4.5 Review

Reshaping Our Knowledge: Advancements in Understanding the Immune Response to Human Respiratory Syncytial Virus

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Review Infectious Diseases

Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: A systematic literature review and meta-analysis

Miloje Savic et al.

Summary: This study conducted a systematic literature review and meta-analysis to estimate the disease burden of respiratory syncytial virus (RSV)-associated acute respiratory infection (ARI) in adults aged >= 60 years in high-income countries. The results showed that the RSV-ARI attack rate was 1.62%, the hospitalization attack rate was 0.15%, and the in-hospital case fatality rate was 7.13% in this population. In 2019, this would translate into approximately 5.2 million cases, 470,000 hospitalizations, and 33,000 in-hospital deaths in >= 60-year-old adults in high-income countries. The study highlights the need for RSV prophylaxis in this age group.

INFLUENZA AND OTHER RESPIRATORY VIRUSES (2023)

Article Immunology

Influenza A and Respiratory Syncytial Virus Trigger a Cellular Response That Blocks Severe Acute Respiratory Syndrome Virus 2 Infection in the Respiratory Tract

Kieran Dee et al.

Summary: Virus-virus interactions can impact the infection dynamics of respiratory viruses. In this study, 3-dimensional cultures of airway epithelium were used to show that SARS-CoV-2 replication is impaired in coinfections with influenza A or respiratory syncytial virus.

JOURNAL OF INFECTIOUS DISEASES (2023)

Letter Infectious Diseases

Decline of RSV-specific antibodies during the COVID-19 pandemic

Gerco den Hartog et al.

LANCET INFECTIOUS DISEASES (2023)

Review Infectious Diseases

The Impact of the COVID-19 Pandemic on Respiratory Syncytial Virus Infection: A Narrative Review

Yu-Chuan Chuang et al.

Summary: RSV is a common respiratory virus that affects both children and vulnerable populations. During the COVID-19 era, the implementation of public health and social measures led to a significant reduction in RSV activity. However, as these measures were lifted, numerous countries experienced a shift in seasonality and a delayed RSV outbreak with a higher number of infections.

INFECTION AND DRUG RESISTANCE (2023)

Article Pediatrics

Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of randomised controlled trials

Eric A. F. Simoes et al.

Summary: This study evaluated the efficacy of nirsevimab using a weight-banded dosing regimen in infants born between 29 weeks gestational age and full term. The results showed that a single dose of nirsevimab protected healthy infants born at term or preterm from RSV lower respiratory tract infection, reducing the incidence of hospital admissions and severe cases associated with RSV. Therefore, nirsevimab has the potential to alleviate the burden of infant RSV disease.

LANCET CHILD & ADOLESCENT HEALTH (2023)

Article Hematology

T cell immune profiling of respiratory syncytial virus for the development of a targeted immunotherapy

Penelope Georgia Papayanni et al.

Summary: RSV-associated viral infections are a significant public health concern for immunologically naive/compromised populations. This study investigates the cellular immune response to RSV and develops targeted T cell therapy for immunocompromised individuals. A clinical trial is currently ongoing to evaluate the safety and activity of these RSV-targeted T cells in haematopoietic stem cell transplant recipients as an off-the-shelf multi-respiratory virus-directed product (NCT04933968).

BRITISH JOURNAL OF HAEMATOLOGY (2023)

Article Medicine, General & Internal

Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults

E. E. Walsh et al.

Summary: The RSVpreF vaccine showed efficacy in preventing RSV-associated lower respiratory tract illness and RSV-associated acute respiratory illness in adults (>= 60 years of age), with no evident safety concerns.

NEW ENGLAND JOURNAL OF MEDICINE (2023)

Article Medicine, General & Internal

Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants

B. Kampmann et al.

Summary: Vaccination of pregnant women with RSVpreF vaccine was effective in reducing severe RSV-associated lower respiratory tract illness in infants. The vaccine showed 81.8% efficacy within 90 days and 69.4% efficacy within 180 days. The vaccine was found to be safe for both mothers and infants.

NEW ENGLAND JOURNAL OF MEDICINE (2023)

Article Medicine, General & Internal

Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults

Alberto Papi et al.

Summary: A phase 3 clinical trial showed that a candidate vaccine for respiratory syncytial virus (RSV) infection has a high efficacy in preventing RSV-related respiratory infection and lower respiratory tract disease in older adults. The vaccine was effective against both RSV subtypes and in individuals with underlying conditions.

NEW ENGLAND JOURNAL OF MEDICINE (2023)

Article Medicine, Research & Experimental

Human T cells efficiently control RSV infection

Chandrav De et al.

Summary: RSV infection causes severe morbidity and mortality in high-risk groups. The study demonstrated the extensive lung damage, proinflammatory immune response and protective adaptive immune response against RSV infection. Human T cells, specifically primed CD8+ T cells or CD4+ T cells, played a key role in controlling RSV replication in the absence of RSV-specific antibodies. These findings support the development of RSV vaccines to improve efficacy by inducing effective T cell responses.

JCI INSIGHT (2023)

Article Pharmacology & Pharmacy

Nirsevimab: First Approval

Susan J. Keam

Summary: Nirsevimab is a long-acting intramuscular recombinant monoclonal antibody developed by AstraZeneca and Sanofi to prevent respiratory syncytial virus (RSV) disease. It has been approved in the EU and UK for the prevention of RSV lower respiratory tract disease in neonates and infants during their first RSV season. This article summarizes the milestones in the development of nirsevimab leading to its first approval for RSV disease prevention in all infants.
Article Immunology

Increased innate immune activation induces protective RSV-specific lung-resident memory T cells in neonatal mice

Allison M. W. Malloy et al.

Summary: This study found that priming with respiratory syncytial virus (RSV) during the neonatal period failed to retain RSV-specific memory T cells, in contrast to priming during adulthood. However, by augmenting immune activation and antigen exposure, neonatal RSV-specific T cells increased expression of tissue-residence markers and were maintained in the lungs, leading to more rapid control of the virus upon reinfection.

MUCOSAL IMMUNOLOGY (2023)

Review Medicine, General & Internal

Why has the epidemiology of RSV changed during the COVID-19 pandemic?

Bahaa Abu-Raya et al.

Summary: The COVID-19 pandemic has had a profound impact on the epidemiology of Respiratory Syncytial Virus (RSV) infections in children. Various theories have been proposed to explain this change, including decreased viral immunity, immune dysregulation induced by SARS-CoV-2, viral interactions between SARS-CoV-2 and RSV, and changes in health-seeking behaviors and healthcare systems. Further research in viral genomics and immunology is needed to guide RSV prevention and healthcare resource planning.

ECLINICALMEDICINE (2023)

Article Immunology

Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection

Chansavath Phetsouphanh et al.

Summary: Phetsouphanh and colleagues found that individuals with long COVID exhibit persistent activation of the immune system even 8 months after infection. They also identified a set of analytes associated with long COVID, suggesting potential opportunities for prevention and treatment.

NATURE IMMUNOLOGY (2022)

Article Microbiology

Type I interferons and MAVS signaling are necessary for tissue resident memory CD8+ T cell responses to RSV infection

Augusto Varese et al.

Summary: Respiratory syncytial virus (RSV) infection presents challenges in eliciting protective memory immune responses. This study uses mouse models to investigate the impact of innate immune response determinants on T-RM cell generation and expansion during RSV infection. The results show that impairment of innate immune recognition and induction of type I interferons lead to reduced expansion and functionality of T-RM cells. Interestingly, treatment with interferon-alpha can restore T-RM cell expansion but not functionality. These findings provide insights into the role of innate immunity in regulating T-RM cell responses to RSV infection.

PLOS PATHOGENS (2022)

Article Immunology

RSV Infection in Neonatal Mice Induces Pulmonary Eosinophilia Responsible for Asthmatic Reaction

Dan Zhang et al.

Summary: Respiratory syncytial virus (RSV) infection can lead to the accumulation of eosinophils and other inflammatory cells in the lungs of neonatal mice, exacerbating the pathological changes of allergic asthma. Adoptive transfer of eosinophils from asthmatic mice with RSV infection can further enhance the pulmonary inflammatory response, but this can be effectively reduced by treatment with an anti-inflammatory drug.

FRONTIERS IN IMMUNOLOGY (2022)

Review Immunology

A Systematic Review and Meta-analysis of Animal Studies Investigating the Relationship Between Serum Antibody, T Lymphocytes, and Respiratory Syncytial Virus Disease

Joseph McGinley et al.

Summary: Studies in mice suggest that measures of T-lymphocyte activity, particularly CD4 and CD8 T cells, may serve as predictive biomarkers of RSV disease severity. Further research is needed to confirm these findings and assess their relevance as biomarkers in human disease.

JOURNAL OF INFECTIOUS DISEASES (2022)

Review Immunology

Disease Burden Estimates of Respiratory Syncytial Virus related Acute Respiratory Infections in Adults With Comorbidity: A Systematic Review and Meta-Analysis

Ting Shi et al.

Summary: RSV-ARI in adults with comorbidities is a significant burden, with limited data available. This study estimated the incidence, hospitalization rate, and in-hospital case fatality ratio of RSV-ARI in this population, and found an association between the disease and any comorbidity.

JOURNAL OF INFECTIOUS DISEASES (2022)

Article Immunology

Waning Immunity Against Respiratory Syncytial Virus During the Coronavirus Disease 2019 Pandemic

Frederic Reicherz et al.

Summary: This article reports a reduction in RSV antibody levels and neutralization activity in serum from women of childbearing age and infants during the COVID-19 pandemic, supporting the notion of relatively short-lived antibody immunity in infants and explaining the interseasonal resurgence of RSV cases.

JOURNAL OF INFECTIOUS DISEASES (2022)

Article Medicine, General & Internal

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis

You Li et al.

Summary: Respiratory syncytial virus (RSV) plays a significant role in morbidity and mortality burden globally in children aged 0-60 months, especially during the first 6 months of life and in low-income and middle-income countries. Passive immunization programs targeting RSV could have a substantial effect on reducing disease burden.

LANCET (2022)

Article Medicine, General & Internal

Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants

Laura L. Hammitt et al.

Summary: A single injection of nirsevimab administered before the RSV season protected healthy late-preterm and term infants from medically attended RSV-associated lower respiratory tract infection.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

Review Immunology

Receptors for Respiratory Syncytial Virus Infection and Host Factors Regulating the Life Cycle of Respiratory Syncytial Virus

Ziheng Feng et al.

Summary: This article reviews the receptors and host factors associated with RSV infection, finding that RSV can bind to multiple receptors and utilize various host factors for infection. The identification and understanding of these receptors and factors are crucial for gaining insight into the pathogenesis of RSV infection.

FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY (2022)

Review Microbiology

Innate Immune Evasion by Human Respiratory Syncytial Virus

Yan Ouyang et al.

Summary: Respiratory syncytial virus (RSV) is the main cause of severe respiratory infections in young children, leading to bronchiolitis and pneumonia; despite the lack of an RSV vaccine, research is focusing on understanding the interaction between RSV infection and innate immunity to discover new drug targets and vaccines.

FRONTIERS IN MICROBIOLOGY (2022)

Article Immunology

Effect of Infant RSV Infection on Memory T Cell Responses at Age 2-3 Years

Tatiana Chirkova et al.

Summary: This study found that RSV infection during infancy has long-term effects on memory T cell responses in children, regardless of the severity of the infection. This may increase the risk of subsequent respiratory viral morbidity in children.

FRONTIERS IN IMMUNOLOGY (2022)

Article Immunology

Adult Memory T Cell Responses to the Respiratory Syncytial Virus Fusion Protein During a Single RSV Season (2018-2019)

Brittani N. Blunck et al.

Summary: This study investigated the longevity of memory T cell responses to the RSV fusion protein following natural RSV infection in adults. The results showed that memory T cell responses mirrored antibody responses and exhibited subtype-specific differences. Some individuals demonstrated a deficiency in the generation of a durable RSV-specific adaptive immune response, indicating a higher risk of re-infection.

FRONTIERS IN IMMUNOLOGY (2022)

Review Genetics & Heredity

Impact of genetic polymorphisms related to innate immune response on respiratory syncytial virus infection in children

Laura Elena Cordova-Davalos et al.

Summary: Variations in key genes affect the development of innate immune response against respiratory syncytial virus (RSV). Understanding these gene variations provides crucial information for understanding viral infection mechanisms, vaccine development, and pharmacological treatments.

VIRUS GENES (2022)

Review Immunology

Alveolar macrophages and airway hyperresponsiveness associated with respiratory syncytial virus infection

Yuxin Wang et al.

Summary: RSV is a common pathogen causing bronchiolitis and pneumonia in children younger than 2 years old, and is closely associated with recurrent wheezing and airway hyperresponsiveness. Alveolar macrophages (AMs) undergo polarization during RSV infection, resulting in two macrophage phenotypes with pro-inflammatory and anti-inflammatory responses, which play important roles in disease progression and airway hyperresponsiveness.

FRONTIERS IN IMMUNOLOGY (2022)

Article Medicine, Research & Experimental

Sustained cellular immune dysregulation in individuals recovering from SARS-CoV-2 infection

Jacob K. Files et al.

Summary: SARS-CoV-2 infection leads to a prolonged period of immune dysregulation, with increased activation and exhaustion markers in T cells and B cells in both hospitalized and nonhospitalized individuals. The changes in T cell activation/exhaustion positively correlate with age, and severely infected individuals exhibited higher expression of activation and exhaustion markers.

JOURNAL OF CLINICAL INVESTIGATION (2021)

Article Immunology

A prospective surveillance study on the kinetics of the humoral immune response to the respiratory syncytial virus fusion protein in adults in Houston, Texas

Brittani N. Blunck et al.

Summary: This study identified three distinct profiles of RSV-specific antibody kinetics corresponding to uninfected, acutely infected, and recently infected individuals. The acute infection group showed a significant increase in antibody response after infection that was maintained for at least 125 days, while the recently infected group experienced a rapid decline in RSV antibody levels within 60 days. These findings suggest potential challenges for developing vaccines with lasting protection against RSV and other respiratory pathogens.

VACCINE (2021)

Article Immunology

Th17/Treg cell imbalance plays an important role in respiratory syncytial virus infection compromising asthma tolerance in mice

Tianyun Shi et al.

Summary: Research suggests that RSV infection in infancy can disrupt asthma tolerance by altering the Th17/Treg ratio, rather than the Th1/Th2 ratio. This indicates that modifying the Th17/Treg ratio could be a potential therapeutic target for asthma caused by RSV or other viruses.

MICROBIAL PATHOGENESIS (2021)

Review Medicine, General & Internal

Palivizumab for preventing severe respiratory syncytial virus (RSV) infection in children

Luis Garegnani et al.

Summary: Palivizumab is effective in reducing hospitalization due to RSV infection in infants and young children. It also shows promising results in reducing hospitalization due to respiratory-related illnesses, RSV infections, and wheezing days.

COCHRANE DATABASE OF SYSTEMATIC REVIEWS (2021)

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Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap?

Robert Cohen et al.

Summary: The COVID-19 pandemic has reduced the incidence of many viral and bacterial infections in children, leading to a positive short-term effect of preventing healthcare system overload. However, the reduced exposure to pathogens and vaccination rates may result in a potential immunity debt and increase the risk of future epidemics when non-pharmaceutical interventions are lifted.

INFECTIOUS DISEASES NOW (2021)

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Monocytes Contribute to IFN-β Production via the MyD88-Dependent Pathway and Cytotoxic T-Cell Responses against Mucosal Respiratory Syncytial. Virus Infection

Tae Hoon Kim et al.

Summary: Monocytes play pivotal roles in cytotoxic T-cell responses and act as type IFN producers during RSV infection, contributing to the antiviral responses against RSV.

IMMUNE NETWORK (2021)

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Respiratory viral infections in the elderly

Alastair Watson et al.

Summary: The global aging population is increasing, leading to a growing clinical need for addressing respiratory viral infections in the elderly. Current diagnostic and treatment methods are limited. To meet this need, prospective screening research, implementation of multiplex point-of-care diagnostics, and further development of novel vaccines and therapeutics are essential.

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Respiratory Syncytial Virus's Non-structural Proteins: Masters of Interference

Elena Margaret Thornhill et al.

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Michael B. Battles et al.

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Respiratory syncytial virus reduces STAT3 phosphorylation in human memory CD8 T cells stimulated with IL-21

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The Human Immune Response to Respiratory Syncytial Virus Infection

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Review Critical Care Medicine

Human Respiratory Syncytial Virus: Infection and Pathology

Karen Bohmwald et al.

SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE (2016)

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Impaired Antibody-mediated Protection and Defective IgA B-Cell Memory in Experimental Infection of Adults with Respiratory Syncytial Virus

Maximillian S. Habibi et al.

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Immunological, Viral, Environmental, and Individual Factors Modulating Lung Immune Response to Respiratory Syncytial Virus

Silvia Vandini et al.

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Peter Mastrangelo et al.

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