Respiratorysyncytial virus (RSV) is the most common pathogen that causes acutelower respiratory infection in children under five years, whichaccounts for 30% of all respiratory pathogens. RSV poses a threat tochild health. However, there are no specific effective antivirals forthe RSV treatment. In 2017, the World Health Organisation (WHO)published RSV vaccine research and development technology roadmap,and WHO Preferred Product Characteristics for RSV vaccines. As aresult of the promotion by WHO, there has been rapid progress in thedevelopment of RSV vaccine and prophylactic antibodies in the recentfive years. Several RSV vaccine and prophylactic antibodiescandidates have shown promises in receiving licensure in the next oneto three years. Therefore, it is necessary to understand the diseaseburden of RSV-associated infections in children and providescientific evidence for RSV immunisation strategy.
On20thMay 2022, Prof. You Li, one of the high-level imported talents, fromSchool of Public Health, Nanjing Medical University, together withProf. Harish Nair from University of Edinburgh, published theresearch article titled Global,regional, and national disease burden estimates of acute lowerrespiratory infections due to respiratory syncytial virus in childrenyounger than 5 years in 2019: a systematic analysisin Lancet. The article systematically analysed and reported theglobal, regional and national disease burden of RSV-associated acutelower respiratory infections in children. The main findings include:(1)infants under six months of age had the highest disease burden ofRSV-associated acute lower respiratory infections,accounting for 20% of total RSV-associated acute lower respiratoryinfections, 39% of total RSV-associated hospital admissions for acutelower respiratory infections, and 46% of total RSV-attributabledeaths among children under five years; (2) low and middle incomecountries had much higher incidence rates of RSV-associated acutelower respiratory infections (52/1000 vs 24/1000) but lowerhospitalisation rates (5/1000 vs 6/1000) than high-income countries.Thishighlighted the fact that children with severe RSV-associated acutelower respiratory infections could not be admitted to hospitals andreceive appropriate treatments, reflecting the shortage ofhealth-care resources in low and middle income countries.(3) there were substantial out-of-hospital deaths attributable to RSVin low and middle income countries; forevery one RSV-attributable death found in the hospital, there couldbe three more RSV-attributable deaths occurring outside the hospital.
Figure1. GlobalRSV morbidity and mortality burden in children under five years in2019
Figure2. Comparisonof RSV disease burden in infants under six months among differentincome regions
Figure3. Comparisonof RSV mortality burden in infants under six months among differentincome regions
Thefindings above collectively suggest that RSV immunisation programmetargeting at infants under six months are potentially effective,especially for low and middle income countries that have limitedhealth-care resources and poor accessibility to these resources —RSV immunisation is expected to reduce the absolute number of casesand lower the pressure in hospital beds, and further avertout-of-hospital RSV deaths caused by no access or no timely access tohealth-care services.
The Lancetjournal invited Prof. Tina Hartert from Vanderbilt University andProf. Justin Ortiz from University of Marylandfor the commentary. The commentary highlighted the importance of thestudy findings in RSV prevention, “The study has many notablefindings which will be important in informing RSV prevention efforts…“important to inform product choice and timing of administration”.
Prof.You Li from School of Public Health, Nanjing Medical University isthe first author of the article; A/Prof. Xin Wang from School ofPublic Health, is the second author; and Prof. Harish Nair fromCentre for Global Health, University of Edinburgh, is thecorresponding author. Prof. You Li is a member of the WHO RSV VaccineValue Profile working group. His research outputs on RSV epidemiologyand mathematical modelling were published in international journalsincluding Lancet Respiratory Health, Lancet Infectious Diseases,Lancet Global Health, Eurosurveillance, and Journal of Infectiousdiseases.
Linkto the commentary:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00623-7/fulltext