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Respiratory Syncytial Virus
directed against a conserved region of the F protein of RSV, was proved to An additional important aspect of RSV LRTI in infancy relates to potential
be safe and effective in the prevention of severe RSV infection long-term sequelae. An association between RSV LRTI in infancy and
(hospitalization) in high-risk infants with prematurity ± CLD, decreasing subsequent episodes of wheezing over the next ≥10 years has been clearly
RSV hospitalization rates from 10.6% in placebo recipients to 4.8% in established.
It is uncertain, however, whether the virus contributes to
A similar trial with this monoclonal antibody airway and/or immunological changes that predispose to later wheezing, or
in infants with hemodynamically significant congenital heart disease
(CHD) also demonstrated safety and efficacy.
has demonstrated continued low hospitalization rates in high-risk infants Recent preliminary data in premature
receiving palivizumab prophylaxis.
Clinical isolates of RSV resistant to
infants suggest that those receiving
palivizumab have not been reported. Guidelines for the use of palivzumab
in the US published in 2006 are outlined in Table 3.
palivizumab had fewer medically
attended respiratory illnesses than
A second-generation monoclonal antibody, motavizumab, which is derived
from palivizumab, is currently in clinical trials in comparison with non-prophylaxed controls over two
palivizumab for safety and efficacy. Motavizumab is 20–100-fold more
to three years.
active against RSV in vitro and in animal models of RSV infection. A
preliminary analysis of >6,600 premature infants randomized to receive
motavizumab or palivizumab prophylaxis for five monthly injections in a whether the severity of the initial RSV infection reflects the individual’s
single RSV season demonstrated non-inferiority of motavizumab for propensity to wheezing, which would have occurred unrelated to the early
decreasing hospitalizations and significantly fewer medically attended RSV LRTI.
Recent preliminary data in premature infants suggest that those
respiratory illnesses in the motavizumab recipients.
receiving palivizumab had fewer medically attended respiratory illnesses than
non-prophylaxed controls over two to three years.
Further verification of
The development of a vaccine to provide active immunization against severe these findings will be important in devising future RSV prevention strategies.
RSV infection for all infants remains an unmet challenge. An early formalin-
inactivated RSV vaccine was associated with enhanced disease after natural In conclusion, on this, the golden anniversary of the discovery of RSV, much
infection. More recently, approaches to RSV vaccine development have has been accomplished in the understanding and management of this
focused on subunit protein or live attenuated viral vaccines.
Although early important infection. Still, there remains important work to do in order to
clinical evaluations of candidate vaccines are ongoing, the extent of safety alleviate the toll of RSV infection on human suffering. In future, I hope we
and efficacy data needed is such that there is not likely to be an RSV vaccine can celebrate further advances that will have led to major inroads in
available for widespread use in the near future. controlling this infection for all infants and children. ■
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36 US INFECTIOUS DISEASE 2007
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