A promise fulfilled: Updates on respiratory syncytial virus vaccines and monoclonal antibodies.

Abstract

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection and hospitalization in infants, older adults, and immunocompromised individuals. In children, early-life RSV infection has been associated with increased risk of recurrent wheezing and asthma. In adults aged ≥60 years, RSV contributes significantly to respiratory morbidity, comparable to influenza in seasonal burden. Recent advancements have led to the licensure of 3 RSV vaccines for older adults and pregnant people. Immunogenicity data show a durable antibody response for more than one respiratory season. Additionally, two new, potent long-acting monoclonal antibodies are now recommended for all infants entering their first RSV season. These preventive tools have expanded public health strategies to reduce RSV-associated illness across age groups. Maternal vaccination and monoclonal antibodies have reduced medically attended RSV illness in infants by more than 50%. Overall, these tools represent major progress in RSV prevention. Areas in need of further investigation include continued postlicensure monitoring for safety and effectiveness, evaluation of the overall durability of protection, considerations of the need for repeat dosing, and monitoring for broader population-level benefits, including the possibility of reduced asthma risk, and expansion of use into high-risk and immunocompromised populations.