1506 - Burden of Respiratory Syncytial Virus (RSV) and Other Lower Respiratory Tract Viral Infections During the First Two Years of Life: a Prospective Study

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Presenting Author(s)

Shabir A. Madhi

Professor of Vaccinology
University of the Witwatersrand, Johannesburg, South Africa
Johannesburg, Gauteng, South Africa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AC

Ana Ceballos

Dr.
Instituto Medico Rio Cuarto
Rio Cuarto, Cordoba, Argentina
Disclosure: GSK group of companies (Scientific Research Study Investigator)
JC

Jo Ann Colas

Ms
Keyrus Life Science on behalf of GSK, Rockville, MD, United States
Rockville, Maryland
Disclosure: GSK group of companies (Consultant)
LC

Luis Cousin

MD/Principal Investigator
Tecnologia en Investigación
San Pedro Sula, Cortes, Honduras
Disclosure: Tecnología en Investigación (Scientific Research Study Investigator)
UD

Ulises D'Andrea

Sub-investigator
Instituto Medico Rio Cuarto
Rio Cuarto, Cordoba, Argentina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ID

Ilse Dieussaert

Head of Maternal Immunization, GSK Vaccines USA
GSK
Rockville, MD
Disclosure: GSK group of companies (Employee, Shareholder)
JD

Joseph B. Domachowske

Professor of Pediatrics
SUNY Upstate Medical University, Syracuse, NY, United States
Syracuse, New York
Disclosure: Astra Zeneca (Other Financial or Material Support, Grant/Research Support paid to my Institution on my behalf for sponsored human clinical trial activities)GSK group of companies (Other Financial or Material Support, Grant/Research Support paid to my Institution on my behalf for sponsored human clinical trial activities)Merck (Other Financial or Material Support, Grant/Research Support paid to my Institution on my behalf for sponsored human clinical trial activities)
Janet A. Englund

Professor
Seattle Children’s Hospital
Seattle, Washington
Disclosure: AstraZeneca (Scientific Research Study Investigator)GSK group of companies (Scientific Research Study Investigator)Meissa vaccines (Consultant)Merck (Scientific Research Study Investigator)Sanofi Pasteur (Consultant)
SG

Sanjay Gandhi

Vice President
GSK
Mumbai, Maharashtra, India
Disclosure: GSK group of companies (Employee)
GH

Gerco Haars

Senior Manager Epidemiology
GSK
Wavre, Brabant Wallon, Belgium
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MH

Mélanie Hercor

Expert Scientist
GSK, Wavre, Belgium
Wavre, Brabant Wallon, Belgium
Disclosure: GSK group of companies (Employee)
Md

Magali de Heusch

Expert Scientist
GSK
Wavre, Brabant Wallon, Belgium
Disclosure: GSK group of companies (Employee)
LJ

Lisa Jose

Dr.
Faculty of Health Sciences, University of the Witwatersrand
Johannesburg, Gauteng, South Africa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Joanne M. Langley

Professor of Pediatrics
Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, NS, Canada
Halifax, Nova Scotia, Canada
Disclosure: GSK group of companies (Research Grant or Support)Immunivaccines Inc (Scientific Research Study Investigator, Research Grant or Support)Janssen (Research Grant or Support)Pfizer (Research Grant or Support)Symvivo (Scientific Research Study Investigator, Research Grant or Support)VBI Vaccines (Research Grant or Support)
AL

Amanda Leach

Dr.
GSK
Rockville, MD
Disclosure: GSK group of companies (Employee)
PS

Peter Silas

Principal Investigator
Wee Care Pediatrics
Syracuse, UT
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JT

Jamaree Teeratakulpisarn

Professor
Khon Kaen University
Khon Kaen, Khon Kaen, Thailand
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Timo Vesikari

Dr
Nordic Research Network
Tampere, Pirkanmaa, Finland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Sonia K. Stoszek

Dr.
GSK
Rockville, MD
Disclosure: GSK group of companies (Employee, Shareholder)

Background: Lower respiratory tract infections (LRTIs) are a leading cause of pediatric morbidity and mortality worldwide, with ~650,000 deaths recorded in < 5-year-olds in 2016. Cross-sectional studies on hospitalized LRTIs are available, but longitudinal studies on the total burden of viral LRTIs are scarce. This study (NCT01995175) prospectively collected incident RSV and other viral LRTIs in a multinational cohort.

Methods: From 2013 to 2017, infants in 8 countries were enrolled at birth and followed for LRTIs up to 2 years of age. Infants with suspected LRTIs were clinically examined and swabbed. Nasal swab samples were tested using quantitative real-time PCR for RSV and multiplex PCR panel for 16 other respiratory viruses/subtypes; bacterial culture was not performed. LRTI and severe LRTI episodes were defined per 2015 WHO LRTI case definitions. Viruses detected from nasal swabs collected from participants with WHO-defined LRTI and severe LRTI episodes are reported.

Results: The 2401 infants followed experienced 1012 LRTI episodes; 259 of these were severe LRTIs. At least 1 virus was detected from 909 (90%) and 235 (91%) LRTI and severe LRTI episodes, respectively. Enteroviruses/Rhinoviruses (EV/RV, 49%) were detected most frequently in samples collected from LRTI episodes, followed by RSV (22%), parainfluenza (PIV, 14%), human metapneumovirus (hMPV, 8%) and seasonal coronavirus (CoV, 6%). RSV was detected in 39% of samples from LRTI episodes in < 3-month-olds and in 18% of 1-year-olds (Table 1). In a similar trend, RSV was detected in 47% of samples from severe LRTI episodes in < 3-month-olds and in 21% of 1-year-olds (Table 2). Co-infection with another virus was common in CoV-positive samples (67%), while most samples positive for RSV (71%), hMPV (70%), EV/RV (67%) and PIV (58%) had no other virus detected.Table 1. Occurrence of laboratory confirmed respiratory viral infections by viral pathogens identified in nasal swab samples from WHO-defined LRTI episodes

Table 2. Occurrence of laboratory confirmed respiratory viral infections by viral pathogens identified in nasal swab samples from WHO-defined severe LRTI episodes

Conclusion: Respiratory viruses are detected in the majority of LRTIs during the first 2 years of life. RSV likely accounts for much of this overall LRTI burden. Our results suggest that RSV most strongly impacted the very young; it was the most commonly detected virus in severe LRTIs in infants aged < 3 months. RSV was also persistently detected at high levels in samples from LRTIs (22%) and severe LRTIs (28%) in children up to 2 years old.

Funding: GlaxoSmithKline Biologicals SA