AN EVALUATION OF THE ROLE OF RESPIRATORY SYNCYTIAL VIRUS (RSV), ALONE AND WITH OTHER PATHOGENS, IN CAUSING RESPIRATORY DISEASE AMONG NATIVE AMERICAN CHILDREN

respiratory syncytial virus;lower respiratory illness;pneumonia;bronchiolitis;motavizumab;not listed

Driscoll, Amanda JenneMoss, William J. ;

Johns Hopkins University

关键词: respiratory syncytial virus;    lower respiratory illness;    pneumonia;    bronchiolitis;    motavizumab;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/59158/DRISCOLL-DISSERTATION-2018.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Respiratory syncytial virus (RSV) is associated with 3.2 million severe lower respiratory illness (LRI) episodes and 118,200 deaths in children <5 years of age annually, with the greatest burden in infants less than 6 months of age. There is no licensed vaccine for RSV, although several candidates are in development. It is not well understood how the prevention of RSV LRI in infancy might impact LRI with other pathogens, or long-term sequelae including subsequent wheeze and asthma. Recently, a double-blinded randomized trial of a monoclonal antibody, motavizumab, showed efficacy for the prevention of RSV-associated medically attended LRI (MALRI) in healthy Native American infants. Infants were followed through three years of age, with nasopharyngeal secretions collected at every MALRI. We tested these samples for respiratory viruses and for Streptococcus pneumoniae in order to:1. Evaluate the role of RSV MALRI prevention in infancy on the prevalence and density of S. pneumoniae carriage in the nasopharynx 2. Evaluate the impact of RSV MALRI prevention in infancy on MALRI with other respiratory viruses, and on subsequent medically attended wheeze 3. Evaluate the risk of RSV MALRI in the second year of lifeRSV MALRI was associated with increased S. pneumoniae density in the nasopharynx, suggesting a role for its prevention in reducing the incidence of pneumococcal pneumonia in vaccinated children and in their communities through indirect protection. Motavizumab prevented RSV MALRI in the presence of co-infecting viruses, with increased efficacy in more severe cases. A family history of asthma, and MALRI in infancy with parainfluenza viruses, rhinovirus and coronaviruses were independently associated with subsequent medically attended wheeze at ages 1-3 years. Infants who broke through motavizumab prophylaxis to have inpatient RSV LRI had higher risk of medically attended wheezing at ages 1-3 years than children in the placebo group with inpatient RSV LRI, and may represent a subgroup at high risk for both outcomes. We found no increased risk of disease in the second RSV season following receipt of motavizumab in the first season, a finding that has not been demonstrated previously in the context of RSV prevention in healthy infants.