Epidemiology and prevention of respiratory syncytial virus infections in children in Italy

Abstract

Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.

Respiratory Syncytial Virus: Knowledge, Attitudes and Beliefs of General Practitioners from North-Eastern Italy (2021)

“…Human respiratory syncytial virus (RSV) (genus orthopneumovirus) is a highly contagious viral pathogen belonging to the family of Pneumoviridae [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Since its original description in 1956 [ 8 ], human RSV has emerged as a leading cause of lower respiratory tract infections (LRTI) in children in the first year of age, with a well-defined seasonal trend [ 3 , 7 ].…”

“…On the one hand, the only available therapeutic option is represented by supportive care (i.e., respiratory support and management of volume depletion) [ 6 , 11 ]. On the other hand, RSV vaccines are commercially unavailable [ 1 , 3 , 9 , 12 , 13 ], and preventive interventions are limited to monoclonal antibodies (mAb) [ 14 , 15 , 16 ]. Despite their efficacy in avoiding hospitalizations and long-term sequelae, their use is forcibly limited to some high-risk groups (i.e., prematurely-born infants under 6 months of age, and children with certain comorbidities under 2 years of age during the RSV season) [ 9 , 17 , 18 , 19 , 20 , 21 ].…”

Respiratory Syncytial Virus: New Challenges for Molecular Epidemiology Surveillance and Vaccination Strategy in Patients with ILI/SARI

“…Vaccines 2021, 9, 1334 2 of 11 Almost every child by the age of 2 years gets infected with hRSV infection, usually with mild symptoms such as influenza-like illness (ILI). However, hRSV may also cause severe acute respiratory infection (SARI) that may lead to the involvement of the lower respiratory tract causing bronchiolitis, pneumonia, and tracheobronchitis [6,7].…”

“…SARI represents one of the prominent causes of hospitalization and death, especially among high-risk groups such as very young children, pregnant women, the elderly and individuals with underlying medical conditions [7,8].…”

Comparative Fecal Microbiota Analysis of Infants With Acute Bronchiolitis Caused or Not Caused by Respiratory Syncytial Virus

“…Global estimates by the World Health Organization in 2014 indicate that RSV accounted for more than 80% of lower respiratory tract infections in infants younger than 1 year ( Piedimonte and Perez, 2014 ). Among local, single-center, ad-hoc studies so far conducted on RSV infections in children in Italy ( Azzari et al., 2021 ), one study showed that 103 (16.5%) of 624 RSV-related hospitalizations over a 5-year period (September 2014–August 2019) required admission to the intensive care unit ( Barbati et al., 2020 ). Of these, 70.9% (73/103) and 45.6% (47/103) involved children <3 months and <1 month of age, respectively.…”