A PRESENTATION DESCRIPS RESPERATORY INFECTIONS CAUSED BY RSV AND PATHOGENESIS , DIAGNOSIS , TREATMENT, VACCINATION,STRUCTRUE AND LIFE CYCLE OF THIS VIRUS
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...Pırıl Erel
Respiratory Syncytial Virus (RSV) places the heaviest clinical burden on paediatric wards in the UK and the US. It is in fact, a global issue with 3.4 million hospitalisations and approximately 66,000 deaths worldwide per annum (Bush et al., 2007) (Lambert et al., 2014). RSV is the leading cause, especially during the winter months, of severe respiratory infections in infants resulting in a rise in hospital admissions where 0.5-1% of infected babies die from respiratory failure. It is also a significant respiratory concern in the elderly population. (Agoti et al., 2014)
RSV has shown to have a willful ability to enter the host resulting in illness both by viral mechanisms and proteins encoded by RSV, dysregulating the synthesis of systemic immune response of the host. Alongside the infiltration of RSV, the heath status and genotype of the host will be a key factor in predetermining disease susceptibility and severity.
It is important to understand RSV has been implicated with further acute and chronic illnesses therefore by considering the epidemiology and pathophysiology of RSV treatment may be implicated during early stages which can influence possible outcomes in the future.
Respiratory syncytial virus (RSV) causes
mild, cold-like symptoms in adults and older children. However, it can cause
serious problems in young babies, including pneumonia and severe breathing
problems. In rare cases it can lead to death. Premature babies and those with
other health problems have the highest risk. A child with RSV may have a fever,
stuffy nose, cough and trouble breathing. Tests can tell if your child has the
virus.
RSV easily spreads from person to person.
You can get it from direct contact with someone who has it or it by touching
infected objects such as toys or surfaces such as countertops. Washing your
hands often and not sharing eating and drinking utensils are simple ways to
help prevent the spread of RSV infection. There is currently no vaccine for
RSV.
A PRESENTATION DESCRIPS RESPERATORY INFECTIONS CAUSED BY RSV AND PATHOGENESIS , DIAGNOSIS , TREATMENT, VACCINATION,STRUCTRUE AND LIFE CYCLE OF THIS VIRUS
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...Pırıl Erel
Respiratory Syncytial Virus (RSV) places the heaviest clinical burden on paediatric wards in the UK and the US. It is in fact, a global issue with 3.4 million hospitalisations and approximately 66,000 deaths worldwide per annum (Bush et al., 2007) (Lambert et al., 2014). RSV is the leading cause, especially during the winter months, of severe respiratory infections in infants resulting in a rise in hospital admissions where 0.5-1% of infected babies die from respiratory failure. It is also a significant respiratory concern in the elderly population. (Agoti et al., 2014)
RSV has shown to have a willful ability to enter the host resulting in illness both by viral mechanisms and proteins encoded by RSV, dysregulating the synthesis of systemic immune response of the host. Alongside the infiltration of RSV, the heath status and genotype of the host will be a key factor in predetermining disease susceptibility and severity.
It is important to understand RSV has been implicated with further acute and chronic illnesses therefore by considering the epidemiology and pathophysiology of RSV treatment may be implicated during early stages which can influence possible outcomes in the future.
Respiratory syncytial virus (RSV) causes
mild, cold-like symptoms in adults and older children. However, it can cause
serious problems in young babies, including pneumonia and severe breathing
problems. In rare cases it can lead to death. Premature babies and those with
other health problems have the highest risk. A child with RSV may have a fever,
stuffy nose, cough and trouble breathing. Tests can tell if your child has the
virus.
RSV easily spreads from person to person.
You can get it from direct contact with someone who has it or it by touching
infected objects such as toys or surfaces such as countertops. Washing your
hands often and not sharing eating and drinking utensils are simple ways to
help prevent the spread of RSV infection. There is currently no vaccine for
RSV.
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
Roseola infantum Made Ridiculously Easy!!!DrYusraShabbir
A brief description of one of the most common viruses affecting children. The presentation describes the disease, its onset, clinical features, signs and symptoms and treatment. Helpful for doctors, dermatologist, child specialists, nurses and medical students preparing for exams.
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
Roseola infantum Made Ridiculously Easy!!!DrYusraShabbir
A brief description of one of the most common viruses affecting children. The presentation describes the disease, its onset, clinical features, signs and symptoms and treatment. Helpful for doctors, dermatologist, child specialists, nurses and medical students preparing for exams.
the realm of preventive medicine, the impact of the Respiratory Syncytial Virus (RSV) vaccine on both children and adults stands as a beacon of hope. With its potential to mitigate the burden of respiratory infections across diverse age groups, understanding the profound effects of this vaccine is paramount.
RSV, a common respiratory virus, poses significant health risks, particularly to vulnerable populations such as infants, the elderly, and individuals with compromised immune systems. Historically, combating RSV has been challenging, but the advent of vaccines has ushered in a new era of protection.
The importance of pertussis booster vaccine doses throughout life - Slideset ...WAidid
Pertussis is still a worldwide problem: every year there are almost 20-50 million cases and 300.000 deaths.
The incidence is increasing especially between adults and adolescents, with consequences on infants. For this reason, the increasing of a vaccination strategy for adolescent and adult is needed...
To learn more, please visit www.waidid.org.
RSV Versus Non-RSV Bronchiolitis at Haykal Hospital between January 2016 and ...asclepiuspdfs
Introduction: Bronchiolitis is a clinical syndrome that occurs in children <2 years, characterized by upper respiratory symptoms followed by lower respiratory tract infection that results in wheezing and/or crackles and other complications. Its typically caused by a viral infection, among which, respiratory syncytial virus (RSV) is the most common cause. Objective: The aim of this study is to determine whether RSV is the most common cause of acute bronchiolitis in North Lebanon and to determine the most common age, season for RSV bronchiolitis, whether it is more prevalent in preterm patients and whether it is a more serious infection. Our study is the first one conducted in North Lebanon that provides information related to RSV versus non-RSV bronchiolitis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. RSV- Definition
Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a member of the Pneumovirus
genus, of the family Paramyxoviridae . The virus is an enveloped, non-segmented virus
containing a single negative-strand of RNA. The viral genome encodes ten proteins
including two envelope proteins, F and G. The G protein mediates the attachment of
the virus to the host cells and the F protein is involved in cell penetration and promotes
cell to cell transmission through the formation of syncytia. 1,2,3
RSV Overview
4. RSV- Clinical Features
• RSV is the most common virus causing respiratory infections in children and
almost all will have been infected with RSV by the age of 2 years. 1
• Primary RSV symptoms include fever, runny nose, cough and wheezing. In 2540% of cases symptoms progress to bronchiolitis or pneumonia. 2
• Risk factors for RSV include premature birth, CHD, BPD/CLD and a
compromised immune system and RSV poses greater risk to children with
underlying vulnerability 3
• Severe RSV infection can lead to long-term complications including the
development of wheezing and asthma later in life.3
• RSV is also associated with a high mortality rate, and in infants under 1 year it
is the most common cause of viral death . 4
5. EPIDEMIOLOGY OF SEVERE RSV INFECTION
Diagnosis & Transmission
Diagnosis
When suspected, infection with RSV may be confirmed using
a number of diagnostic methods such as viral culture, rapid
antigen detection tests (enzyme immunoassay, EIA) and
reverse-transcriptase polymerase chain reaction (RT-PCR). 1,2
Transmission
Severe RSV infection is easily spread,
particularly in environments such as hospitals,
day care, schools and large families. 3
RSV is spread via direct contact with
contaminated hands, surfaces, and respiratory
secretions, as well as unprotected coughing and
sneezing. 4
Annual outbreaks are consistent and seasonal
The RSV season occurs in the winter months. However, the overall length of the season
varies greatly between countries. 1
Overview of RSV annual seasons in different countries. 2,3,4,5
6. EPIDEMIOLOGY OF SEVERE RSV INFECTION
Seasonality
RSV-infection in (almost) all children
It has been estimated that RSV causes as much as 90% of all childhood bronchiolitis and up to 40%
of all paediatric pneumonias.
Approximately two thirds of all infants are infected with RSV during their first year; about one third of
those infected develop LRTI, 2.5% are hospitalised and 0.1% die.
By 2 years, 95% of infants have been infected with RSV at least once and 36% at least twice.27, 77
Peak rates of severe RSV infection occur in infants aged 6 weeks to 6 months.
7. EPIDEMIOLOGY OF SEVERE RSV INFECTION
Re-Infection
Re-infection is common
re-infection occurs because infection does not provide complete longlasting immunity: between 40% and 70% of preschool-age children are
re-infected with RSV, and approximately 20% of school-age children,
adolescents and adults are re-infected.1
RSV is the only pathogen of its kind to have such a high rate of reinfection and a high viral load is thought to be related to risk of
recurrence . 2
Severe RSV infection does not provide complete immunity that may lead
to re-infection 1
However, RSV re-infection can be severe in high-risk patients such as
those born prematurely, those with chronic lung disease (CLD) and those
with congenital heart disease (CHD) . 3
RSV Overview
8. POPULATION AT HIGH RISK
RSV infection in preterm infants
Preterm infants with immature lungs will suffer greater damage to their airways and
respiratory system compared to full term infants. 1
<29 Weeks Gestational Age
29 – 32 Weeks Gestational Age
The highest between the high risk
32 – 35 Weeks Gestational Age
Congenital Heart Disease (<2years at the beginning of the season)
Chronic Lung Disease (<2years at the beginning of the season)
RSV Overview
9. GROUPS AT HIGHEST RISK OF SEVERE RSV
DISEASE
The risk factors listed in Below Table have been shown to increase the risk and severity of
severe RSV infection.
1,2,3,4,5,6,7,8,9
RSV Overview
10. GROUPS AT HIGHEST RISK OF SEVERE
RSV DISEASE
Multiple risk factors associated with severe RSV infection
There are several risk factors for severe RSV infection and premature infants or
infants with BPD/CLD or CHD are particularly vulnerable. 1
Risk factors associated with severe RSV infection in late preterms
These include inadequate housing, socioeconomic status and a poor standard of
hospital care.2
Other social factors such as teenage mothers and unmarried mothers of infants are
also considered to be potential factors in RSV hospitalisation, as well as medical
factors including a NICU stay and/or ventilator assistance at birth. 3
Tobacco smoke has also been linked to an increased risk of RSV hospitalisation but is
also seen as a factor that can be controlled in the home. 1
RSV Overview
11. High Risk Infants Have a Greater Risk of RSV
Hospitalization Relative to Healthy, Term infants
• Retrospective cohort study from the Tennessee Medicaid program (USA) collected
between 1989 and 1993
• 47% of all RSV hospitalizations occurred in babies born prematurely
562
11
1. Boyce et al. J Pediatr 2000;
12. Once Hospitalized, RSV Disease Tends to be
more Severe in High Risk Infant Populations
Patients hospitalized with RSV LRTIs at seven centres in Canada were prospectively
followed (n=689)
Wang EEL, et al. J Peds. 1995:126(2):212–219.
12
RSV Overview
13. RSV Hospitalized CLD Babies Incur Significant
Resource-Use During the First 2 Years of Life
A retrospective chart review in CLD babies <32wGA. Infants that were re-admitted for a proven RSV
infection were compared with infants with non-respiratory re-admission or no re-admission
Mean health resource utilization
*P<0.001
**P<0.01
***P<0.05
**
*
Greenough et al. Arch Dis Child. 2001 (UK study)
***
*
*
13
14. Chronic lung disease and severe RSV infection
BPD/CLD infants have a reduced response to severe RSV infection due to
reduced oxygenation and a poor response to inflammation 2
The burden of RSV in children with BPD/CLD was initially described prospectively in a
cohort of 30 infants <2 years of age at the onset of RSV season who were receiving
home oxygen therapy. During the 4-month study, 27 children had one or more acute
respiratory illnesses and RSV was responsible for 16/27 (59%). Of the 16 children with
RSV, 11 (69%) required hospitalisation. The hospital course was prolonged and
complicated. Seven of the 11 children were hospitalised for more than 1 week; four
were admitted to the intensive care unit and two needed mechanical ventilation. No
children died.3
1.Baraldi E, Flippone M. Chronic Lung Disease after premature birth. N Engl J Med. 2007;357:1946-55
2.Stenmark K. International Congress on Respiratory Viruses 2003. (CONFERENCE PRESENTATION) .
3.Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics. 1988;82(2):199-203.
RSV Overview
15. Congenital heart disease and RSV infection
Congenital heart disease (CHD): CHD refers to heart defects present from birth.
Physical signs of heart disease include tachypnea, hyperpnea and tachycardia. There
are many types of heart defects, e.g. stenotic valve lesions 1
Cyanotic heart disease patients have lower than normal oxygen saturation levels
1
Acyanotic heart disease patients have normal oxygen levels but blood is abnormally
pumped around the body1
CHD patients have increased hospitalisation rates for RSV due to a compromised
cardiovascular function.2
RSV Overview
16. Outcomes in CHD children with RSV compared
to children without CHD
17. BURDEN OF DISEASE
Acute Bronchiolitis is one of the major causes of morbidity in
infants under 12 months who have severe RSV infection with up
to 80 percent of acute bronchiolitis cases are associated with
RSV infection.1
RSV and global rates of acute lower respiratory infections (ALRI)
This equates to 22% of all ALRIs. At least 3.4 million of these were severe cases
requiring hospital admission. 2
RSV burden compared to influenza
In children <1 year, deaths associated with RSV are higher than those caused by
influenza 1
18. BURDEN OF DISEASE
Bronchiolitis Associated Hospitalisation
Severe RSV infection is still the leading cause of bronchiolitis associated hospitalisation
42-45% of LRTI hospitalisations in children under 2 years of age are caused by RSV .
1
67% of children under 2 years hospitalised for bronchiolitis in the US in 2007 were RSV positive . 2
Percentage of bronchiolitis hospitalisations which are RSV-related .
2
19. BURDEN OF DISEASE
RSV Vs Influenza
Rate of emergency department visits per 1000 patients for infants with Influenza or RSV.
Bourgeois F, Valim C, McAdam A, Mandl K. Relative impact of influenza and respiratory syncytial virus in young children.
Pediatrics. 2009;124(6):e1072-e80.
20. BURDEN OF DISEASE
Emergency and Clinic Visits
Rate of RSV emergency department visits and office visits per 1000 patients for infants 0-59
months.
all C, et al. The Burden of Respiratory Syncytial Virus Infection in Young Children. N Engl J Med. 2009;360(6):588-98.
21. BURDEN OF DISEASE
RSV Resource Utilization
Healthcare resource utilization in RSV-bronchiolitus hospitalisations versus non-RSV
bronchiolitis hospitalisations.
Garcia JJ et al. 47th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the Infectious Disease Society of America (IDSA).
Washington DC, USA; October 2008.
RSV Overview
22. BURDEN OF DISEASE
RSV Intensive/Complex Resource Utilization
Resource intensive and complex hospitalisations in
high-risk infants
Hospitalisation rates, length of stay and rates of mechanical ventilation are
higher in infants with risk factors for RSV infection, especially in infants with 3+
risk factors 1
A US study of 684 infants (≤1 year) hospitalised with bronchiolitis or RSV pneumonia
states that 76% of high-risk patients are managed in PICU due to the increased risk of
respiratory complications once hospitalised. Complications are associated with a
longer length of stay and increased costs. 2
1.Thorburn K. Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection. ArchDisChild. 2009;94(2):99103. 2.Willson DF, Landrigan CP, Horn SD, Smout RJ. Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr.
2003;143(5):142-9
RSV Overview
23. BURDEN OF DISEASE
Increased risk of Childhood Asthma
Long-term outcomes of severe RSV disease
Greater severity of RSV bronchiolitis is associated with an increased risk of developing
childhood asthma .
Proportion of patients in each severity group diagnosed with asthma.
Carroll K, Wu P, Gebretsadik T, Griffin M, Dupont W, Mitchel E, et al. Season of infant bronchiolitis and estimates of subsequent risk and burden of early
childhood asthma. J Allergy Clin Immunol. 2009;123(4):964-6.
RSV Overview
24. BURDEN OF DISEASE
Increased risk of Childhood Asthma/Wheezing
Severe RSV bronchiolitis is associated with asthma and wheezing throughout childhood.
RSV LRTI in early childhood is an independent risk factor for the subsequent development
of wheezing up to age 18 years .
Current prevalence (%) of asthma in RSV-infected children and controls by age at follow-up .
Sigurs N, Aljassim F, Kjellmann B. Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. THORAX. 2010.
RSV Overview
25. BURDEN OF DISEASE
Quality of Life
Quality of life in high-risk infants and parents
According to a prospective study conducted in the US, RSV-related hospitalisation
causes significant distress for children.Children’s health and functional status during
hospitalisation for severe RSV infection as assessed by the caregiver was significantly
poorer than that of age-matched controls (the control group were hospitalisations of
premature infants who had no history of RSV, RSV-related illness or RSV prophylaxis).
Caregivers continued to report significantly poorer child health in the RSV group as
long as 60 days after hospital discharge.
Hospitalisation for severe RSV infection results in
significant, lasting consequences for the child
Leidy N, Margolis M, Marcin J, Flynn J, Frankel L, Johnson S, et al. The impact of severe respiratory syncytial virus on the child, caregiver, and family during hospitalization and
recovery. Pediatrics. 2005;115(6):1536-46.
RSV Overview
26. BURDEN OF DISEASE
Severe RSV disease may be fatal
Using US mortality data from the National Center for Health Statistics, Thompson and
colleagues developed a statistical model to estimate the age-specific number of deaths
attributable to RSV and influenza. The results show that, during the period 1990–1999,
RSV was the leading cause of viral death in infants, (mean mortality rates for
underlying respiratory and circulatory deaths) with nearly nine times the mortality
associated with influenza in infants less than 1 year old (5.3 deaths per 100,000
person-years vs 0.6 attributed to influenza).
Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United
States. JAMA. 2003;289(2):179-86.
RSV Overview
27. BURDEN OF DISEASE
Co Morbidity Leading to Fatality
Co morbidity
RSV Case-Fatality Rate Range
High-Risk Infants are at Greater Risk of RSV-Related Death
Chronic Lung Disease (CLD)
3.5%–23%
Congenital Heart Disease (CHD)
2%–37%
Preterm (≤36 wGA)
0%–6.1%
Nosocomial RSV Infection
0%–12.2%
No Comorbidity or Risk Factors
<1%
Table: review of literature identified from a structured literature search (1966–2009)
Mortality specifically attributed to RSV can be difficult to
determine as most pediatric patients do not undergo postmortem
examination to determine cause of death
Welliver, et al. Curr Med Res Opin. 2010
27
RSV Overview
28. BURDEN OF DISEASE
Mortality
Mortality in high-risk infants
Hospitalisation for RSV is associated with greater mortality risk in the two years following
discharge
Sampalis JS. Morbidity and mortality after RSV-associated hospitalizations among premature Canadian infants. J Pediatr. 2003;143(5 Suppl):S150-S6.
RSV Overview
29. CURRENT CLINICAL PRACTICE
Treatment
Treatment for Severe RSV Infection is Limited to Supportive Care
Severe RSV disease can be managed using:
• Hospitalization
• Oxygen supplementation
• Mechanical ventilation
• Pediatric intensive care
Other treatment options include:
• Antibiotics – given for suspected bacterial
infection; NOT for Tx of RSV
• Bronchodilators
• Nebulized hypertonic saline
• Ribavirin is the only approved drug for the
treatment of severe RSV.
However, due to conflicting data and limitations of
the drug, use of ribavirin is controversial.
1. Krilow, Expert Rev. Anti Infect. Ther, 2011
29
RSV Overview
30. CURRENT CLINICAL PRACTICE
Prevention
Synagis® (palivizumab)1 Is the Only Available Effective Option for
Prevention of Severe RSV Infection
• Humanized monoclonal antibody that
provides effective prophylaxis against
severe disease caused by RSV infection
• Injected intramuscularly once monthly
during periods of active RSV circulation
• Binds the F protein of the RS virus
• Blocks fusion of RSV to host cell
membrane and fusion of infected
host cells (“syncytial formation”)
• The F protein does not change in RSV subtypes; palivizumab provide protection
against subtypes of RSV2,3
1.Synagis® (palivizumab) [package insert], Abbott Laboratories
2.Johnson S, et al. J Infect Dis. 1997;176:1215–1224.
3.Williams JV, et al. In: Richman DD, et al, eds.Clinical Virology. 3rd ed
30
RSV Overview
31. CURRENT CLINICAL PRACTICE
Prevention
Prevention Is the Only Viable Strategy to Reduce the Risk of Acquiring an RSV
Infection1
• RSV transmission can be minimized
through a number of different ways:
- Routine hand washing
- Careful handling of contaminated materials
- Cohort infected individuals
- Limit contact with hospital visitors, especially
young children
- Passive immunization with Synagis®
(palivizumab)2
1.Hall et al. J Pediatr. 1981
2.Allen et al. Am J Infect Control. 1990.
31
RSV Overview
Editor's Notes
All pneumoviruses encode two major surface glycoproteins (G and F) which are incorporated in the virus particle: The attachment (G) protein, which binds the virus to the cell receptor, and the F protein, which mediates fusion of cell and viral membranes. Antibodies directed against either G or F protein neutralize virus infectivity and seem to play a major role in protective immunity against human RSV. In experimental animal models the F protein induces a broadly cross-reactive and protective antibody response, whereas the G protein induces neutralizing antibodies that protect only against viruses of the same antigenic group.
The attachment glycoproteins of pneumoviruses share neither sequence nor structural features with the attachment proteins, HN or H, of other paramyxoviruses. In fact, the high serine, threonine, and proline content of the human RSV G glycoprotein, resembles the amino acid composition of mucins, a class of proteins produced and secreted by epithelial cells. The G proteins of respiratory syncytial virus (RSV), pneumonia virus of mice (PVM), and avian pneumovirus (APV) show little homology but have similar overall amino acid content with a high proportion of serine, threonine, and proline residues.
The G protein is the most variable gene product between human RSV isolates, and antigenic differences detected with monoclonal antibodies specific for the G protein have been used to classify human RSV isolates into two group, A and B. Sequence identity at the amino acid level is only 53% between the G proteins of the prototype strains of groups A and B, and up to 20% sequence variation has been observed among the G proteins of human RSV isolates of the same antigenic group. Thus the attachment protein of human RSV is a highly variable protein with unusual structural and immunological features.
Melero JA, Garcia-Barreno B, Martinez I, et al. J Gen Virol. 1997;78:241-18
This slide summarizes the very serious risk to infants and children posed by RSV.
Data from Leader et al. demonstrate that RSV is the leading cause of hospitalization of infants <1 year of age in the US. Shay et al. demonstrated that RSV is responsible for >120,000 admissions per year in children under 5.
RSV-attributable pneumonia mortality was estimated by Thompson et al. to be 3.1 deaths per 100,000 person-years in infants <1 year of age. The RSV-related mortality in infants was much greater than that attributed to influenza. The only group with a higher rate was persons >65 years of age (7.2 deaths per 100,000 person years).
Shay et al. examined the death records from 1979-1997 for children <5 years old which listed bronchiolitis, pneumonia, or any respiratory tract disease as contributing factors. Using published proportions of children hospitalized for bronchiolitis or pneumonia who were RSV-infected to bronchiolitis and pneumonia deaths, it was estimated that ≤510 RSV-associated deaths occurred annually during the 19 year study period.
For children followed up from birth in the Houston Family Study, Glezen et al found that the infection rate was 68.8/100 children <1 year of age and 82.6/100 during the second year of life.
Infants with RSV-induced bronchiolitis appear more likely to develop wheezing and asthma in adulthood. [Welliver]
Based on data compiled from >6000 infants, Weisman reported that premature infants (<36 weeks GA) with RSV are nearly three times as likely to be hospitalized than full-term infants.
Based on data from over 1500 high-risk children in the PICNIC study, Navas et al. determined that the mortality rate for high risk infants hospitalized with RSV infection was about 3.5x the rate for those without high-risk conditions.
Leader S, et al. Pediatrc Infect Dis J. 2002;21:629
Thompson WT, et al. JAMA. 2003;289:179-86
Shay DK, et al. J Infect Dis. 2001;183:16
Glezen WP, et al. Am J Dis Child. 1986;140:543
Welliver RC. Semin Perinatol. 1998;22:87
Stein RT, et al. Lancet. 1999;354:541-5
Weisman L. Pediatrc Infect Dis J. 2003;22:S33-9
Navas L, et al. J Pediatr. 1992;121:348-54