Elsevier

The Lancet

Volume 354, Issue 9181, 4 September 1999, Pages 847-852
The Lancet

Seminar
Respiratory syncytial virus infection

https://doi.org/10.1016/S0140-6736(99)80040-3Get rights and content

Summary

Respiratory syncytial virus (RSV), long recognised as the major viral pathogen of the lower respiratory tract of infants, has also been implicated in severe lung disease in adults, especially the elderly. This fact, and the demonstration that passive prophylaxis with either polyclonal or monoclonal antibody to RSV prevents severe lung disease in high-risk infants and children, has led to renewed interest in the immune mechanisms surrounding protection, and the development of vaccines

Section snippets

Epidemiology

RSV causes a substantial amount of illness in young infants and elderly people. It is a seasonal virus, with peak rates of infection occurring annually in the cold season in temperate climates, and in the rainy season, as temperatures fall, in tropical climates. It affects about 90% of infants and young children by the age of 2 years; peak rates occur in infants aged 6 weeks to 6 months, but particularly in those under 3 months of age. Infection rates in Houston, USA, were 68·8 per 100

RSV and the immune response to infection

The RSV genome comprises a single strand of negative-sense RNA, 15 222 nucleotides in length,14 which yields ten major proteins. The F (fusion) and G (attachment) glycoproteins are the major surface antigenic determinants. Other proteins are primarily structural: the small hydrophobic proteins, matrix proteins, and the 22 kDa protein are associated with the viral envelope, and the nucleoprotein, phosphoprotein, and large nucleoprotein are found in the nuclear capsule. The function and

Clinical manifestations and diagnosis

The most common infection caused by RSV is of the upper respiratory tract; such infections are characterised by rhinitis, cough, and sometimes fever. Acute otitis media occurs in up to a third of children with RSV illness; both RSV and bacterial pathogens have been isolated from the middle ears of children with RSV. Croup also occurs with RSV infection, but bronchiolitis and pneumonia are the commonest manifestations in children. Signs of upper-respiratory-tract involvement commonly precede

Management

Infection of the lower respiratory tract with RSV is a self-limited condition in most cases. In normal infants with RSV lower-respiratory-tract infection, the inflammatory response has a greater effect on severity than does viral replication, and there is no unequivocal evidence to suggest that any antiviral or anti-inflammatory agents (alone or in combination) can reduce the length of RSV-related hospital stays in normal infants and young children. There is, therefore, much variation in the

Prevention

A vaccine for RSV is needed, and a protective live, attenuated vaccine administered at or around birth would be ideal. However, problems such as insufficient attenuation of the vaccine strain of RSV,42 its thermolability, and the need to include A and B strains in each vaccine have hindered trials in infants under 3 months of age. Furthermore, since repeated infections with RSV occur in children, any vaccine will need to be more immunogenic than wild-type RSV itself. Several vaccine strains42,

References (52)

  • RM Chanock et al.

    Recovery from infants with respiratory illness of a virus related to chimpanzee coryza agent: I, isolation, properties and characterization

    Am J Hyg

    (1957)
  • M Garenne et al.

    The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries

    World Health Stat Q

    (1992)
  • VA Fulginiti et al.

    Respiratory virus immunization: I, a field trial of two inactivated respiratory virus vaccines: an aqueous trivalent parainfluenza virus vaccine and an alum-precipitated respiratory syncytial virus vaccine

    Am J Epidemiol

    (1969)
  • JR Groothuis et al.

    Prophylactic administration of respiratory syncytial virus immune globulin to high risk infants and young children

    N Engl J Med

    (1993)
  • Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants

    Pediatrics

    (1998)
  • WP Glezen et al.

    Risk of primary infection and reinfection with respiratory syncytial virus

    Am J Dis Child

    (1986)
  • P Ukkonen et al.

    Age specific prevalence of complement fixing antibodies to sixteen viral antigens: a computer analysis of 58 500 patients covering a period of 8 years

    J Med Virol

    (1984)
  • SF Dowell et al.

    Respiratory syncytial virus is an important cause of community-acquired lower respiratory infection among hospitalized adults

    J Infect Dis

    (1996)
  • AR Falsey et al.

    Respiratory syncytial virus and influenza A infections in the hospitalized elderly

    J Infect Dis

    (1995)
  • BJ Selwyn

    The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries

    Rev Infect Dis

    (1990)
  • MW Weber et al.

    Respiratory syncytial virus infection in tropical and developing countries

    Trop Med Int Health

    (1998)
  • T Cherian et al.

    Bronchiolitis in tropical south India

    Am J Dis Child

    (1990)
  • PL Collins et al.

    Production of infectious human respiratory syncytial virus from cloned cDNA confirms an essential role for the transcription elongation factor from the 5 proximal open reading frame of the M2 mRNA in gene expression and provides a capability for vaccine development

    Proc Natl Acad Sci USA

    (1995)
  • MP Cranage et al.

    Systemic cell-mediated and antibody responses in infants with respiratory syncytial virus infections

    J Med Virol

    (1980)
  • BS Graham et al.

    Role of T- lymphocyte subsets in the pathogenesis of primary infection and rechallenge with respiratory syncytial virus in mice

    J Clin Invest

    (1991)
  • BS Graham

    Pathogenesis of respiratory syncytial virus vaccine-augmented pathology

    Am J Respir Crit Care Med

    (1995)
  • Cited by (0)

    View full text