Respiratory syncytial virus vaccine

A respiratory syncytial virus vaccine (RSV vaccine) is a vaccine which prevents infection by respiratory syncytial virus. No licensed vaccine against RSV exists at this time, although there is at least one vaccine candidate currently in clinical trials.^[1]

Attempts to develop an RSV vaccine began in the 1960s with an unsuccessful inactivated vaccine developed by exposing the RSV virus to formalin (formalin-inactivated RSV (FI-RSV)).^[2] Unfortunately, this vaccine induced a phenomenon that came to be known as vaccine-associated enhanced respiratory disease (VAERD), in which children who had not previously been exposed to RSV and were subsequently vaccinated would develop a severe form of RSV disease if exposed to the virus itself, including fever, wheezing, and bronchopneumonia.^[2] Some eighty percent of such children (vs. 5% of virus-exposed controls) were hospitalized, and two children died of lethal lung inflammatory response during the first natural RSV infection after vaccination of RSV-naive infants.^[2] This disaster hindered vaccine development for many years to come.^[2]

A 1998 paper reported that research toward developing a vaccine had advanced greatly over the previous 10 years.^[3] The desired vaccine would prevent lower respiratory infection from RSV in at-risk populations and if possible be useful in other populations with less risk.^[3] Twenty years later, a 2019 paper similarly claimed that research toward developing a vaccine had advanced greatly over the prior 10 years.^[4] The same study predicted that a vaccine would be available within 10 years.^[4]

The current types of vaccines which are in research are particle-based vaccines, attenuated vaccines, protein subunit vaccines, or vector-based vaccines.^[5]

The DS-Cav1 vaccine for RSV, a protein subunit vaccine, was shown to be safe and to elicit “a robust boost in RSV F-specific antibodies and neutralising activity that was sustained above baseline for at least 44 weeks” in a phase 1 clinical trial, according to a study published in April 2021 in The Lancet Respiratory Medicine.^[1] A vaccine using this antigen, called GSK3888550A and developed by GlaxoSmithKline (GSK), is currently in phase 3 clinical trials, which began in November 2020.^[6] Barney S. Graham and Peter Kwong of the National Institute of Allergy and Infectious Diseases' Vaccine Research Center, along with Jason McLellan, a former postdoctoral researcher at VRC and now an associate professor at The University of Texas at Austin, spearheaded the development of DS-Cav1.^[7] The vaccine’s antigen, a stabilized version of the virus’ F protein, was developed using structure-based vaccine design.^[8][9][10] August 2021, Moderna received US FDA fast track designation for Respiratory Syncytial Virus Vaccine.^[11]

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