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Heinonen S, Velazquez VM, Ye F, Mertz S, Acero-Bedoya S, Smith B, Bunsow E, Garcia-Mauriño C, Oliva S, Cohen DM, Moore-Clingenpeel M, Peeples ME, Ramilo O, Mejias A. Immune profiles provide insights into respiratory syncytial virus disease severity in young children. Sci Transl Med 2021; 12:12/540/eaaw0268. [PMID: 32321862 DOI: 10.1126/scitranslmed.aaw0268] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 11/21/2019] [Accepted: 03/05/2020] [Indexed: 12/29/2022]
Abstract
Respiratory syncytial virus (RSV) is associated with major morbidity in infants, although most cases result in mild disease. The pathogenesis of the disease is incompletely understood, especially the determining factors of disease severity. A better characterization of these factors may help with development of RSV vaccines and antivirals. Hence, identification of a "safe and protective" immunoprofile induced by natural RSV infection could be used as a as a surrogate of ideal vaccine-elicited responses in future clinical trials. In this study, we integrated blood transcriptional and cell immune profiling, RSV loads, and clinical data to identify factors associated with a mild disease phenotype in a cohort of 190 children <2 years of age. Children with mild disease (outpatients) showed higher RSV loads, greater induction of interferon (IFN) and plasma cell genes, and decreased expression of inflammation and neutrophil genes versus children with severe disease (inpatients). Additionally, only infants with severe disease had increased numbers of HLA-DRlow monocytes, not present in outpatients. Multivariable analyses confirmed that IFN overexpression was associated with decreased odds of hospitalization, whereas increased numbers of HLA-DRlow monocytes were associated with increased risk of hospitalization. These findings suggest that robust innate immune responses are associated with mild RSV infection in infants.
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Affiliation(s)
- Santtu Heinonen
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Victoria M Velazquez
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Fang Ye
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Sara Mertz
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Santiago Acero-Bedoya
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Bennett Smith
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Eleonora Bunsow
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Cristina Garcia-Mauriño
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Silvia Oliva
- Division of Pediatric Emergency Medicine and Critical Care, Hospital Regional Universitario de Málaga, Málaga 29001, Spain.,Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Málaga 29071, Spain
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, The Research Institute at Nationwide Children's Hospital Columbus, OH 43205, USA
| | - Mark E Peeples
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. .,Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. .,Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Málaga 29071, Spain.,Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH 43205, USA
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Mejias A, Brenes-Chacon H, Garcia-Mauriño C, Moore-Clingenpeel M, Ramilo O. Clinical Disease Severity Scores and Viral Loads in Children With Respiratory Syncytial Virus Infection. Clin Infect Dis 2021; 72:e1160-e1162. [PMID: 33215632 DOI: 10.1093/cid/ciaa1752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Asuncion Mejias
- Center for Vaccines and Immunity Abigail Wexner Research Institute, Department of Pediatrics at Nationwide Children's Hospital, Columbus, OH, USA.,Division of nfectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.,Departamento de Farmacologia y Pediatria, Facultad de Medicina, Universidad de Malaga, Malaga, Spain
| | - Helena Brenes-Chacon
- Center for Vaccines and Immunity Abigail Wexner Research Institute, Department of Pediatrics at Nationwide Children's Hospital, Columbus, OH, USA
| | - Cristina Garcia-Mauriño
- Center for Vaccines and Immunity Abigail Wexner Research Institute, Department of Pediatrics at Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity Abigail Wexner Research Institute, Department of Pediatrics at Nationwide Children's Hospital, Columbus, OH, USA.,Division of nfectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
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Brenes-Chacon H, Garcia-Mauriño C, Moore-Clingenpeel M, Mertz S, Ye F, Cohen DM, Ramilo O, Mejias A. Age-dependent Interactions Among Clinical Characteristics, Viral Loads and Disease Severity in Young Children With Respiratory Syncytial Virus Infection. Pediatr Infect Dis J 2021; 40:116-122. [PMID: 33433159 PMCID: PMC7808270 DOI: 10.1097/inf.0000000000002914] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Age-dependent differences in clinical presentation and viral loads in infants and young children with respiratory syncytial virus (RSV) infection, and their correlation with disease severity are poorly defined. METHODS Previously healthy children <2 years old with mild (outpatients) and severe (inpatients) RSV infection were enrolled and viral loads measured by polymerase chain reaction in nasopharyngeal swabs. Patients were stratified by age in 0-<3, 3-6 and >6-24 months, and multivariable analyses were performed to identify clinical and viral factors associated with severe disease. RESULTS From 2014 to 2018, we enrolled 534 children with RSV infection, 130 outpatients with mild RSV infection and 404 inpatients with severe RSV disease. Median duration of illness was 4 days for both groups, yet viral loads were higher in outpatients than in inpatients (P < 0.001). In bivariate analyses, wheezing was more frequent in outpatients of older age (>3 months) than in inpatients (P < 0.01), while fever was more common in inpatients than outpatients (P < 0.01) and its frequency increased with age. Adjusted analyses confirmed that increased work of breathing and fever were consistently associated with hospitalization irrespective of age, while wheezing in infants >3 months, and higher RSV loads in children >6-24 months were independently associated with reduced disease severity. CONCLUSIONS Age had a significant impact defining the interactions among viral loads, specific clinical manifestations and disease severity in children with RSV infection. These observations highlight the importance of patient stratification when evaluating interventions against RSV.
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Affiliation(s)
| | | | | | | | - Fang Ye
- Center for Vaccines and Immunity
| | | | - Octavio Ramilo
- Center for Vaccines and Immunity
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
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Garcia-Mauriño C, Moore-Clingenpeel M, Thomas J, Mertz S, Cohen DM, Ramilo O, Mejias A. Viral Load Dynamics and Clinical Disease Severity in Infants With Respiratory Syncytial Virus Infection. J Infect Dis 2020; 219:1207-1215. [PMID: 30418604 PMCID: PMC6452299 DOI: 10.1093/infdis/jiy655] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/08/2018] [Indexed: 01/05/2023] Open
Abstract
Background The association between respiratory syncytial virus (RSV) loads and clinical outcomes in children remains to be defined. In most studies, viral loads (VL) were evaluated in hospitalized children and at a single time-point. We investigated the relationship between VLs and disease severity in both outpatients and inpatients with RSV infection. Methods We enrolled previously healthy children with RSV infection. Disease severity was defined by level of care (outpatients vs ward vs pediatric intensive care unit [PICU]), and a clinical disease severity score (CDSS). Nasopharyngeal VLs by polymerase chain reaction and CDSS were measured at enrollment and daily in inpatients. VL decay according to disease severity was analyzed using linear mixed modeling. Results From February 2015 to March 2017, we enrolled 150 infants: 39 outpatients and 111 inpatients. VLs were higher in outpatients than in age-matched inpatients. Among inpatients, initial VLs were comparable in ward and PICU patients, and preceded the peak CDSS. However, after excluding infants treated with steroids, those hospitalized in the ward had higher VLs than infants requiring PICU care (P < .001). Dynamic analyses showed that VL decay was delayed in PICU patients, especially in those treated with steroids. Conclusions Higher VLs at presentation and a faster and consistent VL decline were both associated with less severe RSV disease in children. Summary Infants with less severe respiratory syncytial virus (RSV) disease had higher viral loads (VL) at presentation, and faster and consistent VL decline. Conversely, VL decay and overall viral exposure were prolonged and higher in infants severe RSV disease receiving steroids.
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Affiliation(s)
- Cristina Garcia-Mauriño
- Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Jessica Thomas
- Department of Clinical Research, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Sara Mertz
- Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Octavio Ramilo
- Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus.,Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Asuncion Mejias
- Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus.,Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
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Garcia-Mauriño C, Moore-Clingenpeel M, Ramilo O, Mejias A. Re: "Discharge Criteria for Bronchiolitis: Does Age Matter?". Pediatr Infect Dis J 2018; 37:e350-e351. [PMID: 30408012 PMCID: PMC6446549 DOI: 10.1097/inf.0000000000002065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cristina Garcia-Mauriño
- Center for Vaccines and Immunity The Research Institute at
Nationwide Children’s Hospital Columbus, OH
| | | | - Octavio Ramilo
- Center for Vaccines and Immunity The Research Institute at
Nationwide Children’s Hospital Columbus, OH Division of Pediatric
Infectious Diseases
| | - Asuncion Mejias
- Center for Vaccines and Immunity The Research Institute at
Nationwide Children’s Hospital Columbus, OH Division of Pediatric
Infectious Diseases Nationwide Children’s Hospital and The Ohio State
University College of Medicine Columbus, OH
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