Table I.
Epidemiology of RSV infection | Being able to compare severity over time and/or across cohorts is useful in hospital-based QI programmes but also in multi-centre networks, such as PEDSIDEA |
Understanding the real-world disease burden caused by RSV will facilitate the study of the effectiveness of antivirals and vaccines, once they become available | |
Recent epidemiological data indicate that RSV infection is an important illness in elderly and high‑risk adults, with a disease burden similar to that of non‑pandemic influenza | |
RSV and immune response | Maternal RSV‑specific antibodies transmitted transplacentally during the third trimester of pregnancy are related to RSV disease severity in young infants |
RSV and miRNAs | A greater understanding of miRNAs may enable them to be used as biomarkers of severe RSV infection and as novel targets for treatment or prophylaxis of RSV infection |
RSV and thrombocytosis | Thrombocytosis in RSV-positive bronchiolitis does not require routine prophylactic anti-platelet treatment or further investigations |
RSV and asthma | There is compelling evidence that severe respiratory infection induced by RSV is associated with subsequent development of asthma later in childhood |
Further understanding of the role of RSV in asthma pathogenesis will enable our understanding of the impact of future vaccines against RSV in asthma prevention | |
RSV as a cause of PIBO | There are only few reports in the literature of children with PIBO secondary to RSV as a single infection |
Further research is required in order to investigate the potential impact of RSV co-infection in the severity and worse outcome in children with PIBO | |
Imaging of RSV infection | Although imaging cannot diagnose RSV infection, it is important to identify the possible pattern of viral disease, in order to avoid unnecessary administration of antibiotic therapy and predict possible late effects |
Standard radiological techniques, including CT, are unable to distinguish between acute bronchiolitis caused by RSV versus that caused by other respiratory viruses | |
HRCT of the lungs may be required to assess possible bronchial thickening and remodeling, the development of bronchiectasis and air-trapping | |
Antivirals against RSV | Ribavirin is currently the only licensed antiviral medication used to treat RSV infection; it has very limited efficacy and multiple toxicities, which means its use is usually reserved for severely immunocompromised children |
Due to ethical and technical constraints human challenge models are only undertaken in adults, but if a product is shown to be efficacious in this setting it allows a faster move to trials in children than traditional trials which often take much longer to do | |
A greater understanding of individual data in newly developed pharmaceutical agents against RSV will potentially lead to future personalized treatment regimens | |
RSV and PICU | HFNC might have a role as a rescue therapy for children with RSV-positive bronchiolitis admitted to PICU to reduce their requirement for high-cost intensive care |
Heliox could be useful in addition to standard medical care in the management of children with RSV-positive bronchiolitis admitted to PICU | |
Prevention of RSV infection | To date, there is only one product available for prevention of RSV infection, palivizumab, the mAb that has been shown to reduce hospital admission due to RSV infection in some high risk infants by up to 80% |
There are currently 43 RSV vaccines in development; of these, 21 are in clinical trials in humans; 14 in Phase 1, five in Phase 2 and two in Phase 3, 12 vaccines are in trials in children, 4 in pregnant women and 10 in older adults | |
A possible route to licensure is currently being sought with the US FDA and European licensing agencies for a maternal RSV vaccine, bringing hope of a vaccine becoming available that could save the lives of countless young infants worldwide |
RSV, respiratory syncytial virus; mAb, monoclonal antibody; FDA, Food and Drug Administration; QI, quality improvement, PEDSIDEA, Partnering for Enhanced Digital Surveillance of Influenza‑like Disease and the Effectiveness of Antivirals and Vaccines; ALRTI, acute lower respiratory tract infection; ILI, influenza‑like illness; CT, computed tomography; HRCT, high‑resolution computed tomography; ICTV, International Committee on Taxonomy of Viruses; miRNAs, microRNAs; PIBO, post infectious bronchiolitis obliterans; PICU, Paediatric Intensive Care Unit; HFNC, high‑flow nasal cannula.