Zar Heather J
Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC unit on Child & Adolescent Health, University of Cape Town, South Africa.
Pediatr Pulmonol. 2025 Mar;60 Suppl 1(Suppl 1):S120-S122. doi: 10.1002/ppul.27310. Epub 2024 Oct 28.
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI), hospitalization, and mortality in infants and young children globally. The greatest burden of severe disease and mortality occurs in low-middle income countries (LMICs), with large and vulnerable childhood populations. The highest rates of RSV-hospitalization occur in healthy-term infants under 3 months of age. Preterm infants, children with chronic lung disease of prematurity, Down's syndrome, congenital heart disease, or immunodeficiency also have a higher risk of severe RSV-LRTI. Early-life RSV-LRTI has also been associated with chronic sequelae, including recurrent LRTI, recurrent wheezing, asthma, and lung function impairment. A RSV pre-fusion (F) maternal vaccine and long-acting monoclonal antibody (nirsevimab) have been licensed for the prevention of RSV-LRTI in infants and young children. Studies show high efficacy and effectiveness particularly for preventing severe RSV-LRTI. Maternal RSV vaccine given at 24-36 weeks of pregnancy was effective in preventing RSV medically attended LRTI and severe RSV-LRTI through 6 months after birth in a phase 3 study conducted in 18 countries over two RSV seasons. Vaccination was safe with no significant difference in adverse events between infants born to mothers who received RSV preF vaccine compared to placebo. A numerical imbalance in preterm births that occurred predominantly in South Africa, unrelated to vaccine timing or gestational age at vaccination and unassociated with mortality, coincided with COVID-19 delta and omicron waves. Nirsevimab, given as a single dose prior or during the RSV season, had high efficacy in preventing RSV-LRTI hospitalization in infants in preterm and in full-term infants, as well as in young children with underlying conditions through 150 days post administration in phase 2 and 3 trials. High effectiveness against hospitalization or severe disease in infants and in at-risk children up to 2 years of age has also been reported in several countries where implementation has occurred. RSV-LRTI is now a preventable disease in infants and young children. Rapid implementation of these highly effective interventions has occurred in many high-income countries, but access remains very limited in LMICs. Access to such RSV preventive interventions is urgently needed for all children to strengthen child health and promote global equity.
呼吸道合胞病毒（RSV）是全球婴幼儿下呼吸道感染（LRTI）、住院和死亡的主要原因。严重疾病和死亡的最大负担发生在低收入和中等收入国家（LMICs），这些国家有大量脆弱的儿童群体。RSV住院率最高的是3个月以下的健康足月儿。早产儿、患有早产儿慢性肺病、唐氏综合征、先天性心脏病或免疫缺陷的儿童也有更高的严重RSV-LRTI风险。生命早期的RSV-LRTI还与慢性后遗症有关，包括反复LRTI、反复喘息、哮喘和肺功能损害。一种RSV融合前（F）母体疫苗和长效单克隆抗体（nirsevimab）已被批准用于预防婴幼儿的RSV-LRTI。研究表明其具有高疗效和有效性，特别是在预防严重RSV-LRTI方面。在18个国家进行的两个RSV季节的3期研究中，孕期24至36周接种的母体RSV疫苗在预防出生后6个月内的RSV就医LRTI和严重RSV-LRTI方面是有效的。接种疫苗是安全的，与接受RSV preF疫苗的母亲所生婴儿相比，安慰剂组婴儿的不良事件没有显著差异。早产数量的不平衡主要发生在南非，与疫苗接种时间或接种时的孕周无关，也与死亡率无关，这与新冠病毒德尔塔和奥密克戎毒株流行期相吻合。在2期和3期试验中，在RSV季节之前或期间单次注射nirsevimab，在预防早产儿和足月儿以及有基础疾病的幼儿的RSV-LRTI住院方面具有高疗效，给药后150天内均有效。在几个已经实施的国家也报告了对1至2岁婴儿和高危儿童预防住院或严重疾病的高效性。RSV-LRTI现在是一种可预防的婴幼儿疾病。这些高效干预措施已在许多高收入国家迅速实施，但在低收入和中等收入国家的可及性仍然非常有限。迫切需要让所有儿童都能获得此类RSV预防干预措施，以加强儿童健康并促进全球公平。
