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Generation and Assembly of Virus-Specific Nucleocapsids of the Respiratory Syncytial Virus
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Viral Load Dynamics and Clinical Disease Severity in Infants With Respiratory Syncytial Virus Infection

Cristina Garcia-Mauriño1, Melissa Moore-Clingenpeel2, Jessica Thomas3

  • 1Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus.

The Journal of Infectious Diseases
|November 13, 2018
PubMed

Insights

Higher respiratory syncytial virus (RSV) loads at the start and a quicker decline are linked to less severe illness in children. Steroid treatment in severe RSV cases prolonged viral load decay.

Area of Science:

  • Pediatrics
  • Virology
  • Infectious Diseases

Background:

  • The relationship between respiratory syncytial virus (RSV) viral loads (VL) and clinical outcomes in children requires further definition.
  • Previous studies often evaluated VLs in hospitalized children at a single time point.
  • This study investigated VLs and disease severity in both outpatient and inpatient settings.

Purpose of the Study:

  • To determine the association between respiratory syncytial virus (RSV) viral loads (VL) and disease severity in pediatric patients.
  • To compare VLs and their decay patterns in outpatients versus inpatients, including those in the pediatric intensive care unit (PICU).

Main Methods:

  • Enrolled previously healthy children with RSV infection.
  • Defined disease severity by level of care (outpatient, ward, PICU) and a clinical disease severity score (CDSS).
  • Measured nasopharyngeal VLs via PCR and CDSS at enrollment and daily for inpatients, analyzing VL decay using linear mixed modeling.

Main Results:

  • 150 infants were enrolled; VLs were higher in outpatients than age-matched inpatients.
  • Among inpatients, initial VLs were similar between ward and PICU patients.
  • Excluding steroid-treated infants, ward patients had higher VLs than PICU patients; VL decay was delayed in PICU patients, particularly those on steroids.

Conclusions:

  • Higher initial viral loads (VL) and faster, consistent VL decline correlate with less severe RSV disease in children.
  • Prolonged VL decay and higher overall viral exposure were observed in severe RSV cases, especially in infants receiving steroids.
Abstract

Keywords:
clinical severityrespiratory syncytial virus; RSVviral dynamicsviral load

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