Respiratory Syncytial Virus Immunoreactivity, Vaccine Development, and Therapeutics

Respiratory syncytial virus (RSV) is an RNA virus that causes lower respiratory tract infection, which poses a significant health and financial burden on pediatric and elderly health services. Everyone is expected to have had an RSV infection by two years of age. There is a high risk of severe respiratory illness in certain high-risk groups like preterm infants and those born with chronic lung or congenital heart diseases. Severe RSV infection in early life is associated with a long-term respiratory illness like asthma or wheeze that persists into adulthood. There is no vaccine for RSV and limited effective antivirals. Vaccines have failed in clinical trials recently, and many more have not been developed past preclinical stages. The failure of vaccine development so far is most likely due to the ability of RSV to either evade or suppress memory IgA B cells in the airway. Perhaps the most significant advancement in RSV research is the elucidation of the structure of prefusion RSV-F, and the principal neutralization determinant termed Ø, which lies at the apex of the prefusion RSV-F trimer. This discovery has led to truly promising therapeutics and vaccine strategies. In this chapter, we summarize the history of RSV vaccine development and address current research in RSV vaccines and therapeutics.