Respiratory syncytial virus prevention within reach: the vaccine and monoclonal antibody landscape. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Mazur, Natalie I; Terstappen, Jonne; Baral, Ranju; Bardají, Azucena; Beutels, Philippe; Buchholz, Ursula J; Cohen, Cheryl; Crowe, James E; Cutland, Clare L; Eckert, Linda; Feikin, Daniel; Fitzpatrick, Tiffany; Fong, Youyi; Graham, Barney S; Heikkinen, Terho; Higgins, Deborah; Hirve, Siddhivinayak; Klugman, Keith P; Kragten-Tabatabaie, Leyla; Lemey, Philippe; Libster, Romina; Löwensteyn, Yvette; Mejias, Asuncion; Munoz, Flor M; Munywoki, Patrick K; Mwananyanda, Lawrence; Nair, Harish; Nunes, Marta C; Ramilo, Octavio; Richmond, Peter; Ruckwardt, Tracy J; Sande, Charles; Srikantiah, Padmini; Thacker, Naveen; Waldstein, Kody A; Weinberger, Dan; Wildenbeest, Joanne; Wiseman, Dexter; Zar, Heather J; Zambon, Maria; Bont, Louis;
• Is Part Of: Lancet infectious diseases. Volume 23:Issue 1(2023)
• Page Start: e2
• Page End: e21
• Publication Date: 2023-01
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; Maladies infectieuses -- Périodiques; Infection -- Périodiques; Communicable diseases; Infection; Periodicals; 616.905
• DOI: 10.1016/S1473-3099(22)00291-2
• Languages: English
• ISSNs: 1473-3099

Abstract

Summary: Respiratory syncytial virus is the second most common cause of infant mortality and a major cause of morbidity and mortality in older adults (aged >60 years). Efforts to develop a respiratory syncytial virus vaccine or immunoprophylaxis remain highly active. 33 respiratory syncytial virus prevention candidates are in clinical development using six different approaches: recombinant vector, subunit, particle-based, live attenuated, chimeric, and nucleic acid vaccines; and monoclonal antibodies. Nine candidates are in phase 3 clinical trials. Understanding the epitopes targeted by highly neutralising antibodies has resulted in a shift from empirical to rational and structure-based vaccine and monoclonal antibody design. An extended half-life monoclonal antibody for all infants is likely to be within 1 year of regulatory approval (from August, 2022) for high-income countries. Live-attenuated vaccines are in development for older infants (aged >6 months). Subunit vaccines are in late-stage trials for pregnant women to protect infants, whereas vector, subunit, and nucleic acid approaches are being developed for older adults. Urgent next steps include ensuring access and affordability of a respiratory syncytial virus vaccine globally. This review gives an overview of respiratory syncytial virus vaccines and monoclonal antibodies in clinical development highlighting different target populations, antigens, and trial results.