Early-life respiratory syncytial virus disease and long-term respiratory health.

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI), hospital admission, and mortality in children worldwide. Early-life RSV LRTI has also been associated with subsequent long-term respiratory sequelae, including recurrent LRTI, recurrent wheezing, asthma, and lung function impairment, and these effects can persist into adulthood as chronic respiratory disease. New preventive measures (maternal vaccine or long-acting monoclonal antibodies) have been licensed to reduce the burden of acute RSV LRTI in infants and children at high risk through passive immunisation. Studies of these RSV prevention products show high efficacy and effectiveness, particularly for preventing severe RSV LRTI, with implementation in many high-income countries, but limited access in low-income and middle-income countries (LMICs). These interventions might also reduce the risk of additional health outcomes and long-term morbidity. This Series paper provides the evidence for the long-term effects of early-life RSV disease, discusses mechanisms of disease development, and addresses the potential full public health value of prevention of RSV illness. Further research is needed to determine whether prevention of RSV LRTI or delay of RSV illness in early life might prevent or ameliorate the development of associated long-term respiratory disease. This potential further underscores the urgency for access and availability of new interventions to prevent early-life RSV LRTI in LMICs.
Competing Interests: Declaration of interests HJZ is supported by the South African Medical Research Council; reports grants from AstraZeneca, Merck, and Pfizer for trials of RSV prevention and from the Gates Foundation for studies in childhood pneumonia (including RSV); has served on advisory boards of Merck and Pfizer on RSV prevention; has received speaker fees from Pfizer; serves on a data safety monitoring board for Moderna outside of the submitted work; and has served on the WHO Technical Advisory Group on new RSV preventive interventions. FC is supported by a National Institutes of Health (NIH) grant (NIH T32 ES007028). AM reports funding support from NIH, Merck, and Jansen; has served on advisory boards for Merck, Pfizer, Sanofi-Pasteur, AstraZeneca, Enanta, and Moderna outside of the submitted work; and has received speaker fees and travel and meeting support from Pfizer and Sanofi-Pasteur for educational lectures. RTS reports having received honoraria for advisory board meetings and pharma-sponsored symposia from Pfizer, Sanofi, Moderna, AstraZeneca, and OM-Pharma. TVH reports grants from the NIH; fees from the American Thoracic Society, the Parker B Francis Council of Scientific Advisors, and the NIH National Health Lung and Blood Institute for serving on council, and from Pfizer for serving on vaccine data safety monitoring boards; and speaker fees for invited talks from the American Academy of Allergy, Asthma and Immunology, and for an invited respiratory forum from Sanofi outside of the submitted work. JRO reports grants from the NIH and The Vaccine Company for research support and for participation on a data safety monitoring board. JRO is on scientific advisory boards for GSK, Moderna, and Pfizer. He has received personal funding from the France Foundation to develop RSV-continuing medical education materials. His institution has received RSV research funds from the Bill & Melinda Gates Foundation and the World Health Organization. TK declares no competing interests.
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