Respiratory syncytial virus (RSV) is a leading cause of severe respiratory illness and death among children worldwide, particularly in children younger than 6 months and in low-income and middle-income countries. Feasible and cost-effective interventions to prevent RSV disease are not yet widely available, although two new products aimed at preventing RSV disease-long-acting monoclonal antibodies and maternal vaccines-have been licensed within the past 2 years. The primary target of these products is reduction of the substantial burden of RSV-associated acute lower respiratory tract infections (LRTI) in infants younger than 1 year. However, other important public health benefits might also accrue with the prevention of RSV-associated LRTI during the first year of life. Mounting evidence shows that preventing RSV-associated LRTI in infants younger than 1 year could prevent secondary pneumonia caused by other pathogens, reduce recurrent hospitalisations due to other respiratory diseases in later childhood, decrease all-cause infant mortality, ameliorate the burden of respiratory diseases on health-care systems, reduce inappropriate antibiotic use, and possibly improve lung health beyond infancy. We herein review current evidence and suggest approaches to better assess the magnitude of these potential secondary effects of RSV prevention, which, if proven substantial, are likely to be relevant to policy makers in many countries as they consider the use of these new products.
Competing Interests: Declaration of interests DMW reports grants or contracts, paid to institution and unrelated to the subject of this work, from the US National Institutes of Health, Bill & Melinda Gates Foundation, US Veterans Affairs Department, Pfizer, and Merck; consulting fees from Merck, Pfizer, and GSK/Affinivax; and payment or honoraria for lectures, presentations, participation in speakers' bureaus, manuscript writing, or educational events from Pfizer and Merck. HJZ reports funding paid to institution from the Gates Foundation, US National Institutes of Health, Pfizer, AstraZeneca, and MSD. RAK reports grants paid to institution from the US National Institutes of Health and Sanofi Pasteur; and is the chair of the WHO Product Development for Vaccines Advisory Committee. DRF and ES report funding paid to institution from the Gates Foundation for respiratory syncytial virus-related activities. SKS and PS declare no competing interests.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)