1887
  1. Home
  2. Eurosurveillance
  3. Volume 29, Issue 5, 01/Feb/2024
  4. Article
Systematic Review Open Access
Like 0
Download

Abstract

Background

There is currently no standardised approach to estimate respiratory syncytial virus (RSV) epidemics’ timing (or seasonality), a critical information for their effective prevention and control.

Aim

We aimed to provide an overview of methods to define RSV seasonality and identify factors supporting method choice or interpretation/comparison of seasonal estimates.

Methods

We systematically searched PubMed and Embase (2016–2021) for studies using quantitative approaches to determine the start and end of RSV epidemics. Studies’ features (data-collection purpose, location, regional/(sub)national scope), methods, and assessment characteristics (case definitions, sampled population’s age, in/outpatient status, setting, diagnostics) were extracted. Methods were categorised by their need of a denominator (i.e. numbers of specimens tested) and their retrospective vs real-time application. Factors worth considering when choosing methods and assessing seasonal estimates were sought by analysing studies.

Results

We included 32 articles presenting 49 seasonality estimates (18 thereof through the 10% positivity threshold method). Methods were classified into eight categories, two requiring a denominator (1 retrospective; 1 real-time) and six not (3 retrospective; 3 real-time). A wide range of assessment characteristics was observed. Several studies showed that seasonality estimates varied when methods differed, or data with dissimilar assessment characteristics were employed. Five factors (comprising study purpose, application time, assessment characteristics, healthcare system and policies, and context) were identified that could support method choice and result interpretation.

Conclusion

Methods and assessment characteristics used to define RSV seasonality are heterogeneous. Our categorisation of methods and proposed framework of factors may assist in choosing RSV seasonality methods and interpretating results.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.5.2300244
2024-02-01
2024-12-21
/content/10.2807/1560-7917.ES.2024.29.5.2300244
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/5/eurosurv-29-5_5.html?itemId=/content/10.2807/1560-7917.ES.2024.29.5.2300244&mimeType=html&fmt=ahah

References

  1. Li Y, Reeves RM, Wang X, Bassat Q, Brooks WA, Cohen C, et al. , RSV Global Epidemiology Network, RESCEU investigators. Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis. Lancet Glob Health. 2019;7(8):e1031-45.  https://doi.org/10.1016/S2214-109X(19)30264-5  PMID: 31303294 
  2. Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, et al. , Respiratory Virus Global Epidemiology Network, RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047-64.  https://doi.org/10.1016/S0140-6736(22)00478-0  PMID: 35598608 
  3. Hall CB, Long CE, Schnabel KC. Respiratory syncytial virus infections in previously healthy working adults. Clin Infect Dis. 2001;33(6):792-6.  https://doi.org/10.1086/322657  PMID: 11512084 
  4. Amand C, Tong S, Kieffer A, Kyaw MH. Healthcare resource use and economic burden attributable to respiratory syncytial virus in the United States: a claims database analysis. BMC Health Serv Res. 2018;18(1):294.  https://doi.org/10.1186/s12913-018-3066-1  PMID: 29678177 
  5. Prasad N, Newbern EC, Trenholme AA, Thompson MG, McArthur C, Wong CA, et al. The health and economic burden of respiratory syncytial virus associated hospitalizations in adults. PLoS One. 2020;15(6):e0234235.  https://doi.org/10.1371/journal.pone.0234235  PMID: 32525898 
  6. European Medicines Agency (EMA). New medicine to protect babies and infants from respiratory syncytial virus (RSV) infection. Amsterdam: EMA; 2022. [Accessed 16 Sep 2022]. Available from: https://www.ema.europa.eu/en/news/new-medicine-protect-babies-infants-respiratory-syncytial-virus-rsv-infection
  7. Drysdale SB, Green CA, Sande CJ. Best practice in the prevention and management of paediatric respiratory syncytial virus infection. Ther Adv Infect Dis. 2016;3(2):63-71.  https://doi.org/10.1177/2049936116630243  PMID: 27034777 
  8. RSV Vaccine and mAb Snapshot. [Accessed 16 Jun 2021]. Available from: https://www.path.org/resources/rsv-vaccine-and-mab-snapshot/
  9. Hampp C, Kauf TL, Saidi AS, Winterstein AG. Cost-effectiveness of respiratory syncytial virus prophylaxis in various indications. Arch Pediatr Adolesc Med. 2011;165(6):498-505.  https://doi.org/10.1001/archpediatrics.2010.298  PMID: 21300647 
  10. Kieffer A, Beuvelet M, Sardesai A, Musci R, Milev S, Roiz J, et al. Expected Impact of Universal Immunization With Nirsevimab Against RSV-Related Outcomes and Costs Among All US Infants in Their First RSV Season: A Static Model. J Infect Dis. 2022;226(Suppl 2):S282-92.  https://doi.org/10.1093/infdis/jiac216  PMID: 35968866 
  11. Teirlinck AC, Broberg EK, Stuwitz Berg A, Campbell H, Reeves RM, Carnahan A, et al. Recommendations for respiratory syncytial virus surveillance at the national level. Eur Respir J. 2021;58(3):2003766.  https://doi.org/10.1183/13993003.03766-2020  PMID: 33888523 
  12. Vos LM, Teirlinck AC, Lozano JE, Vega T, Donker GA, Hoepelman AI, et al. Use of the moving epidemic method (MEM) to assess national surveillance data for respiratory syncytial virus (RSV) in the Netherlands, 2005 to 2017. Euro Surveill. 2019;24(20):1800469.  https://doi.org/10.2807/1560-7917.ES.2019.24.20.1800469  PMID: 31115311 
  13. Grilc E, Prosenc Trilar K, Lajovic J, Sočan M. Determining the seasonality of respiratory syncytial virus in Slovenia. Influenza Other Respir Viruses. 2021;15(1):56-63.  https://doi.org/10.1111/irv.12779  PMID: 32656961 
  14. Renko M, Tapiainen T. Change in respiratory syncytial virus seasonality in Finland. Acta Paediatr. 2020;109(1):202-3.  https://doi.org/10.1111/apa.14983  PMID: 31441534 
  15. van Summeren J, Meijer A, Aspelund G, Casalegno JS, Erna G, Hoang U, et al. , VRS study group in Lyon. Low levels of respiratory syncytial virus activity in Europe during the 2020/21 season: what can we expect in the coming summer and autumn/winter? Euro Surveill. 2021;26(29):2100639.  https://doi.org/10.2807/1560-7917.ES.2021.26.29.2100639  PMID: 34296672 
  16. Miyama T, Iritani N, Nishio T, Ukai T, Satsuki Y, Miyata H, et al. Seasonal shift in epidemics of respiratory syncytial virus infection in Japan. Epidemiol Infect. 2021;149:e55.  https://doi.org/10.1017/S0950268821000340  PMID: 33568242 
  17. Abu-Raya B, Viñeta Paramo M, Reicherz F, Lavoie PM. Why has the epidemiology of RSV changed during the COVID-19 pandemic? EClinicalMedicine. 2023;61:102089.  https://doi.org/10.1016/j.eclinm.2023.102089  PMID: 37483545 
  18. Hamid S, Winn A, Parikh R, Jones JM, McMorrow M, Prill MM, et al. Seasonality of Respiratory Syncytial Virus - United States, 2017-2023. MMWR Morb Mortal Wkly Rep. 2023;72(14):355-61.  https://doi.org/10.15585/mmwr.mm7214a1  PMID: 37022977 
  19. Eden JS, Sikazwe C, Xie R, Deng YM, Sullivan SG, Michie A, et al. , Australian RSV study group. Off-season RSV epidemics in Australia after easing of COVID-19 restrictions. Nat Commun. 2022;13(1):2884.  https://doi.org/10.1038/s41467-022-30485-3  PMID: 35610217 
  20. Rose EB, Wheatley A, Langley G, Gerber S, Haynes A. Respiratory Syncytial Virus Seasonality - United States, 2014-2017. MMWR Morb Mortal Wkly Rep. 2018;67(2):71-6.  https://doi.org/10.15585/mmwr.mm6702a4  PMID: 29346336 
  21. World Health Organization (WHO). Global Epidemiological Surveillance Standards for Influenza. Geneva: WHO; 2013.
  22. Midgley CM, Haynes AK, Baumgardner JL, Chommanard C, Demas SW, Prill MM, et al. Determining the seasonality of respiratory syncytial virus in the United States: The impact of increased molecular testing. J Infect Dis. 2017;216(3):345-55.  https://doi.org/10.1093/infdis/jix275  PMID: 28859428 
  23. Ambrose CS, Steed LL, Brandon M, Frye K, Olajide IR, Thomson G. National and regional modeling of distinct RSV seasonality thresholds for antigen and PCR testing in the United States. J Clin Virol. 2019;120:68-77.  https://doi.org/10.1016/j.jcv.2019.09.010  PMID: 31590113 
  24. Grijalva CG, Poehling KA, Edwards KM, Weinberg GA, Staat MA, Iwane MK, et al. Accuracy and interpretation of rapid influenza tests in children. Pediatrics. 2007;119(1):e6-11.  https://doi.org/10.1542/peds.2006-1694  PMID: 17200259 
  25. Broberg EK, Waris M, Johansen K, Snacken R, Penttinen P, European Influenza Surveillance Network. Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016. Euro Surveill. 2018;23(5):17-00284.  https://doi.org/10.2807/1560-7917.ES.2018.23.5.17-00284  PMID: 29409569 
  26. Baumeister E, Duque J, Varela T, Palekar R, Couto P, Savy V, et al. Timing of respiratory syncytial virus and influenza epidemic activity in five regions of Argentina, 2007-2016. Influenza Other Respir Viruses. 2019;13(1):10-7.  https://doi.org/10.1111/irv.12596  PMID: 30051595 
  27. Obando-Pacheco P, Justicia-Grande AJ, Rivero-Calle I, Rodríguez-Tenreiro C, Sly P, Ramilo O, et al. Respiratory Syncytial Virus Seasonality: A Global Overview. J Infect Dis. 2018;217(9):1356-64.  https://doi.org/10.1093/infdis/jiy056  PMID: 29390105 
  28. Bollyky TJ, Hulland EN, Barber RM, Collins JK, Kiernan S, Moses M, et al. , COVID-19 National Preparedness Collaborators. Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. Lancet. 2022;399(10334):1489-512.  https://doi.org/10.1016/S0140-6736(22)00172-6  PMID: 35120592 
  29. European Medicines Agency (EMA). First RSV vaccine to protect infants up to 6 months of age and older adults. Amsterdam: EMA. [Accessed 11 Oct 2023]. Available from: https://www.ema.europa.eu/en/news/first-rsv-vaccine-protect-infants-6-months-age-older-adults
  30. United States Food and Drug Administration (FDA). FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Rockville: FDA. [Accessed 11 Oct 2023]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  31. Centers for Disease Control and Prevention (CDC). Frequently Asked Questions About RSV Vaccine for Adults. Atlanta: CDC. [Accessed 11 Oct 2023]. Available from: https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults-faqs.html
  32. Wu SL, Mertens AN, Crider YS, Nguyen A, Pokpongkiat NN, Djajadi S, et al. Substantial underestimation of SARS-CoV-2 infection in the United States. Nat Commun. 2020;11(1):4507.  https://doi.org/10.1038/s41467-020-18272-4  PMID: 32908126 
  33. Staadegaard L, Caini S, Wangchuk S, Thapa B, de Almeida WAF, de Carvalho FC, et al. The Global Epidemiology of RSV in Community and Hospitalized Care: Findings From 15 Countries. Open Forum Infect Dis. 2021;8(7):ofab159.  https://doi.org/10.1093/ofid/ofab159  PMID: 34337092 
  34. Simpson RB, Gottlieb J, Zhou B, Hartwick MA, Naumova EN. Completeness of open access FluNet influenza surveillance data for Pan-America in 2005-2019. Sci Rep. 2021;11(1):795.  https://doi.org/10.1038/s41598-020-80842-9  PMID: 33437025 
  35. Healthcare access and quality by level of healthcare spending, 2017. [Accessed 28 Feb 2023]. Available from: https://ourworldindata.org/grapher/haq-by-level-of-healthcare-spending-endpoints?country=NLD~DEU~FRA~ITA~USA
  36. World Bank Group - International Development. Poverty, & Sustainability. [Accessed 28 Feb 2023]. Available from: https://www.worldbank.org/en/home
  37. Paget J, Staadegaard L, Wang X, Li Y, van Pomeren T, van Summeren J, et al. Global and national influenza-associated hospitalisation rates: Estimates for 40 countries and administrative regions. J Glob Health. 2023;13:04003.  https://doi.org/10.7189/jogh.13.04003  PMID: 36701368 
  38. Li Y, Hodgson D, Wang X, Atkins KE, Feikin DR, Nair H. Respiratory syncytial virus seasonality and prevention strategy planning for passive immunisation of infants in low-income and middle-income countries: a modelling study. Lancet Infect Dis. 2021;21(9):1303-12.  https://doi.org/10.1016/S1473-3099(20)30703-9  PMID: 33965062 
  39. Staadegaard L, Caini S, Wangchuk S, Thapa B, de Almeida WAF, de Carvalho FC, et al. Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries. Influenza Other Respir Viruses. 2021;15(6):732-41.  https://doi.org/10.1111/irv.12885  PMID: 34255934 
  40. Chadha M, Hirve S, Bancej C, Barr I, Baumeister E, Caetano B, et al. , WHO RSV Surveillance Group. Human respiratory syncytial virus and influenza seasonality patterns-Early findings from the WHO global respiratory syncytial virus surveillance. Influenza Other Respir Viruses. 2020;14(6):638-46.  https://doi.org/10.1111/irv.12726  PMID: 32163226 
  41. Broberg E, Johansen K, Adlhoch C, Snacken R, Penttinen P. Seasonality of respiratory syncytial virus infection in the EU/EEA, 2010-2016. J Clin Virol. 2016;82:S116-7.  https://doi.org/10.1016/j.jcv.2016.08.234 
  42. Baker RE, Mahmud AS, Wagner CE, Yang W, Pitzer VE, Viboud C, et al. Epidemic dynamics of respiratory syncytial virus in current and future climates. Nat Commun. 2019;10(1):5512.  https://doi.org/10.1038/s41467-019-13562-y  PMID: 31797866 
  43. Harcourt SE, Morbey RA, Smith GE, Loveridge P, Green HK, Pebody R, et al. Developing influenza and respiratory syncytial virus activity thresholds for syndromic surveillance in England. Epidemiol Infect. 2019;147:e163.  https://doi.org/10.1017/S0950268819000542  PMID: 31063101 
  44. Glick AF, Kjelleren S, Hofstetter AM, Subramony A. RSV Hospitalizations in Comparison With Regional RSV Activity and Inpatient Palivizumab Administration, 2010-2013. Hosp Pediatr. 2017;7(5):271-8.  https://doi.org/10.1542/hpeds.2016-0124  PMID: 28381595 
  45. Glatman-Freedman A, Kaufman Z, Applbaum Y, Dichtiar R, Steiman A, Gordon E-S, et al. Respiratory Syncytial Virus hospitalization burden: a nation-wide population-based analysis, 2000-2017. J Infect. 2020;81(2):297-303.  https://doi.org/10.1016/j.jinf.2020.05.078  PMID: 32504738 
  46. Reis J, Yamana T, Kandula S, Shaman J. Superensemble forecast of respiratory syncytial virus outbreaks at national, regional, and state levels in the United States. Epidemics. 2019;26:1-8.  https://doi.org/10.1016/j.epidem.2018.07.001  PMID: 30025885 
  47. Gentile Á, Lucion MF, Juárez MDV, Castellano V, Bakir J, Pacchiotti A, et al. Virus sincicial respiratorio en niños nacidos prematuros: 19 años de vigilancia epidemiológica activa en un hospital pediátrico. [Respiratory syncytial virus in preterm infants: 19 years of active epidemiological surveillance in a children’s hospital]. Arch Argent Pediatr. 2020;118(6):386-92. PMID: 33231045 
  48. Haynes AK, Fowlkes AL, Schneider E, Mutuc JD, Armstrong GL, Gerber SI. Human Metapneumovirus Circulation in the United States, 2008 to 2014. Pediatrics. 2016;137(5):e20152927.  https://doi.org/10.1542/peds.2015-2927  PMID: 27244790 
  49. Olajide I, Ambrose C, Dube C. New method for determining respiratory syncytial virus seasonality in the United States: Results from RSV alert, a hospital-based laboratory surveillance program. J Manag Care Spec Pharm. 2018;24(10A):S67. Available at: https://www.jmcp.org/doi/epdf/10.18553/jmcp.2018.24.10-a.s1
  50. Paz-Bailey G, Adams L, Munoz J, Lozier M, Olsen S, Blanton L, et al. Trends in influenza and other respiratory viruses in Southern Puerto Rico, 2012-2017. Am J Trop Med Hyg. 2018;99(4):524. Available at: https://www.embase.com/records?subaction=viewrecord&id=L627541364
  51. Chi H, Chung C-H, Lin Y-J, Lin C-H. Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan. PLoS One. 2018;13(5):e0197410.  https://doi.org/10.1371/journal.pone.0197410  PMID: 29746578 
  52. Yu J, Liu C, Xiao Y, Xiang Z, Zhou H, Chen L, et al. Respiratory Syncytial Virus Seasonality, Beijing, China, 2007-2015. Emerg Infect Dis. 2019;25(6):1127-35.  https://doi.org/10.3201/eid2506.180532  PMID: 31107230 
  53. Wrotek A, Czajkowska M, Jackowska T. Seasonality of Respiratory Syncytial Virus Hospitalization. Adv Exp Med Biol. 2020;1279:93-100.  https://doi.org/10.1007/5584_2020_503  PMID: 32170670 
  54. Gentile A, Lucion MF, Juarez MDV, Areso MS, Bakir J, Viegas M, et al. Burden of Respiratory Syncytial Virus Disease and Mortality Risk Factors in Argentina: 18 Years of Active Surveillance in a Children’s Hospital. Pediatr Infect Dis J. 2019;38(6):589-94.  https://doi.org/10.1097/INF.0000000000002271  PMID: 30672892 
  55. Pellegrinelli L, Galli C, Bubba L, Cereda D, Anselmi G, Binda S, et al. Respiratory syncytial virus in influenza-like illness cases: Epidemiology and molecular analyses of four consecutive winter seasons (2014-2015/2017-2018) in Lombardy (Northern Italy). J Med Virol. 2020;92(12):2999-3006.  https://doi.org/10.1002/jmv.25917  PMID: 32314816 
  56. Callahan ZY, Smith TK, Ingersoll C, Gardner R, Korgenski EK, Sloan CD. Comparative Seasonal Respiratory Virus Epidemic Timing in Utah. Viruses. 2020;12(3):275.  https://doi.org/10.3390/v12030275  PMID: 32121465 
  57. Ramaekers K, Keyaerts E, Rector A, Borremans A, Beuselinck K, Lagrou K, et al. Prevalence and seasonality of six respiratory viruses during five consecutive epidemic seasons in Belgium. J Clin Virol. 2017;94:72-8.  https://doi.org/10.1016/j.jcv.2017.07.011  PMID: 28772168 
  58. Shapiro D, Bodinayake CK, Nagahawatte A, Devasiri V, Kurukulasooriya R, Hsiang J, et al. Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka. Am J Trop Med Hyg. 2017;97(1):88-96.  https://doi.org/10.4269/ajtmh.17-0032  PMID: 28719323 
  59. Rose EB, Nyawanda BO, Munywoki PK, Murunga N, Bigogo GM, Otieno NA, et al. Respiratory syncytial virus seasonality in three epidemiological zones of Kenya. Influenza Other Respir Viruses. 2021;15(2):195-201.  https://doi.org/10.1111/irv.12810  PMID: 33305543 
  60. Ferrero F, Torres F, Abrutzky R, Ossorio MF, Marcos A, Ferrario C, et al. Seasonality of respiratory syncytial virus in Buenos Aires. Relationship with global climate change. Arch Argent Pediatr. 2016;114(1):52-5. PMID: 26914075 
  61. Montgomery AS, Lustik MB, Jones MU, Horseman TS. Respiratory Viral Pathogens in Children Evaluated at Military Treatment Facilities in Oahu, Hawaii From 2014 to 2018: Seasonality and Climatic Factors. J Pediatric Infect Dis Soc. 2021;10(4):517-20.  https://doi.org/10.1093/jpids/piaa131  PMID: 33219667 
  62. Servia-Dopazo M, Purriños-Hermida MJ, Pérez S, García J, Malvar-Pintos A, Daporta MT, et al. Utilidad de la vigilancia microbiológica del virus respiratorio sincitial en Galicia (España): 2008-2017. [Usefulness of the microbiological surveillance of respiratory syncytial virus in Galicia (Spain): 2008-2017]. Gac Sanit. 2020;34(5):474-9.  https://doi.org/10.1016/j.gaceta.2018.11.009  PMID: 30737055 
Determining the timing of respiratory syncytial virus (RSV) epidemics: a systematic review, 2016 to 2021; method categorisation and identification of influencing factors
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Lisa+Staadegaard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Staadegaard Lisa</a>, <a href="/search?value1=Michel+D%C3%BCckers&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dückers Michel</a>, <a href="/search?value1=Jojanneke+van+Summeren&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Summeren Jojanneke</a>, <a href="/search?value1=Rob+van+Gameren&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Gameren Rob</a>, <a href="/search?value1=Clarisse+Demont&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Demont Clarisse</a>, <a href="/search?value1=Mathieu+Bangert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bangert Mathieu</a>, <a href="/search?value1=You+Li&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Li You</a>, <a href="/search?value1=Jean-Sebastien+Casalegno&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Casalegno Jean-Sebastien</a>, <a href="/search?value1=Saverio+Caini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Caini Saverio</a>, <a href="/search?value1=John+Paget&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Paget John</a></span>. Determining the timing of respiratory syncytial virus (RSV) epidemics: a systematic review, 2016 to 2021; method categorisation and identification of influencing factors . <a href="/content/ecdc">Euro Surveill.</a> 2024;29(5):pii=2300244. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.5.2300244" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.5.2300244</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 03 May 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 23 Oct 2023 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.5.2300244
/content/10.2807/1560-7917.ES.2024.29.5.2300244
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error