Respiratory Syncytial Virus: Immunisation and Prophylaxis

Abstract

Respiratory syncytial virus (RSV) is the second most common cause of mortality in infants worldwide after malaria and the leading cause of hospitalisation in infants in many countries. It is also associated with high levels of morbidity and mortality in older adults (those over 60 years of age). These high levels of healthcare utilisation result in huge associated healthcare costs. As such, the development of an RSV vaccine is listed as a leading global priority by the World Health Organization (WHO). There is a monoclonal antibody (palivizumab) licensed to prevent RSV infection, but it is only used in high‐income countries for the most high‐risk infants owing to its very high cost. The development of an RSV vaccine/prophylactic agent has been hampered by an incomplete understanding of the immunopathogenesis of RSV infection, although many are currently undergoing clinical trials. Adding a new vaccine to the existing vaccine schedules will also present many challenges.

Key Concepts

  • Respiratory syncytial virus (RSV) is a leading cause of morbidity and mortality worldwide in infants, children and older adults.
  • Agents to prevent severe RSV infection are needed to reduce this burden of disease.
  • The immunopathogenesis of RSV infection is incompletely understood, hampering the development of a vaccine.
  • Palivizumab, a monoclonal antibody, is licensed for use in high‐risk infants, but is extremely expensive, and thus newer agents are required.
  • Many RSV vaccines and novel prophylactic monoclonal antibodies are in development, although a licensed product is likely to still be many years away.
  • After a vaccine becomes licensed, there is still a need to ensure that it can be incorporated into the existing vaccine schedules.

Keywords: respiratory syncytial virus; palivizumab; ribavirin; infants; older adults

Figure 1. The host immune response to RSV (respiratory syncytial virus) infection. Reproduced with permission from Rossi and Colin 2015 © ERS 2015.
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Further Reading

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Karron RA and Zar HJ (2017) Determining the outcomes of interventions to prevent respiratory syncytial virus disease in children: what to measure? The Lancet Respiratory Medicine. pii: S2213‐2600(17)30303‐X.

Rossey I, McLellan JS, Saelens X and Schepens B (2017) Clinical potential of prefusion RSV F‐specific antibodies. Trends in Microbiology. pii: S0966‐842X(17)30214‐7. doi: 10.1016/j.tim.2017.09.009.

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Barr, Rachael, and Drysdale, Simon B(Feb 2018) Respiratory Syncytial Virus: Immunisation and Prophylaxis. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0027784]