# Genomic Insights Into Respiratory Syncytial Virus Circulation Patterns and Neutralization by Anti‐F Monoclonal Antibodies in Panama (2018–2024)

## TL;DR

This study analyzes RSV virus patterns in Panama from 2018 to 2024 and tests how monoclonal antibodies neutralize the virus.

## Contribution

The study provides genomic insights into RSV lineages in Panama and evaluates monoclonal antibody neutralization efficacy.

## Key findings

- RSV-A and RSV-B subgroups alternated dominance from 2018 to 2024 with distinct lineage shifts.
- Monoclonal antibodies like MEDI8897* effectively neutralized RSV strains in assays.
- The study establishes a baseline for RSV evolution before potential preventive therapies in Panama.

## Abstract

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalization in infants and children. Whole genome sequencing (WGS) plays a critical role in understanding the evolution and epidemiology of RSV. Limited studies have been conducted in Central America and the Caribbean, and none have specifically focused on lineages involved in recent outbreaks. Furthermore, no assays currently exist to evaluate the sensitivity of the RSV fusion protein to monoclonal antibodies.

In Panama, an epidemiological surveillance system tracks RSV activity through the collection of nasopharyngeal samples from patients with acute respiratory infections. Between January 2018 and July 2024, 303 RSV‐positive samples were analyzed by RT‐qPCR. RSV‐B was the dominant subgroup in 2018, but following years had alternating dominance between RSV‐A and RSV‐B. Of the 303 samples, 115 underwent WGS. Additionally, neutralization assays were done using different Anti‐F Monoclonal Antibodies.

In RSV‐A, 11 lineages were identified, with 3 to 5 cocirculating during each annual outbreak, and a shift in predominance from a.d.1 (2019) to a.d.5.2 (2023–2024). In RSV‐B, two lineages circulated: B.D.4.1.1 (2018–2020) and its descendant B.D.E.1, which predominated from 2021 onward. Several monoclonal antibodies, including nirsevimab's precursor MEDI8897*, effectively neutralized the RSV strains in neutralization assays.

Although Panama has not yet implemented a preventive therapy for RSV, this step could modify outbreak dynamics. The findings from this study provide a baseline reference prior to the implementation of preventive therapies against RSV in Panama and the region, facilitating the assessment of potential changes in the evolutionary dynamics of the virus.