Child research

RSV & Rotavirus:
so much in common
Translational
research is
needed to
improve the
health of
children.
- Louis Bont
lbont@umcutrecht.nl
Louis Bont, MD, PhD
has an interest in understanding,
preventing and treating
respiratory syncytial virus
(RSV) bronchiolitis. He was
one of the founders of the
TULIPS program, which
furthers the career of
multidisciplinary early stage
researchers in the field of
child health.
Infant mortality is a major global health threat and the most
prevalent clinical syndromes are diarrhea and respiratory
infection. According to a Global Burden of Diseases study
conducted by the Institute for Health Metrics and Evaluation
at Washington University, rotavirus and respiratory syncytial
virus (RSV) are the primary causes of infant diarrhea and
infection, respectively.
In a retrospective case series, we’ve demonstrated that indeed, most children
dying from an RSV infection are younger than 6 months of age. The World Health
Organization has prioritized vaccine development for rotavirus and RSV infections;
rotavirus vaccines have now been introduced and it’s expected that RSV vaccines will
soon follow.
RSV is the
second
cause of
death
during
infancy
worldwide
Within the Child Health Program, we also prioritize rotavirus and RSV, which have
much in common. Both are RNA viruses with exclusive tropism for the epithelium.
Although each virus itself is genetically diverse, it appears that, while genetic diversity
is needed to escape the immune system, it doesn’t contribute to disease severity.
Children with co-morbidities, such as preterm birth, have the highest risk of a severe
course of disease, including death.
Developing a vaccine is complicated
Viruses are excellent at evading our immune system, which makes developing an
effective vaccine challenging. An early formalin-inactivated RSV vaccine developed
the 1960s was a disappointment. Rather than prevent infection, it augmented RSV
disease in vaccine recipients upon natural infection in the community; two immunized
infants died upon infection and the clinical trial was abruptly ended. Several decades
later, the first rotavirus vaccine Rotashield® was approved for infant gastroenteritis.
Unfortunately, it increased susceptibility to intussuception, a rare form of bowel
obstruction where the bowel folds upon itself. Upon investigation, it was concluded
that Rotashield® did contribute to or increased the risk of intussuception and the
vaccine was withdrawn from the market.
26 UMC Utrecht - Child research