Sara Manti1 , Annamaria Staiano2 , Luigi Orfeo3 , Fabio Midulla4 , Gian Luigi Marseglia5 , Chiara Ghizzi6 , Stefania Zampogna7 , Virgilio Paolo Carnielli8 , Silvia Favilli9 , Martino Ruggieri10, Domenico Perri11, Giuseppe Di Mauro12, Guido Castelli Gattinara13, Antonio D’Avino14, Paolo Becherucci15, Arcangelo Prete16, Giuseppe Zampino17, Marcello Lanari18, Paolo Biban19, Paolo Manzoni20,21, Susanna Esposito22, Giovanni Corsello23 and Eugenio Baraldi24

Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fuid management and respiratory support. Evidence suggests no beneft with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of efective treatment, the reduction of morbidity must rely on.....

Respiratory syncytial virus (RSV) imposes a substantial burden on pediatric hospital capacity in Europe. Promising prophylactic interventions against RSV including monoclonal antibodies (mAb) and maternal immunizations (MI) are close to licensure. Therefore, we aimed to evaluate the costeffectiveness of potential mAb and MI interventions against RSV in infants, for six European countries. Methods: We used a static cohort model to compare costs and health effects of four intervention programs to no program and to each other: year-round MI, year-round mAb, seasonal mAb (October to April), and seasonal mAb plus a catch-up program in October. Input parameters were obtained from national registries and literature. Influential input parameters were identified with the expected value of partial perfect information and extensive scenario analyses (including the impact of interventions on wheezing and asthma).

Natalie I Mazur, MD et al.
​
Respiratory syncytial virus is the second most common cause of infant mortality and a major cause of morbidity and mortality in older adults (aged >60 years). Efforts to develop a respiratory syncytial virus vaccine or immunoprophylaxis remain highly active. 33 respiratory syncytial virus prevention candidates are in clinical development using six different approaches: recombinant vector, subunit, particle-based, live attenuated, chimeric, and nucleic acid vaccines; and monoclonal antibodies. Nine candidates are in phase 3 clinical trials. Understanding the epitopes targeted by highly neutralising antibodies has resulted in a shift from empirical to rational and structure-based vaccine and monoclonal antibody design. An extended half-life monoclonal antibody for all infants is likely to be within 1 year of regulatory approval (from August, 2022) for high-income countries. Live-attenuated vaccines are in development for older infants (aged >6 months). Subunit vaccines are in late-stage trials for pregnant women to protect infants, whereas vector, subunit, and nucleic acid approaches are being developed for older adults. Urgent next steps include ensuring access and affordability of a respiratory syncytial virus vaccine globally. This review gives an overview of respiratory syncytial virus vaccines and monoclonal antibodies in clinical development highlighting different target populations, antigens, and trial results.

Adda et al. investigated a potential inhibitor of respiratory syncytial virus (RSV) in a human challenge study. An inhibitor, known as EDP-938, would act in such a way whereby it would alter and interfere with a protein that allows for RSV to replicate in the human body. A study was set up to evaluate how participants would react in terms of the viral load (total amount of virus a person has in them) and clinical symptoms (mucus production) after receiving either EDP-938 or a placebo. The participants received the interventions only after they tested positive with the inoculated modified strain of RSV. The results between the different groups showed that the viral load as well as the presentation of symptoms were lower in the groups receiving EDP-938 than in those receiving the placebo. Furthermore, the safety profiles were similar between the inhibitor and the placebo groups. This study supports further exploration of EDP-938 activity and better understanding of potential treatments against RSV.

You Li, PhD, Xin Wang, PhD, Bingbing Cong, BMed, Shuyu Deng, BMed, Daniel R Feikin, MD, Harish Nair, PhD

You Li and co-workers investigated why RSV has rebounded after the expected local RSV season in several countries during the COVID-19 pandemic. The RSV epidemic was late in the 18 countries included, and 11 observed a rebound before September 2021. The risk of observing a rebound of RSV was 23 times higher after re-opening schools. On the contrary, an increase in temperature of 5°C decreased the risk of RSV rebound by 37%. The risk of RSV rebound increased over time, suggesting a role of the accumulation of individuals susceptible to RSV through new births and waning immunity. Increased susceptibility of the population and full re-opening of schools may override the effect of high temperature. Countries that did not yet observe a rebound in RSV should prepare for it, especially in the weeks after re-opening schools and when temperature drops. This study will be instrumental for policy makers to understand impact of distinct non-pharmaceutical interventions to control the COVID pandemic.