Fatal enhanced respiratory syncytial virus disease in toddlers.

Polack, Fernando P; Alvarez-Paggi, Damián; Libster, Romina; Caballero, Mauricio T; Blair, Robert V; Hijano, Diego R; de la Iglesia Niveyro, Paola X; Menendez, Daniel R et al. · Sci Transl Med · 2021

case_report · Level V

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Abstract

In 1967, two toddlers immunized with a formalin-inactivated vaccine against respiratory syncytial virus (FIRSV) in the United States died from enhanced RSV disease (ERD), a severe form of illness resulting from aberrant priming of the antiviral immune response during vaccination. Up to 80% of immunized children subsequently exposed to wild-type virus were hospitalized. These events hampered RSV vaccine development for decades. Here, we provide a characterization of the clinical, immunopathological, and transcriptional signature of fatal human ERD, outlining evidence for safety evaluation of RSV vaccines and a framework for understanding disease enhancement for pathogens in general.

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