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Walsh EE, Pérez Marc G, Zareba AM, Falsey AR, Jiang Q, Patton M, Polack FP, Llapur C, Doreski PA, Ilangovan K, Rämet M, Fukushima Y, Hussen N, Bont LJ, Cardona J, DeHaan E, Castillo Villa G, Ingilizova M, Eiras D, Mikati T, Shah RN, Schneider K, Cooper D, Koury K, Lino MM, Anderson AS, Jansen KU, Swanson KA, Gurtman A, Gruber WC, Schmoele-Thoma B. Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults. N Engl J Med 2023; 388:1465-1477. [PMID: 37018468 DOI: 10.1056/nejmoa2213836] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection causes considerable illness in older adults. The efficacy and safety of an investigational bivalent RSV prefusion F protein-based (RSVpreF) vaccine in this population are unknown. METHODS In this ongoing, phase 3 trial, we randomly assigned, in a 1:1 ratio, adults (≥60 years of age) to receive a single intramuscular injection of RSVpreF vaccine at a dose of 120 μg (RSV subgroups A and B, 60 μg each) or placebo. The two primary end points were vaccine efficacy against seasonal RSV-associated lower respiratory tract illness with at least two or at least three signs or symptoms. The secondary end point was vaccine efficacy against RSV-associated acute respiratory illness. RESULTS At the interim analysis (data-cutoff date, July 14, 2022), 34,284 participants had received RSVpreF vaccine (17,215 participants) or placebo (17,069 participants). RSV-associated lower respiratory tract illness with at least two signs or symptoms occurred in 11 participants in the vaccine group (1.19 cases per 1000 person-years of observation) and 33 participants in the placebo group (3.58 cases per 1000 person-years of observation) (vaccine efficacy, 66.7%; 96.66% confidence interval [CI], 28.8 to 85.8); 2 cases (0.22 cases per 1000 person-years of observation) and 14 cases (1.52 cases per 1000 person-years of observation), respectively, occurred with at least three signs or symptoms (vaccine efficacy, 85.7%; 96.66% CI, 32.0 to 98.7). RSV-associated acute respiratory illness occurred in 22 participants in the vaccine group (2.38 cases per 1000 person-years of observation) and 58 participants in the placebo group (6.30 cases per 1000 person-years of observation) (vaccine efficacy, 62.1%; 95% CI, 37.1 to 77.9). The incidence of local reactions was higher with vaccine (12%) than with placebo (7%); the incidences of systemic events were similar (27% and 26%, respectively). Similar rates of adverse events through 1 month after injection were reported (vaccine, 9.0%; placebo, 8.5%), with 1.4% and 1.0%, respectively, considered by the investigators to be injection-related. Severe or life-threatening adverse events were reported in 0.5% of vaccine recipients and 0.4% of placebo recipients. Serious adverse events were reported in 2.3% of participants in each group through the data-cutoff date. CONCLUSIONS RSVpreF vaccine prevented RSV-associated lower respiratory tract illness and RSV-associated acute respiratory illness in adults (≥60 years of age), without evident safety concerns. (Funded by Pfizer; RENOIR ClinicalTrials.gov number, NCT05035212; EudraCT number, 2021-003693-31.).
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Affiliation(s)
- Edward E Walsh
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Gonzalo Pérez Marc
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Agnieszka M Zareba
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Ann R Falsey
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Qin Jiang
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Michael Patton
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Fernando P Polack
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Conrado Llapur
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Pablo A Doreski
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kumar Ilangovan
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Mika Rämet
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Yasushi Fukushima
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Nazreen Hussen
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Louis J Bont
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Jose Cardona
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Elliot DeHaan
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Giselle Castillo Villa
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Marinela Ingilizova
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Daniel Eiras
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Tarek Mikati
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Rupal N Shah
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Katherine Schneider
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - David Cooper
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kenneth Koury
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Maria-Maddalena Lino
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Annaliesa S Anderson
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kathrin U Jansen
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Kena A Swanson
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Alejandra Gurtman
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - William C Gruber
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
| | - Beate Schmoele-Thoma
- From the University of Rochester Medical Center, Rochester (E.E.W., A.R.F.), and Vaccine Research and Development (E.D., G.C.V., M.I., D.E., T.M., R.N.S., K.S., D.C., K.K., K.U.J., K.A.S., A.G., W.C.G.) and Worldwide Research, Development, and Medical (A.S.A.), Pfizer, Pearl River - both in New York; iTrials-Hospital Militar Central (G.P.M.), Fundación INFANT (F.P.P.), and Fundación Respirar Clinical Research Unit (P.A.D.), Buenos Aires, and Clinica Mayo de Urgencias Médicas Cruz Blanca, San Miguel de Tucumán (C.L.) - all in Argentina; Vaccine Research and Development, Pfizer, Collegeville, PA (A.M.Z., Q.J.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (M.P.); Vaccine Research and Development, Pfizer, Raleigh, NC (K.I.); Faculty of Medicine and Health Technology, Tampere University, and Finnish Vaccine Research - both in Tampere, Finland (M.R.); Fukuwa Clinic, Tokyo (Y.F.); Netcare Lakeview Hospital, Benoni, South Africa (N.H.); the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist - both in the Netherlands (L.J.B.); Indago Research and Health Center, Hialeah, FL (J.C.); Worldwide Safety, Pfizer, Milan (M.-M.L.); and Vaccine Research and Development, Pfizer Pharma, Berlin (B.S.-T.)
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Falsey AR, Williams K, Gymnopoulou E, Bart S, Ervin J, Bastian AR, Menten J, De Paepe E, Vandenberghe S, Chan EKH, Sadoff J, Douoguih M, Callendret B, Comeaux CA, Heijnen E. Efficacy and Safety of an Ad26.RSV.preF-RSV preF Protein Vaccine in Older Adults. N Engl J Med 2023; 388:609-620. [PMID: 36791161 DOI: 10.1056/nejmoa2207566] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) can cause serious lower respiratory tract disease in older adults, but no licensed RSV vaccine currently exists. An adenovirus serotype 26 RSV vector encoding a prefusion F (preF) protein (Ad26.RSV.preF) in combination with RSV preF protein was previously shown to elicit humoral and cellular immunogenicity. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 2b, proof-of-concept trial to evaluate the efficacy, immunogenicity, and safety of an Ad26.RSV.preF-RSV preF protein vaccine. Adults who were 65 years of age or older were randomly assigned in a 1:1 ratio to receive vaccine or placebo. The primary end point was the first occurrence of RSV-mediated lower respiratory tract disease that met one of three case definitions: three or more symptoms of lower respiratory tract infection (definition 1), two or more symptoms of lower respiratory tract infection (definition 2), and either two or more symptoms of lower respiratory tract infection or one or more symptoms of lower respiratory tract infection plus at least one systemic symptom (definition 3). RESULTS Overall, 5782 participants were enrolled and received an injection. RSV-mediated lower respiratory tract disease meeting case definitions 1, 2, and 3 occurred in 6, 10, and 13 vaccine recipients and in 30, 40, and 43 placebo recipients, respectively. Vaccine efficacy was 80.0% (94.2% confidence interval [CI], 52.2 to 92.9), 75.0% (94.2% CI, 50.1 to 88.5), and 69.8% (94.2% CI, 43.7 to 84.7) for case definitions 1, 2, and 3, respectively. After vaccination, RSV A2 neutralizing antibody titers increased by a factor of 12.1 from baseline to day 15, a finding consistent with other immunogenicity measures. Percentages of participants with solicited local and systemic adverse events were higher in the vaccine group than in the placebo group (local, 37.9% vs. 8.4%; systemic, 41.4% vs. 16.4%); most adverse events were mild to moderate in severity. The frequency of serious adverse events was similar in the vaccine group and the placebo group (4.6% and 4.7%, respectively). CONCLUSIONS In adults 65 years of age or older, Ad26.RSV.preF-RSV preF protein vaccine was immunogenic and prevented RSV-mediated lower respiratory tract disease. (Funded by Janssen Vaccines and Prevention; CYPRESS ClinicalTrials.gov number, NCT03982199.).
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Affiliation(s)
- Ann R Falsey
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Kristi Williams
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Efi Gymnopoulou
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Stephan Bart
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - John Ervin
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Arangassery R Bastian
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Joris Menten
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Els De Paepe
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Sjouke Vandenberghe
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Eric K H Chan
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Jerald Sadoff
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Macaya Douoguih
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Benoit Callendret
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Christy A Comeaux
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
| | - Esther Heijnen
- From the University of Rochester School of Medicine, Rochester, NY (A.R.F.); Janssen Vaccines and Prevention, Leiden, the Netherlands (K.W., A.R.B., J.S., M.D., B.C., C.A.C., E.H.); Janssen Infectious Diseases, Beerse, Belgium (E.G., J.M., E.D.P., S.V.); Trial Professionals Consultant Group, Woodstock, MD (S.B.); AMR Kansas City, Kansas City, MO (J.E.); and Janssen Global Services, Raritan, NJ (E.K.H.C.)
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