Abstract
Respiratory syncytial virus (RSV) is one of the last remaining major causes of serious paediatric respiratory infection for which no vaccine or other wide-scale intervention is available. Although an effective prophylactic antibody (palivizumab) has been available for more than two decades, 1 The IMpact-RSV Study GroupPalivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics. 1998; 102: 531-537 Crossref Scopus (1716) Google Scholar its effect on the overall disease burden has been modest. The relatively high cost of palivizumab and its narrow indication to only a small proportion of infants who are at high risk of infection 1 The IMpact-RSV Study GroupPalivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics. 1998; 102: 531-537 Crossref Scopus (1716) Google Scholar has meant that the majority of infants at high risk from RSV do not receive palivizumab prophylaxis. Collectively, these shortcomings have translated into a large unmet burden of disease that puts millions of infants at risk of serious, life-threatening disease every year. 2 Shi T McAllister DA O'Brien KL et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017; 390: 946-958 Summary Full Text Full Text PDF PubMed Scopus (964) Google Scholar The mortality burden due to RSV is disproportionately borne by children from low-income countries; data from 2010 suggest that more than 99% of RSV-attributable deaths occur in low-income and middle-income countries (LMICs). 3 Nair H Nokes DJ Gessner BD et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010; 375: 1545-1555 Summary Full Text Full Text PDF PubMed Scopus (1823) Google Scholar Respiratory syncytial virus seasonality and prevention strategy planning for passive immunisation of infants in low-income and middle-income countries: a modelling studyIn LMICs with clear RSV seasonality, seasonal approaches to monoclonal antibody and maternal vaccine administration might optimise disease prevention by dose given compared with year-round administration. More data are needed to clarify if seasonal administration of RSV monoclonal antibodies or maternal immunisation is programmatically suitable and cost effective in LMICs. Full-Text PDF Open Access
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