One of the perks of being a physician-scientist is attending scientific conventions in different parts of the world. For a Filipino scientist, it can’t get any farther than South America, specifically the colorful country of Brazil. The 13th International RSV Symposium this year was held in Foz de Iguaçu in the state of Parana. Foz de Iguaçu is home to the eponymous Iguazu Falls, the largest waterfall system in the world.
The biggest problem with visiting Brazil from the Philippines is getting there. Manila is more than 10,000 miles away, and there are no direct flights. In my case, I flew from Manila to Dubai which is a nine-and-a-half-hour flight, followed by a 15-and-a-half-hour flight from Dubai to Sao Paolo, and a relatively short hop of two hours from Sao Paolo to Foz de Iguaçu. With layover time, it is nearly 36 hours each way and a full three days for the entire round trip. The conference itself ran for four days, which means I spent almost as much time traveling compared with the amount of time attending the scientific sessions.
The 13th International RSV Symposium is organized by the International Society for Influenza and Other Respiratory Virus Diseases. These kinds of conferences are state-of-the-art meetings with leading researchers and academics presenting their latest research findings and networking with other scientists to determine the gaps in knowledge and how to address them. With the Covid-19 pandemic, respiratory viruses have gained a major boost in importance and the medical community is now appreciating the significant impact they have on health, especially in vulnerable populations. The increasing availability of molecular testing such as RT-PCR now allows clinicians to diagnose these diseases definitively and recognize clinical syndromes where there used to be a lot of uncertainty.
The convention kicked off with talks on RSV and a similar respiratory virus known as HMPV. RSV (respiratory syncytial virus) and HMPV (human metapneumovirus) have been shown to be at least as deadly as influenza during the respiratory virus season, more so among young children and the elderly. The keynote speakers were the world’s foremost experts on these viruses. Presentations included talks on molecular epidemiology, the burden of illness, immunopathogenesis, diagnostics, therapeutics, and vaccines.
As an infectious diseases doctor, I see patients with respiratory infections all the time. When I was training, we had very limited tests for diagnosing viruses. The default was always to think of any kind of pneumonia as being caused by bacteria unless proven otherwise. We used a lot of antibiotics if someone had a fever, cough, and an abnormal chest X-ray. When the Covid-19 pandemic hit, viruses such as SARS-CoV-2 were shown to be a common cause of pneumonia, including severe pneumonia. The use of multiplex PCR technologies (which test for multiple targets like viruses, fungi, and bacteria) such as the Biofire®Film Array® Respiratory Panel to test for SARS-CoV-2 had the effect of also diagnosing influenza, RSV, HMPV, and other respiratory viruses as common pathogens. This clearly showed to physicians that a significant proportion of pneumonia patients did not need antibiotics. Since the end of the emergency phase of the pandemic, we have continued to use these tools in our pneumonia patients and they have given us a renewed appreciation of the contribution of respiratory viruses to our burden of illness.
As a result of the recognition of the increased impact of these viruses, new vaccines and therapeutic options have been and continue to be developed at a rapid pace. Two RSV vaccines have recently been launched, decreasing hospitalization rates among the elderly by up to 80 percent. One RSV vaccine can even be given to pregnant women to reduce the risk of RSV in their newborn infants up to six months. This is a true breakthrough because there is no effective vaccine for children, and RSV is the deadliest among those with immature immune systems. A third RSV vaccine based on mRNA technology has likewise been developed, and other candidates are being tested as well.
HMPV was a relatively unknown virus until there were reports of an outbreak in China in late 2024. With increasing recognition and testing, it has become apparent that it can have a similar impact as RSV and has some pandemic potential. HMPV has been observed in most countries of the world, including the Philippines. One of the keynote speakers at the conference was Dr. Bernadette van den Hoogen, one of the co-discoverers of HMPV. She spoke about how they discovered the virus in 2001 and presented their newest research with insights into the behavior of the virus. Needless to say, her talk was a tour de force of cutting-edge science with the vibe of a compelling detective novel.
After the convention program, we found some time to explore Iguazu Falls which is found inside the Iguazu National Park, a UNESCO World Heritage site. It has been dubbed one of the seven wonders of the natural world. The falls are actually 275 individual falls and large islands on Brazil’s border with two other countries, Paraguay and Argentina. Water flows at an average rate of 1.5 million liters per second and can substantially increase during the rainy season. Entry into the park is by timed entry, and only authorized vehicles are allowed. Our tour was divided into two parts. The first leg was a journey into the park known as the Macuco safari which involves hiking through the forest and riding a boat through the rapids and under the falls. Everyone ended up wet from this adventure, which wasn’t such a bad thing since it was a hot day. The second part of the tour involved hiking on a 1.5 km trail along different panoramic outlooks that provided breathtaking views of the majestic falls. The cold spray along with the roaring flow of the water was nothing short of exhilarating as we stared at this spectacle of nature. Aside from the knowledge we gained from the scientific convention, the falls themselves served as icing on the cake, making the epic journey to this incredible country most definitely worth the trip.