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Respiratory syncytial virus bronchiolitis : current and future strategies for treatment and prophylaxis
Susana Chávez-Bueno1, Asunción Mejías, Robert C Welliver
1Department of Pediatrics, Division of Infectious Diseases, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Insights
Respiratory syncytial virus (RSV) causes severe illness in infants and the elderly. While prevention strategies like handwashing and passive immunization exist, developing a safe and effective RSV vaccine remains a critical, ongoing challenge.
Area of Science:
- Virology
- Immunology
- Pediatrics
Background:
- Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract illness in infants globally, leading to significant hospitalizations.
- RSV also poses a major threat to the elderly and other vulnerable populations, causing conditions like bronchiolitis, pneumonia, and respiratory failure.
- The link between RSV infection and recurrent childhood wheezing is recognized, but the underlying immune mechanisms are not fully understood.
Purpose of the Study:
- To review the current understanding of RSV disease, its manifestations, and the host immune response.
- To summarize existing and emerging prevention and treatment strategies for RSV infection.
- To highlight the ongoing challenges and progress in developing a safe and effective RSV vaccine.
Main Methods:
- Literature review of RSV epidemiology, pathogenesis, and clinical manifestations.
- Analysis of current treatment options, including their limitations.
- Evaluation of preventive measures, including passive immunization and vaccine development efforts.
Main Results:
- RSV is a significant cause of infant hospitalizations and a major pathogen in high-risk adults.
- Current treatments are limited in efficacy, with supportive care and prevention being key.
- Passive immunization offers protection for high-risk infants, and vaccine development shows promise but is not yet realized.
Conclusions:
- Effective prevention strategies, including improved hygiene and passive immunization, are crucial for reducing RSV morbidity.
- Despite past setbacks, research into safe and effective RSV vaccines is progressing, offering hope for future control.
- Addressing RSV is vital for mitigating both acute illness and potential long-term consequences like recurrent wheezing.
Abstract:
Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract illness in infants and children worldwide and is responsible for over 120 000 annual hospitalizations in infants in the US alone. RSV is also recognized as a major respiratory viral pathogen in the elderly and other high-risk populations. Bronchiolitis, pneumonia, apnea, respiratory failure, and death are well known manifestations of severe acute RSV disease. RSV infection has also been associated with recurrent wheezing in children, but the mechanisms involved in this association are not completely understood. The host immune response plays a significant role in controlling the infection but is likely also involved in augmenting the disease through pathways that have not been completely identified. The treatment options for RSV infection are very limited. Ribavirin, corticosteroids, and bronchodilators are not used routinely because they have not proven to be sufficiently effective. Education of caregivers, strict handwashing, and avoidance of exposure to environmental factors associated with severe forms of RSV infection are among the most effective preventive means. Passive immunization with monoclonal antibodies provides protection against severe RSV disease in high-risk children. Clinical trials to evaluate the safety and efficacy of a second-generation monoclonal antibody are underway. Efforts to develop a safe and effective RSV vaccine have continued despite the poor outcomes observed following the administration of formalin-inactivated formulations in the 1960s. In the last decade, live attenuated vaccines (including those developed by recombinant techniques) and purified subunit vaccines have all been evaluated in humans. Results of clinical trials have been encouraging, but the availability of a safe and effective RSV vaccine is not a reality yet. Better prevention strategies will have an impact, not only on acute morbidity caused by RSV, but will also likely have an effect on ameliorating the chronic consequences of this disease.
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