Kelly Matthew S, Cunningham Coleen K, McFarland Elizabeth J, Giganti Mark J, Lindsey Jane C, Perlowski Charlotte, Libous Jennifer L, Jean-Philippe Patrick, Moye Jack, Karron Ruth A, Collins Peter L, Buchholz Ursula J
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Pediatrics, University of California Irvine School of Medicine, Orange, California, USA.
Open Forum Infect Dis. 2024 Nov 13;11(12):ofae679. doi: 10.1093/ofid/ofae679. eCollection 2024 Dec.
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory illness among young children. Human immunodeficiency virus (HIV)-exposed, uninfected (HEU) children experience a higher burden of RSV disease and have immune abnormalities that may influence their responses to live-attenuated RSV vaccines.
In a pooled analysis of clinical trials of 7 live-attenuated, intranasal RSV vaccines conducted by the IMPAACT Network among children 6 to <25 months of age with serum RSV-neutralizing titers of <1:40, the infectivity and immunogenicity of these vaccines were compared among HEU and HIV-unexposed, uninfected (HUU) children. Nasal washes were collected during the first 28 days after vaccination. Serum RSV-neutralizing and anti-RSV F glycoprotein immunoglobulin G (IgG) antibodies were measured prior to and 56 days after vaccination, and before and after the following winter season.
Of 156 children, 90 (58%) were HUU and 66 (42%) were HEU. Seventy-six (84%) HUU and 63 (95%) HEU participants were infected with vaccine (shed vaccine virus and/or had a ≥4-fold rise in serum RSV antibodies at 56 days after vaccination). HUU children had higher serum RSV-neutralizing and anti-RSV F IgG titers prior to vaccination. Compared to HEU children, lower percentages of HUU children had ≥4-fold rises in RSV-neutralizing (67% vs 88%) and anti-RSV F IgG (70% vs 89%) titers at 56 days after vaccination.
Live-attenuated RSV vaccines are highly immunogenic in HEU children. Given their increased burden of RSV disease and higher early childhood mortality in some settings, HEU children should be prioritized for vaccination against RSV as these vaccines become available.
呼吸道合胞病毒（RSV）是幼儿急性下呼吸道疾病的主要病因。暴露于人类免疫缺陷病毒（HIV）但未感染（HEU）的儿童患RSV疾病的负担更高，且存在免疫异常，这可能会影响他们对减毒活RSV疫苗的反应。
在IMPAACT网络针对6至<25月龄、血清RSV中和滴度<1:40的儿童开展的7种减毒活鼻内RSV疫苗临床试验的汇总分析中，比较了HEU儿童与未暴露于HIV且未感染（HUU）儿童中这些疫苗的感染性和免疫原性。在接种疫苗后的前28天收集鼻洗液。在接种疫苗前、接种后56天以及接下来的冬季前后测量血清RSV中和抗体和抗RSV F糖蛋白免疫球蛋白G（IgG）抗体。
156名儿童中，90名（58%）为HUU儿童，66名（42%）为HEU儿童。76名（84%）HUU参与者和63名（95%）HEU参与者感染了疫苗（接种疫苗后56天排出疫苗病毒和/或血清RSV抗体升高≥4倍）。HUU儿童在接种疫苗前血清RSV中和抗体和抗RSV F IgG滴度更高。与HEU儿童相比，接种疫苗后56天，RSV中和抗体（67%对88%）和抗RSV F IgG滴度（70%对89%）升高≥4倍的HUU儿童百分比更低。
减毒活RSV疫苗在HEU儿童中具有高度免疫原性。鉴于HEU儿童患RSV疾病的负担增加，且在某些情况下幼儿死亡率更高，随着这些疫苗的上市，应优先为HEU儿童接种RSV疫苗。
