to structure-based design of RSV therapeutics, and controlled human infection model studies have provided early-stage proof of concept for novel RSV monoclonal antibodies, vaccines and antiviral drugs. The world's first vaccines and first monoclonal antibody to prevent RSV among older adults and all infants, respectively, have recently been approved. Large-scale introduction of RSV prophylactics emphasizes the need for active surveillance to understand the global impact of these interventions over time and to timely identify viral mutants that are able to escape novel prophylactics. In this Review, we provide an overview of RSV interventions in clinical development, highlighting global disease burden, seasonality, pathogenesis, and host and viral factors related to RSV immunity.
Collapse
Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
- ReSViNET Foundation, Zeist, the Netherlands.
| |
Collapse
|
2
|
Van Effelterre T, Hens N, White LJ, Gravenstein S, Bastian AR, Buyukkaramikli N, Cheng CY, Hartnett J, Krishnarajah G, Weber K, Pastor LH. Modeling Respiratory Syncytial Virus Adult Vaccination in the United States With a Dynamic Transmission Model. Clin Infect Dis 2023; 77:480-489. [PMID: 36949605 DOI: 10.1093/cid/ciad161] [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: 10/29/2022] [Revised: 11/17/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is shown to cause substantial morbidity, hospitalization, and mortality in infants and older adults. Population-level modeling of RSV allows to estimate the full burden of disease and the potential epidemiological impact of novel prophylactics. METHODS We modeled the RSV epidemiology in the United States across all ages using a deterministic compartmental transmission model. Population-level symptomatic RSV acute respiratory tract infection (ARI) cases were projected across different natural history scenarios with and without vaccination of adults aged ≥60 years. The impact of vaccine efficacy against ARIs, infectiousness and vaccine coverage on ARI incidence were assessed. The impact on medical attendance, hospitalization, complications, death, and other outcomes was also derived. RESULTS Without a vaccine, we project 17.5-22.6 million symptomatic RSV ARI cases annually in adults aged ≥18 years in the US, with 3.6-4.8 million/year occurring in adults aged ≥60 years. Modeling indicates that up to 2.0 million symptomatic RSV-ARI cases could be prevented annually in ≥60-year-olds with a hypothetical vaccine (70% vaccine efficacy against symptomatic ARI and 60% vaccine coverage) and that up to 0.69 million/year could be prevented in the nonvaccinated population, assuming 50% vaccine impact on infectiousness. CONCLUSIONS The model provides estimated burden of RSV in the US across all age groups, with substantial burden projected specifically in older adults. Vaccination of adults aged ≥60 years could significantly reduce the burden of disease in this population, with additional indirect effect in adults aged <60 years due to reduced transmissibility.
Collapse
Affiliation(s)
- T Van Effelterre
- Janssen Pharmaceutica N.V., Global Commercial Strategy Organization, Beerse, Belgium
| | - N Hens
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - L J White
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - S Gravenstein
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - A R Bastian
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - N Buyukkaramikli
- Janssen Pharmaceutica N.V., Global Commercial Strategy Organization, Beerse, Belgium
| | - C Y Cheng
- Janssen Pharmaceutica N.V., Global Commercial Strategy Organization, Beerse, Belgium
| | - J Hartnett
- Janssen Infectious Diseases and Vaccines, Titusville, New Jersey, USA
| | | | - K Weber
- Janssen-Cilag Pharma GmbH, Vienna, Austria
| | - L Hernandez Pastor
- Janssen Pharmaceutica N.V., Market Access, Global Commercial Strategy Organization, Beerse, Belgium
| |
Collapse
|
3
|
Biggs HM, Simões EAF, Khader IA, Thompson MG, Gordon A, Hunt DR, DeGroote NP, Porter RM, Bino S, Marar BI, Gresh L, de Jesus-Cornejo J, Langley G, Thornburg NJ, Peret TCT, Whitaker B, Zhang Y, Wang L, Patel MC, McMorrow M, Campbell W, Hasibra I, Duka E, Al-Gazo M, Kubale J, Sanchez F, Lucero MG, Tallo VL, Azziz-Baumgartner E, Simaku A, Gerber SI. Respiratory Syncytial Virus Infection Among Hospitalized Infants in Four Middle-Income Countries. J Pediatric Infect Dis Soc 2023; 12:394-405. [PMID: 37313727 PMCID: PMC11268525 DOI: 10.1093/jpids/piad042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies. METHODS Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, and preterm birth). RESULTS Of 3634 enrolled hospitalized infants, 1129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4-6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; P < .01), low weight-for-age z-score (aOR 1.9, 95% CI: 1.2-2.8; P < .01), ICU care after birth (aOR 1.6, 95% CI: 1.0-2.5; P = .048), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; P = .03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old. CONCLUSIONS RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.
Collapse
Affiliation(s)
- Holly M. Biggs
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric A. F. Simões
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ilham Abu Khader
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Mark G. Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicholas P. DeGroote
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachael M. Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Bino
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | | | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Joanne de Jesus-Cornejo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Gayle Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J. Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa C. T. Peret
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yange Zhang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Wang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mira C. Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Iris Hasibra
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Enkeleda Duka
- Pediatric Department, Mother Theresa University Hospital Center, Tirana, Albania
| | - Mahmoud Al-Gazo
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Felix Sanchez
- Hospital Infantil Manuel de Jesus Rivera, Ministry of Health, Managua, Nicaragua
| | - Marilla G. Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Veronica L. Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Artan Simaku
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Li X, Hodgson D, Flaig J, Kieffer A, Herring WL, Beyhaghi H, Willem L, Jit M, Bilcke J, Beutels P. Cost-Effectiveness of Respiratory Syncytial Virus Preventive Interventions in Children: A Model Comparison Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:508-518. [PMID: 36442831 DOI: 10.1016/j.jval.2022.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Model-based cost-effectiveness analyses on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs. METHODS We compared 3 static and 2 dynamic models using a common input parameter set for a hypothetical birth cohort of 100 000 infants. Year-round and seasonal programs were evaluated for MV and mAb interventions, using available evidence during the study period (eg, phase III MV and phase IIb mAb efficacy). RESULTS Three static models estimated comparable medically attended (MA) cases averted versus no intervention (MV, 1019-1073; mAb, 5075-5487), with the year-round MV directly saving ∼€1 million medical and €0.3 million nonmedical costs, while gaining 4 to 5 discounted quality-adjusted life years (QALYs) annually in <1-year-olds, and mAb resulting in €4 million medical and €1.5 million nonmedical cost savings, and 21 to 25 discounted QALYs gained. In contrast, both dynamic models estimated fewer MA cases averted (MV, 402-752; mAb, 3362-4622); one showed an age shift of RSV cases, whereas the other one reported many non-MA symptomatic cases averted, especially by MV (2014). These differences can be explained by model types, assumptions on non-MA burden, and interventions' effectiveness over time. CONCLUSIONS Our static and dynamic models produced overall similar hospitalization and death estimates, but also important differences, especially in non-MA cases averted. Despite the small QALY decrement per non-MA case, their larger number makes them influential for the costs per QALY gained of RSV interventions.
Collapse
Affiliation(s)
- Xiao Li
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - David Hodgson
- Center of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Julien Flaig
- Epidemiology and Modeling of Infectious Diseases (EPIMOD), Lyon, France
| | - Alexia Kieffer
- Health Economics and Value Assessment, Sanofi, Lyon, France
| | - William L Herring
- RTI Health Solutions, Research Triangle Park, NC, USA; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Mark Jit
- Center of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Joke Bilcke
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
5
|
Nakajo K, Nishiura H. Age-specific hospitalization risk of primary and secondary respiratory syncytial virus infection among young children. Int J Infect Dis 2022; 124:14-20. [PMID: 36100066 DOI: 10.1016/j.ijid.2022.09.008] [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: 05/24/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Elucidating the infection dynamics that lead to severe respiratory syncytial virus (RSV) pneumonia and hospitalization among young children are critical. We explored the role of infection parity as well as age in months for RSV-associated hospitalization among young children in Japan. METHODS We used a sequential transmission catalytic model to capture the transmission mechanisms of RSV among infants in an endemic state. We investigated data on the age-dependent seroprevalence and incidence rate of hospitalization in Japan, and jointly estimated the age-specific risk of hospitalization during primary RSV infection and relative risk of hospitalization during secondary infection in children aged <5 years. RESULTS The estimated risk of hospitalization with primary infection was 0.08 (95% CI: 0.05-0.14) in infants aged 0-2 months. The estimated relative risk of hospitalization owing to secondary infection was 0.18 (95% CI: 0.01-2.04). CONCLUSION Our simple models successfully captured the infection dynamics of RSV among young children in Japan. The age group of early infancy may be most vulnerable to infection and hospitalization, offering key insights into future vaccinations. The burden of hospitalization from secondary infection may be less important in young children.
Collapse
Affiliation(s)
- Ko Nakajo
- Kyoto University School of Public Health, Kyoto, Japan; Sanofi K.K. Tokyo Opera City Tower, 3-20-2, Nishi Shinjuku, Shinjuku-ku, Tokyo, Japan
| | | |
Collapse
|
6
|
Challenges in Maximizing Impacts of Preventive Strategies against Respiratory Syncytial Virus (RSV) Disease in Young Children. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:293-300. [PMID: 35782467 PMCID: PMC9235255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract illness in infants and young children. It causes substantial morbidity and mortality in young children and older adults. As few therapeutic and prophylaxis options against RSV illness are currently available, there is a great need for effective RSV vaccines and immune-prophylaxis. Encouragingly, multiple vaccines and immuno-prophylaxis aiming to protect pediatric populations have shown promising progress in clinical trials. The three major preventive strategies include RSV F-protein-based vaccines for pregnant women, extended half-life monoclonal antibodies for neonates, and live-attenuated vaccines for infants. Each preventive strategy has its own merits and challenges yet to be overcome. Challenges also exist in maximizing vaccine impacts in the post-implementation era. This perspectives piece focuses on RSV preventive strategies in young children and highlights the remaining questions in current development of RSV immunization products and design of immunization programs.
Collapse
|
7
|
Odumade OA, van Haren SD, Angelidou A. Implications of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on the Epidemiology of Pediatric Respiratory Syncytial Virus Infection. Clin Infect Dis 2022; 75:S130-S135. [PMID: 35579506 PMCID: PMC9129219 DOI: 10.1093/cid/ciac373] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Respiratory viral infections account for a large percentage of global disease and death. Respiratory syncytial virus is a seasonal virus affecting immunologically vulnerable populations, such as preterm newborns and young infants; however, its epidemiology has changed drastically during the coronavirus disease 2019 pandemic. In this perspective, we discuss the implications of coronavirus disease 2019 on respiratory syncytial virus seasonality patterns and mitigation efforts, as well as the urgent need for vaccination as a preventive tool.
Collapse
Affiliation(s)
- Oludare A Odumade
- Correspondence: Oludare Odumade, Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, CC BCH 3136, Boston, MA 02115 ()
| | - Simon D van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Asimenia Angelidou
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Use of mathematical modelling to assess respiratory syncytial virus epidemiology and interventions: a literature review. J Math Biol 2022; 84:26. [PMID: 35218424 PMCID: PMC8882104 DOI: 10.1007/s00285-021-01706-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/10/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection worldwide, resulting in approximately sixty thousand annual hospitalizations of< 5-year-olds in the United States alone and three million annual hospitalizations globally. The development of over 40 vaccines and immunoprophylactic interventions targeting RSV has the potential to significantly reduce the disease burden from RSV infection in the near future. In the context of RSV, a highly contagious pathogen, dynamic transmission models (DTMs) are valuable tools in the evaluation and comparison of the effectiveness of different interventions. This review, the first of its kind for RSV DTMs, provides a valuable foundation for future modelling efforts and highlights important gaps in our understanding of RSV epidemics. Specifically, we have searched the literature using Web of Science, Scopus, Embase, and PubMed to identify all published manuscripts reporting the development of DTMs focused on the population transmission of RSV. We reviewed the resulting studies and summarized the structure, parameterization, and results of the models developed therein. We anticipate that future RSV DTMs, combined with cost-effectiveness evaluations, will play a significant role in shaping decision making in the development and implementation of intervention programs.
Collapse
|
9
|
Voirin N, Virlogeux V, Demont C, Kieffer A. Potential Impact of Nirsevimab on RSV Transmission and Medically Attended Lower Respiratory Tract Illness Caused by RSV: A Disease Transmission Model. Infect Dis Ther 2022; 11:277-292. [PMID: 34813073 PMCID: PMC8847469 DOI: 10.1007/s40121-021-00566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is associated with significant morbidity worldwide, especially among infants. We evaluated the potential impact of prophylactic nirsevimab, a monoclonal antibody, in infants experiencing their first RSV season, and the number of medically-attended lower respiratory tract infection episodes caused by RSV (RSV-MALRTI) in the USA. METHODS We developed an age-structured, dynamic, deterministic compartmental model reflecting RSV natural history, incorporating USA demographic data and an age-specific contact matrix. We assumed either no effect of nirsevimab on transmission (scenario 1) or a 50% reduction of viral shedding (scenario 2). Model outcomes were RSV-MALRTIs, ICD-9 coded in the Marketscan® database by month. We focused on age groups corresponding to the first 2 years of life, during seven RSV seasons (2008-2015). RESULTS Scenario 1 illustrated the direct individual benefit when a universal immunization strategy is applied to all infants. In scenario 2, herd protection was observed across age groups, with 15.5% of all avoided cases due to reduced transmission; the greatest impact was in the youngest age group and a benefit was observed in those aged 65+ years. CONCLUSION These preliminary data suggest that single-dose nirsevimab will benefit infants experiencing their first RSV season, with a potential increase in effectiveness dependent on nirsevimab's mechanism of action.
Collapse
Affiliation(s)
- Nicolas Voirin
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Lent, France
| | - Victor Virlogeux
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Lent, France
- Hospices Civils de Lyon, Lyon, France
| | - Clarisse Demont
- Vaccine and Epidemiology Modelling, Sanofi Pasteur, Lyon, France
| | - Alexia Kieffer
- Health Economics and Value Assessment, Sanofi Pasteur, Siège Mondial, 14 Espace Henry Vallée, 69007, Lyon, France.
| |
Collapse
|
10
|
Glowinski R, Mejias A, Ramilo O. New preventive strategies for respiratory syncytial virus infection in children. Curr Opin Virol 2021; 51:216-223. [PMID: 34781106 DOI: 10.1016/j.coviro.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023]
Abstract
Respiratory syncytial virus (RSV) infections result in significant morbidity and mortality for young children worldwide. The development of preventive strategies for RSV has faced different challenges, including the legacy of the first vaccine attempt, and an incomplete understanding of the host immune response to the virus. However, promising preventive strategies against RSV are in the pipeline and their development has advanced rapidly in the past decade due in part to our improved knowledge about the structural conformation of key RSV proteins. These strategies include monoclonal antibodies and different vaccines platforms directed towards the main target populations.
Collapse
Affiliation(s)
- Rebecca Glowinski
- Center for Vaccines & Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Asuncion Mejias
- Center for Vaccines & Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA; Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pharmacology and Pediatrics, Malaga Medical School (UMA), Malaga University, Spain
| | - Octavio Ramilo
- Center for Vaccines & Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA; Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
| |
Collapse
|
11
|
Liu D, Leung K, Jit M, Wu JT. Cost-effectiveness of strategies for preventing paediatric lower respiratory infections associated with respiratory syncytial virus in eight Chinese cities. Vaccine 2021; 39:5490-5498. [PMID: 34454783 DOI: 10.1016/j.vaccine.2021.08.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND New monoclonal antibodies (mAbs) and vaccines against RSV with promising efficacy and protection duration are expected to be available in the near future. We evaluated the cost-effectiveness of the administration of maternal immunisation (MI), infant mAb (IA) and paediatric immunisation (PI) as well as their combinations in eight Chinese cities. METHODS We used a static model to estimate the impact of these preventive interventions on reducing the burden of RSV-ALRI in twelve monthly birth cohorts from a societal perspective. In addition to year-round administration, we also considered seasonal administration of MI and IA (i.e., administered only to children born in selected months). The primary outcome was threshold strategy cost (TSC), defined as the maximum costs per child for a strategy to be cost-effective. RESULTS With a willingness-to-pay threshold of one national GDP per capita per QALY gained for all the cities, TSC of year-round strategies was: (i) US$2.4 (95% CI: 1.9-3.4) to US$14.7 (11.6-21.4) for MI; (ii) US$19.9 (16.9-25.9) to US$144.2 (124.6-184.7) for IA; (iii) US$28.7 (22.0-42.0) to US$201.0 (156.5-298.6) for PI; (iv) US$31.1 (24.0-45.5) to US$220.7 (172.0-327.3) for maternal plus paediatric immunisation (MPI); and (v) US$41.3 (32.6-58.9) to US$306.2 (244.1-441.3) for infant mAb plus paediatric immunisation (AP). In all cities, the top ten seasonal strategies (ranked by TSC) protected infants from 5 or fewer monthly birth cohorts. CONCLUSIONS Administration of these interventions could be cost-effective if they are suitably priced. Suitably-timed seasonal administration could be more cost-effective than their year-round counterpart. Our results can inform the optimal strategy once these preventive interventions are commercially available.
Collapse
Affiliation(s)
- Di Liu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kathy Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Mark Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQs, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China.
| |
Collapse
|
12
|
Linssen RS, Teirlinck AC, van Boven M, Biarent D, Stona L, Amigoni A, Comoretto RI, Leteurtre S, Bruandet A, Bentsen GK, Drage IM, Wang X, Campbell H, van Woensel JBM, Bont L, Bem RA. Increasing burden of viral bronchiolitis in the pediatric intensive care unit; an observational study. J Crit Care 2021; 68:165-168. [PMID: 34304966 DOI: 10.1016/j.jcrc.2021.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Viral bronchiolitis is a major cause of pediatric intensive care unit (PICU) admission. Insight in the trends of bronchiolitis-associated PICU admissions is limited, but imperative for future PICU resource and capacity planning. MATERIALS AND METHODS We retrospectively studied trends in PICU admissions for bronchiolitis in six European sites, including three full national registries, between 2000 and 2019 and calculated population-based estimates per 100,000 children where appropriate. Information concerning risk factors for severe disease and use of invasive mechanical ventilation was also collected when available. RESULTS In total, there were 15,606 PICU admissions for bronchiolitis. We observed an increase in the annual number, rate and estimates per 100,000 children of PICU admissions for bronchiolitis at all sites over the last two decades, while the proportion of patients at high risk for severe disease remained relatively stable. CONCLUSIONS The international increased burden of bronchiolitis for the PICU is concerning, and warrants further international attention and investigation.
Collapse
Affiliation(s)
- Rosalie S Linssen
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands.
| | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Dominique Biarent
- Pediatric Intensive Care and Emergency Department, Hospital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Belgium
| | - Luca Stona
- Fondazione Penta Child Health Research ONLUS, Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's, Health, University Hospital of Padova, Padova, Italy
| | - Rosanna I Comoretto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Stephane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Groupe Francophone de Réanimation et d'Urgences pédiatriques - GFRUP-, Paris, France
| | - Amélie Bruandet
- Medical Information Department, Lille University Hospital, Lille, France
| | - Gunnar K Bentsen
- Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Inger Marie Drage
- Division of Emergencies and Critical Care, Oslo University Hospital - Ullevaal, Oslo, Norway
| | - Xin Wang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Louis Bont
- UMCU Laboratory of Translational Immunology, Wilhelmina Children's Hospital, University Medical Center of Utrecht, Utrecht, the Netherlands; Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, the Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| |
Collapse
|
13
|
Treskova M, Pozo-Martin F, Scholz S, Schönfeld V, Wichmann O, Harder T. Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data. PHARMACOECONOMICS 2021; 39:287-315. [PMID: 33462760 PMCID: PMC7813556 DOI: 10.1007/s40273-020-00991-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several vaccine and antibody candidates are currently in development for the prevention of lower respiratory tract infections caused by the respiratory syncytial virus (RSV). METHODS We searched MEDLINE, Embase, and SCOPUS and included model-based evaluations of RSV vaccinations. Two reviewers performed the selection, data extraction, and quality evaluation with EVIDEM. Cost-effectiveness (CE) estimates were converted to $US purchasing power parity (PPP), year 2018 values. Potential economic and epidemiological outcomes were summarised for maternal, infant, children, and elderly vaccinations. The PROSPERO identifier is CRD42019122570. RESULTS In total, 22 model-based studies were reviewed. On average, a potential 27% reduction in RSV hospitalisations in infants was projected for maternal vaccination and 50% for direct infant immunisation. The CE of maternal vaccination was $US1766-5857 PPP 2018/disability-adjusted life-years (DALYs) for Global Alliance for Vaccines and Immunisation (Gavi)-eligible countries. For England, the maximum cost-effective price of maternal vaccination was estimated at $US81.5 PPP 2018. Infant vaccination was associated with higher CE ratios in low- and high-income settings. Vaccination of neonates born before the RSV season was the most cost effective in high-income settings. Higher values for vaccine effectiveness, duration of protection, and vaccine uptake increased the benefits. Due to indirect effects, the vaccination of school-age children and a cocooning strategy were effective alternatives to protect infants, and the vaccination of children aged < 5 years had a beneficial impact on the elderly. CONCLUSION RSV vaccines with anticipated characteristics may reduce a sizeable proportion of the RSV burden. The results are subject to uncertainty because of the limited epidemiological and clinical data. Data on RSV incidence and hospitalisation risk for granular age strata should be prioritised to facilitate the evaluation of RSV interventions and decision making.
Collapse
Affiliation(s)
- Marina Treskova
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany.
| | | | - Stefan Scholz
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| |
Collapse
|
14
|
Mathematical modelling of respiratory syncytial virus (RSV) in low- and middle-income countries: A systematic review. Epidemics 2021; 35:100444. [PMID: 33662812 PMCID: PMC8262087 DOI: 10.1016/j.epidem.2021.100444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/31/2021] [Accepted: 02/17/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Due to high burden of respiratory syncytial virus (RSV) in low- and middle-income countries (LMIC), international funding organizations have prioritized the development of RSV vaccines. Mathematical models of RSV will play an important role in assessing the relative value of these interventions. Our objectives were to provide an overview of the existing RSV modelling literature in LMIC and summarize available results on population-level effectiveness and cost-effectiveness. Methods: We searched MEDLINE from 2000 to 2020 for English language publications that employed a mathematical model of RSV calibrated to LMIC. Qualitative data were extracted on study and model characteristics. Quantitative data were collected on key model input assumptions and base case effectiveness and cost-effectiveness estimates for various immunization strategies. Findings: Of the 283 articles reviewed, 15 met inclusion criteria. Ten studies used modelling techniques to explore RSV transmission and/or natural history, while eight studies evaluated RSV vaccines and/or monoclonal antibodies, three of which included cost-effectiveness analyses. Six studies employed deterministic compartmental models, five studies employed individual transmission models, and four studies used different types of cohort models. Nearly every model was calibrated to at least one middle-income country, while four were calibrated to low-income countries. Interpretation: The mathematical modelling literature in LMIC has demonstrated the potential effectiveness of RSV vaccines and monoclonal antibodies. This review has demonstrated the importance of accounting for seasonality, social contact rates, immunity from prior infection and maternal antibody transfer. Future models should consider incorporating individual-level risk factors, subtype-specific effects, long-term sequelae of RSV infections, and out-of-hospital mortality.
Collapse
|
15
|
Zylbersztejn A, Pembrey L, Goldstein H, Berbers G, Schepp R, van der Klis F, Sande C, Mason D, Wright J, Smyth R, Hardelid P. Respiratory syncytial virus in young children: community cohort study integrating serological surveys, questionnaire and electronic health records, Born in Bradford cohort, England, 2008 to 2013. ACTA ACUST UNITED AC 2021; 26. [PMID: 33573711 PMCID: PMC7879500 DOI: 10.2807/1560-7917.es.2021.26.6.2000023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Bronchiolitis caused by respiratory syncytial virus (RSV) is a major cause of mortality and morbidity in infants. Aim To describe RSV epidemiology in children in the community in a high-income setting. Methods We used stored blood samples from the United Kingdom Born in Bradford cohort study that had been collected at birth, age 1 and 2 years old, tested for IgG RSV postfusion F antibody and linked to questionnaires and primary and hospital care records. We used finite mixture models to classify children as RSV infected/not infected according to their antibody concentrations at age 1 and 2 years. We assessed risk factors for primary RSV infection at each age using Poisson regression models. Results The study cohort included 700 children with cord blood samples; 490 had additional blood samples taken at both ages 1 and 2 years old. Of these 490 children, 258 (53%; 95% confidence interval (CI): 48–57%) were first infected with RSV at age 1, 99 of whom (38%; 95% CI: 33–43%) had been in contact with healthcare during peak RSV season (November–January). Having older siblings, birth in October–June and attending formal childcare were associated with risk of RSV infection in infancy. By age 2, a further 164 of 490 children (33%; 95% CI: 29–38%) had been infected. Conclusion Over half of children experienced RSV infection in infancy, a further one third had evidence of primary RSV infection by age 2, and one in seven remained seronegative by their second birthday. These findings will inform future analyses to assess the cost-effectiveness of RSV vaccination programmes in high-income settings.
Collapse
Affiliation(s)
- Ania Zylbersztejn
- Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lucy Pembrey
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Harvey Goldstein
- Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Guy Berbers
- Centre of Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rutger Schepp
- Centre of Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Fiona van der Klis
- Centre of Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Charles Sande
- Kemri-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Rosalind Smyth
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Pia Hardelid
- Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| |
Collapse
|
16
|
Kombe IK, Agoti CN, Munywoki PK, Baguelin M, Nokes DJ, Medley GF. Integrating epidemiological and genetic data with different sampling intensities into a dynamic model of respiratory syncytial virus transmission. Sci Rep 2021; 11:1463. [PMID: 33446831 PMCID: PMC7809427 DOI: 10.1038/s41598-021-81078-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 01/04/2021] [Indexed: 01/06/2023] Open
Abstract
Respiratory syncytial virus (RSV) is responsible for a significant burden of severe acute lower respiratory tract illness in children under 5 years old; particularly infants. Prior to rolling out any vaccination program, identification of the source of infant infections could further guide vaccination strategies. We extended a dynamic model calibrated at the individual host level initially fit to social-temporal data on shedding patterns to include whole genome sequencing data available at a lower sampling intensity. The study population was 493 individuals (55 aged < 1 year) distributed across 47 households, observed through one RSV season in coastal Kenya. We found that 58/97 (60%) of RSV-A and 65/125 (52%) of RSV-B cases arose from infection probably occurring within the household. Nineteen (45%) infant infections appeared to be the result of infection by other household members, of which 13 (68%) were a result of transmission from a household co-occupant aged between 2 and 13 years. The applicability of genomic data in studies of transmission dynamics is highly context specific; influenced by the question, data collection protocols and pathogen under investigation. The results further highlight the importance of pre-school and school-aged children in RSV transmission, particularly the role they play in directly infecting the household infant. These age groups are a potential RSV vaccination target group.
Collapse
Affiliation(s)
- Ivy K Kombe
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya.
| | - Charles N Agoti
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Patrick K Munywoki
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Marc Baguelin
- Centre for Mathematical Modelling of Infectious Disease and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya.,School of Life Sciences and Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, CV4 7AL, UK
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| |
Collapse
|
17
|
Hodgson D, Pebody R, Panovska-Griffiths J, Baguelin M, Atkins KE. Evaluating the next generation of RSV intervention strategies: a mathematical modelling study and cost-effectiveness analysis. BMC Med 2020; 18:348. [PMID: 33203423 PMCID: PMC7672821 DOI: 10.1186/s12916-020-01802-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. METHODS To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes. FINDINGS Our transmission model suggests that maternal protection of infants is seasonal, with 38-62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80. CONCLUSIONS In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.
Collapse
Affiliation(s)
- David Hodgson
- Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK. .,Department of Mathematics, University College London, London, UK. .,Modelling and Economics Unit, Public Health England, London, UK. .,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Richard Pebody
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Jasmina Panovska-Griffiths
- Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK.,Department of Mathematics, University College London, London, UK.,Department of Applied Health Research, University College London, London, UK
| | - Marc Baguelin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Katherine E Atkins
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
18
|
Campbell PT, Geard N, Hogan AB. Modelling the household-level impact of a maternal respiratory syncytial virus (RSV) vaccine in a high-income setting. BMC Med 2020; 18:319. [PMID: 33176774 PMCID: PMC7661211 DOI: 10.1186/s12916-020-01783-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infects almost all children by the age of 2 years, with the risk of hospitalisation highest in the first 6 months of life. Development and licensure of a vaccine to prevent severe RSV illness in infants is a public health priority. A recent phase 3 clinical trial estimated the efficacy of maternal vaccination at 39% over the first 90 days of life. Households play a key role in RSV transmission; however, few estimates of population-level RSV vaccine impact account for household structure. METHODS We simulated RSV transmission within a stochastic, individual-based model framework, using an existing demographic model, structured by age and household and parameterised with Australian data, as an exemplar of a high-income country. We modelled vaccination by immunising pregnant women and explicitly linked the immune status of each mother-infant pair. We quantified the impact on children for a range of vaccine properties and uptake levels. RESULTS We found that a maternal immunisation strategy would have the most substantial impact in infants younger than 3 months, reducing RSV infection incidence in this age group by 16.6% at 70% vaccination coverage. In children aged 3-6 months, RSV infection was reduced by 5.3%. Over the first 6 months of life, the incidence rate for infants born to unvaccinated mothers was 1.26 times that of infants born to vaccinated mothers. The impact in older age groups was more modest, with evidence of infections being delayed to the second year of life. CONCLUSIONS Our findings show that while individual benefit from maternal RSV vaccination could be substantial, population-level reductions may be more modest. Vaccination impact was sensitive to the extent that vaccination prevented infection, highlighting the need for more vaccine trial data.
Collapse
Affiliation(s)
- Patricia T. Campbell
- Epidemiology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicholas Geard
- Epidemiology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
- School of Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
| | - Alexandra B. Hogan
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
19
|
van Boven M, Teirlinck AC, Meijer A, Hooiveld M, van Dorp CH, Reeves RM, Campbell H, van der Hoek W. Estimating Transmission Parameters for Respiratory Syncytial Virus and Predicting the Impact of Maternal and Pediatric Vaccination. J Infect Dis 2020; 222:S688-S694. [PMID: 32821916 PMCID: PMC7751153 DOI: 10.1093/infdis/jiaa424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of respiratory tract illness in young children and a major cause of hospital admissions globally. METHODS Here we fit age-structured transmission models with immunity propagation to data from the Netherlands (2012-2017). Data included nationwide hospitalizations with confirmed RSV, general practitioner (GP) data on attendance for care from acute respiratory infection, and virological testing of acute respiratory infections at the GP. The transmission models, equipped with key parameter estimates, were used to predict the impact of maternal and pediatric vaccination. RESULTS Estimates of the basic reproduction number were generally high (R0 > 10 in scenarios with high statistical support), while susceptibility was estimated to be low in nonelderly adults (<10% in persons 20-64 years) and was higher in older adults (≥65 years). Scenario analyses predicted that maternal vaccination reduces the incidence of infection in vulnerable infants (<1 year) and shifts the age of first infection from infants to young children. CONCLUSIONS Pediatric vaccination is expected to reduce the incidence of infection in infants and young children (0-5 years), slightly increase incidence in 5 to 9-year-old children, and have minor indirect benefits.
Collapse
Affiliation(s)
- Michiel van Boven
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Anne C Teirlinck
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Christiaan H van Dorp
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Rachel M Reeves
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| |
Collapse
|
20
|
Kinyanjui T, Pan-Ngum W, Saralamba S, Taylor S, White L, Nokes DJ. Model evaluation of target product profiles of an infant vaccine against respiratory syncytial virus (RSV) in a developed country setting. Vaccine X 2020; 4:100055. [PMID: 32123865 PMCID: PMC7037978 DOI: 10.1016/j.jvacx.2020.100055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 01/04/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract disease in children worldwide and is a significant cause of hospital admissions in young children in England. No RSV vaccine has been licensed but a number are under development. In this work, we present two structurally distinct mathematical models, parameterized using RSV data from the UK, which have been used to explore the effect of introducing an RSV paediatric vaccine to the National programme. We have explored different vaccine properties, and dosing regimens combined with a range of implementation strategies for RSV control. The results suggest that vaccine properties that confer indirect protection have the greatest effect in reducing the burden of disease in children under 5 years. The findings are reinforced by the concurrence of predictions from the two models with very different epidemiological structure. The approach described has general application in evaluating vaccine target product profiles.
Collapse
Affiliation(s)
- Timothy Kinyanjui
- Department of Mathematics, University of Manchester, Oxford Road, Manchester, UK
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research – Coast, Kilifi, Kenya
- Peak AI, Neo, Charlotte Street, Manchester, UK
| | - Wirichada Pan-Ngum
- Mathematical and Economics Modelling (MAEMOD) Research Group, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sompob Saralamba
- Mathematical and Economics Modelling (MAEMOD) Research Group, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Lisa White
- Mathematical and Economics Modelling (MAEMOD) Research Group, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - D. James Nokes
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research – Coast, Kilifi, Kenya
- School of Life Sciences and Zeeman Institute for Systems Biology an Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, UK
| |
Collapse
|
21
|
Li X, Willem L, Antillon M, Bilcke J, Jit M, Beutels P. Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries. BMC Med 2020; 18:82. [PMID: 32248817 PMCID: PMC7132892 DOI: 10.1186/s12916-020-01537-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/18/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) frequently causes acute lower respiratory infection in children under 5, representing a high burden in Gavi-eligible countries (mostly low-income and lower-middle-income). Since multiple RSV interventions, including vaccines and monoclonal antibody (mAb) candidates, are under development, we aim to evaluate the key drivers of the cost-effectiveness of maternal vaccination and infant mAb for 72 Gavi countries. METHODS A static Multi-Country Model Application for RSV Cost-Effectiveness poLicy (MCMARCEL) was developed to follow RSV-related events monthly from birth until 5 years of age. MCMARCEL was parameterised using country- and age-specific demographic, epidemiological, and cost data. The interventions' level and duration of effectiveness were guided by the World Health Organization's preferred product characteristics and other literature. Maternal vaccination and mAb were assumed to require single-dose administration at prices assumed to align with other Gavi-subsidised technologies. The effectiveness and the prices of the interventions were simultaneously varied in extensive scenario analyses. Disability-adjusted life years (DALYs) were the primary health outcomes for cost-effectiveness, integrated with probabilistic sensitivity analyses and Expected Value of Partially Perfect Information analysis. RESULTS The RSV-associated disease burden among children in these 72 countries is estimated at an average of 20.8 million cases, 1.8 million hospital admissions, 40 thousand deaths, 1.2 million discounted DALYs, and US$611 million discounted direct costs. Strategy 'mAb' is more effective due to its assumed longer duration of protection versus maternal vaccination, but it was also assumed to be more expensive. Given all parameterised uncertainty, the optimal strategy of choice tends to change for increasing willingness to pay (WTP) values per DALY averted from the current situation to maternal vaccination (at WTP > US$1000) to mAB (at WTP > US$3500). The age-specific proportions of cases that are hospitalised and/or die cause most of the uncertainty in the choice of optimal strategy. Results are broadly similar across countries. CONCLUSIONS Both the maternal and mAb strategies need to be competitively priced to be judged as relatively cost-effective. Information on the level and duration of protection is crucial, but also more and better disease burden evidence-especially on RSV-attributable hospitalisation and death rates-is needed to support policy choices when novel RSV products become available.
Collapse
Affiliation(s)
- Xiao Li
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium.
| | - Lander Willem
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| | - Marina Antillon
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium.,Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland.,University of Basel, Petersplatz 1, Basel, Switzerland
| | - Joke Bilcke
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, UK
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| |
Collapse
|
22
|
Brand SP, Munywoki P, Walumbe D, Keeling MJ, Nokes DJ. Reducing respiratory syncytial virus (RSV) hospitalization in a lower-income country by vaccinating mothers-to-be and their households. eLife 2020; 9:47003. [PMID: 32216871 PMCID: PMC7556875 DOI: 10.7554/elife.47003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/26/2020] [Indexed: 01/15/2023] Open
Abstract
Respiratory syncytial virus is the leading cause of lower respiratory tract infection among infants. RSV is a priority for vaccine development. In this study, we investigate the potential effectiveness of a two-vaccine strategy aimed at mothers-to-be, thereby boosting maternally acquired antibodies of infants, and their household cohabitants, further cocooning infants against infection. We use a dynamic RSV transmission model which captures transmission both within households and communities, adapted to the changing demographics and RSV seasonality of a low-income country. Model parameters were inferred from past RSV hospitalisations, and forecasts made over a 10-year horizon. We find that a 50% reduction in RSV hospitalisations is possible if the maternal vaccine effectiveness can achieve 75 days of additional protection for newborns combined with a 75% coverage of their birth household co-inhabitants (~7.5% population coverage).
Collapse
Affiliation(s)
- Samuel Pc Brand
- Zeeman Institute of Systems Biology and Infectious Disease Research (SBIDER), University of Warwick, Warwick, United Kingdom.,School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | - Patrick Munywoki
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - David Walumbe
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Matthew J Keeling
- Zeeman Institute of Systems Biology and Infectious Disease Research (SBIDER), University of Warwick, Warwick, United Kingdom.,School of Life Sciences, University of Warwick, Coventry, United Kingdom.,Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - David James Nokes
- Zeeman Institute of Systems Biology and Infectious Disease Research (SBIDER), University of Warwick, Warwick, United Kingdom.,School of Life Sciences, University of Warwick, Coventry, United Kingdom.,Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| |
Collapse
|
23
|
Meeting report: WHO consultation on Respiratory Syncytial Virus (RSV) vaccine development, Geneva, 25–26 April 2016. Vaccine 2019; 37:7355-7362. [DOI: 10.1016/j.vaccine.2017.02.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 11/23/2022]
|
24
|
Hilton J, Keeling MJ. Incorporating household structure and demography into models of endemic disease. J R Soc Interface 2019; 16:20190317. [PMID: 31387486 PMCID: PMC6731502 DOI: 10.1098/rsif.2019.0317] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The spread of infectious diseases is intimately linked with the strength and type of contact between individuals. Multiple observational and modelling studies have highlighted the importance of two forms of social mixing: age structure, where the likelihood of interaction between two individuals is determined by their ages; and household structure, which recognizes the much stronger contacts and hence transmission potential within the family setting. Age structure has been ubiquitous in predictive models of both endemic and epidemic infections, in part due to the ease of assessing someone’s age. By contrast, although household structure is potentially the dominant heterogeneity, it has received less attention, in part due to an absence of the necessary methodology. Here, we develop the modelling framework necessary to predict the behaviour of endemic infections (which necessitates capturing demographic processes) in populations that possess both household and age structure. We compare two childhood infections, with measles-like and mumps-like parameters, and two populations with UK-like and Kenya-like characteristics, which allows us to disentangle the impact of epidemiology and demography. For this high-dimensional model, we predict complex nonlinear dynamics, where the dynamics of within-household outbreaks are tempered by historical waves of infection and the immunity of older individuals.
Collapse
Affiliation(s)
- Joe Hilton
- MathSys CDT, Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK.,Zeeman Institute (SBIDER), University of Warwick, Coventry CV4 7AL, UK
| | - Matt J Keeling
- Zeeman Institute (SBIDER), University of Warwick, Coventry CV4 7AL, UK.,Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK.,School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK
| |
Collapse
|
25
|
Genomic analysis of respiratory syncytial virus infections in households and utility in inferring who infects the infant. Sci Rep 2019; 9:10076. [PMID: 31296922 PMCID: PMC6624209 DOI: 10.1038/s41598-019-46509-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022] Open
Abstract
Infants (under 1-year-old) are at most risk of life threatening respiratory syncytial virus (RSV) disease. RSV epidemiological data alone has been insufficient in defining who acquires infection from whom (WAIFW) within households. We investigated RSV genomic variation within and between infected individuals and assessed its potential utility in tracking transmission in households. Over an entire single RSV season in coastal Kenya, nasal swabs were collected from members of 20 households every 3-4 days regardless of symptom status and screened for RSV nucleic acid. Next generation sequencing was used to generate >90% RSV full-length genomes for 51.1% of positive samples (191/374). Single nucleotide polymorphisms (SNPs) observed during household infection outbreaks ranged from 0-21 (median: 3) while SNPs observed during single-host infection episodes ranged from 0-17 (median: 1). Using the viral genomic data alone there was insufficient resolution to fully reconstruct within-household transmission chains. For households with clear index cases, the most likely source of infant infection was via a toddler (aged 1 to <3 years-old) or school-aged (aged 6 to <12 years-old) co-occupant. However, for best resolution of WAIFW within households, we suggest an integrated analysis of RSV genomic and epidemiological data.
Collapse
|
26
|
Mahikul W, J. White L, Poovorawan K, Soonthornworasiri N, Sukontamarn P, Chanthavilay P, F. Medley G, Pan-ngum W. Modeling household dynamics on Respiratory Syncytial Virus (RSV). PLoS One 2019; 14:e0219323. [PMID: 31287832 PMCID: PMC6615606 DOI: 10.1371/journal.pone.0219323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Respiratory Syncytial Virus (RSV) is the most common cause of respiratory tract infection in infants and children and shows increasing trend among elderly people worldwide. In many developing country settings, population and household structures have gone through some significant changes in the past decades, namely fewer births, more elderly population, and smaller household size but more RSV high-risk individuals. These dynamics have been captured in a mathematical model with RSV transmission dynamics to predict the disease burden on the detailed population for future targeted interventions. The population and disease dynamics model was constructed and tested against the hospitalization data for Acute Lower Respiratory Tract Infection due to RSV in rural Thai settings between 2005 and 2011. The proportion of extended families is predicted to increase by about 10% from 2005 to 2020, especially for those with elderly population, while the classic nuclear family type (with adults and children) will decline by about 10%. For RSV, infections from extended family type (approximately 60% of all household types) have majorly contributed to the force of infection (FOI). While the model predicted the increase of FOI from the extended family by 15% from 2005 to 2020, the FOI contributed by other household types would be either stable or decrease in the same time period. RSV incidence rate is predominantly high among babies (92.2%) and has been predicted to decrease slightly over time (from 940 to 864 cases per 100,000 population by 2020), while the incidence rates among children and elderly people may remain steadily low over the same period. However, the estimated incidence rates among elderly people were twice than those in children. The model predicts that approximately 60% of FOI for RSV will come from members of the extended family type. The incidence rate of RSV among children and elderly in extended families was about 20 times lower than that in infants and the trend is steady. Targeted intervention strategies, such as health education in some specific groups and targeted vaccination, may be considered, with the focus on extended family type. Target interventions on babies can lessen the transmission to children and elderly especially when transmission within households of extended family type is high.
Collapse
Affiliation(s)
- Wiriya Mahikul
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lisa J. White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Phetsavanh Chanthavilay
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Institute of Research and Education Development, UHS, Vientiane, Lao PDR
| | - Graham F. Medley
- Centre for Mathematical Modelling of Infectious Disease & Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wirichada Pan-ngum
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
27
|
Kombe IK, Munywoki PK, Baguelin M, Nokes DJ, Medley GF. Model-based estimates of transmission of respiratory syncytial virus within households. Epidemics 2019; 27:1-11. [PMID: 30591267 PMCID: PMC6543068 DOI: 10.1016/j.epidem.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes a significant respiratory disease burden in the under 5 population. The transmission pathway to young children is not fully quantified in low-income settings, and this information is required to design interventions. METHODS We used an individual level transmission model to infer transmission parameters using data collected from 493 individuals distributed across 47 households over a period of 6 months spanning the 2009/2010 RSV season. A total of 208 episodes of RSV were observed from 179 individuals. We model competing transmission risk from within household exposure and community exposure while making a distinction between RSV groups A and B. RESULTS We find that 32-53% of all RSV transmissions are between members of the same household; the rate of pair-wise transmission is 58% (95% CrI: 30-74%) lower in larger households (≥8 occupants) than smaller households; symptomatic individuals are 2-7 times more infectious than asymptomatic individuals i.e. 2.48 (95% CrI: 1.22-5.57) among symptomatic individuals with low viral load and 6.7(95% CrI: 2.56-16) among symptomatic individuals with high viral load; previous infection reduces susceptibility to re-infection within the same epidemic by 47% (95% CrI: 17%-68%) for homologous RSV group and 39% (95%CrI: -8%-69%) for heterologous group; RSV B is more frequently introduced into the household, and RSV A is more rapidly transmitted once in the household. DISCUSSION Our analysis presents the first transmission modelling of cohort data for RSV and we find that it is important to consider the household social structuring and household size when modelling transmission. The increased infectiousness of symptomatic individuals implies that a vaccine against RSV related disease would also have an impact on infection transmission. Together, the weak cross immunity between RSV groups and the possibility of different transmission niches could form part of the explanation for the group co-existence.
Collapse
Affiliation(s)
- Ivy K Kombe
- KEMRI-Wellcome Trust Research Programme, KEMRI Center for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya; Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
| | - Patrick K Munywoki
- KEMRI-Wellcome Trust Research Programme, KEMRI Center for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Marc Baguelin
- Centre for Mathematical Modelling of Infectious Disease and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, KEMRI Center for Geographical Medical Research-Coast, P.O. Box 230-80108, Kilifi, Kenya; School of Life Sciences and Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, CV4 7AL, UK
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| |
Collapse
|
28
|
Goldstein E, Nguyen HH, Liu P, Viboud C, Steiner CA, Worby CJ, Lipsitch M. On the Relative Role of Different Age Groups During Epidemics Associated With Respiratory Syncytial Virus. J Infect Dis 2019; 217:238-244. [PMID: 29112722 DOI: 10.1093/infdis/jix575] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/31/2017] [Indexed: 11/14/2022] Open
Abstract
Background While circulation of respiratory syncytial virus (RSV) results in high rates of hospitalization, particularly among young children and elderly individuals, little is known about the role of different age groups in propagating annual RSV epidemics. Methods We evaluate the roles played by individuals in different age groups during RSV epidemics in the United States between 2001 and 2012, using the previously defined relative risk (RR) statistic estimated from the hospitalization data from the Healthcare Cost and Utilization Project. Transmission modeling was used to examine the robustness of our inference method. Results Children aged 3-4 years and 5-6 years each had the highest RR estimate for 5 of 11 seasons included in this study, with RSV hospitalization rates in infants being generally higher during seasons when children aged 5-6 years had the highest RR estimate. Children aged 2 years had the highest RR estimate during one season. RR estimates in infants and individuals aged ≥11 years were mostly lower than in children aged 1-10 years. Highest RR values aligned with groups for which vaccination had the largest impact on epidemic dynamics in most model simulations. Conclusions Our estimates suggest the prominent relative roles of children aged ≤10 years (particularly among those aged 3-6 years) in propagating RSV epidemics. These results, combined with further modeling work, should help inform RSV vaccination policies.
Collapse
Affiliation(s)
- Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Hieu H Nguyen
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Patrick Liu
- Yale School of Medicine, New Haven, Connecticut
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda
| | - Claudia A Steiner
- Agency for HealthCare Research and Quality, Department of Health and Human Services, Rockville, Maryland.,Institute for Health Research, Kaiser Permanente Colorado, Denver
| | - Colin J Worby
- Department of Ecology and Evolutionary Biology, Princeton University, New Jersey
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
29
|
Leung T, Campbell PT, Hughes BD, Frascoli F, McCaw JM. Infection-acquired versus vaccine-acquired immunity in an SIRWS model. Infect Dis Model 2018; 3:118-135. [PMID: 30839933 PMCID: PMC6326260 DOI: 10.1016/j.idm.2018.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 12/02/2022] Open
Abstract
In some disease systems, the process of waning immunity can be subtle, involving a complex relationship between the duration of immunity-acquired either through natural infection or vaccination-and subsequent boosting of immunity through asymptomatic re-exposure. We present and analyse a model of infectious disease transmission where primary and secondary infections are distinguished to examine the interplay between infection and immunity. Additionally we allow the duration of infection-acquired immunity to differ from that of vaccine-acquired immunity to explore the impact on long-term disease patterns and prevalence of infection in the presence of immune boosting. Our model demonstrates that vaccination may induce cyclic behaviour, and the ability of vaccinations to reduce primary infections may not lead to decreased transmission. Where the boosting of vaccine-acquired immunity delays a primary infection, the driver of transmission largely remains primary infections. In contrast, if the immune boosting bypasses a primary infection, secondary infections become the main driver of transmission under a sufficiently long duration of immunity. Our results show that the epidemiological patterns of an infectious disease may change considerably when the duration of vaccine-acquired immunity differs from that of infection-acquired immunity. Our study highlights that for any particular disease and associated vaccine, a detailed understanding of the waning and boosting of immunity and how the duration of protection is influenced by infection prevalence are important as we seek to optimise vaccination strategies.
Collapse
Affiliation(s)
- Tiffany Leung
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Patricia T. Campbell
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
- Infection and Immunity Research Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia
| | - Barry D. Hughes
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Federico Frascoli
- Department of Mathematics, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - James M. McCaw
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria 3010, Australia
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
- Infection and Immunity Research Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010, Australia
| |
Collapse
|
30
|
Kinyanjui T, Middleton J, Güttel S, Cassell J, Ross J, House T. Scabies in residential care homes: Modelling, inference and interventions for well-connected population sub-units. PLoS Comput Biol 2018; 14:e1006046. [PMID: 29579037 PMCID: PMC5898763 DOI: 10.1371/journal.pcbi.1006046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 04/13/2018] [Accepted: 02/20/2018] [Indexed: 12/03/2022] Open
Abstract
In the context of an ageing population, understanding the transmission of infectious diseases such as scabies through well-connected sub-units of the population, such as residential care homes, is particularly important for the design of efficient interventions to mitigate against the effects of those diseases. Here, we present a modelling methodology based on the efficient solution of a large-scale system of linear differential equations that allows statistical calibration of individual-based random models to real data on scabies in residential care homes. In particular, we review and benchmark different numerical methods for the integration of the differential equation system, and then select the most appropriate of these methods to perform inference using Markov chain Monte Carlo. We test the goodness-of-fit of this model using posterior predictive intervals and propagate forward the resulting parameter uncertainty in a Bayesian framework to consider the economic cost of delayed interventions against scabies, quantifying the benefits of prompt action in the event of detection. We also revisit the previous methodology used to assess the safety of treatments in small population sub-units-in this context ivermectin-and demonstrate that even a very slight relaxation of the implicit assumption of homogeneous death rates significantly increases the plausibility of the hypothesis that ivermectin does not cause excess mortality based upon the data of Barkwell and Shields.
Collapse
Affiliation(s)
| | - Jo Middleton
- Department of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Stefan Güttel
- School of Mathematics, University of Manchester, United Kingdom
| | - Jackie Cassell
- Department of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Joshua Ross
- School of Mathematical Sciences, The University of Adelaide, Adelaide, Australia
| | - Thomas House
- School of Mathematics, University of Manchester, United Kingdom
| |
Collapse
|
31
|
Enhancing the Thermostability and Immunogenicity of a Respiratory Syncytial Virus (RSV) Live-Attenuated Vaccine by Incorporating Unique RSV Line19F Protein Residues. J Virol 2018; 92:JVI.01568-17. [PMID: 29263264 DOI: 10.1128/jvi.01568-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants, and an effective vaccine is not yet available. We previously generated an RSV live-attenuated vaccine (LAV) candidate, DB1, which was attenuated by a low-fusion subgroup B F protein (BAF) and codon-deoptimized nonstructural protein genes. DB1 was immunogenic and protective in cotton rats but lacked thermostability and stability of the prefusion conformation of F compared to strains with the line19F gene. We hypothesized that substitution of unique residues from the thermostable A2-line19F strain could thermostabilize DB1 and boost its immunogenicity. We therefore substituted 4 unique line19F residues into the BAF protein of DB1 by site-directed mutagenesis and rescued the recombinant virus, DB1-QUAD. Compared to DB1, DB1-QUAD had improved thermostability at 4°C and higher levels of prefusion F as measured by enzyme-linked immunosorbent assays (ELISAs). DB1-QUAD was attenuated in normal human bronchial epithelial cells, in BALB/c mice, and in cotton rats but grew to wild-type titers in Vero cells. In mice, DB1-QUAD was highly immunogenic and generated significantly higher neutralizing antibody titers to a panel of RSV A and B strains than did DB1. DB1-QUAD was also efficacious against wild-type RSV challenge in mice and cotton rats. Thus, substitution of unique line19F residues into RSV LAV DB1 enhanced vaccine thermostability, incorporation of prefusion F, and immunogenicity and generated a promising vaccine candidate that merits further investigation.IMPORTANCE We boosted the thermostability and immunogenicity of an RSV live-attenuated vaccine candidate by substituting 4 unique residues from the RSV line19F protein into the F protein of the heterologous vaccine strain DB1. The resultant vaccine candidate, DB1-QUAD, was thermostable, attenuated in vivo, highly immunogenic, and protective against RSV challenge in mice and cotton rats.
Collapse
|
32
|
Otieno JR, Kamau EM, Agoti CN, Lewa C, Otieno G, Bett A, Ngama M, Cane PA, Nokes DJ. Spread and Evolution of Respiratory Syncytial Virus A Genotype ON1, Coastal Kenya, 2010-2015. Emerg Infect Dis 2018; 23:264-271. [PMID: 28098528 PMCID: PMC5324789 DOI: 10.3201/eid2302.161149] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In February 2012, the novel respiratory syncytial virus (RSV) group A, genotype ON1, was detected in Kilifi County, coastal Kenya. ON1 is characterized by a 72-nt duplication within the highly variable G gene (encoding the immunogenic attachment surface protein). Cases were diagnosed through surveillance of pneumonia in children at the county hospital. Analysis of epidemiologic, clinical, and sequence data of RSV-A viruses detected over 5 RSV seasons (2010/2011 to 2014/2015) indicated the following: 1) replacement of previously circulating genotype GA2 ON1, 2) an abrupt expansion in the number of ON1 variants detected in the 2014/2015 epidemic, 3) recently accumulation of amino acid substitutions within the ON1 duplicated sequence, and 4) no clear evidence of altered pathogenicity relative to GA2. The study demonstrates the public health importance of molecular surveillance in defining the spread, clinical effects, and evolution of novel respiratory virus variants.
Collapse
|
33
|
Hogan AB, Campbell PT, Blyth CC, Lim FJ, Fathima P, Davis S, Moore HC, Glass K. Potential impact of a maternal vaccine for RSV: A mathematical modelling study. Vaccine 2017; 35:6172-6179. [PMID: 28967522 DOI: 10.1016/j.vaccine.2017.09.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 11/16/2022]
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory morbidity and one of the main causes of hospitalisation in young children. While there is currently no licensed vaccine for RSV, a vaccine candidate for pregnant women is undergoing phase 3 trials. We developed a compartmental age-structured model for RSV transmission, validated using linked laboratory-confirmed RSV hospitalisation records for metropolitan Western Australia. We adapted the model to incorporate a maternal RSV vaccine, and estimated the expected reduction in RSV hospitalisations arising from such a program. The introduction of a vaccine was estimated to reduce RSV hospitalisations in Western Australia by 6-37% for 0-2month old children, and 30-46% for 3-5month old children, for a range of vaccine effectiveness levels. Our model shows that, provided a vaccine is demonstrated to extend protection against RSV disease beyond the first three months of life, a policy using a maternal RSV vaccine could be effective in reducing RSV hospitalisations in children up to six months of age, meeting the objective of a maternal vaccine in delaying an infant's first RSV infection to an age at which severe disease is less likely.
Collapse
Affiliation(s)
- Alexandra B Hogan
- Research School of Population Health, The Australian National University, 62 Mills Rd, The Australian National University, Acton ACT 2601, Australia.
| | - Patricia T Campbell
- Doherty Epidemiology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Infection and Immunity, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Rd, Parkville 3052, Victoria, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Princess Margaret Hospital for Children, Roberts Rd, Subiaco, Perth, WA 6008, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia; Department of Infectious Disease and PathWest Department of Microbiology, Princess Margaret Hospital for Children, Roberts Rd, Subiaco, WA 6008, Australia
| | - Faye J Lim
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia
| | - Stephanie Davis
- Research School of Population Health, The Australian National University, 62 Mills Rd, The Australian National University, Acton ACT 2601, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, Perth, WA 6008, Australia
| | - Kathryn Glass
- Research School of Population Health, The Australian National University, 62 Mills Rd, The Australian National University, Acton ACT 2601, Australia
| |
Collapse
|
34
|
Heath PT, Culley FJ, Jones CE, Kampmann B, Le Doare K, Nunes MC, Sadarangani M, Chaudhry Z, Baker CJ, Openshaw PJM. Group B streptococcus and respiratory syncytial virus immunisation during pregnancy: a landscape analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:e223-e234. [PMID: 28433702 DOI: 10.1016/s1473-3099(17)30232-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 12/30/2022]
Abstract
Group B streptococcus and respiratory syncytial virus are leading causes of infant morbidity and mortality worldwide. No licensed vaccines are available for either disease, but vaccines for both are under development. Severe respiratory syncytial virus disease can be prevented by passively administered antibody. The presence of maternal IgG antibody specific to respiratory syncytial virus is associated with reduced prevalence and severity of respiratory syncytial virus disease in the first few weeks of life, whereas maternal serotype-specific anticapsular antibody is associated with protection against both early-onset and late-onset group B streptococcus disease. Therefore, vaccination in pregnancy might protect infants against both diseases. This report describes what is known about immune protection against group B streptococcus and respiratory syncytial virus, identifies knowledge gaps regarding the immunobiology of both diseases, and aims to prioritise research directions in maternal immunisation.
Collapse
Affiliation(s)
- Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Fiona J Culley
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beate Kampmann
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK; Medical Research Council Unit, Serrekunda, The Gambia
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK; Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - Marta C Nunes
- Department of Science and Technology and National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Manish Sadarangani
- Department of Paediatrics, University of Oxford, Oxford, UK; Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Zain Chaudhry
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Carol J Baker
- Department of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J M Openshaw
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
35
|
Flasche S, Ojal J, Le Polain de Waroux O, Otiende M, O'Brien KL, Kiti M, Nokes DJ, Edmunds WJ, Scott JAG. Assessing the efficiency of catch-up campaigns for the introduction of pneumococcal conjugate vaccine: a modelling study based on data from PCV10 introduction in Kilifi, Kenya. BMC Med 2017; 15:113. [PMID: 28592303 PMCID: PMC5463405 DOI: 10.1186/s12916-017-0882-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organisation recommends the use of catch-up campaigns as part of the introduction of pneumococcal conjugate vaccines (PCVs) to accelerate herd protection and hence PCV impact. The value of a catch-up campaign is a trade-off between the costs of vaccinating additional age groups and the benefit of additional direct and indirect protection. There is a paucity of observational data, particularly from low- and middle-income countries, to quantify the optimal breadth of such catch-up campaigns. METHODS In Kilifi, Kenya, PCV10 was introduced in 2011 using the three-dose Expanded Programme on Immunisation infant schedule and a catch-up campaign in children <5 years old. We fitted a transmission dynamic model to detailed local data, including nasopharyngeal carriage and invasive pneumococcal disease (IPD), to infer the marginal impact of the PCV catch-up campaign over hypothetical routine cohort vaccination in that setting and to estimate the likely impact of alternative campaigns and their dose efficiency. RESULTS We estimated that, within 10 years of introduction, the catch-up campaign among children <5 years old prevents an additional 65 (48-84) IPD cases across age groups, compared to PCV cohort introduction alone. Vaccination without any catch-up campaign prevented 155 (121-193) IPD cases and used 1321 (1058-1698) PCV doses per IPD case prevented. In the years after implementation, the PCV programme gradually accrues herd protection, and hence its dose efficiency increases: 10 years after the start of cohort vaccination alone the programme used 910 (732-1184) doses per IPD case averted. We estimated that a two-dose catch-up among children <1 year old uses an additional 910 (732-1184) doses per additional IPD case averted. Furthermore, by extending a single-dose catch-up campaign to children aged 1 to <2 years and subsequently to those aged 2 to <5 years, the campaign uses an additional 412 (296-606) and 543 (403-763) doses per additional IPD case averted. These results were not sensitive to vaccine coverage, serotype competition, the duration of vaccine protection or the relative protection of infants. CONCLUSIONS We find that catch-up campaigns are a highly dose-efficient way to accelerate population protection against pneumococcal disease.
Collapse
Affiliation(s)
- Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
| | - John Ojal
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Olivier Le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Mark Otiende
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Katherine L O'Brien
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Moses Kiti
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - D James Nokes
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- University of Warwick and WIDER, Coventry, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| |
Collapse
|
36
|
Nyiro JU, Kombe IK, Sande CJ, Kipkoech J, Kiyuka PK, Onyango CO, Munywoki PK, Kinyanjui TM, Nokes DJ. Defining the vaccination window for respiratory syncytial virus (RSV) using age-seroprevalence data for children in Kilifi, Kenya. PLoS One 2017; 12:e0177803. [PMID: 28531224 PMCID: PMC5439681 DOI: 10.1371/journal.pone.0177803] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract disease in early life and a target for vaccine prevention. Data on the age-prevalence of RSV specific antibodies will inform on optimizing vaccine delivery. Methods Archived plasma samples were randomly selected within age strata from 960 children less than 145 months of age admitted to Kilifi County Hospital pediatric wards between 2007 and 2010. Samples were tested for antibodies to RSV using crude virus IgG ELISA. Seroprevalence (and 95% confidence intervals) was estimated as the proportion of children with specific antibodies above a defined cut-off level. Nested catalytic models were used to explore different assumptions on antibody dynamics and estimate the rates of decay of RSV specific maternal antibody and acquisition of infection with age, and the average age of infection. Results RSV specific antibody prevalence was 100% at age 0-<1month, declining rapidly over the first 6 months of life, followed by an increase in the second half of the first year of life and beyond. Seroprevalence was lowest throughout the age range 5–11 months; all children were seropositive beyond 3 years of age. The best fit model to the data yielded estimates for the rate of infection of 0.78/person/year (95% CI 0.65–0.97) and 1.69/person/year (95% CI 1.27–2.04) for ages 0-<1 year and 1-<12 years, respectively. The rate of loss of maternal antibodies was estimated as 2.54/year (95% CI 2.30–2.90), i.e. mean duration 4.7 months. The mean age at primary infection was estimated at 15 months (95% CI 13–18). Conclusions The rate of decay of maternal antibody prevalence and subsequent age-acquisition of infection are rapid, and the average age at primary infection early. The vaccination window is narrow, and suggests optimal targeting of vaccine to infants 5 months and above to achieve high seroconversion.
Collapse
Affiliation(s)
- Joyce U. Nyiro
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Ivy K. Kombe
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- * E-mail:
| | - Charles J. Sande
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - James Kipkoech
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Patience K. Kiyuka
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Clayton O. Onyango
- Kenya Medical Research Institute/ Centre for Disease Control and Prevention, Kisumu, Kenya
| | - Patrick K. Munywoki
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | | | - D. James Nokes
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- School of Life Sciences and WIDER, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
37
|
Smith RJ, Hogan AB, Mercer GN. Unexpected Infection Spikes in a Model of Respiratory Syncytial Virus Vaccination. Vaccines (Basel) 2017; 5:E12. [PMID: 28524109 PMCID: PMC5492009 DOI: 10.3390/vaccines5020012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/06/2017] [Accepted: 05/15/2017] [Indexed: 12/04/2022] Open
Abstract
Respiratory Syncytial Virus (RSV) is an acute respiratory infection that infects millions of children and infants worldwide. Recent research has shown promise for the development of a vaccine, with a range of vaccine types now in clinical trials or preclinical development. We extend an existing mathematical model with seasonal transmission to include vaccination. We model vaccination both as a continuous process, applying the vaccine during pregnancy, and as a discrete one, using impulsive differential equations, applying pulse vaccination. We develop conditions for the stability of the disease-free equilibrium and show that this equilibrium can be destabilised under certain extreme conditions, even with 100% coverage using an (unrealistic) vaccine. Using impulsive differential equations and introducing a new quantity, the impulsive reproduction number, we showed that eradication could be acheived with 75% coverage, while 50% coverage resulted in low-level oscillations. A vaccine that targets RSV infection has the potential to significantly reduce the overall prevalence of the disease, but appropriate coverage is critical.
Collapse
Affiliation(s)
- Robert J Smith
- Department of Mathematics and Faculty of Medicine, The University of Ottawa, 585 King Edward Ave, Ottawa, ON K1N 6N5, Canada.
| | - Alexandra B Hogan
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, London W2 1PG, UK and Research School of Population Health, The Australian National University, Canberra 2601, Australia.
| | - Geoffry N Mercer
- Research School of Population Health, The Australian National University, Canberra 2601, Australia.
| |
Collapse
|
38
|
Wathuo M, Medley GF, Nokes D, Munywoki PK. Quantification and determinants of the amount of respiratory syncytial virus (RSV) shed using real time PCR data from a longitudinal household study. Wellcome Open Res 2016. [DOI: 10.12688/wellcomeopenres.10284.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A better understanding of respiratory syncytial virus (RSV) epidemiology requires realistic estimates of RSV shedding patterns, quantities shed, and identification of the related underlying factors. Methods: RSV infection data arise from a cohort study of 47 households with 493 occupants, in coastal Kenya, during the 2009/2010 RSV season. Nasopharyngeal swabs were taken every 3 to 4 days and screened for RSV using a real time polymerase chain reaction (PCR) assay. The amount of virus shed was quantified by calculating the ‘area under the curve’ using the trapezoidal rule applied to rescaled PCR cycle threshold output. Multivariable linear regression was used to identify correlates of amount of virus shed. Results: The median quantity of virus shed per infection episode was 29.4 (95% CI: 15.2, 54.2) log10 ribonucleic acid (RNA) copies. Young age (<1 year), presence of upper respiratory symptoms, intra-household acquisition of infection, an individual’s first infection episode in the RSV season, and having a co-infection of RSV group A and B were associated with increased amount of virus shed. Conclusions: The findings provide insight into which groups of individuals have higher potential for transmission, information which may be useful in designing RSV prevention strategies.
Collapse
|
39
|
Wathuo M, Medley GF, Nokes DJ, Munywoki PK. Quantification and determinants of the amount of respiratory syncytial virus (RSV) shed using real time PCR data from a longitudinal household study. Wellcome Open Res 2016; 1:27. [PMID: 28066826 PMCID: PMC5218551 DOI: 10.12688/wellcomeopenres.10284.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A better understanding of respiratory syncytial virus (RSV) epidemiology requires realistic estimates of RSV shedding patterns, quantities shed, and identification of the related underlying factors. Methods RSV infection data arise from a cohort study of 47 households with 493 occupants, in coastal Kenya, during the 2009/2010 RSV season. Nasopharyngeal swabs were taken every 3 to 4 days and screened for RSV using a real time polymerase chain reaction (PCR) assay. The amount of virus shed was quantified by calculating the 'area under the curve' using the trapezoidal rule applied to rescaled PCR cycle threshold output. Multivariable linear regression was used to identify correlates of amount of virus shed. Results The median quantity of virus shed per infection episode was 29.4 (95% CI: 15.2, 54.2) log10 ribonucleic acid (RNA) copies. Young age (<1 year), presence of upper respiratory symptoms, intra-household acquisition of infection, an individual's first infection episode in the RSV season, and having a co-infection of RSV group A and B were associated with increased amount of virus shed. Conclusions The findings provide insight into which groups of individuals have higher potential for transmission, information which may be useful in designing RSV prevention strategies.
Collapse
Affiliation(s)
- Miriam Wathuo
- KEMRI - Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - D James Nokes
- KEMRI - Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya.,School of Life Sciences and SBIDER, University of Warwick, Coventry, UK
| | - Patrick K Munywoki
- KEMRI - Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya.,Department of Nursing Sciences, Pwani University, Kilifi, Kenya
| |
Collapse
|
40
|
Pan-Ngum W, Kinyanjui T, Kiti M, Taylor S, Toussaint JF, Saralamba S, Van Effelterre T, Nokes DJ, White LJ. Predicting the relative impacts of maternal and neonatal respiratory syncytial virus (RSV) vaccine target product profiles: A consensus modelling approach. Vaccine 2016; 35:403-409. [PMID: 27914740 PMCID: PMC5221409 DOI: 10.1016/j.vaccine.2016.10.073] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 02/03/2023]
Abstract
Background Respiratory syncytial virus (RSV) is the major viral cause of infant and childhood lower respiratory tract disease worldwide. Defining the optimal target product profile (TPP) is complicated due to a wide range of possible vaccine properties, modalities and an incomplete understanding of the mechanism of natural immunity. We report consensus population level impact projections based on two mathematical models applied to a low income setting. Method Two structurally distinct age-specific deterministic compartmental models reflecting uncertainty associated with the natural history of infection and the mechanism by which immunity is acquired and lost were constructed. A wide range of vaccine TPPs were explored including dosing regime and uptake, and effects in the vaccinated individual on infectiousness, susceptibility, duration of protection, disease severity and interaction with maternal antibodies and natural induced immunity. These were combined with a range of vaccine implementation strategies, targeting the highest priority age group and calibrated using hospitalization data from Kilifi County Hospital, Kenya. Findings Both models were able to reproduce the data. The impact predicted by the two models was qualitatively similar across the range of TPPs, although one model consistently predicted higher impact than the other. For a proposed realistic range of scenarios of TPP combinations, the models predicted up to 70% reduction in hospitalizations in children under five years old. Vaccine designs which reduced the duration and infectiousness of infection were predicted to have higher impacts. The models were sensitive to the coverage and rate of loss of vaccine protection but not to the interaction between vaccine and maternal/naturally acquired immunity. Conclusion The results suggest that vaccine properties leading to reduced virus circulation by lessening the duration and infectiousness of infection upon challenge are of major importance in population RSV disease control. These features should be a focus for vaccine development.
Collapse
Affiliation(s)
- Wirichada Pan-Ngum
- Mathematical and Economics Modelling (MAEMOD) Research Group, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Timothy Kinyanjui
- School of Mathematics, Alan Turing Building, University of Manchester, Oxford Road, Manchester, UK; KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | - Moses Kiti
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | | | | | - Sompob Saralamba
- Mathematical and Economics Modelling (MAEMOD) Research Group, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research - Coast, Kilifi, Kenya; School of Life Sciences and WIDER, University of Warwick, Coventry, UK
| | - Lisa J White
- Mathematical and Economics Modelling (MAEMOD) Research Group, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
41
|
Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data. PLoS One 2016; 11:e0163567. [PMID: 27689356 PMCID: PMC5045176 DOI: 10.1371/journal.pone.0163567] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022] Open
Abstract
Background Worldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed. Objectives To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey. Methods A multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter)national literature and publicly available data from the Turkish Statistical Institute (TÜÏK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained. Results Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $ in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US $ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER. Conclusion RSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using relatively conservative assumptions, all evaluated strategies remained slightly below the threshold of 3 times the GDP per capita.
Collapse
|
42
|
Kiti MC, Tizzoni M, Kinyanjui TM, Koech DC, Munywoki PK, Meriac M, Cappa L, Panisson A, Barrat A, Cattuto C, Nokes DJ. Quantifying social contacts in a household setting of rural Kenya using wearable proximity sensors. EPJ DATA SCIENCE 2016; 5:21. [PMID: 27471661 PMCID: PMC4944592 DOI: 10.1140/epjds/s13688-016-0084-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
UNLABELLED Close proximity interactions between individuals influence how infections spread. Quantifying close contacts in developing world settings, where such data is sparse yet disease burden is high, can provide insights into the design of intervention strategies such as vaccination. Recent technological advances have enabled collection of time-resolved face-to-face human contact data using radio frequency proximity sensors. The acceptability and practicalities of using proximity devices within the developing country setting have not been investigated. We present and analyse data arising from a prospective study of 5 households in rural Kenya, followed through 3 consecutive days. Pre-study focus group discussions with key community groups were held. All residents of selected households carried wearable proximity sensors to collect data on their close (<1.5 metres) interactions. Data collection for residents of three of the 5 households was contemporaneous. Contact matrices and temporal networks for 75 individuals are defined and mixing patterns by age and time of day in household contacts determined. Our study demonstrates the stability of numbers and durations of contacts across days. The contact durations followed a broad distribution consistent with data from other settings. Contacts within households occur mainly among children and between children and adults, and are characterised by daily regular peaks in the morning, midday and evening. Inter-household contacts are between adults and more sporadic when measured over several days. Community feedback indicated privacy as a major concern especially regarding perceptions of non-participants, and that community acceptability required thorough explanation of study tools and procedures. Our results show for a low resource setting how wearable proximity sensors can be used to objectively collect high-resolution temporal data without direct supervision. The methodology appears acceptable in this population following adequate community engagement on study procedures. A target for future investigation is to determine the difference in contact networks within versus between households. We suggest that the results from this study may be used in the design of future studies using similar electronic devices targeting communities, including households and schools, in the developing world context. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (doi:10.1140/epjds/s13688-016-0084-2) contains supplementary material.
Collapse
Affiliation(s)
- Moses C Kiti
- />KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Michele Tizzoni
- />Data Science Laboratory, ISI Foundation, Via Alassio 11/c, Torino, 10126 Italy
| | - Timothy M Kinyanjui
- />KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
- />School of Mathematics, The University of Manchester, Manchester, UK
| | | | | | | | - Luca Cappa
- />Data Science Laboratory, ISI Foundation, Via Alassio 11/c, Torino, 10126 Italy
| | - André Panisson
- />Data Science Laboratory, ISI Foundation, Via Alassio 11/c, Torino, 10126 Italy
| | - Alain Barrat
- />Data Science Laboratory, ISI Foundation, Via Alassio 11/c, Torino, 10126 Italy
- />Aix-Marseille Université, Université de Toulon, CNRS, CPT, UMR 7332, Marseille, 13288 France
| | - Ciro Cattuto
- />Data Science Laboratory, ISI Foundation, Via Alassio 11/c, Torino, 10126 Italy
| | - D James Nokes
- />KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
- />School of Life Sciences and WIDER, University of Warwick, Coventry, UK
| |
Collapse
|
43
|
Nair H, Ramilo O, Eichler I, Pelfrene E, Mejias A, Polack FP, Pouwels KB, Langley JM, Nunes M, van der Maas N, Kragten–Tabatabaie L, Baraldi E, Heikkinen T, Fauroux B, Sharland M, Park C, Manzoni P, Papadopoulos NG, Martinón–Torres F, Stein R, Bont L. Meeting Report: Harmonization of RSV therapeutics – from design to performance. J Glob Health 2016. [PMCID: PMC4920015 DOI: 10.7189/jogh.06.010205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Harish Nair
- Center for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, Edinburgh, UK
| | - Octavio Ramilo
- Paediatric Infectious Diseases, Nationwide Children’s Hospital, and The Ohio State University, Columbus, Ohio, United States of America
| | | | | | - Asuncion Mejias
- Paediatric Infectious Diseases, Nationwide Children’s Hospital, and The Ohio State University, Columbus, Ohio, United States of America
| | - Fernando P Polack
- Fundacion INFANT, Buenos Aires, Argentina
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Koen B. Pouwels
- Modelling & Economics Unit, Public Health England, London, UK
- Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, the Netherlands
| | - Joanne M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
| | - Marta Nunes
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicoline van der Maas
- Department Epidemiology and Surveillance of the National Immunisation Programme, CIb–RIVM, the Netherlands
| | | | - Eugenio Baraldi
- Women’s and Children’s Health Department, Unit of Respiratory Medicine and Allergy, Padova, Italy
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Brigitte Fauroux
- Noninvasive ventilation and Sleep Unit, Necker Pediatric University Hospital, Paris Descartes University, Paris, France
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George’s University London, UK
| | | | - Paolo Manzoni
- Neonatology and Neonatal Intensive Care Unit, S Anna Hospital, Torino, Italy
| | - Nikolaos G. Papadopoulos
- University of Manchester, Manchester, UK
- Allergy Dept 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Federico Martinón–Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hóspital Clínico Universitario de Santiago de Compostela, University of Santiago, La Coruña
| | - Renato Stein
- Pediatric Pulmonology Unit, Pontifícia Universidade Católica RS, Porto Alegre, Brazil
| | - Louis Bont
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | |
Collapse
|
44
|
Ugonna K, Douros K, Bingle CD, Everard ML. Cytokine responses in primary and secondary respiratory syncytial virus infections. Pediatr Res 2016; 79:946-50. [PMID: 26882371 DOI: 10.1038/pr.2016.29] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Primary respiratory syncytial virus (RSV) infections are characterized by high levels of IL-8 and an intense neutrophilia. Little is known about the cytokine responses in secondary infections. Preschool children experiencing RSV secondary infections were recruited from the siblings of infants admitted to hospital with RSV acute bronchiolitis. METHODS Fifty-one infants with acute bronchiolitis (39 RSV positive, 12 RSV negative) and 20 age-matched control infants were recruited. In addition, seven older siblings of infants from the RSV-positive cohort and confirmed RSV infection were recruited. Samples of nasal secretions were obtained using a flocked swab, and secretions extracted using centrifugation. Cytokine bead array was used to obtain levels of interleukin (IL)-17A, IL-8, IL-6, IL-21, and tumor necrosis factor-α. RESULTS Levels of IL-8 and IL-6 were significantly lower in the RSV-positive siblings compared with the RSV-positive infants. There were no significant differences between levels of the other cytokines in the primary and secondary infections. CONCLUSION The very high levels of IL-8 and IL-6 response characteristic of the primary RSV infection was not observed in secondary RSV-positive infections and this did not appear to be due to a global reduction in cytokine production.
Collapse
Affiliation(s)
- Kelechi Ugonna
- Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Konstantinos Douros
- Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Colin D Bingle
- Department of Infection and Immunity, University of Sheffield, Sheffield, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| |
Collapse
|
45
|
Drysdale SB, Green CA, Sande CJ. Best practice in the prevention and management of paediatric respiratory syncytial virus infection. Ther Adv Infect Dis 2016; 3:63-71. [PMID: 27034777 PMCID: PMC4784570 DOI: 10.1177/2049936116630243] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is ubiquitous with almost all infants having been infected by 2 years of age and lifelong repeated infections common. It is the second largest cause of mortality, after malaria, in infants outside the neonatal period and causes up to 200,000 deaths per year worldwide. RSV results in clinical syndromes that include upper respiratory tract infections, otitis media, bronchiolitis (up to 80% of cases) and lower respiratory tract disease including pneumonia and exacerbations of asthma or viral-induced wheeze. For the purposes of this review we will focus on RSV bronchiolitis in infants in whom the greatest disease burden lies. For infants requiring hospital admission, the identification of the causative respiratory virus is used to direct cohorting or isolation and infection control procedures to minimize nosocomial transmission. Nosocomial RSV infections are associated with poorer clinical outcomes, including increased mortality, the need for mechanical ventilation and longer length of hospital stay. Numerous clinical guidelines for the management of infants with bronchiolitis have been published, although none are specific for RSV bronchiolitis. Ribavirin is the only licensed drug for the specific treatment of RSV infection but due to drug toxicity and minimal clinical benefit it has not been recommended for routine clinical use. There is currently no licensed vaccine to prevent RSV infection but passive immunoprophylaxis using a monoclonal antibody, palivizumab, reduces the risk of hospitalization due to RSV infection by 39-78% in various high-risk infants predisposed to developing severe RSV disease. The current management of RSV bronchiolitis is purely supportive, with feeding support and oxygen supplementation until the infant immune system mounts a response capable of controlling the disease. The development of a successful treatment or prophylactic agent has the potential to revolutionize the care and outcome for severe RSV infections in the world's most vulnerable infants.
Collapse
|