Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Lancet Respir Med. 2024 Oct;12(10):810-821. doi: 10.1016/S2213-2600(24)00246-7. Epub 2024 Sep 9.
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI), hospital admission, and mortality in children worldwide. Early-life RSV LRTI has also been associated with subsequent long-term respiratory sequelae, including recurrent LRTI, recurrent wheezing, asthma, and lung function impairment, and these effects can persist into adulthood as chronic respiratory disease. New preventive measures (maternal vaccine or long-acting monoclonal antibodies) have been licensed to reduce the burden of acute RSV LRTI in infants and children at high risk through passive immunisation. Studies of these RSV prevention products show high efficacy and effectiveness, particularly for preventing severe RSV LRTI, with implementation in many high-income countries, but limited access in low-income and middle-income countries (LMICs). These interventions might also reduce the risk of additional health outcomes and long-term morbidity. This Series paper provides the evidence for the long-term effects of early-life RSV disease, discusses mechanisms of disease development, and addresses the potential full public health value of prevention of RSV illness. Further research is needed to determine whether prevention of RSV LRTI or delay of RSV illness in early life might prevent or ameliorate the development of associated long-term respiratory disease. This potential further underscores the urgency for access and availability of new interventions to prevent early-life RSV LRTI in LMICs.
呼吸道合胞病毒（RSV）是导致全球儿童下呼吸道感染（LRTI）、住院和死亡的主要原因。婴儿期 RSV LRTI 也与随后的长期呼吸道后遗症有关，包括反复 LRTI、反复喘息、哮喘和肺功能损害，这些影响在成年后可能持续存在为慢性呼吸道疾病。新的预防措施（母体疫苗或长效单克隆抗体）已获得许可，通过被动免疫来减轻高风险婴儿和儿童急性 RSV LRTI 的负担。这些 RSV 预防产品的研究表明，其具有高度的疗效和有效性，特别是在预防严重 RSV LRTI 方面，在许多高收入国家已经实施，但在低收入和中等收入国家（LMICs）的获得途径有限。这些干预措施也可能降低其他健康结果和长期发病率的风险。本系列论文提供了婴儿期 RSV 疾病长期影响的证据，讨论了疾病发展的机制，并探讨了预防 RSV 疾病的潜在全面公共卫生价值。还需要进一步研究，以确定预防 RSV LRTI 或延迟婴儿期 RSV 疾病是否可以预防或改善相关长期呼吸道疾病的发展。这一潜在情况进一步凸显了在 LMICs 中获得和提供新的干预措施以预防婴儿期 RSV LRTI 的紧迫性。
