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Lower respiratory viral infections in immunocompetent children
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Insights
Understanding viral lower respiratory infections (LRIs) is crucial. New diagnostics and vaccines are improving LRI diagnosis and prevention, with ongoing research into viral variations impacting future treatments.
Area of Science:
- Virology
- Epidemiology
- Immunology
Background:
- Viral lower respiratory disease (LRI) poses a significant societal burden.
- Existing knowledge of LRI epidemiology is expanding with new molecular techniques.
- Rhinoviruses and coronaviruses are newly recognized as significant LRI causes in children.
Purpose of the Study:
- To highlight advancements in understanding viral LRI epidemiology.
- To discuss the impact of new diagnostic techniques on LRI diagnosis.
- To review current and future therapeutic and prophylactic strategies for viral LRIs.
Main Methods:
- Review of current literature on viral LRI epidemiology and diagnostics.
- Analysis of existing and developing antiviral therapies and vaccines.
- Exploration of molecular techniques for identifying viral genetic and antigenic variation.
Main Results:
- New molecular techniques are revealing significant genetic and antigenic variation in previously homogenous viruses.
- Rhinoviruses and coronaviruses should be considered important causes of LRI in children.
- Antiviral drugs exist for influenza A, B, and RSV; high-titer antiviral IVIG shows promise.
- Improved vaccines for influenza, HPIV, and RSV are expected; adenoviral vaccines may be limited.
Conclusions:
- Enhanced understanding of viral epidemiology and variation is critical for future vaccine and antiviral drug development.
- Rapid diagnostics and novel therapeutics, including IVIG and vaccines, are improving LRI management.
- Continued research into viral substrain differences is essential for targeted interventions.
Abstract:
Viral lower respiratory disease causes a heavy burden on our society. Better understanding of the epidemiology of these viruses combined with new rapid diagnostic techniques will provide more rapid and more reliable diagnosis of these agents in the future. Two agents not commonly thought of as causes of LRI in children (rhinoviruses, coronaviruses) should now be added to an already long list. Effective drugs exist for prophylaxis against influenza virus type A and therapy for influenza virus type A, type B, and RSV. While no new antiviral drugs are near clinical use at this time, new antiviral agents are constantly being tested and developed. High-titer, specific antiviral IVIG appears promising for both therapy and prophylaxis. Over the next decade, improved influenza virus vaccines and safe and effective vaccines against HPIV and RSV are expected. Adenoviral vaccines for use in immunocompromised patients are possible, but a generally available vaccine for all children is less likely. Although the basic clinical epidemiology of these viruses has been well investigated over the last 30 years, new molecular techniques are greatly expanding our understanding of these agents. Antigenic and genetic variation is being found in many viruses previously thought homogeneous. The exact role and biologic significance of this variation is just beginning to be explored, but already there is evidence of differences in pathogenicity and immunogenicity in many of these substrains. All of this information will have an impact on future vaccine and antiviral drug development.