Tristram D A, Welliver R C
Department of Pediatrics, State University of New York at Buffalo.
Pediatr Ann. 1993 Dec;22(12):715-8. doi: 10.3928/0090-4481-19931201-06.
Both inactivated and live RSV candidate vaccines will continue to be tested in infants and young children. Sequential vaccination, with a first dose of live attenuated vaccine followed by boosting with intramuscular subunit vaccines, also is an option. We are encouraged by the fact that influenza subunit and cold-adapted live vaccines are both safe and immunogenic in infants and children of the same age group. Testing of RSV vaccines must proceed at a slower pace because of the phenomenon of vaccine-induced enhanced disease. Curiously, this phenomenon of disease enhancement has not been demonstrated in the case of inactivated influenza or parainfluenza virus vaccines. Another important step in the development of RSV vaccines is to determine a target population. Clearly, children with underlying cardiac or pulmonary disease would benefit from an RSV vaccine. It can be expected that 1% of all infants in the general population will be hospitalized for RSV infection during their first year of life. These infants also would appear to be good candidates for an RSV vaccine, but it is unclear how they would be identified before infection occurs. Immunization of the entire population of infants to protect these 1% would be feasible only if the vaccine were inexpensive and easily administered.
灭活和活的呼吸道合胞病毒（RSV）候选疫苗都将继续在婴幼儿中进行测试。序贯接种，即先接种一剂减毒活疫苗，随后用肌肉注射亚单位疫苗加强接种，也是一种选择。同一年龄组的婴幼儿中，流感亚单位疫苗和冷适应活疫苗都安全且具有免疫原性，这一事实让我们备受鼓舞。由于疫苗诱导的疾病增强现象，RSV疫苗的测试必须以较慢的速度进行。奇怪的是，这种疾病增强现象在灭活流感或副流感病毒疫苗的情况下并未得到证实。RSV疫苗研发的另一个重要步骤是确定目标人群。显然，患有潜在心脏或肺部疾病的儿童将从RSV疫苗中受益。预计普通人群中1%的婴儿在出生后第一年将因RSV感染而住院。这些婴儿似乎也是RSV疫苗的良好候选对象，但尚不清楚在感染发生前如何识别他们。只有在疫苗价格低廉且易于接种的情况下，对全体婴儿进行免疫以保护这1%的婴儿才可行。
