Abstract
Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.
Highlights
Respiratory syncytial virus (RSV) is a negative-sense, single-stranded RNA virus of the Pneumoviridae family [1]
While studies looking at defects in aged dendritic cells (DCs) during RSV infection are limited, reports on influenza have demonstrated that DCs from aged mice show delayed migration kinetics into the lungs and lung draining lymph nodes following infection [67,68]
Studies looking at both basic RSV immunology and vaccine-specific responses have provided some insight into the factors that are critical for a robust RSV-specific immune response
Summary
Respiratory syncytial virus (RSV) is a negative-sense, single-stranded RNA virus of the Pneumoviridae family [1]. Palivizumab is expensive and reduces the rate of severe RSV-associated hospitalization by only ~50% when multiple doses are administered prior to an RSV infection [9,10]. While it is an active area of research, there is currently no licensed vaccine for RSV. The total hospitalization cost of patients with RSV-related symptoms is estimated to be $150–680 million annually, with the highest burden in those aged >65 years [16,17]. Individuals are at an increased risk of developing more severe symptoms including pneumonia and bronchiolitis following RSV infection, resulting in prolonged hospitalizations [3,18,19]. We review the current literature on RSV vaccines for the elderly, and discuss important factors that must be considered for generating the most efficacious vaccine formulation
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