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Review
. 2021 Oct 2;47(1):198.
doi: 10.1186/s13052-021-01148-8.

Epidemiology and prevention of respiratory syncytial virus infections in children in Italy

Chiara Azzari  1 , Eugenio Baraldi  2 , Paolo Bonanni  3 , Elena Bozzola  4 , Alessandra Coscia  5 , Marcello Lanari  6 , Paolo Manzoni  7 , Teresa Mazzone  8 , Fabrizio Sandri  9 , Giovanni Checcucci Lisi  10 , Salvatore Parisi  10 , Giorgio Piacentini  11 , Fabio Mosca  12   13
Affiliations
Review

Epidemiology and prevention of respiratory syncytial virus infections in children in Italy

Chiara Azzari et al. Ital J Pediatr. .

Abstract

Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.

Keywords: LRTI; Monoclonal antibodies; RSV; RSV epidemiology; RSV pediatric burden; RSV prevention; RSV vaccines; Respiratory syncytial virus.

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Conflict of interest statement

All authors have been participants at advisory boards and/or have been speakers at symposia and/or lecture sponsored by Sanofi and/or AbbVie. G Checcucci Lisi and S Parisi are employees of Sanofi Pasteur, working at the Medical Affairs Department, and may hold shares/stock options as part of remuneration package.

Figures

Fig. 1
Fig. 1
Number of respiratory samples sent by sentinel physicians and number of samples testing positive for influenza virus, SARS-COV-2, and RSV; 2020–2021 season, Lombardy (updated January 27, 2021). SARS-COV-2 was the only virus detected in tested influenza-like illness samples. RSV respiratory syncytial virus [12]
Fig. 2
Fig. 2
Structure of RSV. RSV respiratory syncytial virus. Modified from [16]
Fig. 3
Fig. 3
Number of RSV-positive and RSV-negative samples and ILI incidence per 1000 residents per week in four consecutive seasons. ILI influenza-like illness; RSV respiratory syncytial virus. Modified from [37, 39]
Fig. 4
Fig. 4
Seasonal trend of pediatric hospitalizations due to respiratory infections from RSV in Tuscany, 2015–2019. RSV respiratory syncytial virus [1]
Fig. 5
Fig. 5
Periods of potential protection from RSV infection using different prevention strategies, based on RSV seasonality in Italy. RSV respiratory syncytial virus. Modified from [5]
See this image and copyright information in PMC

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