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Babies Who Catch RSV Are At Higher Risk Of Later Asthma, Study Finds

A common and sometimes dangerous respiratory germ might also raise the risk of asthma if encountered early in life, new research this month suggests. The study found that children were more likely to develop asthma if they caught a respiratory syncytial virus (RSV) infection before the age of 1. The findings might highlight yet another benefit of effective vaccines and treatments for RSV that are expected to reach the public soon.

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RSV is one of the most ubiquitous respiratory germs around, with most people expected to catch it by age 2. The infection usually causes mild cold symptoms, such as runny nose, coughs, and sneezing. But it has a higher risk of causing serious, even life-threatening, illness in the very young and old. According to the Centers for Disease Control and Prevention, RSV hospitalizes tens of thousands of Americans over the age of 65 and under the age of 5 every year.

For many years now, studies have suggested that severe RSV infections in childhood can raise people's risk of asthma and allergies. But there's still a lot we don't understand about this connection, including the exact risk factors that might make children more susceptible to developing asthma following RSV infection. This new study, conducted by researchers in Tennessee, was designed to sniff out some of these factors.

The research is called the Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure, or INSPIRE, study. The researchers proactively followed around 1,700 healthy children born in the state between 2012 to 2013 for up to five years. Along the way, they tracked when and if the children were exposed to RSV infection and whether they were diagnosed with asthma by age 5.

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Overall, around half of the children caught RSV in their first year of life, and these children were then more likely to develop asthma by the time they turned 5. Specifically, children who caught RSV in infancy had a 26% higher risk of having asthma than those who didn't catch it as early. The team's findings were published earlier this month in The Lancet.

Previous research has suggested that there's a shared genetic component underlying the link between severe RSV and asthma. In other words, the same genetic variations that make a child more vulnerable to severe RSV infection also seem to make them more vulnerable to asthma. These new results don't invalidate this past work, but they likely add a new wrinkle. As is often true in medicine, it might be both the environment and genetics that affect a child's risk of developing asthma after RSV infection.

"We focused on the first year of life because we think the first year is a very important period of lung and immune development," said study author Christian Rosas-Salazar, a pediatrician at Vanderbilt University Medical Center, in a statement from the university. "We believe that when a child is infected with RSV in the first year of life, when the lungs and immune system are still under development, that could lead to certain abnormalities that can later cause asthma."

While the initial years of the pandemic saw a decline of many common infections, these germs—including RSV—have since returned in full force. RSV's toll on the young and elderly has long made it an appealing target for vaccination and other treatments. After decades of failure, we're finally on the brink of having several effective vaccines meant for older adults, newborns, and even pregnant mothers who can pass on their immunity to their children.

It's unknown whether any of these vaccines can provide long-term protection yet, but they should substantially reduce the risk of severe illness prior to the RSV season (typically winter), much like the annual flu shot. And given the team's findings here, it's also worth finding out if childhood RSV vaccines can prevent RSV-related cases of asthma, the study authors say.

"We hope the results of this study motivate long-term follow-up of common respiratory outcomes among children in ongoing clinical trials of RSV prevention products, including vaccines and monoclonal antibodies that can decrease the severity of the infection," Rosas-Salazar said.

Children Who Had RSV As Infants Are More Likely To Develop Asthma, Research Shows

Last fall, hospitals across the United States experienced a surge of children infected with respiratory syncytial virus, a common illness that can have serious effects on infants. They include an increased risk of developing other respiratory conditions.

Scientists have observed a link between RSV in infancy and the later development of asthma for decades, but the underlying mechanisms are still not clear. The most recent study, published last week by The Lancet, explored how the severity of an RSV infection in the first year of life affects childhood asthma risk.

"For 60 years investigators have repeatedly identified the link between severe RSV and asthma; however, we've shown that this link is explained in part by shared heredity to both severe RSV and asthma," said Dr. Tina Hartert, director of the Center for Asthma and Environmental Sciences Research at Vanderbilt University in Tennessee.

The researchers found that infants that were not infected with RSV during their first year of life were 26% less likely to develop childhood asthma. More than half of the the 1,900 infants involved in the study came down with RSV.

By age 2, most children have been infected by RSV, according to the U.S. Centers for Disease Control and Prevention. Symptoms include coughing and wheezing and, in severe cases, difficulty breathing.

Premature and very young infants are among those with the highest risk of serious complications from a RSV infection. RSV is the leading cause of bronchiolitis, a lower respiratory infection common in infants and young children.

An RSV infection during infancy, when the lungs and immune system are still developing, may cause abnormalities that later lead to asthma, the researchers said. But they cautioned that, to prove causality, research must be conducted on the impact that various RSV interventions have on the development of childhood asthma.

An age-dependent link

Even within the first year of life, the risks posed by RSV may differ, other research has shown.

One study found that infants ages 6-12 months that were hospitalized with RSV had a higher risk of developing childhood asthma or chronic wheezing than those that were hospitalized with RSV in their first 6 months of life.

The researchers estimated that the risk for hospitalization for asthma was up to 7 times higher in children that were hospitalized for RSV when they were 6-12 months old. This was despite the fact that more RSV infections occur before 6 months of age.

They theorized that maternal antibodies may offer more protection during the first 6 months of life. The alveolar multiplication and airway remodeling that naturally occur during the first 6 months may prevent permanent damage to the respiratory system, they said. Alveoli are tiny air sacs located at the end of the bronchioles in the lungs. Their job is to transport oxygen and carbon dioxide molecules back and forth from the lungs and the bloodstream.

Another study suggested that a child's susceptibility to allergies plays a role in whether an RSV infection leads to the development of asthma. The study also identified higher birth weight and later RSV onset as risk factors.

Preventing RSV infections

There are no vaccines available for RSV, but several candidates are in development. The Asthma and Allergy Foundation of America recommends the following preventive measures to protect children from RSV:

• Make sure children are vaccinated against influenza and COVID-19 to reduce their risk of severe respiratory illness.• Wash hands often with soap and water for at least 20 seconds and avoid touching faces with unwashed hands.• Avoid coming in close contact with sick people.• Talk to child care providers about their RSV prevention policies.• Limit children's time in highly contagious settings where exposure is more likely.

Children that are considered at high risk for severe RSV may benefit from palivizumab, a monoclonal antibody treatment. The medicine can't prevent an infection, but it can reduce the severity of illness.

Study Finds Early RSV Infection Linked To Significantly Increased Risk Of Asthma In Children

Severe respiratory syncytial virus (RSV) infection has long been associated with the onset of childhood wheezing diseases, but the relationship between RSV infection during infancy and the development of childhood asthma has remained unclear.

A new observational study by Vanderbilt University Medical Center researchers has found that RSV infection in the first year of life is associated with a significantly increased risk of asthma in children. The study, the first to look at the effects of RSV infections of all different severities on childhood asthma risk at a population level, was published in The Lancet.

RSV is a seasonal respiratory virus that affects almost all children by the age of 2 and repeatedly throughout life. It is the leading cause of bronchiolitis, a lower respiratory tract infection that presents as coughing and wheezing in infants and young children. The symptoms are mild in most children and usually resolve in about a week, but it can lead to serious illness and death especially in premature or very young infants and those with chronic lung disease or congenital heart disease.

It is the most common cause of hospitalizations worldwide due to respiratory issues in the first year of life, said Christian Rosas-Salazar, MD, MPH, assistant professor of Pediatrics in the Division of Allergy, Immunology and Pulmonary Medicine, the first author of the study.

"For 60 years investigators have repeatedly identified the link between severe RSV and asthma; however, we've shown that this link is explained in part by shared heredity to both severe RSV and asthma," said the study's principal investigator and senior author Tina Hartert, MD, MPH, professor of Medicine and Pediatrics, director of the Center for Asthma and Environmental Sciences Research, Vice President for Translational Research and the Lulu H. Owen Professor of Medicine.

"The solution in our study was to understand the link between RSV and asthma by ensuring all RSV infections would be captured using molecular techniques and post-season serology," she said.

"In our study, among healthy children born at term, not being infected with RSV in the first year of life was associated with a substantially reduced risk of developing childhood asthma, which affects about 8% of the children in the U.S.," Rosas-Salazar said. "Our findings show an age-dependent association between RSV infection during infancy and childhood asthma."

"We focused on the first year of life because we think the first year is a very important period of lung and immune development," Rosas-Salazar said. "We believe that when a child is infected with RSV in the first year of life, when the lungs and immune system are still under development, that could lead to certain abnormalities that can later cause asthma," he said.

The INSPIRE (Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure) study included 1,946 eligible healthy infants who were 6 months old or younger at the beginning of RSV season (November to March in Tennessee). The infants were recruited from 11 pediatric practices across Middle Tennessee. Biweekly surveillance and serology tests were used to classify infants as infected or not infected in the first year of life. Fifty-four percent of infants were infected with RSV in the first year of life; 46% were uninfected.

The infants were followed annually and then evaluated for asthma at 5 years old. The study found infants who weren't infected with RSV in the first year of life had a 26% lower risk of asthma at age 5.

"Showing efficacy of RSV vaccines against childhood asthma would increase public health interest and vaccine uptake," Hartert said.

More information: Christian Rosas-Salazar et al, Respiratory syncytial virus infection during infancy and asthma during childhood in the USA (INSPIRE): a population-based, prospective birth cohort study, The Lancet (2023). DOI: 10.1016/S0140-6736(23)00811-5

Citation: Study finds early RSV infection linked to significantly increased risk of asthma in children (2023, April 24) retrieved 27 April 2023 from https://medicalxpress.Com/news/2023-04-early-rsv-infection-linked-significantly.Html

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