Pneumonia in Immunocompromised Patients: Overview, Causes of Pneumonia, HIV/AIDS

RSV In Older Adults

When most people think of respiratory syncytial virus (RSV), they usually think of babies. But you can get it at any age. And if you're older than 60, you're at even greater risk for RSV. "The virus is increasingly recognized as a significant cause of respiratory illness in older adults in the U.S.," says William Schaffner, MD, a spokesperson and former medical director for the National Foundation for Infectious Diseases. The CDC estimates that 177,000 older adults are hospitalized every year and 14,000 die from RSV infections.

What should older adults know about RSV? It is a highly contagious respiratory virus. That means it spreads very easily. RSV infects your nose, throat, lungs, and breathing passages. You'll have symptoms like those of a common cold.

RSV can be easily dismissed as a cold in people who are healthy. It's also easy to confuse RSV with other viruses, like the flu and COVID-19. Loved ones and caregivers should be aware of the chance that RSV in older adults can cause serious sickness or may even be fatal.

Are RSV Symptoms in Older Adults Different?

Symptoms of RSV may look different, depending on how old you are. Young infants may be cranky, not as active, and have a hard time breathing. In adults, symptoms can include: 

Runny nose

Cough

Not much of an appetite

Low-grade fever

Sneezing 

Serious infections in adults may cause pneumonia (an infection in one or both lungs) or bronchiolitis (an inflammation of the respiratory tract). You can watch for signs that RSV may be getting worse, such as:

High fever

Really bad cough

Wheezing – a loud whistling sound when breathing 

Fast breathing

Blue skin because of not enough oxygen 

If you're having trouble breathing or your skin turns bluish, call 911 right away.

Diagnosing RSV in Adults

Since RSV often seems like a cold or the flu, your doctor will try to figure out exactly what you have. First, they'll ask questions about your medical history. They'll pay special attention to the symptoms you tell them about. Next, your doctor will give you a physical exam.  If they suspect RSV, they'll likely do some follow-up lab tests, which may include:

Rapid RSV antigen test: This is the quickest way to diagnose RSV. A fluid sample is taken from your nose (with a nasal swab or gentle suction) to check for certain proteins called antigens. You can usually get results in about an hour.

Molecular test: Sometimes, only small amounts of the virus are in your nose. For older adults, an RT-PCR test (which also uses a nasal swab) can find a smaller amount, compared to an antigen test. The samples are usually sent to a lab. In certain cases, your doctor might run a respiratory panel test to look for RSV as well as other viruses and bacteria. 

You don't have to do anything to prepare for these tests. But you may feel some discomfort from the nasal swab. The best time to do these tests is within the first days of symptoms. 

How Do Adults Spread RSV?

RSV often spreads quickly. Children can spread RSV and other germs in day care. But adults pass on RSV in any situation similar to how they might spread a cold. Here are some common ways it can happen:

A person with RSV coughs or sneezes, and virus droplets get into your nose, eyes, or mouth.

You touch a surface – like a kitchen counter or doorknob – that has RSV on it, then either rub your eyes or touch your face without washing your hands. RSV can live on hard surfaces for several hours.

You have close contact with someone who is infected with RSV, like an adult or child that you may kiss. 

If you have RSV, you can be contagious for at least 3-8 days. But if you have a weakened immune system, you can spread the disease for as long as 4 weeks, even if you don't have symptoms anymore. RSV infections most often happen in the fall, winter, and spring (November to April). But you can get it in any season. 

How Does RSV Affect Adults Older Than 60?

For most adults, RSV will cause cold-like symptoms and will get better within 1 or 2 weeks. 

But some adults may have more serious complications, like:

Pneumonia

Bronchiolitis

Congestive heart failure – when the heart can't pump enough blood and oxygen throughout the body

Worsening of asthma or chronic obstructive pulmonary disease (COPD)

RSV symptoms can be much more serious in older adults who have asthma, COPD, and weakened immune systems. And almost everyone's immune system gets weaker as we age, which puts older adults at greater risk. 

Sometimes, RSV is fatal. 

What Treatments Are Available for Adults with RSV?

There are vaccines to protect older adults from severe cases of RSV. 

Your doctor may suggest over-the-counter pain relievers or fever reducers. And saline drops or sprays can help with stuffy noses. While symptoms will go away for most adults, older adults with complications may have to go to the hospital. Generally, treatments involve supportive care, like: 

IV fluids (in your vein) to make sure you're hydrated

Oxygen

A ventilator to help you breathe

Breathing treatments

Early treatment with aerosol ribavirin that you inhale and immunoglobulin in your vein may improve survival if you have a very weak immune system.

How Can RSV in Older People Be Prevented?

If you're at high risk for RSV – or you're a caregiver or loved one of an adult over 60 who may be more prone to getting it – there are things you can do to keep yourself and them healthy:

Get vaccinated. The FDA has approved two RSV vaccines for adults 60 and older.

Avoid close contact with sick people. This includes touching, kissing, or hugging someone who has cold-like symptoms. Don't drink from the same glass or share eating utensils. If you can't avoid close contact, think about using a mask or gloves.

Wash your hands often. Use soap and water for at least 20 seconds. If washing your hands isn't an option, use an alcohol-based sanitizer to keep germs off fingers and palms. 

Avoid putting your hands on your face. Germs can be spread by touching your nose, eyes, and mouth. 

Clean and disinfect surfaces. Regularly cleaning counters, doorknobs, mobile devices, or other surfaces you constantly touch is a good practice to help stop illness. RSV can stay on surfaces for several hours. That is true whether someone with RSV coughs or sneezes droplets onto the surfaces or just touches them.

Cover your mouth when you sneeze or cough. If you are around an older loved one a lot, make sure you are covering your mouth and nose when you cough or sneeze. Use a tissue, then throw it away afterward (and wash your hands). If you feel a sneeze coming on and don't have a tissue, sneeze into your upper shirt sleeve.

What Is the Outlook for People Over 60 Who Get RSV?

Not all adults with RSV will have to go to the hospital. But some may face serious complications, especially if they already have weakened immune systems or long-term lung and heart problems.

Researchers have found ways to stop and treat RSV. Those include vaccines and monoclonal antibodies targeted for infants and young children, older adults, pregnant people, and people who have weak immune systems.

"There is a need for rapid, inexpensive, highly accurate, and easy-to-use RSV" tests at places where people go for health care. That's especially true for "primary care practices, which can help increase awareness of RSV infection in vulnerable populations," Schaffner says.

RSV Vaccines

FILE - This electron microscope image provided by the National Institutes of Health shows human respiratory syncytial virus (RSV) virions, colorized blue, and anti-RSV F protein/gold antibodies, colorized yellow, shedding from the surface of human lung cells. In a report released Thursday, May 30, 2024, the Centers for Disease Control and Prevention said they are continuing to investigate a link between two new RSV vaccines and cases of a rare nervous system disorder in older U.S. Adults.

Uncredited - hogp, ASSOCIATED PRESS

Lethally RSV Infected Animals Orally Treated With NV-387 Showed Normal Lung Histology, Indicating Potential Cure

NV-387, A Broad-Spectrum Antiviral with Strong Activity Against RSV, Influenza A, Coronaviruses, Others

SHELTON, CT / ACCESSWIRE / May 20, 2024 / NanoViricides, Inc. (NYSE American:NNVC) (the "Company"), a global leader in broad-spectrum antiviral nanomedicines, says that the strong antiviral activity of NV-387 against RSV/A2 is clearly demonstrated by lungs remaining normal and showing no infection-related damage, when treated orally with NV-387, in a lethal lung RSV infection animal model. The animals in only the NV-387 treated group survived completely, as previously reported. The complete survival and clear lungs indicate that NV-387 treatment completely protected the animals and could be potentially a cure for RSV infection.

In this study, extended dosing of NV-387 given orally was compared with a high dose of ribavirin given orally. Two doses were given on first day of dosing followed by one daily dose for next 9 days (total 11 doses).

The lethally RSV-infected animals in the NV-387-treated group showed no lung damage in lung histo-pathology study at all time points during the study, including at the end of the study. This demonstrates that the the NV-387 oral treatment completely protected the animals from the lethal level of RSV infection. Animals in this group survived completely, beyond the 21-day study period, as previously reported.

In contrast, lethally infected animals in the Ribavirin oral treatment group showed progressive lung pathology, demonstrating progressive inflammation in the lung tissue which resulted in moderate levels of inflammation as well as infected cells in the inflammatory infiltrate on day 10, increasing to severely infected lungs with alveolitis and severe pneumonia by day 13. All animals in the ribavirin-treated RSV infected group died by 14 days.

These lung histo-pathology results support our belief that NV-387 oral treatment led to complete cure of the lethal RSV infection.

There is currently no approved treatment for RSV other than the highly toxic, last-resort drug, ribavirin. A safe and effective treatment remains an unmet medical need.

"These results clearly demonstrate that NV-387 oral treatment would be of great clinical value for protecting infants and children from RSV," said Anil R. Diwan, PhD, adding, "We are very pleased with these results and plan on advancing NV-387 for the treatment of RSV infection into clinical trials as soon as possible."

RSV is an important disease in infants and children less than 5 years old, as well as in older persons over 65 years old. According to the CDC, each year in the United States, RSV leads to approximately:

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58,000-80,000 hospitalizations among children younger than 5 years old;

60,000-160,000 hospitalizations among adults 65 years and older;

6,000-10,000 deaths among adults 65 years and older; and

100-300 deaths in children younger than 5 years old.

Two vaccines have recently been approved for protection of persons 60+ years old from RSV infection (Arexvy®, GSK, and Abrysvo®, Pfizer). Abrysvo was recently approved for use in pregnant women for protection of infants. Palivizumab (Synagis®), an antibody, as well as a new antibody, nirsevimab (Beyfortus®) have been approved by the US FDA for protection of newborn children at risk of RSV disease, but not for treatment of RSV infection and disease.

About NanoViricides

NanoViricides, Inc. (the "Company") (www.Nanoviricides.Com) is a development stage company that is creating special purpose nanomaterials for antiviral therapy. The Company's novel nanoviricide® class of drug candidates are designed to specifically attack enveloped virus particles and to dismantle them. Additionally, nanoviricides mimick the host-side features that the viruses continue to require in spite of mutations, and therefore the viruses would be highly unlikely to escape the nanvoricide drugs.

Our lead drug candidate is NV-387 (drug product NV-CoV-2) for the treatment of RSV, COVID-19, Long COVID, Influenza, Bird Flu H5N1, and other respiratory viral infections. NV-387 has successfully completed a Phase 1a/1b human clinical trial in healthy subjects with no reported adverse events even at the highest and repeated dosages. The Company is currently focused on advancing NV-387 into Phase II human clinical trials for treatment of RSV infection.

Our other advanced candidate is NV-HHV-1 for the treatment of Shingles rash, HSV-1 "cold sores" and HSV-2 "genital ulcers". The Company cannot project an exact date for filing an IND for any of its drugs because of dependence on a number of external collaborators and consultants.

The Company is also developing drugs against a number of viral diseases including oral and genital Herpes, viral diseases of the eye including EKC and herpes keratitis, H1N1 swine flu, H5N1 bird flu, seasonal Influenza, HIV, Hepatitis C, Rabies, Dengue fever, and Ebola virus, among others. NanoViricides' platform technology and programs are based on the TheraCour® nanomedicine technology of TheraCour, which TheraCour licenses from AllExcel. NanoViricides holds a worldwide exclusive perpetual license to this technology for several drugs with specific targeting mechanisms in perpetuity for the treatment of the following human viral diseases: Human Immunodeficiency Virus (HIV/AIDS), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Rabies, Herpes Simplex Virus (HSV-1 and HSV-2), Varicella-Zoster Virus (VZV), Influenza and Asian Bird Flu Virus, Dengue viruses, Japanese Encephalitis virus, West Nile Virus, Ebola/Marburg viruses, and certain Coronaviruses. The Company intends to obtain a license for poxviruses and/or enteroviruses if the initial research is successful. The Company's technology is based on broad, exclusive, sub-licensable, field licenses to drugs developed in these areas from TheraCour Pharma, Inc. The Company's business model is based on licensing technology from TheraCour Pharma Inc. For specific application verticals of specific viruses, as established at its foundation in 2005.

As is customary, the Company must state the risk factor that the path to typical drug development of any pharmaceutical product is extremely lengthy and requires substantial capital. As with any drug development efforts by any company, there can be no assurance at this time that any of the Company's pharmaceutical candidates would show sufficient effectiveness and safety for human clinical development. Further, there can be no assurance at this time that successful results against coronavirus in our lab will lead to successful clinical trials or a successful pharmaceutical product.

This press release contains forward-looking statements that reflect the Company's current expectation regarding future events. Actual events could differ materially and substantially from those projected herein and depend on a number of factors. Certain statements in this release, and other written or oral statements made by NanoViricides, Inc. Are "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. You should not place undue reliance on forward-looking statements since they involve known and unknown risks, uncertainties and other factors which are, in some cases, beyond the Company's control and which could, and likely will, materially affect actual results, levels of activity, performance or achievements. The Company assumes no obligation to publicly update or revise these forward-looking statements for any reason, or to update the reasons actual results could differ materially from those anticipated in these forward-looking statements, even if new information becomes available in the future. Important factors that could cause actual results to differ materially from the company's expectations include, but are not limited to, those factors that are disclosed under the heading "Risk Factors" and elsewhere in documents filed by the company from time to time with the United States Securities and Exchange Commission and other regulatory authorities. Although it is not possible to predict or identify all such factors, they may include the following: demonstration and proof of principle in preclinical trials that a nanoviricide is safe and effective; successful development of our product candidates; our ability to seek and obtain regulatory approvals, including with respect to the indications we are seeking; the successful commercialization of our product candidates; and market acceptance of our products.

The phrases "safety", "effectiveness" and equivalent phrases as used in this press release refer to research findings including clinical trials as the customary research usage and do not indicate evaluation of safety or effectiveness by the US FDA.

FDA refers to US Food and Drug Administration. IND application refers to "Investigational New Drug" application. CGMP refers to current Good Manufacturing Practices. CMC refers to "Chemistry, Manufacture, and Controls". CHMP refers to the Committee for Medicinal Products for Human Use, which is the European Medicines Agency's (EMA) committee responsible for human medicines. API stands for "Active Pharmaceutical Ingredient". API means active pharmaceutical ingredient.

Contact:NanoViricides, Inc.Info@nanoviricides.Com

Public Relations Contact:MJ Clyburn, TraDigital IRclyburn@tradigitalir.Com

SOURCE: NanoViricides, Inc.

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