In context of the RSV GOLD Project, multiple articles have been published.

RSV-related mortality and Down syndrome

Down syndrome is an important risk factor of severe RSV infection, but global data on RSV-related mortality in children with Down syndrome is lacking. The RSV GOLD team collected cases of children younger than 5 years with Down syndrome who died with RSV infection and described demographic and clinical characteristics. The study was published in de Pediatric Infectious Disease Journal in 2020.

A total of 53 children from 20 different countries were included. One-fourth of children did not have risk factors for severe RSV disease. The majority of children was older than 3 months, indicating that maternal vaccination is not sufficient to protect this high-risk group against RSV-related mortality.  

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Citation: Löwensteyn YN, Phijffer EWEM, Simons JVL, Scheltema NM, Mazur NI, Nair H et al. Respiratory syncytial virus-related death in children with Down syndrome: The RSV GOLD study. Pediatr Infect Dis J. 2020 Apr 23.

Potential impact of vaccination

After having gathered data on characteristics of young children who died with RSV-infection and information regarding vaccine candidates, the RSV GOLD team aimed to estimate the potential impact of maternal vaccination against RSV. For this study, which was published in Vaccine in 2018, a mathematical model was developed.

The model predicted that maternal vaccination at 30 weeks gestational age could have prevented a substantial portion of global RSV-related in-hospital mortality. Preterm children and children with comorbidities were predicted to benefit less than (healthy) term children.

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Citation: Scheltema NM, Kavelaars XM, Thorburn K, Hennus MP, van Woensel JB, van der Ent CK et al. Potential impact of maternal vaccination on life-threatening respiratory syncytial virus infection during infancy. Vaccine. 2018; 36(31): 4693-4700.

RSV Vaccine Landscape

The RSV GOLD team has written a review on vaccine development that was published in The Lancet Infectious diseases in 2018. As RSV vaccine development has gained momentum over recent years, we aimed to provide a comprehensive overview of RSV vaccine candidates and monoclonal antibodies in clinical development.

The RSV vaccine landscape includes 19 vaccine candidates and monoclonal antibodies in clinical trials using four approaches: (1) particle-based, (2) live-attenuated or chimeric, (3) subunit, (4) vector-based.

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Citation: Mazur NI, Higgins D, Nunes MC, Melero JA, Langedijk AC, Horsley N et al. The respiratory syncytial virus vaccine landscape: lessons from the graveyard and promising candidates. Lancet Infect Dis. 2018; 18(10): e295-e311.

Breast milk and maternal vaccines

Protection by maternal vaccination is mainly based on transplacental antibody transfer. Antibody transfer via breast milk might offer additional protection. In 2018, this study on the potential role of breast milk as a route of administration for RSV vaccines was published in The Journal of Infectious Diseases.

The study involved 174 infants under the age of 6 months. Infants were stratified by risk factors into a group with and a group without RSV. A slightly lower IgG antibody count was found in the group with RSV. This suggests that addition of IgG to breast milk will probably transfer protection to infants against RSV disease, additional to transplacental antibody transfer.

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Citation: Mazur NI, Horsley NM, Englund JA, Nederend M, Magaret A, Kumar A et al. Breast Milk Prefusion F Immunoglobulin G as a Correlate of Protection Against Respiratory Syncytial Virus Acute Respiratory Illness. J Infect Dis. 2019; 219(1): 59-67.

Retrospective case series

In 2017, the RSV GOLD pilot case series of children who died with RSV infection was published in The Lancet Global Health. Through performing this study, the RSV GOLD team aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related in-hospital mortality.

A total of 358 children from 23 countries across the world were included in the analysis, which showed that a substantial proportion of children with RSV-related death had comorbidities. These children died at a younger age than children without comorbidity and may therefore need additional preventive interventions.

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Citation: Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA et al. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series. Lancet Glob Health. 2017; 5(10): e984-e991.


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