Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK.
Lancet Infect Dis. 2021 Sep;21(9):1303-1312. doi: 10.1016/S1473-3099(20)30703-9. Epub 2021 May 6.
Respiratory syncytial virus (RSV) represents a substantial burden of disease in young infants in low-income and middle-income countries (LMICs). Because RSV passive immunisations, including maternal vaccination and monoclonal antibodies, can only grant a temporary period of protection, their effectiveness and efficiency will be determined by the timing of the immunisation relative to the underlying RSV seasonality. We aimed to assess the potential effect of different approaches for passive RSV immunisation of infants in LMICs.
We included 52 LMICs in this study on the basis of the availability of RSV seasonality data and developed a mathematical model to compare the effect of different RSV passive immunisation approaches (seasonal approaches vs a year-round approach). For each candidate approach, we calculated the expected annual proportion of RSV incidence among infants younger than 6 months averted (effectiveness) and the ratio of per-dose cases averted between that approach and the year-round approach (relative efficiency).
39 (75%) of 52 LMICs included in the study had clear RSV seasonality, defined as having more than 75% of annual RSV cases occurring in 5 or fewer months. In these countries with clear RSV seasonality, the seasonal approach in which monoclonal antibody administration began 3 months before RSV season onset was only a median of 16% (IQR 13-18) less effective in averting RSV-associated acute lower respiratory infection (ALRI) hospital admissions than a year-round approach, but was a median of 70% (50-97) more efficient in reducing RSV-associated hospital admissions per dose. The seasonal approach that delivered maternal vaccination 1 month before the season onset was a median of 27% (25-33) less effective in averting hospital admissions associated with RSV-ALRI than a year-round approach, but was a median of 126% (87-177) more efficient at averting these hospital admissions per dose.
In LMICs with clear RSV seasonality, seasonal approaches to monoclonal antibody and maternal vaccine administration might optimise disease prevention by dose given compared with year-round administration. More data are needed to clarify if seasonal administration of RSV monoclonal antibodies or maternal immunisation is programmatically suitable and cost effective in LMICs.
The Bill & Melinda Gates Foundation, World Health Organization.
呼吸道合胞病毒（RSV）在低收入和中等收入国家（LMICs）的婴幼儿中造成了相当大的疾病负担。由于 RSV 被动免疫制剂，包括母体疫苗接种和单克隆抗体，只能提供暂时的保护期，因此它们的有效性和效率将取决于免疫接种相对于潜在 RSV 季节性的时间安排。我们旨在评估在 LMICs 中对婴儿进行 RSV 被动免疫接种的不同方法的潜在效果。
我们根据 RSV 季节性数据的可用性将 52 个 LMIC 纳入本研究，并开发了一个数学模型来比较不同 RSV 被动免疫接种方法（季节性方法与全年方法）的效果。对于每个候选方法，我们计算了 6 个月以下婴儿 RSV 发病率预期每年减少的比例（有效性），以及该方法与全年方法相比每剂量病例减少的比例（相对效率）。
在本研究中纳入的 52 个 LMIC 中有 39 个（75%）有明确的 RSV 季节性，定义为每年超过 75%的 RSV 病例发生在 5 个月或更短的时间内。在这些具有明确 RSV 季节性的国家中，单克隆抗体给药开始于 RSV 季节前 3 个月的季节性方法仅比全年方法平均少 16%（13-18 中位数）在预防 RSV 相关急性下呼吸道感染（ALRI）住院方面有效，但每剂量 RSV 相关住院的平均效率高 70%（50-97）。在季节开始前 1 个月给予母体疫苗接种的季节性方法在预防与 RSV-ALRI 相关的住院方面比全年方法平均少 27%（25-33）有效，但每剂量 RSV 相关住院的平均效率高 126%（87-177）。
在 RSV 季节性明确的 LMIC 中，与全年给药相比，单克隆抗体和母体疫苗接种的季节性方法可能通过剂量优化疾病预防。需要更多的数据来澄清季节性 RSV 单克隆抗体给药或母体免疫接种在 LMIC 中是否在方案上合适且具有成本效益。
比尔和梅琳达·盖茨基金会，世界卫生组织。
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