Fernando Polack, M.D., the Cesar Milstein Associate Professor of Pediatrics at Vanderbilt, has received a Bill and Melinda Gates Foundation award for $1.5 million to study the burden of respiratory syncytial virus (RSV) bronchiolitis in children from underserved populations. The study will be conducted over three years in Buenos Aires, Argentina.
In children under age 1, RSV is the most common cause of bronchiolitis, an inflammation of the small airway in the lungs. By age 2, almost all children will have suffered an RSV infection. RSV remains one of the most significant causes of hospitalization for infants and toddlers.
Fifteen hospitals in the Southern districts of Buenos Aires, a region where 85 percent of the population lives below the poverty line, will collect data. The population includes more than 200,000 children.
"While we know that a majority, in fact more than 90 percent of children who die from RSV, are in poor countries, we need to better understand why this happens and who are the children at greatest risk for very severe or fatal disease. Part of the reason why it has been difficult to document is that a great deal of deaths in the developing world occur at home." Polack said.
Polack said the time is right for this research. RSV tests have become more sensitive and vaccines have been developed against other agents of severe lung disease in children. Other research, some conducted by Vanderbilt experts, has been able to show the burden of serious disease in RSV infection is great, even in developed countries. While the fatality rate from RSV bronchiolitis is low, estimated to be below 1 percent of cases, about half of the world's population gets infected with the virus in the first year of life.
"Because RSV is extremely frequent, the number of deaths becomes substantial. But, given that death is an infrequent event, very large studies are needed to look at risk factors for fatal disease. It takes many patients to identify what demographic or clinical characteristics are common to fatal cases," Polack said.
"Fernando is addressing a question of enormous global health importance that will impact the lives of countless children in underserved, impoverished areas. The support from the Gates Foundation will generate important new information on risk for serious disease in this common infection that will spur new interventions," said Lou Muglia, M.D., Ph.D., the Edward Claiborne Stahlman Professor of Pediatrics and vice chair for Research Affairs in the Department of Pediatrics.
It has been particularly tricky to develop a vaccine against RSV. Even the natural immune response doesn't last, so that most people get RSV again within five years of having the infection. This means a vaccine would need to promote a greater response than exposure to the natural virus. No current vaccines are able to do this.
"But an important milestone for encouraging agencies to fund work promoting RSV vaccine development to protect infants in developing countries is to show the impact of the virus on children in underserved areas," Polack said.
Polack also serves as the director of the INFANT Foundation, a research and clinical institute based in Buenos Aires that works closely with Vanderbilt's Vaccine Center. The RSV surveillance project begins in May 2011, the beginning of the bronchiolitis and flu season in South America.
Tags: Vanderbilt Children's Health Improvement and Prevention, Department of Pediatrics
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