The respiratory syncytial virus vaccine and monoclonal antibody landscape: the road to global access - 28/11/24

Doi : 10.1016/S1473-3099(24)00455-9

Jonne Terstappen, MD ^a, Sarah F Hak, MD ^a, Anant Bhan, MHSc ^b, Debby Bogaert, ProfPhD ^c, Louis J Bont, ProfPhD ^a,^e, Ursula J Buchholz, PhD ^f, Andrew D Clark, PhD ^g, Cheryl Cohen, PhD ^h, Ron Dagan, ProfMD ⁱ, Daniel R Feikin, MD ^j, Barney S Graham, ProfPhD ^k, Anuradha Gupta, MBA ^l, Pradeep Haldar, MD ^m, Rose Jalang’o, MD ⁿ, Ruth A Karron, ProfMD ^o, Leyla Kragten, PhD ^e, You Li, ProfPhD ^d,^p, Yvette N Löwensteyn, MD ^a, Patrick K Munywoki, PhD ^q, Rosemary Njogu, MD ^r, Ab Osterhaus, ProfPhD ^s, Andrew J Pollard, ProfPhD ^t, Luiza Reali Nazario, PhD ^e, Charles Sande, PhD ^u,^v, Ashish R Satav, MD ^w, Padmini Srikantiah, MD ^x, Renato T Stein, MD ^y, Naveen Thacker, MD ^z,^aa, Rachael Thomas, BA ^ab, Marta Tufet Bayona, PhD ^ac, Natalie I Mazur, PhD ^a,⁎

^a Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands

^b Yenepoya Medical College & Centre for Ethics, Yenepoya University, Mangalore, India

^c Paediatric Medicine, University of Edinburgh, Edinburgh, UK

^d Centre for Global Health, University of Edinburgh, Edinburgh, UK

^e ReSViNET Foundation, Zeist, Netherlands

^f National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

^g Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

^h Center for Respiratory Diseases and Meningitis, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa

ⁱ The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel

^j Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland

^k Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA, USA

^l Global Immunization, Sabin Vaccine Institute, Washington, DC, USA

^m Government of India, Ministry of Health and Family Welfare, Delhi, India

ⁿ National Vaccines and Immunization Program, Ministry of Health, Nairobi, Kenya

^o Boomberg School of Public Health Department of International Health, Johns Hopkins Bloomberg Baltimore, MD, USA

^p School of Public Health, Nanjing Medical University, Nanjing, China

^q Centers for Disease Control and Prevention, Nairobi, Kenya

^r Department of International Health, Jhpiego, Nairobi, Kenya

^s Center of Infection Medicine and Zoonosis Research, University of Veterinary Medicine, Hannover, Germany

^t Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, UK

^u Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK

^v KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya

^w MAHAN Trust Mahatma Gandhi Tribal Hospital, Melghat, India

^x Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA, USA

^y Pneumologia Pediátrica, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

^z International Pediatric Association, Webster Groves, MI, USA

^aa Child Health Foundation, Mumbai, India

^ab ReSViNET Patient Network, East Sussex, UK

^ac Gavi, The Vaccine Alliance, Geneva, Switzerland

^* Correspondence to: Dr Natalie I Mazur, Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 EA Utrecht, Netherlands Department of Paediatric Infectious Disease & Immunology Wilhelmina Children’s Hospital University Medical Center Utrecht Utrecht EA 3584 Netherlands

Summary

Respiratory syncytial virus (RSV) is the second most common pathogen causing infant mortality. Additionally, RSV is a major cause of morbidity and mortality in older adults (age ≥60 years) similar to influenza. A protein-based maternal vaccine and monoclonal antibody (mAb) are now market-approved to protect infants, while an mRNA and two protein-based vaccines are approved for older adults. First-year experience protecting infants with nirsevimab in high-income countries shows a major public health benefit. It is expected that the RSV vaccine landscape will continue to develop in the coming years to protect all people globally. The vaccine and mAb landscape remain active with 30 candidates in clinical development using four approaches: protein-based, live-attenuated and chimeric vector, mRNA, and mAbs. Candidates in late-phase trials aim to protect young infants using mAbs, older infants and toddlers with live-attenuated vaccines, and children and adults using protein-based and mRNA vaccines. This Review provides an overview of RSV vaccines highlighting different target populations, antigens, and trial results. As RSV vaccines have not yet reached low-income and middle-income countries, we outline urgent next steps to minimise the vaccine delay.

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Plan

Introduction

Methods

RSV vaccine and mAb landscape

Protein-based vaccines

Chimeric vectors and live-attenuated vaccines

mRNA vaccines

Immunoprophylaxis with mAbs

Vaccine strategy and implementation per target population

Public health effects

Implementation considerations and challenges in LMICs

Discussion

Contributors

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Vol 24 - N° 12

P. e747-e761 - décembre 2024 Retour au numéro

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The respiratory syncytial virus vaccine and monoclonal antibody landscape: the road to global access - 28/11/24

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