Section 4 RSV Prophylaxis

*The Burden of Respiratory Syncytial Virus Infection in the Young*

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February 15, 2019]

14, 2019]

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**Chapter 4**

Trials

**Abstract**

**1. Introduction**

persistent immunity.

RSV: Available Prophylactic

*Debra T. Linfield and Fariba Rezaee*

major hurdles in the development of an effective RSV vaccine.

RSV, persistent wheezing, and childhood asthma [6–8].

**Keywords:** respiratory syncytial virus (RSV), pediatric, respiratory infection, palivizumab, antiviral therapy, immuno-prophylaxis, RSV vaccine, clinical trials

RSV, a member of the Paramyxoviridae family, is an enveloped, negativesense, single-stranded RNA virus [1]. Especially within the winter months, it is an important cause of morbidity and mortality among young children, the elderly, and immunocompromised individuals [2]. Infection is transmitted by either direct or indirect contact with respiratory droplets, and prior infection does not result in

RSV accounts for approximately 2.1 million outpatient visits among children younger than 5 years old [3]. Additionally, there are 177,000 hospitalizations and 14,000 deaths among adults older than 65 years due to RSV infection [4, 5] each year in the United States. Human studies have shown strong associations between

Symptoms usually begin 4–6 days after transmission and present with nasal congestion, rhinorrhea, fever, or cough. RSV is one of the leading causes of lower respiratory tract infection (LRTI), and can cause tachypnea, wheeze, hypoxemia, or

Options and Vaccines in Clinical

Respiratory syncytial virus (RSV) is the leading cause of serious lower respiratory infection (ALRI)-related hospitalization in children worldwide, and a source of morbidity and mortality in high-risk adults. There are strong associations between RSV, persistent wheezing and childhood asthma. Despite extensive research, no effective treatment is available aside from supportive care. The trial of a formalininactivated RSV vaccine in the 1960s resulted in priming the severe illness upon natural infection. Palivizumab, a monoclonal antibody approved for RSV prophylaxis in high-risk infants, has only moderately decreased hospital admissions due to RSV infection. Live-attenuated, vector, and protein-based vaccine candidates are being investigated in many clinical trials. Developing a vaccine remains challenging due to finding the right balance between adequate immunogenicity and attenuation of vaccine. Here we review the clinical significance of RSV in infants, young children, high-risk adults, elderly population, pregnant women; clinical manifestations and consequences of RSV infection; the pharmacologic strategies currently available, the current stages of RSV vaccine clinical trials, different strategies, and

## **Chapter 4**
