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Review
. 2021 Aug 28;9(9):961.
doi: 10.3390/vaccines9090961.

Bringing Preventive RSV Monoclonal Antibodies to Infants in Low- and Middle-Income Countries: Challenges and Opportunities

Jintanat Ananworanich  1   2 , Penny M Heaton  1
Affiliations
Review

Bringing Preventive RSV Monoclonal Antibodies to Infants in Low- and Middle-Income Countries: Challenges and Opportunities

Jintanat Ananworanich et al. Vaccines (Basel). .

Abstract

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections (LRTIs) in infants. Most deaths occur in infants under 3 months old, and those living in low and middle-income countries (LMICs). There are no maternal or infant RSV vaccines currently approved. An RSV monoclonal antibody (mAb) could fill the gap until vaccines are available. It could also be used when a vaccine is not given, or when there is insufficient time to vaccinate and generate an antibody response. The only currently approved RSV mAb, palivizumab, is too costly and needs monthly administration, which is not possible in LMICs. It is imperative that a safe, effective, and affordable mAb to prevent severe RSV LRTI be developed for infants in LMICs. Next generation, half-life extended mAbs in clinical development, such as nirsevimab, show promise in protecting infants against RSV LRTI. Given that a single dose could cover an entire 5-month season, there is an opportunity to make RSV mAbs affordable for LMICs by investing in improvements in manufacturing efficiency. The challenges of using RSV mAbs in LMICs are the complexities of integrating them into existing healthcare delivery programs and surveillance systems, both of which are needed to define seasonal patterns, and monitor for escape mutants. Collaboration with key stakeholders such as the World Health Organization and Gavi, the Vaccine Alliance, will be essential for achieving this goal.

Keywords: LMIC; RSV; lower respiratory tract infection; monoclonal antibody.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Locations of 6 antigenic sites on the prefusion (left) and postfusion (right) structures of RSV F glycoprotein and their neutralizing potencies. Reprinted by permission from Springer Nature. Clin Microbiol & Infect Dis. Human respiratory syncytial virus: pathogenesis, immune responses, and current vaccine approaches. Taleb, et al., 2018 [11]. copyright permission from Springer.
Figure 2
Figure 2
RSV-preventing strategies for infants.
See this image and copyright information in PMC

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