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Respiratory Syncytial Virus (RSV) in Adults Learning Zone

Congress Highlights

Read time: 30 mins
Last updated:29th Apr 2022
Published:25th Apr 2022

ECCMID 2022 Congress highlights

Stay up to date with the latest in infectious diseases from the 32nd European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) 2022, covering:

  • The impact of the COVID-19 pandemic on infectious disease research, surveillance and treatment
  • Other infectious respiratory diseases
  • A focus on respiratory syncytial virus (RSV) infections

Day One – Impact of COVID-19 on infectious disease

By Heather Mason

The 32nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) kicked off in a hybrid format, both online and on site, in Lisbon, Portugal on April 23rd. In his welcome speech, the President of host society ESCMID, Maurizio Sanguinetti, acknowledged the changes that have occurred since the last ECCMID meeting in 2019. Notably, that COVID-19 was then unknown, and that it now represents the subject of over 20% of all abstracts submitted to this meeting.

The COVID-19 pandemic has served to highlight several aspects of infectious disease management. These include the central position of laboratory medicine in healthcare systems, with the expansion of rapid testing capacity and test refinement; biobanking to tackle the multifactorial aspects of disease; machine learning to integrate clinical and laboratory data; collaboration towards national surveillance systems, and syndromic diagnostics (such as respiratory) to prevent patient isolation and decrease antibiotic use. Each of these topics will be covered in more detail during the coming days of the congress.

While the programme covers a broad range of topics, the COVID-19 pandemic has also affected the incidence of other respiratory viruses, largely due to the implementation of public health measures. Several poster presentations showed that the usual winter peaks of respiratory syncytial virus (RSV) infections and influenza disappeared during the winter of 2020-2021, but that RSV reappeared during the summer months, perhaps due to the mitigation of COVID-19 health measures1-3.

COVID treatment insights – what have we learnt?

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Are there positives to come out of the COVID-19 pandemic?

What positive outcome could have possibly come out of the COVID-19 pandemic? Essentially, the revolution of respiratory virus testing. Even as recently as 2019, the capacity, turnaround time, and specificity of testing were a challenge. With the pandemic, laboratories and industry have collaborated to provide more accurate and rapid testing, with increased testing capacity for a wide range of respiratory viruses.

Despite extensive morbidity and mortality, the COVID-19 pandemic has spurred advances in multiple areas of infectious disease care, particularly rapid testing for respiratory infections

An integrated symposium called for an end to prescribing antibiotics for viral respiratory infections, noting that they are contributing to antibiotic resistance. Louis Bont presented data where an expert panel diagnosed paediatric patients between 2 and 60 months of age with a bacterial, viral or unknown cause respiratory infection, based on presenting symptoms and follow-up data9. Their responses were compared to results from genomic data, which revealed that most respiratory infections were of viral origin, for which the study showed a high percentage of clinicians would have prescribed antibiotics. The future of diagnosing and successfully treating paediatric respiratory viruses lies with bedside multiplex polymerase chain reaction (PCR) diagnosis.

Co-existence of SARS-CoV-2 and respiratory viruses

Yonat Shemer presented data on the prevalence of common infectious diseases after COVID-19 vaccination and the easing of mitigation measures10. Growth rates of respiratory infections in the community were examined over time, detected by real-time PCR testing. Circulating adenovirus, human coronavirus, and rhinovirus levels did not change during 2020-2021, while influenza A, B, RSV, and human metapneumovirus (HMPV) disappeared. It is unknown why certain viruses disappeared while others did not. This trend has also been seen globally.

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Day Four – Respiratory syncytial virus burden in infants

By Heather Mason

This year’s ECCMID draws to a close

As we reach the end of this ECCMID congress, we will conclude our coverage with the burden of respiratory syncytial virus (RSV) infection in infants and the final flash mini-oral session on respiratory viruses.

The burden of RSV in infants

Virtually all infants are infected with RSV in the first two years of life, which can lead to severe bronchiolitis and pneumonia. One in five infants infected with RSV will require outpatient care, and one in fifty is hospitalised within the first year of life, an event linked to a 39% increase in recurrent wheezing in adolescence24. There is a current lack of approved prophylaxis other than palivizumab which is only approved for high-risk and preterm infants25.

Paulo Manzoni reviewed the trends of RSV during the COVID-19 pandemic26. In Piedmont, Italy, a 76% decrease in paediatric hospital admissions related to infectious diseases was found during the pandemic, as well as an 84% decrease in acute bronchiolitis, trends reflected across the rest of Europe. This drop in bronchiolitis cases was not due to the reduction in the circulation of RSV alone. Other enveloped virus infections were significantly reduced, while non-enveloped viruses such as rhinovirus, adenovirus, and bocavirus remained at typical infection rates. Data from 244 children hospitalised for COVID-19 found co-infections in 28.3% of cases (viral n = 45; bacterial n = 32). Of these, 11.6% had multiple infections. In a separate study, COVID-19 and RSV (n = 6) co-infections were always mild and uncomplicated.

Following the relaxation of social distancing measures, there has been a surge of RSV infections, an alteration of historical seasonality, and increased severity during peak phases. Explanations for the surge in RSV may relate to the infant population naïve to RSV after 12–18 months of lockdown, potentially causing reduced immune defences, less viral clearance, increased severity, and older age of infection. Also, pregnant mothers have had lower exposure to RSV, meaning that fewer maternal antibodies are passed to the infants. Experts predict that increased RSV incidence in older infants will continue for one or two following seasons.

RSV incidence has changed in light of public health measures and may continue to affect infants more severely in the near future

Heather Zar presented new data on the persistent burden of RSV and future interventions27. Around 79% of infants hospitalised with RSV are born healthy with no comorbidities (unlike the adult population), and RSV accounts for 2% of all infant deaths <6 months of age in developing countries. The Drakenstein birth cohort longitudinal study looked at the acute and persistent burden of RSV28. The study found that children with a first RSV lower respiratory tract infection (LRTI) were three times more likely to develop recurrent LRTI than those with non-RSV LRTI.

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References

References

    1. Bernet Sanchez A, Lopez Gonzalez E, Mormeneo Bayo S, Prats I, Belles Belles A, Aramburu Arnuelos J, et al. What happens with RSV? Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. P0042.
    2. Sebastião M, Fradique AR, Gata L, Rodrigues F. Respiratory syncytial virus (RSV) infection in children in the era of SARS-CoV-2. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. L0354.
    3. Torres A, Martinón-Torres F, Weber K, Cáceres A, Gutierrez C. Clinical burden of respiratory syncytial virus (RSV) and influenza in hospitalised adults: a retrospective IASIST analysis. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 23 April. LIsbon. P0026.
    4. Balena F, Pallara E, Vita ED, Lattanzio R, Iaco GD, Mariani MF, et al. Association of home corticosteroids therapy with COVID-19 disease severity and mortality. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. O0140.
    5. Motos A, Cillóniz C, Ceccato A, Fernández-Barat L, Gabarrús A, Bermejo J, et al. Benefit and harm of corticosteroids in large population of COVID-19 patients admitted to Spanish intensive care units. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. O0145.
    6. Monk P, Tear V, Brookes J, Batten T, Mankowski M, Gabbay F, et al. Effects of inhaled interferon-beta on hospitalised COVID-19 patients receiving supplemental oxygen. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. O0143.
    7. Giamarellos-Bourboulis E, Kotsaki A, Metallidis S, Papailiou A, Rapti A, Taddei E, et al. Long-term benefit of early anakinra treatment in COVID pneumonia at risk: results of the SAVE-MORE trial. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. O0144.
    8. Montgomery H, Hobbs R, Padilla F, Arbetter D, Templeton A, Seegobin S, et al. Efficacy and safety of intramuscular administration of AZD7442 (tixagevimab/cilgavimab) for early outpatient treatment of COVID-19: the TACKLE phase III trial. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 23 April. Lisbon. O0146.
    9. Bont L, Bogaert D, Tiemann C. Facing a 'new normal': co-existence of SARS-CoV-2 and respiratory viruses. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 24 April. Lisbon. IS17.
    10. Shemer Y. The trend prediction and prospectives on respiratory disease in the "Living with COVID-19" and "Post COVID-19" era. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 24 April. Lisbon. IS17
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    26. Manzoni P. Rethinking RSV epidemiology, past, present, and future. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 24 April. Lisbon. IS30.
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    30. Beard K. Impact of integrating routine, syndromic molecular Point-of-Care testing for SARS-CoV-2 and other respiratory viruses into an acute oncology service. Presented at the European Congress of Clinical Microbiology and Infectious Diseases 2022, 26 April. Lisbon. OF222.
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