Insights Into monoclonal antibodies and vaccines targeting respiratory viruses

Viral respiratory infections are a leading cause of morbidity and mortality in children worldwide, with lower respiratory tract infections (LRTIs) a major contributor to hospitalizations and healthcare utilization. Among respiratory pathogens, respiratory syncytial virus (RSV) is the leading cause of severe disease in early life and has driven major advances in preventive strategies. Increasing evidence also suggests that early-life viral infections may influence long-term respiratory outcomes, including recurrent wheezing and asthma.

This article provides a comprehensive overview of the epidemiological burden, risk factors, and long-term consequences of pediatric viral infections. It also examines RSV as a case study in the evolution of preventive strategies and explores knowledge that can be translated from RSV management to other major respiratory viruses, including influenza, SARS-CoV-2, rhinovirus, human metapneumovirus (HMPV), and parainfluenza.

RSV has reshaped pediatric respiratory prevention through the development of monoclonal antibodies and maternal vaccination strategies, enabling a shift from high-risk-based approaches to broader population-level protection. Advances in structural virology have enabled targeting of conserved viral epitopes, thereby improving efficacy and the duration of protection. Similar strategies are being explored for other respiratory viruses. However, antigenic variability, limited pediatric data, and incomplete vaccine effectiveness remain significant barriers.

RSV experience provides a robust foundation for preventing viral respiratory infections. Integrating passive and active immunization strategies, targeting conserved viral structures, and improving global access are essential to reduce the disease burden of pediatric respiratory infections.