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Updated: Sep 13, 2025
An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Beyond the first breath: comprehensive respiratory syncytial virus prevention through maternal immunization and
Napaporn Chantasrisawad1,2,3, Wicharn Boonjindasup4, Thanyawee Puthanakit3,2
1Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok 10330, Thailand.
Insights
New maternal vaccines and infant monoclonal antibodies offer significant protection against severe respiratory syncytial virus lower respiratory tract infections in infants. These advancements provide season-long defense, reducing hospitalizations and improving infant health outcomes.
Area of Science:
- Immunology
- Pediatrics
- Vaccinology
Background:
- Respiratory syncytial virus (RSV) is a leading cause of infant hospitalizations and mortality.
- Infants under six months, premature infants, and those with chronic conditions are at highest risk for severe RSV-LRTI.
- Existing interventions like palivizumab have limitations in broad protection.
Purpose of the Study:
- To evaluate the efficacy of maternal RSV immunization and long-acting monoclonal antibodies for infant protection.
- To assess the impact of these new strategies on reducing severe RSV-LRTI and hospitalizations.
- To inform public health recommendations for RSV prevention in vulnerable infants.
Main Methods:
- Maternal immunization with bivalent RSVPreF vaccine during pregnancy.
- Administration of single-dose, long-acting monoclonal antibodies (Nirsevimab) to infants.
- Clinical trials assessing medically attended severe RSV-associated LRTI and hospitalizations.
Main Results:
- Maternal immunization demonstrated high efficacy (81.8% at 90 days) in preventing severe RSV-LRTI in infants.
- Nirsevimab provided season-long protection, reducing RSV-LRTI and hospitalizations by approximately 70%-80%.
- These interventions show significant promise in reducing the burden of RSV in infants.
Conclusions:
- Maternal RSV vaccination and infant monoclonal antibodies are highly effective strategies for preventing severe RSV-LRTI.
- Global health organizations recommend the introduction of these interventions for infant RSV prevention.
- These advancements represent a significant step forward in protecting infants from RSV disease.
Abstract:
Respiratory syncytial virus (RSV) is a major respiratory pathogen that particularly affects infants under 6 months, premature infants, and those with congenital heart disease (CHD) or chronic lung disease. In 2019, there was estimated 3.6 million hospital admissions among children under 5 years of age due to RSV-related lower respiratory tract infection (RSV-LRTI), with more than 26,000 deaths. For decades, monthly palivizumab injection has provided passive immunization for high-risk infants and has demonstrated efficacy in reducing RSV-related hospitalizations, while breastfeeding has been known to protect against severe RSV-LRTI. Recent advances aiming to reduce severe RSV-LRTI, that is, bronchiolitis and pneumonia, include maternal RSV immunization and long-acting monoclonal antibodies for infants. Bivalent non-adjuvanted RSV vaccine (Abrysvo®), RSVPreF, administered during pregnancy (gestational age 24-36 weeks) transfers protective RSV IgG antibodies across the placenta with high cord-to-maternal ratio at ~1.5. Studies have shown that maternal immunization significantly reduced medically attended severe RSV-associated LRTI in infants, with an efficacy of 81.8% at 90 days and 69.4% at 180 days after birth, respectively. For medically attended RSV-associated LRTI, the efficacy was 57.1% at 90 days and 51.3% at 180 days. Additionally, long-acting RSV monoclonal antibodies (Nirsevimab) provide season-long protection with a single dose for infants during the first RSV season, reducing both medically attended RSV-LRTI and hospitalizations by approximately 70%-80% in infants during their first RSV season. Consequently, in 2024, the Strategic Advisory Group of Experts (SAGE) recommended that countries introduce maternal RSVPreF vaccination and/or RSV monoclonal antibodies for infant RSV prevention. Many countries have already adopted these interventions, demonstrating cost-effectiveness of monoclonal antibodies.
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