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Respiratory syncytial virus bronchiolitis: clinical aspects and epidemiology
1Dept of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Respiratory syncytial virus (RSV) causes most bronchiolitis cases, with unique epidemiology affecting infants severely, even with maternal antibodies. Infants with cardiac issues or bronchopulmonary dysplasia are at higher risk for severe RSV bronchiolitis.
Area of Science:
- Pediatrics
- Virology
- Epidemiology
Background:
- Bronchiolitis is primarily caused by Respiratory Syncytial Virus (RSV), accounting for 60-90% of cases.
- RSV exhibits unusual epidemiology, infecting most infants within the first year and peaking in hospitalized infants aged 2-6 months.
- Severe disease in the first month of life, despite maternal antibodies, and lifelong symptomatic infections are characteristic of RSV.
Purpose of the Study:
- To review the epidemiology of Respiratory Syncytial Virus (RSV) and its clinical implications.
- To highlight risk factors for severe RSV bronchiolitis in infants, including prematurity and underlying conditions.
- To discuss complications like apnea and nosocomial spread, and emerging insights into post-bronchiolitis wheeze.
Main Methods:
- Literature review and synthesis of existing epidemiological data on RSV.
- Analysis of clinical characteristics and risk factors associated with RSV bronchiolitis.
- Examination of complications and long-term outcomes, including wheezing post-infection.
Main Results:
- RSV is the leading cause of bronchiolitis, with nearly universal infant infection and a peak hospitalization age of 2-6 months.
- Infants with cardiac disease or bronchopulmonary dysplasia are highly susceptible to severe RSV bronchiolitis.
- Apnea in infants under 3 months, nosocomial spread, and a predisposition to wheeze in infants with pre-existing airflow limitation are significant findings.
Conclusions:
- RSV poses a significant public health challenge due to its high prevalence and potential for severe infant disease.
- Identifying high-risk infants and preventing nosocomial infections are crucial for managing RSV.
- Understanding the factors contributing to post-bronchiolitis wheeze can inform clinical management and prognosis.
Abstract:
Sixty to ninety percent of the clinical syndrome of bronchiolitis is caused by respiratory syncytial virus (RSV) infection. RSV epidemiology has several unusual characteristics. RSV infects nearly all infants in the first year of life, with a peak incidence of hospitalized infants with bronchiolitis between 2-6 months of age. It is the only virus that causes most severe disease during the first month of life, i.e. at a time when maternal antibodies are present. Lower respiratory tract infections caused by RSV are limited to children younger than 3 yrs but symptomatic infection with RSV occurs throughout life. Infants with cardiac disease as well as infants with bronchopulmonary dysplasia are especially prone to develop severe RSV bronchiolitis. Apnoea is a complication that occurs in infants younger than 3 months and after a history of apnoea of prematurity. Nosocomial infection is a major health problem. Hospital staff may spread the infection by becoming infected and shedding the virus, or by carrying contaminated secretions between patients. Classical teaching has been that the prevalence of wheeze is high after acute viral bronchiolitis in infancy, but recent data suggest that infants with already lower maximal expiratory flows at functional residual capacity are more prone to develop wheeze at the time of RSV bronchiolitis.