Introduction

Among the dominant issues of interest currently in the field of clinical virology research are three essential questions: What threats do known and emerging viruses pose? What specific populations are most threatened by these illnesses? What evidence exists to direct how best to combat these threats? Research into the basic biology and clinical management of infection with severe acute respiratory syndrome and other newly identified coronaviruses, human metapneumovirus and other emerging agents is ongoing. Significant research concerning pandemic influenza virus infection and vaccination planning, and the role of antiviral agents in containment strategies, is under investigation. Another area of interest is the chronic effect that viral infection can have on pulmonary function, including the role of epithelial factors in asthma pathogenesis. The use of animal models has made it possible to gain a greater understanding of the effect of viral illness on lung function. New imaging techniques for assessing infant lung function and structure, such as raised volume rapid thoracoabdominal compression and controlled ventilation, high resolution computed tomography, optimize opportunities for prevention and early treatment among this vulnerable population. Another area of focus within contemporary respiratory virology has been an effort to gain a greater understanding of the threat of respiratory syncytial virus (RSV) among high risk populations, including patients with neuromuscular disease and technology dependence. Recent advances have been accomplished through outcomes studies assessing the predictors of risk for severe RSV disease from various subgroups of premature infants. Advances have also been made in the identification of RSV risk factors. The PICNIC (Pediatric Investigators Collaborative Network on Infections in Canada) and FLIP (Identify Those Risk Factors That Most Likely May Lead to Development of RSV-Related Respiratory Infection and Subsequent Hospital Admission Among Premature Infants Born 33 to 35 Weeks Gestational Age) studies used different methodologies to arrive at consistent findings in terms of risk factors for RSV hospitalization among infants. Recent research on the factors controlling RSV and influenza virus outbreaks has scrutinized shifting demographics and epidemiologic patterns of the viruses and their impact on hospitalization and mortality rates. New vaccines and technologies have emerged to address these threats. Pandemic preparation, a topic introduced at the 2003 International Congress on Respiratory Viruses, has been reevaluated, but with a sharper focus on influenza virus, and specific response strategies and specific antiviral agents. Recent developments in control include the use of live attenuated influenza virus vaccine versus killed vaccine and the role of monoclonal antibodies in the prevention of serious disease caused by respiratory viral infection. Vaccine delivery mechanisms continue to evolve, and safety and efficacy issues surrounding administration of live attenuated vaccines among high risk populations are a topic of concern. The New Vaccine Surveillance Network, an initiative funded by the Centers for Disease Control and Prevention, provides data to help measure the impact of vaccines that decrease the burden of acute respiratory illness in young children. Recent data show that there is considerable variation in admission rates by season and site, with admission rates highest among children <6 months of age. This ongoing initiative is expected to provide information about the effectiveness of influenza vaccine, the epidemiology of respiratory viruses in children and the impact of the pediatric influenza vaccination program. In this supplement, the authors explore these critical and emerging issues in virology. These topics were covered at the 2004 International Congress on Respiratory Viruses and augment the valuable information exchanged at the Congress. The goal of this supplement is to provide a resource to distribute the ideas presented at the Congress and to lay the groundwork for future progress in preventing viral illness. James E. Crowe Jr., MD Vanderbilt University Medical Center Nashville, TN Harry B. Greenberg, MD Stanford University School of Medicine Stanford, CA

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