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Wang Q, Xiu S, Yang L, Li L, Yang M, Wang X, Shen Y, Wang W, Lin L. Perceptions about respiratory syncytial virus (RSV) and attitudes toward the RSV vaccine among the general public in China: A cross-sectional survey. Hum Vaccin Immunother 2024; 20:2310916. [PMID: 38369712 PMCID: PMC10877988 DOI: 10.1080/21645515.2024.2310916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
Our study aims to assess the public's perceptions of respiratory syncytial virus (RSV) and attitudes toward the RSV vaccine and to identify associated factors in China. A nationwide cross-sectional survey conducted using an online platform between August 16 and September 14, 2023. Questions related to socio-demographics, awareness, knowledge, perceptions of susceptibility and severity of RSV, and attitudes toward the RSV vaccine were included in the questionnaire. We used the chi-square test and logistic regression model to explore the associated factors. Overall, 2133 individuals were included in this study. Nearly a quarter of participants (24.3%) indicated that they had never heard of RSV. The proportion of individuals aged over 50 years reporting never having heard of RSV (36.5%) and having a low knowledge level of RSV (55.3%) was significantly higher that of other younger age groups. More than half of individuals (55.7%) exhibited low level of perceptions of susceptibility concerning RSV infection. A total of 68.4% of the participants expressed willingness to receive the RSV vaccine. Younger age was positively associated with a higher willingness to be vaccinated. The most frequent reason for declining the vaccine was "Concern about vaccine's safety or side effects." About 60% of individuals considered a price of RSV vaccine below 200 CNY (28 USD) as acceptable. The awareness and perceived susceptibility to RSV infection were limited to the Chinese public. It is necessary to take measures to address the low awareness and knowledge of RSV and acceptability of the RSV vaccine among older adults.
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Affiliation(s)
- Qiang Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Shixin Xiu
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Lan Li
- Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Min Yang
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Xuwen Wang
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Yuan Shen
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Weibing Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong KongSpecial Administrative Region, China
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Du Z, Wang S, Chen R, Shan S, Bai Y, Wang L, Lau EHY, Wu P, Cowling BJ. Efficacy and safety of respiratory syncytial virus prefusion F protein vaccines in adults. J Infect 2024; 89:106211. [PMID: 38942239 DOI: 10.1016/j.jinf.2024.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/20/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Zhanwei Du
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China.
| | - Shuqi Wang
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Ruohan Chen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Songwei Shan
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Yuan Bai
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Lin Wang
- Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Institute for Health Transformation & School of Health & Social Development, Deakin University, Melbourne, Australia
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
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De Angelis A, Johnson ED, Sutharsan S, Aliberti S. Exacerbations of bronchiectasis. Eur Respir Rev 2024; 33:240085. [PMID: 39048130 PMCID: PMC11267293 DOI: 10.1183/16000617.0085-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Bronchiectasis presents a significant challenge due to its rising prevalence, associated economic burden and clinical heterogeneity. This review synthesises contemporary understanding and literature of bronchiectasis exacerbations, addressing the transition from stable state to exacerbations, underlining the importance of early and precise recognition, rigorous severity assessment, prompt treatment, and prevention measures, as well as emphasising the need for strategies to assess and improve early and long-term patient outcomes. The review highlights the interplay between stable state phases and exacerbations in bronchiectasis, introducing the concept of "exogenous and endogenous changes in airways homeostasis" and the "adapted island model" with a particular focus on "frequent exacerbators", a group of patients associated with specific clinical characteristics and worse outcomes. The pathophysiology of exacerbations is explored through the lens of microbial and nonmicrobial triggers and the presence and the activity of comorbidities, elaborating on the impact of both exogenous insults, such as infections and pollution, and endogenous factors such as inflammatory endotypes. Finally, the review proposes a multidisciplinary approach to care, integrating advancements in precision medicine and biomarker research, paving the way for tailored treatments that challenge the traditional antibiotic paradigm.
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Affiliation(s)
- Alessandro De Angelis
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Emma D Johnson
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sivagurunathan Sutharsan
- Division of Cystic Fibrosis, Department of Pulmonary Medicine, University Medicine Essen -Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
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4
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Holmdahl I, Bents SJ, Baker RE, Casalegno JS, Trovão NS, Park SW, Metcalf JE, Viboud C, Grenfell B. Differential impact of COVID-19 non-pharmaceutical interventions on the epidemiological dynamics of respiratory syncytial virus subtypes A and B. Sci Rep 2024; 14:14527. [PMID: 38914626 PMCID: PMC11196647 DOI: 10.1038/s41598-024-64624-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
Nonpharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic have disrupted the dynamics of respiratory syncytial virus (RSV) on a global scale; however, the cycling of RSV subtypes in the pre- and post-pandemic period remains poorly understood. Here, we used a two subtype RSV model supplemented with epidemiological data to study the impact of NPIs on the two circulating subtypes, RSV-A and RSV-B. The model is calibrated to historic RSV subtype data from the United Kingdom and Finland and predicts a tendency for RSV-A dominance over RSV-B immediately following the implementation of NPIs. Using a global genetic dataset, we confirm that RSV-A has prevailed over RSV-B in the post-pandemic period, consistent with a higher R0 for RSV-A. With new RSV infant monoclonals and maternal and elderly vaccines becoming widely available, these results may have important implications for understanding intervention effectiveness in the context of disrupted subtype dynamics.
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Affiliation(s)
- Inga Holmdahl
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Samantha J Bents
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| | - Rachel E Baker
- School of Public Health, Brown University, Providence, RI, USA
| | - Jean-Sebastien Casalegno
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Biologie Nord, Institut des Agents Infectieux, Laboratoire de Virologie, Lyon, France
| | | | - Sang Woo Park
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Cécile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Bryan Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
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Sheshadri A, Evans SE. Respiratory Syncytial Virus Vaccination in the Adult Pulmonary Patient. Chest 2024:S0012-3692(24)00705-0. [PMID: 38885895 DOI: 10.1016/j.chest.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
TOPIC IMPORTANCE Since its discovery in 1957, respiratory syncytial virus (RSV) has been widely recognized as a common and deadly pathogen. Although early studies focused on the impact of RSV on the health of children, more recent data show that RSV imposes a significant burden on individuals aged ≥ 70 years. RSV also substantially harms the health of individuals with cardiopulmonary diseases. REVIEW FINDINGS Early efforts to develop an RSV vaccine were hampered by toxicity due to antibody-enhanced viral pneumonia and a lack of efficacy in vaccines that targeted the postfusion configuration of the F fusion protein, which is crucial to the pathogenesis of RSV-mediated injury. A newer wave of vaccines has targeted a stabilized prefusion F protein, generating effective neutralizing antibodies and reducing the burden of mild and severe RSV lower respiratory tract injury. This review focuses on the burden of RSV in patients with pulmonary diseases, highlights the tumultuous path from the early days of RSV vaccine development to the modern era, and offers insights into key gaps in knowledge that must be addressed to adequately protect the vulnerable population of patients with severe pulmonary diseases. SUMMARY RSV vaccination with bivalent RSVPreF or RSVPreF3OA, which target the stabilized prefusion F protein, can be broadly recommended to adults with pulmonary diseases aged ≥ 60 years. However, more data are needed to understand how these vaccinations affect key clinical outcomes in individuals with pulmonary disease.
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Affiliation(s)
- Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Scott E Evans
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Middleton C, Larremore DB. Modeling the transmission mitigation impact of testing for infectious diseases. SCIENCE ADVANCES 2024; 10:eadk5108. [PMID: 38875334 PMCID: PMC11177932 DOI: 10.1126/sciadv.adk5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/10/2024] [Indexed: 06/16/2024]
Abstract
A fundamental question of any program focused on the testing and timely diagnosis of a communicable disease is its effectiveness in reducing transmission. Here, we introduce testing effectiveness (TE)-the fraction by which testing and post-diagnosis isolation reduce transmission at the population scale-and a model that incorporates test specifications and usage, within-host pathogen dynamics, and human behaviors to estimate TE. Using TE to guide recommendations, we show that today's rapid diagnostics should be used immediately upon symptom onset to control influenza A and respiratory syncytial virus but delayed by up to two days to control omicron-era severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Furthermore, while rapid tests are superior to reverse transcription quantitative polymerase chain reaction (RT-qPCR) to control founder-strain SARS-CoV-2, omicron-era changes in viral kinetics and rapid test sensitivity cause a reversal, with higher TE for RT-qPCR despite longer turnaround times. Last, we illustrate the model's flexibility by quantifying trade-offs in the use of post-diagnosis testing to shorten isolation times.
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Affiliation(s)
- Casey Middleton
- Department of Computer Science, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
| | - Daniel B. Larremore
- Department of Computer Science, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
- Santa Fe Institute, Santa Fe, NM, USA
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Eom J, Kim Y, Kim D, Lee E, Kwon SH, Jo MW, Jung J, Park H, Park B. Cost-benefit analysis of human adenovirus vaccine development in a Korean military setting. Vaccine 2024:S0264-410X(24)00622-4. [PMID: 38806354 DOI: 10.1016/j.vaccine.2024.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Human adenovirus (HAdV) is a prevalent causative agent of acute respiratory disease (ARD) and is frequently responsible for outbreaks, particularly in military environments. Current vaccines do not effectively cover HAdV subtypes commonly found among Korean military personnel, highlighting the need for a new targeted vaccine. This study presents a cost-benefit analysis to evaluate the economic viability of developing and implementing such a vaccine within a military context. METHODS We adopted a societal perspective for this cost-benefit analysis, which included estimating costs associated with vaccine development, production, and distribution over a projected timeline. We assumed a development period of five years, after which vaccine production and administration were initiated in the sixth year. The cost associated with vaccine development, production, and dispensation was considered. The benefits were calculated based on both direct and indirect cost savings from preventing HAdV infections through vaccination. All financial figures were expressed in 2023 US dollars. A sensitivity analysis was conducted to explore the impact of varying factors such as vaccination rate, incidence of infection, vaccine efficacy, and discount rate. RESULTS For the base case scenario, we assumed a vaccination rate of 100 %, an incidence rate of 0.02, and a vaccine efficacy of 95 %, applying a 3 % discount rate. Initially, in the sixth year, the benefit-cost ratio stood at 0.71, suggesting a cost disadvantage at the onset of vaccination. However, this ratio improved to 1.32 in the following years, indicating a cost benefit from the seventh year onward. The cumulative benefit-cost ratio over a decade reached 2.72. The outcomes from the sensitivity analysis were consistent with these findings. CONCLUSION Our cost-benefit analysis demonstrates that the introduction of an HAdV vaccine for the Korean military is economically advantageous, with substantial cost benefits accruing from the seventh year after the commencement of vaccination.
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Affiliation(s)
- Jungmin Eom
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
| | - Yeonjae Kim
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
| | - Donghoon Kim
- Department of Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, South Korea.
| | - Eunyoung Lee
- Department of Laboratory Medicine, Armed Forces Capital Hospital, Seongnam, South Korea.
| | - Soon-Hwan Kwon
- Department of Infectious Diseases Research, Armed Forces Medical Research Institute, Daejeon, South Korea.
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea; Artificial Intelligence and Big-Data Convergence Centre, Gil Medical Centre, Gachon University College of Medicine, Incheon, South Korea.
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Graduate Program for System Health Science and Engineering, Ewha Womans University, Seoul, South Korea.
| | - Bomi Park
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
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8
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Falsey AR, Hosman T, Bastian AR, Vandenberghe S, Chan EKH, Douoguih M, Heijnen E, Comeaux CA, Callendret B. Long-term efficacy and immunogenicity of Ad26.RSV.preF-RSV preF protein vaccine (CYPRESS): a randomised, double-blind, placebo-controlled, phase 2b study. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00226-3. [PMID: 38801826 DOI: 10.1016/s1473-3099(24)00226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Ad26.RSV.preF-RSV preF protein showed 80·0% vaccine efficacy against respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) in older adults during one RSV season. No RSV vaccines have shown three-season efficacy. We aimed to evaluate efficacy of Ad26.RSV.preF-RSV preF protein over three RSV seasons. METHODS CYPRESS was a randomised, double-blind, placebo-controlled, phase 2b study done at 40 US clinical research centres wherein adults aged 65 years or older were centrally randomly assigned 1:1 by computer algorithm to receive Ad26.RSV.preF-RSV preF protein or placebo (one intramuscular injection) on day 1. Investigators, participants, site personnel, and the sponsor were masked to vaccine allocation, except for individuals involved in preparation of study vaccinations. The primary endpoint (first occurrence of RSV-mediated LRTD meeting one of three case definitions) was previously reported. Here, the predefined exploratory endpoint of vaccine efficacy against RSV-positive LRTD was assessed in the per-protocol efficacy set (all participants randomly assigned and vaccinated without protocol deviations affecting efficacy) through season 1 and from day 365 until the end of season 3. Humoral and cellular immunogenicity was assessed in a subset of randomly assigned and vaccinated participants. The secondary endpoint of safety through the first RSV season was previously reported; follow-up for selected safety outcomes (fatal adverse events, adverse events leading to study discontinuation, serious adverse events, and vaccine-related serious adverse events) until study completion is reported here in all randomly assigned and vaccinated participants. This trial is registered with ClinicalTrials.gov, NCT03982199 and is complete. FINDINGS Of 6672 adults screened, 5782 participants (2891 each receiving vaccine or placebo) were enrolled and vaccinated between Aug 5 and Nov 13, 2019. The season 2 per-protocol efficacy set included 2124 vaccine recipients and 2126 placebo recipients (season 3: 864 and 881; across three seasons: 2795 and 2803, respectively). Vaccine efficacy against RSV LRTD was 76·1% (95% CI 26·9-94·2) over seasons 2 and 3 and 78·7% (57·3-90·4) across three seasons. For those in the immunogenicity subset (vaccine n=97; placebo n=98), immune responses remained above baseline for at least 1 year. Serious adverse events occurred in 47 (2·1%) and 12 (1·3%) vaccine recipients and 45 (2·1%) and 10 (1·1%) placebo recipients during seasons 2 and 3, respectively. No treatment-related serious or fatal adverse events were reported. INTERPRETATION Ad26.RSV.preF-RSV preF protein maintained high efficacy against RSV LRTD in older adults across three RSV seasons. FUNDING Janssen Vaccines & Prevention.
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Affiliation(s)
- Ann R Falsey
- University of Rochester School of Medicine, Infectious Diseases Unit, Rochester, NY, USA
| | - Tessa Hosman
- Janssen Vaccines & Prevention, Leiden, Netherlands
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Verstraelen S, Roymans D, Jacobs A, Hollanders K, Remy S, Jochmans D, Klein J, Grauwet T. Proof of stability of an RSV Controlled Human Infection Model challenge agent. Virol J 2024; 21:112. [PMID: 38750558 PMCID: PMC11097566 DOI: 10.1186/s12985-024-02386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
In 2018, SGS Belgium NV developed RSV-NICA (Respiratory Syncytial Virus-Nasobronchial Infective Challenge Agent), an RSV type A challenge agent for use in RSV Controlled Human Infection Model (CHIM) studies.It is widely recognized that the stability of RSV can be influenced by a variety of environmental parameters, such as temperature and pH. Consequently, our objective was to evaluate the stability of the viral titer of RSV-NICA following five years of controlled storage and to determine the uniformity of the viral titers across different vials of a GMP-qualified batch of RSV-NICA. In addition, we examined the capacity of RSV-NICA to infect human primary airway epithelial cells (MucilAir™), the principal target cells of RSV, and evaluated the influence of single and recurrent freeze-thaw cycles on the infectious viral titer of the challenge agent.The aliquoted RSV-NICA virus stock was subjected to standard virological and molecular methods to gather data on the titer and consistency of the viral titer contained within 24 representative vials of the stock. Our findings illustrate that over a span of five years of cryo-storage, the infectious viral titer in 75% of the tested vials exhibited a comparable average infectious viral titer (4.75 ± 0.06 vs 4.99 ± 0.11; p-value = 0.14). A considerable reduction down to an undetectable level of infectious virus was observed in the remaining vials. RSV-NICA demonstrated its capacity to effectively infect differentiated human airway epithelial cells, with active virus replication detected in these cells through increasing RSV genome copy number over time. Virus tropism for ciliated cells was suggested by the inhibition of cilia beating coupled with an increase in viral RNA titers. No discernable impact on membrane barrier function of the epithelial lung tissues nor cytotoxicity was detected. Pooling of vials with infectious titers > 4.0 log10 TCID50/ml and freeze-thawing of these combined vials showed no deterioration of the infectious titer. Furthermore, pooling and re-aliquoting of vials spanning the entire range of viral titers (including vials with undetectable infectious virus) along with subjecting the vials to three repeated freeze-thaw cycles did not result in a decrease of the infectious titers in the tested vials.Taken together, our findings indicate that long-term cryo-storage of vials containing RSV-NICA challenge agent may influence the infectious viral titer of the virus, leading to a decrease in the homogeneity of this titer throughout the challenge stock. However, our study also demonstrates that when heterogeneity of the infectious titer of an RSV stock is observed, rounds of pooling, re-aliquoting and subsequent re-titration serve as an effective method not only to restore the homogeneity of the infectious titer of an RSV-A stock, but also to optimize patient-safety, scientific and operational aspects of viral inoculation of study participants during at least the period of one RSV CHIM trial. RSV-NICA is a stable, suitable CHIM challenge agent that can be utilized in efficacy trials for RSV vaccines and antiviral entities.
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Affiliation(s)
- Sandra Verstraelen
- Environmental Intelligence Unit, Flemish Institute for Technological Research (VITO), Industriezone Vlasmeer 7, Mol, 2400, Belgium.
| | - Dirk Roymans
- DNS Life Sciences Consulting, Brandhoefstraat 63, Turnhout, 2300, Belgium
| | - An Jacobs
- Environmental Intelligence Unit, Flemish Institute for Technological Research (VITO), Industriezone Vlasmeer 7, Mol, 2400, Belgium
| | - Karen Hollanders
- Environmental Intelligence Unit, Flemish Institute for Technological Research (VITO), Industriezone Vlasmeer 7, Mol, 2400, Belgium
| | - Sylvie Remy
- Environmental Intelligence Unit, Flemish Institute for Technological Research (VITO), Industriezone Vlasmeer 7, Mol, 2400, Belgium
| | - Dirk Jochmans
- Rega Institute for Medical Research, Herestraat 49, Leuven, 3000, Belgium
| | - Jelle Klein
- Clinical Pharmacology Unit, SGS, Drie Eikenstraat 655, Edegem, 2650, Belgium
| | - Tini Grauwet
- Clinical Pharmacology Unit, SGS, Drie Eikenstraat 655, Edegem, 2650, Belgium
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10
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Baker J, Aliabadi N, Munjal I, Jiang Q, Feng Y, Brock LG, Cooper D, Anderson AS, Swanson KA, Gruber WC, Gurtman A. Equivalent immunogenicity across three RSVpreF vaccine lots in healthy adults 18-49 years of age: Results of a randomized phase 3 study. Vaccine 2024; 42:3172-3179. [PMID: 38616438 DOI: 10.1016/j.vaccine.2024.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Bivalent RSV prefusion F subunit vaccine (RSVpreF), comprised of equal quantities of stabilized prefusion F antigens from the major circulating subgroups (RSV A, RSV B), is licensed for prevention of RSV-associated lower respiratory tract illness (LRTI) in older adults and for maternal vaccination for prevention of RSV-associated LRTI in infants. To support licensure and large-scale manufacturing, this lot consistency study was conducted to demonstrate equivalence in immunogenicity across 3 RSVpreF lots. METHODS This phase 3, multicenter, parallel-group, placebo-controlled, randomized (1:1:1:1), double-blind study evaluated immunogenicity, safety, and tolerability of RSVpreF in healthy 18-49-year-old adults. Participants received a single 120-µg injection of 1 of 3RSVpreF lots or placebo. Geometric mean ratio (GMR) of RSV serum 50 % neutralizing geometric mean titers obtained 1 month after vaccination were compared between each vaccine lot for RSV A and RSV B, separately. Equivalence between lots was defined using a 1.5-fold criterion (GMR 95 % CIs for every lot pair within the 0.667-1.5 interval). Safety and tolerability were assessed. RESULTS Of 992participants vaccinated, 948 were included in the evaluable immunogenicity population. All 3 RSVpreF lots elicited strong immune responses, meeting the 1.5-fold equivalence criterion for all between-lot comparisons for both RSV A and RSV B. Across the 3 lots, RSV A and RSV B 50 % neutralizing geometric mean titers substantially increased from baseline (RSV A, 1671-1795; RSV B 1358-1429) to 1 month after RSVpreF vaccination (RSV A, 24,131-25,238; RSV B, 19,238-21,702), corresponding to ≥14-fold increases in 50 % neutralizing titers for both RSV A and RSV B from before to 1 month after vaccination. Single doses of RSVpreF were safe and well tolerated, with similar safety profiles across the 3 RSVpreF lots. CONCLUSIONS These findings support the reproducibility of RSVpreF vaccine manufacturing with similar safety and reactogenicity profiles (NCT05096208).
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Affiliation(s)
- Jeffrey Baker
- Clinical Research Prime, 187 E 13th St, Idaho Falls, ID 83404, USA
| | - Negar Aliabadi
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Iona Munjal
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA.
| | - Qin Jiang
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Ye Feng
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Linda G Brock
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - David Cooper
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Annaliesa S Anderson
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Kena A Swanson
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Alejandra Gurtman
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
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11
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Pang Y, Lu H, Cao D, Zhu X, Long Q, Tian F, Long X, Li Y. Efficacy, immunogenicity and safety of respiratory syncytial virus prefusion F vaccine: systematic review and meta-analysis. BMC Public Health 2024; 24:1244. [PMID: 38711074 PMCID: PMC11075318 DOI: 10.1186/s12889-024-18748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE A notable research gap exists in the systematic review and meta-analysis concerning the efficacy, immunogenicity, and safety of the respiratory syncytial virus (RSV) prefusion F vaccine. METHODS We conducted a comprehensive search across PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov to retrieve articles related to the efficacy, immunogenicity, and safety of RSV prefusion F vaccines, published through September 8, 2023. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 22 randomized controlled trials involving 78,990 participants were included in this systematic review and meta-analysis. The RSV prefusion F vaccine exhibited a vaccine effectiveness of 68% (95% CI: 59-75%) against RSV-associated acute respiratory illness, 70% (95% CI: 60-77%) against medically attended RSV-associated lower respiratory tract illness, and 87% (95% CI: 71-94%) against medically attended severe RSV-associated lower respiratory tract illness. Common reported local adverse reactions following RSV prefusion F vaccination include pain, redness, and swelling at the injection site, and systemic reactions such as fatigue, headache, myalgia, arthralgia, nausea, and chills. CONCLUSIONS Our meta-analysis suggests that vaccines using the RSV prefusion F protein as antigen exhibit appears broadly acceptable efficacy, immunogenicity, and safety in the population. In particular, it provides high protective efficiency against severe RSV-associated lower respiratory tract disease.
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Affiliation(s)
- Yi Pang
- Youjiang Medical University for Nationalities, Baise, China
| | - Haishan Lu
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Demin Cao
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Xiaoying Zhu
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Qinqin Long
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Fengqin Tian
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Xidai Long
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China.
| | - Yulei Li
- Clinicopathological Diagnosis & Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China.
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12
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Morimoto T, Morikawa T, Imura H, Nezu M, Hamazaki K, Sakuma M, Chaumont A, Moitinho de Almeida M, Moreno VP, Ho Y, Harrington L, Matsuki T, Nakamura T. Rationale and protocol for a prospective cohort study of respiratory viral infections in patients admitted from emergency departments of community hospitals: Effect of respiratory Virus infection on EmeRgencY admission (EVERY) study. BMJ Open 2024; 14:e081037. [PMID: 38626982 PMCID: PMC11029217 DOI: 10.1136/bmjopen-2023-081037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a causative virus for the common cold worldwide and can result in hospitalisations and even death in patients with high-risk conditions and older adults. However, the relationship between RSV or other incidental respiratory infections and acute exacerbations of underlying conditions has not been well investigated. The primary objective of this study is to estimate RSV prevalence, risk factors for adverse outcomes or hospitalisation and their effect on the hospital course of patients with acute respiratory symptoms admitted from emergency departments. Furthermore, we evaluate the prevalence of other respiratory viruses associated with respiratory symptoms. METHODS AND ANALYSIS We are conducting a multicentre prospective cohort study in Japan. We plan to enrol 3000 consecutive patients admitted from emergency departments with acute respiratory symptoms or signs from 1 July 2023 to 30 June 2024. A nasopharyngeal swab is obtained within 24 hours of admission and the prevalence of RSV and other respiratory viruses is measured using the FilmArray Respiratory 2.1 panel. Paired serum samples are collected from patients with suspected lower respiratory infections to measure RSV antibodies at admission and 30 days later. Information on patients' hospital course is retrieved from the electronic medical records at discharge, death or 30 days after admission. Furthermore, information on readmission to the hospital and all-cause mortality is collected 180 days after admission. We assess the differences in clinical outcomes between patients with RSV or other respiratory viruses and those without, adjusting for baseline characteristics. Clinical outcomes include in-hospital mortality, length of hospital stay, disease progression, laboratory tests and management of respiratory symptoms or underlying conditions. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review boards of participating hospitals. Our study reports will be published in academic journals as well as international meetings. TRIAL REGISTRATION NUMBER NCT05913700.
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Affiliation(s)
- Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Toru Morikawa
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
- Department of General Medicine, Nara City Hospital, Nara, Japan
| | - Haruki Imura
- Department of Infectious Disease, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Mari Nezu
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Kenya Hamazaki
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
- Department of General Internal Medicine, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | | | | | | | | | | | | | - Tsukasa Nakamura
- Department of Infectious Disease, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
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13
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Papazisis G, Topalidou X, Gioula G, González PA, Bueno SM, Kalergis AM. Respiratory Syncytial Virus Vaccines: Analysis of Pre-Marketing Clinical Trials for Immunogenicity in the Population over 50 Years of Age. Vaccines (Basel) 2024; 12:353. [PMID: 38675736 PMCID: PMC11054105 DOI: 10.3390/vaccines12040353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Immunosenescence refers to age-related alterations in immune system function affecting both the humoral and cellular arm of immunity. Understanding immunosenescence and its impact on the vaccination of older adults is essential since primary vaccine responses in older individuals can fail to generate complete protection, especially vaccines targeting infections with increased incidence among the elderly, such as the respiratory syncytial virus. Here, we review clinical trials of both candidate and approved vaccines against respiratory syncytial virus (RSV) that include adults aged ≥50 years, with an emphasis on the evaluation of immunogenicity parameters. Currently, there are 10 vaccine candidates and 2 vaccines approved for the prevention of RSV in the older adult population. The number of registered clinical trials for this age group amounts to 42. Our preliminary evaluation of published results and interim analyses of RSV vaccine clinical trials indicates efficacy in older adult participants, demonstrating immunity levels that closely resemble those of younger adult participants.
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Affiliation(s)
- Georgios Papazisis
- Clinical Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Xanthippi Topalidou
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Georgia Gioula
- Department of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Pablo A. González
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile (A.M.K.)
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile (A.M.K.)
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile (A.M.K.)
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
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14
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Gidwani SV, Brahmbhatt D, Zomback A, Bassie M, Martinez J, Zhuang J, Schulze J, McLellan JS, Mariani R, Alff P, Frasca D, Blomberg BB, Marshall CP, Yondola MA. Engineered dityrosine-bonding of the RSV prefusion F protein imparts stability and potency advantages. Nat Commun 2024; 15:2202. [PMID: 38485927 PMCID: PMC10940300 DOI: 10.1038/s41467-024-46295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 02/21/2024] [Indexed: 03/18/2024] Open
Abstract
Viral fusion proteins facilitate cellular infection by fusing viral and cellular membranes, which involves dramatic transitions from their pre- to postfusion conformations. These proteins are among the most protective viral immunogens, but they are metastable which often makes them intractable as subunit vaccine targets. Adapting a natural enzymatic reaction, we harness the structural rigidity that targeted dityrosine crosslinks impart to covalently stabilize fusion proteins in their native conformations. We show that the prefusion conformation of respiratory syncytial virus fusion protein can be stabilized with two engineered dityrosine crosslinks (DT-preF), markedly improving its stability and shelf-life. Furthermore, it has 11X greater potency as compared with the DS-Cav1 stabilized prefusion F protein in immunogenicity studies and overcomes immunosenescence in mice with simply a high-dose formulation on alum.
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Affiliation(s)
- Sonal V Gidwani
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA
| | | | - Aaron Zomback
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA
| | - Mamie Bassie
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA
| | | | - Jian Zhuang
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - John Schulze
- Molecular Structure Facility, University of California, Davis, Davis, CA, USA
| | - Jason S McLellan
- Department of Molecular Biosciences, University of Texas at Austin, College of Natural Sciences, Austin, TX, USA
| | - Roberto Mariani
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA
- CUNY Kingsborough Community College, Brooklyn, NY, USA
| | - Peter Alff
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA
| | - Daniela Frasca
- Department of Microbiology and Immunology, University of Miami, Miami, FL, USA
| | - Bonnie B Blomberg
- Department of Microbiology and Immunology, University of Miami, Miami, FL, USA
| | | | - Mark A Yondola
- Calder Biosciences Inc., Brooklyn Army Terminal, Brooklyn, NY, USA.
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15
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Köndgen S, Oh DY, Thürmer A, Sedaghatjoo S, Patrono LV, Calvignac-Spencer S, Biere B, Wolff T, Dürrwald R, Fuchs S, Reiche J. A robust, scalable, and cost-efficient approach to whole genome sequencing of RSV directly from clinical samples. J Clin Microbiol 2024; 62:e0111123. [PMID: 38407068 PMCID: PMC10935636 DOI: 10.1128/jcm.01111-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections causing significant morbidity and mortality among children and the elderly; two RSV vaccines and a monoclonal antibody have recently been approved. Thus, there is an increasing need for a detailed and continuous genomic surveillance of RSV circulating in resource-rich and resource-limited settings worldwide. However, robust, cost-effective methods for whole genome sequencing of RSV from clinical samples that are amenable to high-throughput are still scarce. We developed Next-RSV-SEQ, an experimental and computational pipeline to generate whole genome sequences of historic and current RSV genotypes by in-solution hybridization capture-based next generation sequencing. We optimized this workflow by automating library preparation and pooling libraries prior to enrichment in order to reduce hands-on time and cost, thereby augmenting scalability. Next-RSV-SEQ yielded near-complete to complete genome sequences for 98% of specimens with Cp values ≤31, at median on-target reads >93%, and mean coverage depths between ~1,000 and >5,000, depending on viral load. Whole genomes were successfully recovered from samples with viral loads as low as 230 copies per microliter RNA. We demonstrate that the method can be expanded to other respiratory viruses like parainfluenza virus and human metapneumovirus. Next-RSV-SEQ produces high-quality RSV genomes directly from culture isolates and, more importantly, clinical specimens of all genotypes in circulation. It is cost-efficient, scalable, and can be extended to other respiratory viruses, thereby opening new perspectives for a future effective and broad genomic surveillance of respiratory viruses. IMPORTANCE Respiratory syncytial virus (RSV) is a leading cause of severe acute respiratory tract infections in children and the elderly, and its prevention has become an increasing priority. Recently, vaccines and a long-acting monoclonal antibody to protect effectively against severe disease have been approved for the first time. Hence, there is an urgent need for genomic surveillance of RSV at the global scale to monitor virus evolution, especially with an eye toward immune evasion. However, robust, cost-effective methods for RSV whole genome sequencing that are suitable for high-throughput of clinical samples are currently scarce. Therefore, we have developed Next-RSV-SEQ, an experimental and computational pipeline that produces reliably high-quality RSV genomes directly from clinical specimens and isolates.
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Affiliation(s)
- Sophie Köndgen
- Influenza and Other Respiratory Viruses, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch-Institute, Berlin, Germany
| | - Djin-Ye Oh
- Influenza and Other Respiratory Viruses, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch-Institute, Berlin, Germany
| | - Andrea Thürmer
- Genome Competence Center, Robert Koch-Institute, Berlin, Germany
| | | | - Livia V. Patrono
- Epidemiology of highly pathogenic microorganisms, Robert Koch-Institute, Berlin, Germany
| | | | - Barbara Biere
- Influenza and Other Respiratory Viruses, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch-Institute, Berlin, Germany
| | - Thorsten Wolff
- Influenza and Other Respiratory Viruses, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch-Institute, Berlin, Germany
| | - Ralf Dürrwald
- Influenza and Other Respiratory Viruses, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch-Institute, Berlin, Germany
| | - Stephan Fuchs
- Genome Competence Center, Robert Koch-Institute, Berlin, Germany
| | - Janine Reiche
- Influenza and Other Respiratory Viruses, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch-Institute, Berlin, Germany
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16
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Middleton C, Larremore DB. Modeling the Transmission Mitigation Impact of Testing for Infectious Diseases. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.09.22.23295983. [PMID: 37808825 PMCID: PMC10557819 DOI: 10.1101/2023.09.22.23295983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A fundamental question of any program focused on the testing and timely diagnosis of a communicable disease is its effectiveness in reducing transmission. Here, we introduce testing effectiveness (TE)-the fraction by which testing and post-diagnosis isolation reduce transmission at the population scale-and a model that incorporates test specifications and usage, within-host pathogen dynamics, and human behaviors to estimate TE. Using TE to guide recommendations, we show that today's rapid diagnostics should be used immediately upon symptom onset to control influenza A and respiratory syncytial virus (RSV), but delayed by up to 2d to control omicron-era SARS-CoV-2. Furthermore, while rapid tests are superior to RT-qPCR for control of founder-strain SARS-CoV-2, omicron-era changes in viral kinetics and rapid test sensitivity cause a reversal, with higher TE for RT-qPCR despite longer turnaround times. Finally, we illustrate the model's flexibility by quantifying tradeoffs in the use of post-diagnosis testing to shorten isolation times.
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Affiliation(s)
- Casey Middleton
- Department of Computer Science, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
| | - Daniel B Larremore
- Department of Computer Science, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
- Santa Fe Institute, Santa Fe, NM, USA
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17
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Bean R, Giurgea LT, Han A, Czajkowski L, Cervantes-Medina A, Gouzoulis M, Mateja A, Hunsberger S, Reed S, Athota R, Baus HA, Kash JC, Park J, Taubenberger JK, Memoli MJ. Mucosal correlates of protection after influenza viral challenge of vaccinated and unvaccinated healthy volunteers. mBio 2024; 15:e0237223. [PMID: 38193710 PMCID: PMC10865821 DOI: 10.1128/mbio.02372-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
The induction of systemic antibody titers against hemagglutinin has long been the main focus of influenza vaccination strategies, but mucosal immunity has also been shown to play a key role in the protection against respiratory viruses. By vaccinating and challenging healthy volunteers, we demonstrated that inactivated influenza vaccine (IIV) modestly reduced the rate of influenza while predominantly boosting serum antibody titers against hemagglutinin (HA) and HA stalk, a consequence of the low neuraminidase (NA) content of IIV and the intramuscular route of administration. The viral challenge induced nasal and serum responses against both HA and NA. Correlations between mucosal IgA and serum IgG against specific antigens were low, whether before or after challenge, suggesting a compartmentalization of immune responses. Even so, volunteers who developed viral shedding for multiple days had lower baseline titers across both systemic and mucosal compartments as compared to those with no shedding or a single day of shedding. Regression analysis showed that pre-challenge HA inhibition titers were the most consistent correlate of protection across clinical outcomes combining shedding and symptoms, with NA inhibition titers and HA IgG levels only predicting the duration of shedding. Despite the inclusion of data from multiple binding and functional antibody assays against HA and NA performed on both serum and nasal samples, multivariate models were unable to account for the variability in outcomes, emphasizing our imperfect understanding of immune correlates in influenza and the importance of refining models with assessments of innate and cellular immune responses.IMPORTANCEThe devastating potential of influenza has been well known for over 100 years. Despite the development of vaccines since the middle of the 20th century, influenza continues to be responsible for substantial global morbidity and mortality. To develop next-generation vaccines with enhanced effectiveness, we must synthesize our understanding of the complex immune mechanisms culminating in protection. Our study outlines the differences in immune responses to influenza vaccine and influenza infection, identifying potential gaps in vaccine-induced immunity, particularly at the level of the nasal mucosa. Furthermore, this research underscores the need to refine our imperfect models while recognizing potential pitfalls in past and future attempts to identify and measure correlates of protection.
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Affiliation(s)
- Rachel Bean
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Luca T. Giurgea
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alison Han
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lindsay Czajkowski
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Adriana Cervantes-Medina
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Monica Gouzoulis
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Allyson Mateja
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Sally Hunsberger
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Reed
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rani Athota
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Holly Ann Baus
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - John C. Kash
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jaekeun Park
- Department of Veterinary Medicine, VA-MD College of Veterinary Medicine, University of Maryland, College Park, Maryland, USA
| | - Jeffery K. Taubenberger
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew J. Memoli
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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18
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Riccò M, Baldassarre A, Corrado S, Bottazzoli M, Marchesi F. Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023). EPIDEMIOLOGIA 2024; 5:41-79. [PMID: 38390917 PMCID: PMC10885116 DOI: 10.3390/epidemiologia5010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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19
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Kawahara E, Yamamoto S, Shibata T, Hirai T, Yoshioka Y. CpG ODN enhances the efficacy of F protein vaccine against respiratory syncytial virus infection in the upper respiratory tract via CD4 + T cells. Biochem Biophys Res Commun 2023; 686:149143. [PMID: 37926041 DOI: 10.1016/j.bbrc.2023.149143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of severe respiratory illness worldwide, particularly in infants and older adults. Vaccines targeting the fusion glycoprotein (F protein) -one of the surface antigens of RSV- are highly effective in preventing RSV-associated severe lower respiratory tract disease. However, the efficacy of these vaccines against upper respiratory tract challenge needs improvement. Here, we aimed to examine the efficacy of F protein vaccines with or without CpG oligodeoxynucleotide (CpG ODN) as an adjuvant in the upper and lower respiratory tracts in mice. F + CpG ODN induced higher levels of F-specific IgG than that induced by F alone; however, levels of neutralizing antibodies did not increase compared to those induced by F alone. F + CpG ODN induced T helper 1 (Th1) cells while F alone induced T helper 2 (Th2) cells. Moreover, F + CpG ODN improved the protection against RSV challenge in the upper respiratory tract compared to F alone, which was largely dependent on CD4+ T cells. Meanwhile, both F + CpG ODN and F alone protected the lower respiratory tract. In conclusion, we demonstrated that induction of F-specific Th1 cells is an effective strategy to prevent RSV challenge in the upper respiratory tract in F protein vaccines. These data support the development of novel F protein vaccines.
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Affiliation(s)
- Eigo Kawahara
- Laboratory of Nano-design for Innovative Drug Development, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka, 565-0871, Japan; Vaccine Creation Group, Research Institute for Microbial Diseases, Osaka University, 1-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinya Yamamoto
- The Research Foundation for Microbial Diseases of Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan; Institute for Open and Transdisciplinary Research Initiatives, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takehiko Shibata
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Toshiro Hirai
- Laboratory of Nano-design for Innovative Drug Development, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka, 565-0871, Japan; Vaccine Creation Group, Research Institute for Microbial Diseases, Osaka University, 1-6 Yamadaoka, Suita, Osaka, 565-0871, Japan; Institute for Open and Transdisciplinary Research Initiatives, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan; Center for Advanced Modalities and DDS, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasuo Yoshioka
- Laboratory of Nano-design for Innovative Drug Development, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka, 565-0871, Japan; Vaccine Creation Group, Research Institute for Microbial Diseases, Osaka University, 1-6 Yamadaoka, Suita, Osaka, 565-0871, Japan; The Research Foundation for Microbial Diseases of Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan; Institute for Open and Transdisciplinary Research Initiatives, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan; Center for Advanced Modalities and DDS, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan; Center for Infectious Disease Education and Research, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan; Global Center for Medical Engineering and Informatics, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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20
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See KC. Vaccination for Respiratory Syncytial Virus: A Narrative Review and Primer for Clinicians. Vaccines (Basel) 2023; 11:1809. [PMID: 38140213 PMCID: PMC10747850 DOI: 10.3390/vaccines11121809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Respiratory syncytial virus (RSV) poses a significant burden on public health, causing lower respiratory tract infections in infants, young children, older adults, and immunocompromised individuals. Recent development and licensure of effective RSV vaccines provide a promising approach to lessening the associated morbidity and mortality of severe infections. This narrative review aims to empower clinicians with the necessary knowledge to make informed decisions regarding RSV vaccination, focusing on the prevention and control of RSV infections, especially among vulnerable populations. The paper explores the available RSV vaccines and existing evidence regarding their efficacy and safety in diverse populations. Synthesizing this information for clinicians can help the latter understand the benefits and considerations associated with RSV vaccination, contributing to improved patient care and public health outcomes.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
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21
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Bouzid D, Visseaux B, Ferré VM, Peiffer-Smadja N, Le Hingrat Q, Loubet P. Respiratory syncytial virus in adults with comorbidities: an update on epidemiology, vaccines, and treatments. Clin Microbiol Infect 2023; 29:1538-1550. [PMID: 37666450 DOI: 10.1016/j.cmi.2023.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is widely known as a frequent cause of respiratory distress among adults, particularly in older people. Recent years have witnessed several improvements in respiratory virus detection, leading to more questions about therapeutic management strategies. OBJECTIVES This narrative review focuses on the RSV burden in older people and adults with risk factors and provides an update on the main recent developments regarding managing this infection. SOURCES A comprehensive PubMed search was conducted till August 2023 to identify studies on RSV among the adult population. We included observational studies, RCTs on vaccines, and different therapies. CONTENT This review should give clinicians an overview of RSV epidemiology and burden among older people and adults with pre-existing risk factors, the most recent randomized clinical trials on RSV vaccines, and the existing data on the different therapeutics existing and under development. IMPLICATIONS There is a growing body of evidence on RSV burden in adults. The landscape of preventive and curative treatments is quickly evolving.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Emergency Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Benoit Visseaux
- Laboratoire Cerba, Infectious Diseases Department, Saint Ouen l'Aumône, France
| | - Valentine Marie Ferré
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Infectious Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Virology Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Quentin Le Hingrat
- Université Paris Cité, INSERM UMR1137, IAME, F-75018, Paris, France; AP-HP Nord, Infectious Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Paul Loubet
- Université de Montpellier, VBMI, Inserm U1047, Nîmes, France; Department of Infectious and Tropical Diseases, CHU Nîmes, Université de Montpellier, Nîmes, France.
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22
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El Chaer F, Kaul DR, Englund JA, Boeckh M, Batista MV, Seo SK, Carpenter PA, Navarro D, Hirsch HH, Ison MG, Papanicolaou GA, Chemaly RF. American Society of Transplantation and Cellular Therapy Series: #7 - Management of Respiratory Syncytial Virus Infections in Hematopoietic Cell Transplant Recipients. Transplant Cell Ther 2023; 29:730-738. [PMID: 37783338 DOI: 10.1016/j.jtct.2023.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy (ASTCT) partnered with its Transplant Infectious Disease Special Interest Group (TID-SIG) to update the 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A new approach was adopted to better serve clinical providers by publishing each standalone topic in the infectious disease series in a concise format of frequently asked questions (FAQ), tables, and figures. Experts in HCT and infectious diseases identified FAQs and then provided answers based on the strength of the recommendation and the level of supporting evidence. In the seventh guideline in the series, we focus on the respiratory syncytial virus (RSV) with FAQs addressing epidemiology, clinical diagnosis, prophylaxis, and treatment. Special consideration was given to RSV in pediatric, cord blood, haploidentical, and T cell-depleted HCT and chimeric antigen receptor T cell therapy recipients, as well as to identify future research directions.
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Affiliation(s)
- Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia.
| | - Daniel R Kaul
- Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington
| | - Michael Boeckh
- Clinical Research and Vaccine and Infectious Disease Divisions, Fred Hutchinson Cancer Center and Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Marjorie V Batista
- Department of Infectious Diseases, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Susan K Seo
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, and Department of Microbiology, School of Medicine, University of Valencia, Valencia & Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans H Hirsch
- Clinical Virology Laboratory, Laboratory Medicine, University Hospital Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Michael G Ison
- Respiratory Disease Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
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23
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Abo YN, Jamrozik E, McCarthy JS, Roestenberg M, Steer AC, Osowicki J. Strategic and scientific contributions of human challenge trials for vaccine development: facts versus fantasy. THE LANCET. INFECTIOUS DISEASES 2023; 23:e533-e546. [PMID: 37573871 DOI: 10.1016/s1473-3099(23)00294-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 08/15/2023]
Abstract
The unprecedented speed of delivery of SARS-CoV-2 pandemic vaccines has redefined the limits for all vaccine development. Beyond the aspirational 100-day timeline for tomorrow's hypothetical pandemic vaccines, there is a sense of optimism that development of other high priority vaccines can be accelerated. Early in the COVID-19 pandemic, an intense and polarised academic and public discourse arose concerning the role of human challenge trials for vaccine development. A case was made for human challenge trials as a powerful tool to establish early proof-of-concept of vaccine efficacy in humans, inform vaccine down selection, and address crucial knowledge gaps regarding transmission, pathogenesis, and immune protection. We review the track record of human challenge trials contributing to the development of vaccines for 19 different pathogens and discuss relevant limitations, barriers, and pitfalls. This Review also highlights opportunities for efforts to broaden the scope and boost the effects of human challenge trials, to accelerate all vaccine development.
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Affiliation(s)
- Yara-Natalie Abo
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
| | - Euzebiusz Jamrozik
- Ethox and Pandemic Sciences Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Monash-WHO Collaborating Centre for Bioethics, Monash University, Melbourne, VIC, Australia
| | - James S McCarthy
- Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, Australia; Victorian Infectious Diseases Services, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Meta Roestenberg
- Controlled Human Infections Center, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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24
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Kopera E, Czajka H, Zapolnik P, Mazur A. New Insights on Respiratory Syncytial Virus Prevention. Vaccines (Basel) 2023; 11:1797. [PMID: 38140201 PMCID: PMC10747926 DOI: 10.3390/vaccines11121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a well-known infant pathogen transmitted mainly by droplets. It is a leading cause of upper respiratory tract infections in children, usually with a mild course of illness. RSV has also been a threat to older people, especially those with underlying medical conditions. For a long time, prevention was limited to passive immunoprophylaxis with palivizumab for high-risk infants. There was a strong need to find other treatment or prevention methods against RSV infections. In addition, after the coronavirus disease 2019 (COVID-19) pandemic, some significant changes in RSV epidemiology have been observed. Researchers noticed the shift in RSV seasonality and age distribution and the increased number of cases in older infants and adults. All of these made the need to find other medical options even stronger. Fortunately, two protein-based vaccines against RSV have successfully passed all phases of clinical trials and have been approved for use by adults and older people. One of them is also approved for infants from birth to 6 months of age (after maternal immunisation during pregnancy) and for pregnant women between 24 and 36 weeks of pregnancy. Also, a new passive immunisation option named nirsevimab (a highly potent monoclonal antibody with a long half-life) is now available for the paediatric group. In this review, we will discuss the previous and current RSV prevention methods in the light of structural discoveries of RSV antigens.
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Affiliation(s)
| | - Hanna Czajka
- College of Medical Sciences, University of Rzeszów, 35-315 Rzeszów, Poland; (E.K.); (P.Z.); (A.M.)
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25
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Fleming JA, Baral R, Higgins D, Khan S, Kochar S, Li Y, Ortiz JR, Cherian T, Feikin D, Jit M, Karron RA, Limaye RJ, Marshall C, Munywoki PK, Nair H, Newhouse LC, Nyawanda BO, Pecenka C, Regan K, Srikantiah P, Wittenauer R, Zar HJ, Sparrow E. Value profile for respiratory syncytial virus vaccines and monoclonal antibodies. Vaccine 2023; 41 Suppl 2:S7-S40. [PMID: 37422378 DOI: 10.1016/j.vaccine.2022.09.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 07/10/2023]
Abstract
Respiratory syncytial virus (RSV) is the predominant cause of acute lower respiratory infection (ALRI) in young children worldwide, yet no licensed RSV vaccine exists to help prevent the millions of illnesses and hospitalizations and tens of thousands of young lives taken each year. Monoclonal antibody (mAb) prophylaxis exists for prevention of RSV in a small subset of very high-risk infants and young children, but the only currently licensed product is impractical, requiring multiple doses and expensive for the low-income settings where the RSV disease burden is greatest. A robust candidate pipeline exists to one day prevent RSV disease in infant and pediatric populations, and it focuses on two promising passive immunization approaches appropriate for low-income contexts: maternal RSV vaccines and long-acting infant mAbs. Licensure of one or more candidates is feasible over the next one to three years and, depending on final product characteristics, current economic models suggest both approaches are likely to be cost-effective. Strong coordination between maternal and child health programs and the Expanded Program on Immunization will be needed for effective, efficient, and equitable delivery of either intervention. This 'Vaccine Value Profile' (VVP) for RSV is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations, and in collaboration with stakeholders from the WHO headquarters. All contributors have extensive expertise on various elements of the RSV VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Jessica A Fleming
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Ranju Baral
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Deborah Higgins
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Sadaf Khan
- Maternal, Newborn, Child Health and Nutrition, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Sonali Kochar
- Global Healthcare Consulting and Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, Seattle, WA 98105, United States.
| | - You Li
- School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province 211166, PR China.
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201-1509, United States.
| | - Thomas Cherian
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Daniel Feikin
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, University of London, Keppel St, London WC1E 7HT, United Kingdom.
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins University, Department of International Health, 624 N. Broadway, Rm 117, Baltimore, MD 21205, United States.
| | - Rupali J Limaye
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States.
| | - Caroline Marshall
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
| | - Patrick K Munywoki
- Center for Disease Control and Prevention, KEMRI Complex, Mbagathi Road off Mbagathi Way, PO Box 606-00621, Village Market, Nairobi, Kenya.
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, United Kingdom.
| | - Lauren C Newhouse
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Bryan O Nyawanda
- Kenya Medical Research Institute, Hospital Road, P.O. Box 1357, Kericho, Kenya.
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Katie Regan
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave Suite 200, Seattle, WA 98121, United States.
| | - Padmini Srikantiah
- Bill & Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, United States.
| | - Rachel Wittenauer
- Department of Pharmacy, University of Washington, Health Sciences Building, 1956 NE Pacific St H362, Seattle, WA 98195, United States.
| | - Heather J Zar
- Department of Paediatrics & Child Health and SA-MRC Unit on Child & Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town 7700, South Africa.
| | - Erin Sparrow
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
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26
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Petherbridge L, Davis C, Robinson A, Evans T, Sebastian S. Pre-Clinical Development of an Adenovirus Vector Based RSV and Shingles Vaccine Candidate. Vaccines (Basel) 2023; 11:1679. [PMID: 38006010 PMCID: PMC10674764 DOI: 10.3390/vaccines11111679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
Respiratory syncytial virus (RSV) infection and shingles are two viral diseases that affect older adults, and a combined vaccine to protect against both could be beneficial. RSV infection causes hospitalisations and significant morbidity in both children and adults and can be fatal in the elderly. The RSV fusion (F) envelope glycoprotein induces a strong RSV-neutralising antibody response and is the target of protective immunity in the first RSV vaccine for older adults, recently approved by the FDA. An initial childhood infection with the varicella zoster virus (VZV) results in chickenpox disease, but reactivation in older adults can cause shingles. This reactivation in sensory and autonomic neurons is characterized by a skin-blistering rash that can be accompanied by prolonged pain. The approved protein-in-adjuvant shingles vaccine induces VZV glycoprotein E (gE)-fspecific antibody and CD4+ T cell responses and is highly effective. Here we report the evaluation of RSV/shingles combination vaccine candidates based on non-replicating chimpanzee adenovirus (ChAd) vectors. We confirmed the cellular and humoral immunogenicity of the vaccine vectors in mice using T cell and antibody assays. We also carried out an RSV challenge study in cotton rats which demonstrated protective efficacy following a homologous prime-boost regimen with our preferred vaccine candidate.
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Affiliation(s)
| | | | | | | | - Sarah Sebastian
- Vaccitech Ltd., Harwell OX11 0DF, UK; (L.P.); (A.R.); (T.E.)
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27
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Langedijk AC, Bont LJ. Respiratory syncytial virus infection and novel interventions. Nat Rev Microbiol 2023; 21:734-749. [PMID: 37438492 DOI: 10.1038/s41579-023-00919-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
The large global burden of respiratory syncytial virus (RSV) respiratory tract infections in young children and older adults has gained increased recognition in recent years. Recent discoveries regarding the neutralization-specific viral epitopes of the pre-fusion RSV glycoprotein have led to a shift from empirical to structure-based design of RSV therapeutics, and controlled human infection model studies have provided early-stage proof of concept for novel RSV monoclonal antibodies, vaccines and antiviral drugs. The world's first vaccines and first monoclonal antibody to prevent RSV among older adults and all infants, respectively, have recently been approved. Large-scale introduction of RSV prophylactics emphasizes the need for active surveillance to understand the global impact of these interventions over time and to timely identify viral mutants that are able to escape novel prophylactics. In this Review, we provide an overview of RSV interventions in clinical development, highlighting global disease burden, seasonality, pathogenesis, and host and viral factors related to RSV immunity.
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Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
- ReSViNET Foundation, Zeist, the Netherlands.
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28
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Syed YY. Respiratory Syncytial Virus Prefusion F Subunit Vaccine: First Approval of a Maternal Vaccine to Protect Infants. Paediatr Drugs 2023; 25:729-734. [PMID: 37831328 DOI: 10.1007/s40272-023-00598-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Pfizer is developing a bivalent respiratory syncytial virus (RSV) prefusion F subunit vaccine (RSVpreF; ABRYSVO™) for preventing RSV illness in infants and individuals aged ≥ 60 years. RSVpreF received approval for vaccination of pregnant individuals to help protect infants against RSV illness on 21 August 2023 in the USA. RSVpreF is also approved in the USA (31 May 2023) for active immunization of individuals aged ≥ 60 years for the prevention of lower respiratory tract disease (LRTD) caused by RSV. In the EU, RSVpreF has received approval for both indications, and it has been submitted for regulatory approval in Canada (both indications) and in Japan (maternal immunization to protect infants). This article summarizes the milestones in the development of RSVpreF leading to the approval for use in pregnant individuals to prevent LRTD in infants.
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Affiliation(s)
- Yahiya Y Syed
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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29
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Nussbaum J, Cao X, Railkar RA, Sachs JR, Spellman DS, Luk J, Shaw CA, Cejas PJ, Citron MP, Al-Ibrahim M, Han D, Pagnussat S, Stoch SA, Lai E, Bett AJ, Espeseth AS. Evaluation of a stabilized RSV pre-fusion F mRNA vaccine: Preclinical studies and Phase 1 clinical testing in healthy adults. Vaccine 2023; 41:6488-6501. [PMID: 37777449 DOI: 10.1016/j.vaccine.2023.05.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 10/02/2023]
Abstract
Human respiratory syncytial virus (RSV) causes a substantial proportion of respiratory tract infections worldwide. Although RSV reinfections occur throughout life, older adults, particularly those with underlying comorbidities, are at risk for severe complications from RSV. There is no RSV vaccine available to date, and treatment of RSV in adults is largely supportive. A correlate of protection for RSV has not yet been established, but antibodies targeting the pre-fusion conformation of the RSV F glycoprotein play an important role in RSV neutralization. We previously reported a Phase 1 study of an mRNA-based vaccine (V171) expressing a pre-fusion-stabilized RSV F protein (mDS-Cav1) in healthy adults. Here, we evaluated an mRNA-based vaccine (V172) expressing a further stabilized RSV pre-fusion F protein (mVRC1). mVRC1 is a single chain version of RSV F with interprotomer disulfides in addition to the stabilizing mutations present in the mDS-Cav1 antigen. The immunogenicity of the two mRNA-based vaccines encoding mVRC1 (V172) or a sequence-optimized version of mDS-Cav1 to improve transcriptional fidelity (V171.2) were compared in RSV-naïve and RSV-experienced African green monkeys (AGMs). V172 induced higher neutralizing antibody titers than V171.2 and demonstrated protection in the AGM challenge model. We conducted a Phase 1, randomized, placebo-controlled, clinical trial of 25 μg, 100 μg, 200 μg, or 300 μg of V172 in healthy older adults (60-79 years old; N = 112) and 100 μg, 200 μg, or 300 μg of V172 in healthy younger adults (18-49 years old; N = 48). The primary clinical objectives were to evaluate the safety and tolerability of V172, and the secondary objective was to evaluate RSV serum neutralization titers. The most commonly reported solicited adverse events were injection-site pain, injection-site swelling, headache, and tiredness. V172 was generally well tolerated in older and younger adults and increased serum neutralizing antibody titers, pre-fusion F-specific competing antibody titers, and RSV F-specific T-cell responses.
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Affiliation(s)
| | - Xin Cao
- Merck & Co., Inc., Rahway, NJ, USA
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30
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Topalidou X, Kalergis AM, Papazisis G. Respiratory Syncytial Virus Vaccines: A Review of the Candidates and the Approved Vaccines. Pathogens 2023; 12:1259. [PMID: 37887775 PMCID: PMC10609699 DOI: 10.3390/pathogens12101259] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Respiratory syncytial virus (RSV) is responsible for a significant proportion of global morbidity and mortality affecting young children and older adults. In the aftermath of formalin-inactivated RSV vaccine development, the effort to develop an immunizing agent was carefully guided by epidemiologic and pathophysiological evidence of the virus, including various vaccine technologies. The pipeline of RSV vaccine development includes messenger ribonucleic acid (mRNA), live-attenuated (LAV), subunit, and recombinant vector-based vaccine candidates targeting different virus proteins. The availability of vaccine candidates of various technologies enables adjustment to the individualized needs of each vulnerable age group. Arexvy® (GSK), followed by Abrysvo® (Pfizer), is the first vaccine available for market use as an immunizing agent to prevent lower respiratory tract disease in older adults. Abrysvo is additionally indicated for the passive immunization of infants by maternal administration during pregnancy. This review presents the RSV vaccine pipeline, analyzing the results of clinical trials. The key features of each vaccine technology are also mentioned. Currently, 24 vaccines are in the clinical stage of development, including the 2 licensed vaccines. Research in the field of RSV vaccination, including the pharmacovigilance methods of already approved vaccines, promotes the achievement of successful prevention.
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Affiliation(s)
- Xanthippi Topalidou
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Alexis M. Kalergis
- Millennium Institute of Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile;
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Clinical Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Jordan E, Kabir G, Schultz S, Silbernagl G, Schmidt D, Jenkins VA, Weidenthaler H, Stroukova D, Martin BK, De Moerlooze L. Reduced Respiratory Syncytial Virus Load, Symptoms, and Infections: A Human Challenge Trial of MVA-BN-RSV Vaccine. J Infect Dis 2023; 228:999-1011. [PMID: 37079393 PMCID: PMC10582911 DOI: 10.1093/infdis/jiad108] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes significant disease burden in older adults. MVA-BN-RSV is a novel poxvirus-vectored vaccine encoding internal and external RSV proteins. METHODS In a phase 2a randomized double-blind, placebo-controlled trial, healthy participants aged 18 to 50 years received MVA-BN-RSV or placebo, then were challenged 4 weeks later with RSV-A Memphis 37b. Viral load was assessed from nasal washes. RSV symptoms were collected. Antibody titers and cellular markers were assessed before and after vaccination and challenge. RESULTS After receiving MVA-BN-RSV or placebo, 31 and 32 participants, respectively, were challenged. Viral load areas under the curve from nasal washes were lower (P = .017) for MVA-BN-RSV (median = 0.00) than placebo (median = 49.05). Total symptom scores also were lower (median = 2.50 and 27.00, respectively; P = .004). Vaccine efficacy against symptomatic, laboratory-confirmed or culture-confirmed infection was 79.3% to 88.5% (P = .022 and .013). Serum immunoglobulin A and G titers increased approximately 4-fold after MVA-BN-RSV vaccination. Interferon-γ-producing cells increased 4- to 6-fold after MVA-BN-RSV in response to stimulation with the encoded RSV internal antigens. Injection site pain occurred more frequently with MVA-BN-RSV. No serious adverse events were attributed to vaccination. CONCLUSIONS MVA-BN-RSV vaccination resulted in lower viral load and symptom scores, fewer confirmed infections, and induced humoral and cellular responses. CLINICAL TRIALS REGISTRATION NCT04752644.
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Bueno CA, Salinas FM, Vazquez L, Alché LE, Michelini FM. Two synthetic steroid analogs reduce human respiratory syncytial virus replication and the immune response to infection both in vitro and in vivo. Heliyon 2023; 9:e20148. [PMID: 37822633 PMCID: PMC10562772 DOI: 10.1016/j.heliyon.2023.e20148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
HRSV is responsible for many acute lower airway infections and hospitalizations in infants, the elderly and those with weakened immune systems around the world. The strong inflammatory response that mediates viral clearance contributes to pathogenesis, and is positively correlated with disease severity. There is no specific effective therapy on hand. Antiviral synthetic stigmastanes (22S, 23S)-22,23-dihydroxystigmast-4-en-3-one (Compound 1) and 22,23-dihydroxystigmasta-1,4-dien-3-one (Compound 2) have shown to be active inhibiting unrelated virus like Herpes Simplex type 1 virus (HSV-1) and Adenovirus, without cytotoxicity. We have also shown that Compound 1 modulates the activation of cell signaling pathways and cytokine secretion in infected epithelial cells as well as in inflammatory cells activated by nonviral stimuli. In the present work, we investigated the inhibitory effect of both compounds on HRSV replication and their modulatory effect on infected epithelial and inflammatory cells. We show that compounds 1 and 2 inhibit in vitro HRSV replication and propagation and reduce cytokine secretion triggered by HRSV infection in epithelial and inflammatory cells. The compounds reduce viral loads and inflammatory infiltration in the lungs of mice infected with HRSV.
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Affiliation(s)
- Carlos A. Bueno
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | - Franco M. Salinas
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | - L. Vazquez
- UOCCB (Unidad Operativa Centro de Contención Biológica), Instituto Dr. Carlos G. Malbrán, ANLIS (Administración Nacional de Laboratorios e Institutos de Salud), Argentina
| | - Laura E. Alché
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | - Flavia M. Michelini
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
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Simon S, Joean O, Welte T, Rademacher J. The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus. Eur Respir Rev 2023; 32:230034. [PMID: 37673427 PMCID: PMC10481333 DOI: 10.1183/16000617.0034-2023] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Exacerbations of COPD are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression and death. At least 70% of COPD exacerbations are infectious in origin, with respiratory viruses identified in approximately 30% of cases. Despite long-standing recommendations to vaccinate patients with COPD, vaccination rates remain suboptimal in this population.Streptococcus pneumoniae is one of the leading morbidity and mortality causes of lower respiratory tract infections. The Food and Drug Administration recently approved pneumococcal conjugate vaccines that showed strong immunogenicity against all 20 included serotypes. Influenza is the second most common virus linked to severe acute exacerbations of COPD. The variable vaccine efficacy across virus subtypes and the impaired immune response are significant drawbacks in the influenza vaccination strategy. High-dose and adjuvant vaccines are new approaches to tackle these problems. Respiratory syncytial virus is another virus known to cause acute exacerbations of COPD. The vaccine candidate RSVPreF3 is the first authorised for the prevention of RSV in adults ≥60 years and might help to reduce acute exacerbations of COPD. The 2023 Global Initiative for Chronic Lung Disease report recommends zoster vaccination to protect against shingles for people with COPD over 50 years.
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Affiliation(s)
- Susanne Simon
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
| | - Oana Joean
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
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34
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Agac A, Kolbe SM, Ludlow M, Osterhaus ADME, Meineke R, Rimmelzwaan GF. Host Responses to Respiratory Syncytial Virus Infection. Viruses 2023; 15:1999. [PMID: 37896776 PMCID: PMC10611157 DOI: 10.3390/v15101999] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Respiratory syncytial virus (RSV) infections are a constant public health problem, especially in infants and older adults. Virtually all children will have been infected with RSV by the age of two, and reinfections are common throughout life. Since antigenic variation, which is frequently observed among other respiratory viruses such as SARS-CoV-2 or influenza viruses, can only be observed for RSV to a limited extent, reinfections may result from short-term or incomplete immunity. After decades of research, two RSV vaccines were approved to prevent lower respiratory tract infections in older adults. Recently, the FDA approved a vaccine for active vaccination of pregnant women to prevent severe RSV disease in infants during their first RSV season. This review focuses on the host response to RSV infections mediated by epithelial cells as the first physical barrier, followed by responses of the innate and adaptive immune systems. We address possible RSV-mediated immunomodulatory and pathogenic mechanisms during infections and discuss the current vaccine candidates and alternative treatment options.
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Affiliation(s)
| | | | | | | | | | - Guus F. Rimmelzwaan
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (A.A.); (S.M.K.); (M.L.); (A.D.M.E.O.); (R.M.)
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35
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Ruckwardt TJ. The road to approved vaccines for respiratory syncytial virus. NPJ Vaccines 2023; 8:138. [PMID: 37749081 PMCID: PMC10519952 DOI: 10.1038/s41541-023-00734-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
After decades of work, several interventions to prevent severe respiratory syncytial virus (RSV) disease in high-risk infant and older adult populations have finally been approved. There were many setbacks along the road to victory. In this review, I will discuss the impact of RSV on human health and how structure-based vaccine design set the stage for numerous RSV countermeasures to advance through late phase clinical evaluation. While there are still many RSV countermeasures in preclinical and early-stage clinical trials, this review will focus on products yielding long-awaited efficacy results. Finally, I will discuss some challenges and next steps needed to declare a global victory against RSV.
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Affiliation(s)
- Tracy J Ruckwardt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, 20892, USA.
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36
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Trauth J. [Respiratory viral infections : Under special consideration of severe acute respiratory syndrome coronavirus 2 and influenza viruses]. Med Klin Intensivmed Notfmed 2023; 118:445-453. [PMID: 37642653 DOI: 10.1007/s00063-023-01050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 08/31/2023]
Abstract
Respiratory viruses cause the highest number of morbidities and deaths annually among all infectious pathogens. This article discusses the current epidemiology, pathogenesis, risk factors, and drug treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses, respiratory syncytial virus (RSV), and other respiratory viruses. The SARS-CoV‑2 and influenza are preventable with vaccines and a first vaccine against RSV is available since 08/2023. For infections with SARS-CoV‑2 and influenza, a stage-specific (antiviral) drug treatment is also recommended. Due to the high and commonly underestimated disease burden caused by RSV, it must be hoped that antiviral substances will be found in the future. In patients at risk, particular attention should be paid to an adequate vaccination status against respiratory pathogens and if there is clinical suspicion of a viral airway infection, the pathogen should be promptly identified and, if necessary, specific treatment should be carried out. Now that effective vaccinations and antiviral drugs are available, the challenge is to use them for all patients at risk and thus really prevent avoidable infections, severe courses and long-term sequelae.
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Affiliation(s)
- Janina Trauth
- Universitätsklinikum Gießen und Marburg GmbH, Medizinische Klinik V für Innere Medizin m.S. Infektiologie und Krankenhaushygiene, Justus-Liebig-Universität Gießen, Klinikstr 33, 35392, Gießen, Deutschland.
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Wilkinson T, Beaver S, Macartney M, McArthur E, Yadav V, Lied‐Lied A. Burden of respiratory syncytial virus in adults in the United Kingdom: A systematic literature review and gap analysis. Influenza Other Respir Viruses 2023; 17:e13188. [PMID: 37744994 PMCID: PMC10511839 DOI: 10.1111/irv.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Despite the growing recognition of a potentially significant respiratory syncytial virus (RSV) disease burden in adults, relevant evidence in the United Kingdom (UK) is limited. This systematic literature review (SLR) aimed to identify the disease burden of RSV in UK adults, including certain high-risk subgroups and existing evidence gaps. Published studies (2011 onwards) reporting epidemiological, economic and clinical burden outcomes in UK adults (≥15 years) with RSV were identified from indexed databases, including MEDLINE, Embase and the Cochrane library. High-risk groups included elderly (≥65 years), immunocompromised, co-morbid and co-infected patients. Outcomes included RSV incidence/prevalence, mortality, clinical presentation and direct/indirect resource use/costs. Twenty-eight publications on 28 unique studies were identified, mostly in general/respiratory indicator (n = 17), elderly (n = 10) and immunocompromised (n = 6) cohorts. Main outcomes reported in the general/respiratory indicator cohort were RSV infection incidence (seasonal/annual: 0.09-17.9%/6.6-15.1%), mortality (8,482 deaths/season) and direct resource use (including mean general practitioner [GP] episodes/season: 487,247). Seasonal/annual incidence was 14.6-26.5%/0.7-16% in high-risk cohorts. Attributed to RSV in the elderly were 7,915 deaths/season and 175,070 mean GP episodes/season. Only two studies reported on co-morbid cohorts. Clinical burden outcomes were only reported in general and immunocompromised patients, and no evidence was found in any cohort on indirect economic burden or RSV complications. Evidence captured suggests that RSV may have a substantial burden in UK adults. However, available data were limited and highly heterogenous, with further studies needed to characterise the burden of RSV in adults and to validate our findings.
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Affiliation(s)
- Tom Wilkinson
- Clinical and Experimental SciencesUniversity of Southampton Faculty of MedicineSouthamptonUK
- National Institute for Health and Care Research Southampton Biomedical Research CentreSouthamptonUK
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Numata M, Kandasamy P, Voelker DR. The anti-inflammatory and antiviral properties of anionic pulmonary surfactant phospholipids. Immunol Rev 2023; 317:166-186. [PMID: 37144896 PMCID: PMC10524216 DOI: 10.1111/imr.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
The pulmonary surfactant system of the lung is a lipid and protein complex, which regulates the biophysical properties of the alveoli to prevent lung collapse and the innate immune system in the lung. Pulmonary surfactant is a lipoprotein complex consisting of 90% phospholipids and 10% protein, by weight. Two minor components of pulmonary surfactant phospholipids, phosphatidylglycerol (PG) and phosphatidylinositol (PI), exist at very high concentrations in the extracellular alveolar compartments. We have reported that one of the most dominant molecular species of PG, palmitoyl-oleoyl-phosphatidylglycerol (POPG) and PI inhibit inflammatory responses induced by multiple toll-like receptors (TLR2/1, TLR3, TLR4, and TLR2/6) by interacting with subsets of multiprotein receptor components. These lipids also exert potent antiviral effects against RSV and influenza A, in vitro, by inhibiting virus binding to host cells. POPG and PI inhibit these viral infections in vivo, in multiple animal models. Especially noteworthy, these lipids markedly attenuate SARS-CoV-2 infection including its variants. These lipids are natural compounds that already exist in the lung and, thus, are less likely to cause adverse immune responses by hosts. Collectively, these data demonstrate that POPG and PI have strong potential as novel therapeutics for applications as anti-inflammatory compounds and preventatives, as treatments for broad ranges of RNA respiratory viruses.
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Affiliation(s)
- Mari Numata
- Department of Medicine, National Jewish Health, Denver, CO 80206
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO 80206
| | - Pitchaimani Kandasamy
- Department of Medicine, National Jewish Health, Denver, CO 80206
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO 80206
| | - Dennis R. Voelker
- Department of Medicine, National Jewish Health, Denver, CO 80206
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO 80206
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Habbous S, Hota S, Allen VG, Henry M, Hellsten E. Changes in hospitalizations and emergency department respiratory viral diagnosis trends before and during the COVID-19 pandemic in Ontario, Canada. PLoS One 2023; 18:e0287395. [PMID: 37327212 PMCID: PMC10275476 DOI: 10.1371/journal.pone.0287395] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Population-level surveillance systems have demonstrated reduced transmission of non-SARS-CoV-2 respiratory viruses during the COVID-19 pandemic. In this study, we examined whether this reduction translated to reduced hospital admissions and emergency department (ED) visits associated with influenza, respiratory syncytial virus (RSV), human metapneumovirus, human parainfluenza virus, adenovirus, rhinovirus/enterovirus, and common cold coronavirus in Ontario. METHODS Hospital admissions were identified from the Discharge Abstract Database and exclude elective surgical admissions and non-emergency medical admissions (January 2017-March 2022). Emergency department (ED) visits were identified from the National Ambulatory Care Reporting System. International Classification of Diseases (ICD-10) codes were used to classify hospital visits by virus type (January 2017-May 2022). RESULTS At the onset of the COVID-19 pandemic, hospitalizations for all viruses were reduced to near-trough levels. Hospitalizations and ED visits for influenza (9,127/year and 23,061/year, respectively) were nearly absent throughout the pandemic (two influenza seasons; April 2020-March 2022). Hospitalizations and ED visits for RSV (3,765/year and 736/year, respectively) were absent for the first RSV season during the pandemic, but returned for the 2021/2022 season. This resurgence of hospitalizations for RSV occurred earlier in the season than expected, was more likely among younger infants (age ≤6 months), more likely among older children (aged 6.1-24 months), and less likely to comprise of patients residing in higher areas of ethnic diversity (p<0.0001). CONCLUSION During the COVID-19 pandemic, there was a reduced the burden of other respiratory infections on patients and hospitals. The epidemiology of respiratory viruses in the 2022/23 season remains to be seen.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Susy Hota
- Department of Medicine, Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada
| | - Vanessa G. Allen
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
- Department of Medicine, Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health/ University Health Network, Toronto, Ontario, Canada
| | - Michele Henry
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
| | - Erik Hellsten
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
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Zhaori G. Nirsevimab brings breakthrough in the prevention of respiratory syncytial virus infection in infants - Importance of design. Pediatr Investig 2023; 7:144-146. [PMID: 37324599 PMCID: PMC10262870 DOI: 10.1002/ped4.12377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Getu Zhaori
- Editorial Office, Pediatric Investigation, Beijing Children's HospitalCapital Medical University, National Center for Children's HealthBeijingChina
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41
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Hederman AP, Ackerman ME. Leveraging deep learning to improve vaccine design. Trends Immunol 2023; 44:333-344. [PMID: 37003949 PMCID: PMC10485910 DOI: 10.1016/j.it.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 04/03/2023]
Abstract
Deep learning has led to incredible breakthroughs in areas of research, from self-driving vehicles to solutions, to formal mathematical proofs. In the biomedical sciences, however, the revolutionary results seen in other fields are only now beginning to be realized. Vaccine research and development efforts represent an application with high public health significance. Protein structure prediction, immune repertoire analysis, and phylogenetics are three principal areas in which deep learning is poised to provide key advances. Here, we opine on some of the current challenges with deep learning and how they are being addressed. Despite the nascent stage of deep learning applications in immunological studies, there is ample opportunity to utilize this new technology to address the most challenging and burdensome infectious diseases confronting global populations.
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Affiliation(s)
| | - Margaret E Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Department of Microbiology and Immunology, Geisel School of Medicine, Hanover, NH, USA.
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Kampmann B, Madhi SA, Munjal I, Simões EAF, Pahud BA, Llapur C, Baker J, Pérez Marc G, Radley D, Shittu E, Glanternik J, Snaggs H, Baber J, Zachariah P, Barnabas SL, Fausett M, Adam T, Perreras N, Van Houten MA, Kantele A, Huang LM, Bont LJ, Otsuki T, Vargas SL, Gullam J, Tapiero B, Stein RT, Polack FP, Zar HJ, Staerke NB, Duron Padilla M, Richmond PC, Koury K, Schneider K, Kalinina EV, Cooper D, Jansen KU, Anderson AS, Swanson KA, Gruber WC, Gurtman A. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med 2023; 388:1451-1464. [PMID: 37018474 DOI: 10.1056/nejmoa2216480] [Citation(s) in RCA: 237] [Impact Index Per Article: 237.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV)-associated lower respiratory tract illness in newborns and infants is uncertain. METHODS In this phase 3, double-blind trial conducted in 18 countries, we randomly assigned, in a 1:1 ratio, pregnant women at 24 through 36 weeks' gestation to receive a single intramuscular injection of 120 μg of a bivalent RSV prefusion F protein-based (RSVpreF) vaccine or placebo. The two primary efficacy end points were medically attended severe RSV-associated lower respiratory tract illness and medically attended RSV-associated lower respiratory tract illness in infants within 90, 120, 150, and 180 days after birth. A lower boundary of the confidence interval for vaccine efficacy (99.5% confidence interval [CI] at 90 days; 97.58% CI at later intervals) greater than 20% was considered to meet the success criterion for vaccine efficacy with respect to the primary end points. RESULTS At this prespecified interim analysis, the success criterion for vaccine efficacy was met with respect to one primary end point. Overall, 3682 maternal participants received vaccine and 3676 received placebo; 3570 and 3558 infants, respectively, were evaluated. Medically attended severe lower respiratory tract illness occurred within 90 days after birth in 6 infants of women in the vaccine group and 33 infants of women in the placebo group (vaccine efficacy, 81.8%; 99.5% CI, 40.6 to 96.3); 19 cases and 62 cases, respectively, occurred within 180 days after birth (vaccine efficacy, 69.4%; 97.58% CI, 44.3 to 84.1). Medically attended RSV-associated lower respiratory tract illness occurred within 90 days after birth in 24 infants of women in the vaccine group and 56 infants of women in the placebo group (vaccine efficacy, 57.1%; 99.5% CI, 14.7 to 79.8); these results did not meet the statistical success criterion. No safety signals were detected in maternal participants or in infants and toddlers up to 24 months of age. The incidences of adverse events reported within 1 month after injection or within 1 month after birth were similar in the vaccine group (13.8% of women and 37.1% of infants) and the placebo group (13.1% and 34.5%, respectively). CONCLUSIONS RSVpreF vaccine administered during pregnancy was effective against medically attended severe RSV-associated lower respiratory tract illness in infants, and no safety concerns were identified. (Funded by Pfizer; MATISSE ClinicalTrials.gov number, NCT04424316.).
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Affiliation(s)
- Beate Kampmann
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Shabir A Madhi
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Iona Munjal
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Eric A F Simões
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Barbara A Pahud
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Conrado Llapur
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Jeffrey Baker
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Gonzalo Pérez Marc
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - David Radley
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Emma Shittu
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Julia Glanternik
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Hasra Snaggs
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - James Baber
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Philip Zachariah
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Shaun L Barnabas
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Merlin Fausett
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Tyler Adam
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Nicole Perreras
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Marlies A Van Houten
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Anu Kantele
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Li-Min Huang
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Louis J Bont
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Takeo Otsuki
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Sergio L Vargas
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Joanna Gullam
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Bruce Tapiero
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Renato T Stein
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Fernando P Polack
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Heather J Zar
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Nina B Staerke
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - María Duron Padilla
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Peter C Richmond
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Kenneth Koury
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Katherine Schneider
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Elena V Kalinina
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - David Cooper
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Kathrin U Jansen
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Annaliesa S Anderson
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Kena A Swanson
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - William C Gruber
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Alejandra Gurtman
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
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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: 146] [Impact Index Per Article: 146.0] [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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Respiratory Syncytial Virus Infection: Treatments and Clinical Management. Vaccines (Basel) 2023; 11:vaccines11020491. [PMID: 36851368 PMCID: PMC9962240 DOI: 10.3390/vaccines11020491] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/29/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a major healthcare concern, especially for immune-compromised individuals and infants below 5 years of age. Worldwide, it is known to be associated with incidences of morbidity and mortality in infants. Despite the seriousness of the issue and continuous rigorous scientific efforts, no approved vaccine or available drug is fully effective against RSV. The purpose of this review article is to provide insights into the past and ongoing efforts for securing effective vaccines and therapeutics against RSV. The readers will be able to confer the mechanism of existing therapies and the loopholes that need to be overcome for future therapeutic development against RSV. A methodological approach was applied to collect the latest data and updated results regarding therapeutics and vaccine development against RSV. We outline the latest throughput vaccination technologies and prophylactic development efforts linked with RSV. A range of vaccination approaches with the already available vaccine (with limited use) and those undergoing trials are included. Moreover, important drug regimens used alone or in conjugation with adjuvants or vaccines are also briefly discussed. After reading this article, the audience will be able to understand the current standing of clinical management in the form of the vaccine, prophylactic, and therapeutic candidates against RSV. An understanding of the biological behavior acting as a reason behind the lack of effective therapeutics against RSV will also be developed. The literature indicates a need to overcome the limitations attached to RSV clinical management, drugs, and vaccine development that could be explained by dealing with the challenges of current study designs with continuous improvement and further work and approval on novel therapeutic applications.
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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: 48] [Impact Index Per Article: 48.0] [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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Papi A, Ison MG, Langley JM, Lee DG, Leroux-Roels I, Martinon-Torres F, Schwarz TF, van Zyl-Smit RN, Campora L, Dezutter N, de Schrevel N, Fissette L, David MP, Van der Wielen M, Kostanyan L, Hulstrøm V. Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults. N Engl J Med 2023; 388:595-608. [PMID: 36791160 DOI: 10.1056/nejmoa2209604] [Citation(s) in RCA: 198] [Impact Index Per Article: 198.0] [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) is an important cause of acute respiratory infection, lower respiratory tract disease, clinical complications, and death in older adults. There is currently no licensed vaccine against RSV infection. METHODS In an ongoing, international, placebo-controlled, phase 3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive a single dose of an AS01E-adjuvanted RSV prefusion F protein-based candidate vaccine (RSVPreF3 OA) or placebo before the RSV season. The primary objective was to show vaccine efficacy of one dose of the RSVPreF3 OA vaccine against RSV-related lower respiratory tract disease, confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), during one RSV season. The criterion for meeting the primary objective was a lower limit of the confidence interval around the efficacy estimate of more than 20%. Efficacy against severe RSV-related lower respiratory tract disease and RSV-related acute respiratory infection was assessed, and analyses according to RSV subtype (A and B) were performed. Safety was evaluated. RESULTS A total of 24,966 participants received one dose of the RSVPreF3 OA vaccine (12,467 participants) or placebo (12,499). Over a median follow-up of 6.7 months, vaccine efficacy against RT-PCR-confirmed RSV-related lower respiratory tract disease was 82.6% (96.95% confidence interval [CI], 57.9 to 94.1), with 7 cases (1.0 per 1000 participant-years) in the vaccine group and 40 cases (5.8 per 1000 participant-years) in the placebo group. Vaccine efficacy was 94.1% (95% CI, 62.4 to 99.9) against severe RSV-related lower respiratory tract disease (assessed on the basis of clinical signs or by the investigator) and 71.7% (95% CI, 56.2 to 82.3) against RSV-related acute respiratory infection. Vaccine efficacy was similar against the RSV A and B subtypes (for RSV-related lower respiratory tract disease: 84.6% and 80.9%, respectively; for RSV-related acute respiratory infection: 71.9% and 70.6%, respectively). High vaccine efficacy was observed in various age groups and in participants with coexisting conditions. The RSVPreF3 OA vaccine was more reactogenic than placebo, but most adverse events for which reports were solicited were transient, with mild-to-moderate severity. The incidences of serious adverse events and potential immune-mediated diseases were similar in the two groups. CONCLUSIONS A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related acute respiratory infection and lower respiratory tract disease and severe RSV-related lower respiratory tract disease in adults 60 years of age or older, regardless of RSV subtype and the presence of underlying coexisting conditions. (Funded by GlaxoSmithKline Biologicals; AReSVi-006 ClinicalTrials.gov number, NCT04886596.).
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Affiliation(s)
- Alberto Papi
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Michael G Ison
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Joanne M Langley
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Dong-Gun Lee
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Isabel Leroux-Roels
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Federico Martinon-Torres
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Tino F Schwarz
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Richard N van Zyl-Smit
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Laura Campora
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Nancy Dezutter
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Nathalie de Schrevel
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Laurence Fissette
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Marie-Pierre David
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Marie Van der Wielen
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Lusine Kostanyan
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Veronica Hulstrøm
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
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Jenkins VA, Hoet B, Hochrein H, De Moerlooze L. The Quest for a Respiratory Syncytial Virus Vaccine for Older Adults: Thinking beyond the F Protein. Vaccines (Basel) 2023; 11:vaccines11020382. [PMID: 36851260 PMCID: PMC9963583 DOI: 10.3390/vaccines11020382] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a common cause of paediatric respiratory tract infection and causes a significant health burden in older adults. Natural immunity to RSV is incomplete, permitting recurrent symptomatic infection over an individual's lifespan. When combined with immunosenescence, this increases older adults' susceptibility to more severe disease symptoms. As RSV prophylaxis is currently limited to infants, older adults represent an important target population for RSV vaccine development. The relationship between RSV and our immune systems is complex, and these interactions require deeper understanding to tailor an effective vaccine candidate towards older adults. To date, vaccine candidates targeting RSV antigens, including pre-F, F, G (A), G (B), M2-1, and N, have shown efficacy against RSV infection in older adults in clinical trial settings. Although vaccine candidates have demonstrated robust neutralising IgG and cellular responses, it is important that research continues to investigate the RSV immune response in order to further understand how the choice of antigenic target site may impact vaccine effectiveness. In this article, we discuss the Phase 3 vaccine candidates being tested in older adults and review the hurdles that must be overcome to achieve effective protection against RSV.
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Affiliation(s)
- Victoria A. Jenkins
- Bavarian Nordic AG, 6301 Zug, Switzerland
- Correspondence: ; Tel.: +41-79-558-89-39
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Colosia A, Costello J, McQuarrie K, Kato K, Bertzos K. Systematic literature review of the signs and symptoms of respiratory syncytial virus. Influenza Other Respir Viruses 2023; 17:e13100. [PMID: 36824394 PMCID: PMC9899685 DOI: 10.1111/irv.13100] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 02/07/2023] Open
Abstract
Respiratory syncytial virus (RSV) is responsible for over 30 million lower respiratory tract infections (LRTIs) and 3 million hospitalizations worldwide each year. Despite the risk RSV poses to young children, older adults, and individuals with comorbidities or suppressed immunity, there is limited understanding of RSV symptom presentation across these at-risk groups, and there is no vaccine for RSV. We conducted two systematic literature reviews (SLRs) of studies that document signs and symptoms (S&S) of RSV in (1) children aged ≤5 years and (2) immunocompromised adolescents and adults, and adults at high risk for severe RSV due to age or comorbidities. Symptom duration and hospital length of stay (LOS) were explored. Electronic database searches were performed following PRISMA guidelines. Studies captured RSV S&S across community and hospital settings. Clinicians and caregivers reported (n = 25 studies) nasal discharge/congestion, cough, shortness of breath, feeding abnormalities, and fever in ≥40% of children across studies and settings. Median hospital stays for children ranged from 2 days in the United States to 7.5 days in China. High-risk adults with RSV (n = 6 studies) commonly (≥40% of adults) reported cough, sputum, dyspnea, and fever/feverishness. Median length of hospital stay in adults ranged from 6 to 15 days across studies. Caregivers and clinicians reported similar RSV S&S in young children, including upper and lower respiratory and systemic symptoms. In high-risk and immunocompromised adults, the most frequent (in multiple publications) and commonly reported RSV S&S were primarily LRTI symptoms. RSV symptoms could last for weeks and are variable based on geography.
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Affiliation(s)
- Ann Colosia
- RTI Health SolutionsResearch Triangle ParkNorth CarolinaUSA
| | | | - Kelly McQuarrie
- Janssen Global ServicesHorshamPennsylvaniaUSA,Present address:
Merck & CompanyRahwayNew JerseyUSA
| | - Kelly Kato
- Janssen Global ServicesRaritanNew JerseyUSA
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Akash S, Emran TB, Amin R, Dhama K. Respiratory syncytial virus infection: a new threat of public health, epidemiology, pathogenesis, genomic characteristics, and current status. Int J Surg 2023; 109:191-192. [PMID: 36799848 PMCID: PMC10389305 DOI: 10.1097/js9.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Shopnil Akash
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka
| | - Talha B. Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
| | - Ruhul Amin
- Faculty of Pharmaceutical Science, Assam Down Town University, Panikhaiti, Guwahati, Assam
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar, Uttar Pradesh, India
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McGinnes Cullen L, Luo B, Wen Z, Zhang L, Durr E, Morrison TG. The Respiratory Syncytial Virus (RSV) G Protein Enhances the Immune Responses to the RSV F Protein in an Enveloped Virus-Like Particle Vaccine Candidate. J Virol 2023; 97:e0190022. [PMID: 36602367 PMCID: PMC9888267 DOI: 10.1128/jvi.01900-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a serious human respiratory pathogen, but no RSV vaccine has been licensed. Many vaccine candidates are focused on the viral F protein since the F protein is more conserved than the viral G protein across RSV strains and serotypes; thus, the F protein is thought more likely to induce a broader range of protection from infection. However, it is the G protein that binds the likely receptor, CX3CR1, in lung ciliated epithelial cells, raising the question of the importance of the G protein in vaccine candidates. Using virus-like particle (VLP) vaccine candidates, we have directly compared VLPs containing only the prefusion F protein (pre-F), only the G protein, or both glycoproteins. We report that VLPs containing both glycoproteins bind to anti-F-protein-specific monoclonal antibodies differently than do VLPs containing only the prefusion F protein. In RSV-naive cotton rats, VLPs assembled with only the pre-F protein stimulated extremely weak neutralizing antibody (NAb) titers, as did VLPs assembled with G protein. However, VLPs assembled with both glycoproteins stimulated quite robust neutralizing antibody titers, induced improved protection of the animals from RSV challenge compared to pre-F VLPs, and induced significantly higher levels of antibodies specific for F protein antigenic site 0, site III, and the AM14 binding site than did VLPs containing only the pre-F protein. These results indicate that assembly of pre-F protein with G protein in VLPs further stabilized the prefusion conformation or otherwise altered the conformation of the F protein, increasing the induction of protective antibodies. IMPORTANCE Respiratory syncytial virus (RSV) results in significant disease in infants, young children, and the elderly. Thus, development of an effective vaccine for these populations is a priority. Most ongoing efforts in RSV vaccine development have focused on the viral fusion (F) protein; however, the importance of the inclusion of G in vaccine candidates is unclear. Here, using virus-like particles (VLPs) assembled with only the F protein, only the G protein, or both glycoproteins, we show that VLPs assembled with both glycoproteins are a far superior vaccine in a cotton rat model compared with VLPs containing only F protein or only G protein. The results show that the presence of G protein in the VLPs influences the conformation of the F protein and the immune responses to F protein, resulting in significantly higher neutralizing antibody titers and better protection from RSV challenge. These results suggest that inclusion of G protein in a vaccine candidate may improve its effectiveness.
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Affiliation(s)
- Lori McGinnes Cullen
- Department of Microbiology and Physiological Systems, Program in Immunology and Microbiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Bin Luo
- Pharmacology, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Zhiyun Wen
- Infectious Diseases and Vaccines Discovery, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Lan Zhang
- Infectious Diseases and Vaccines Discovery, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Eberhard Durr
- Infectious Diseases and Vaccines Discovery, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Trudy G. Morrison
- Department of Microbiology and Physiological Systems, Program in Immunology and Microbiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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