Airway response to respiratory syncytial virus has incidental antibacterial effects.

RSV infection is typically associated with secondary bacterial infection. We hypothesise that the local airway immune response to RSV has incidental antibacterial effects. Using coordinated proteomics and metagenomics analysis we simultaneously analysed the microbiota and proteomes of the upper airway and determined direct antibacterial activity in airway secretions of RSV-infected children. Here, we report that the airway abundance of Streptococcus was higher in samples collected at the time of RSV infection compared with samples collected one month later. RSV infection is associated with neutrophil influx into the airway and degranulation and is marked by overexpression of proteins with known antibacterial activity including BPI, EPX, MPO and AZU1. Airway secretions of children infected with RSV, have significantly greater antibacterial activity compared to RSV-negative controls. This RSV-associated, neutrophil-mediated antibacterial response in the airway appears to act as a regulatory mechanism that modulates bacterial growth in the airways of RSV-infected children

Understanding of Coupled Terrestrial Carbon, Nitrogen and Water Dynamics—An Overview

Coupled terrestrial carbon (C), nitrogen (N) and hydrological processes play a crucial role in the climate system, providing both positive and negative feedbacks to climate change. In this review we summarize published research results to gain an increased understanding of the dynamics between vegetation and atmosphere processes. A variety of methods, including monitoring (e.g., eddy covariance flux tower, remote sensing, etc.) and modeling (i.e., ecosystem, hydrology and atmospheric inversion modeling) the terrestrial carbon and water budgeting, are evaluated and compared. We highlight two major research areas where additional research could be focused: (i) Conceptually, the hydrological and biogeochemical processes are closely linked, however, the coupling processes between terrestrial C, N and hydrological processes are far from well understood; and (ii) there are significant uncertainties in estimates of the components of the C balance, especially at landscape and regional scales. To address these two questions, a synthetic research framework is needed which includes both bottom-up and top-down approaches integrating scalable (footprint and ecosystem) models and a spatially nested hierarchy of observations which include multispectral remote sensing, inventories, existing regional clusters of eddy-covariance flux towers and CO2 mixing ratio towers and chambers

Cost-effectiveness of rule-based immunoprophylaxis against respiratory syncytial virus infections in preterm infants

The objective of the paper is to assess the cost-effectiveness of targeted respiratory syncytial virus (RSV) prophylaxis based on a validated prediction rule with 1-year time horizon in moderately preterm infants compared to no prophylaxis. Data on health care consumption were derived from a randomised clinical trial on wheeze reduction following RSV prophylaxis and a large birth cohort study on risk prediction of RSV hospitalisation. We calculated the incremental cost-effectiveness ratio (ICER) of targeted RSV prophylaxis vs. no prophylaxis per quality-adjusted life year (QALYs) using a societal perspective, including medical and parental costs and effects. Costs and health outcomes were modelled in a decision tree analysis with sensitivity analyses. Targeted RSV prophylaxis in infants with a first-year RSV hospitalisation risk of > 10% resulted in a QALY gain of 0.02 (0.931 vs. 0.929) per patient against additional cost of €472 compared to no prophylaxis (ICER €214,748/QALY). The ICER falls below a threshold of €80,000 per QALY when RSV prophylaxis cost would be lowered from €928 (baseline) to €406 per unit. At a unit cost of €97, RSV prophylaxis would be cost saving. Conclusions: Targeted RSV prophylaxis is not cost-effective in reducing RSV burden of disease in moderately preterm infants, but it can become cost-effective if lower priced biosimilar palivizumab or a vaccine would be available