Recent developments in the treatment and prevention of respiratory syncytial virus infection

Abstract

Respiratory syncytial virus infection is the leading cause of lower respiratory tract infection in infants and young children. Premature infants, as well as those with underlying lung disease (chronic lung disease of infancy), congenital heart disease, neuromuscular disease or metabolic disorders, are at greater risk of severe disease when infected with RSV. Infants hospitalised by RSV infection have an increased frequency of subsequent episodes of wheezing throughout childhood. The elderly and bone marrow transplant patients have also been shown to be at risk of severe RSV disease. Treatment of RSV infection is primarily supportive care. The antiviral drug ribavirin (Virazole™ , ICN Pharm.) is the only approved agent for treating infants with severe RSV disease; however, its use has been limited by the mode of administration (prolonged aerosol), cost and limited efficacy. The humanised mAb palivizumab (Synagis™, MedImmune) is indicated for the prevention of severe RSV disease in premature infants and those with CLD but has not proven effective for treating established RSV disease. More recent antiviral compounds with anti-RSV activity in vitro are being developed. Additionally, mAbs against RSV with improved affinity and/or half-life are being developed, as are a number of approaches to developing safe and effective RSV vaccines. Finally, treatment of RSV disease may require anti-inflammatory, as well as antiviral, medications.