The future of RSV prevention is behind the door: immunization or antibodies?

Respiratory syncytial virus (RSV) was first isolated in 1956 from a chimpanzee with a cold. It has a single RNA chain with negative polarity with 10 genes that encode for 11 proteins, 3 of whom are structural. According to the variability of the G protein there are two groups A and B. 12 different genotypes belong to Group A and 20 to Group B. It is ubiquitous and 50% of the infants are infected during the first year of life and more than 70% at the end of the second year.
The most important structural protein of RSV is the F protein. F protein has two conformations pre-F and post-F. The pre-F protein has 5 known epitopes and only two of them remain on post-F. Antibodies against post-F epitopes are less neutralizing than antibodies against pre-F epitopes. The conformation pre-F is more stable comparing to the post -F and probably this can be a strategy of the virus to escape neutralizing antibodies. Antibodies induced by vaccines and monoclonal antibodies against antigens of pre-F protein sites have a higher neutralizing activity. RSV can affect all the age and normally it can cause a more severe disease in the extremities of life, neonates, and elderly adulthood. A recent systematic review has shown that RSV cause more than 33.8 million RSV LRTI worldwide (22% of all LRTI are due to RSV), 3.4 million LRTI episodes requiring hospitalization and 199.000 deaths (99% in low-income countries). A study performed in UK in the adult population has shown that RSV LRTI are the cause of more than 500,000 GP consultation (36% in adults >65 years), 18,000 hospitalizations (79% in adults >65 years) and almost 9,000 deaths (93% in adults >65 years). Moreover, it is well known the association between RSV infection in early life and the development of recurrent wheeze and asthma. After only 4 years from RSV isolation in the early 1960, immunization of seronegative infants for RSV with a virus inactivated in formalin was a disaster. 80% of the infants who receive the vaccine were hospitalized with a severe form of bronchiolitis with two deaths after wild infection.

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Received: May 17, 2023
Accepted: May 20, 2023
Published: June 1, 2023