# Current and Emerging Strategies for the Prevention of Respiratory Syncytial Virus (RSV) Infections: A Comprehensive Review of Vaccines and Antibody Therapies

## TL;DR

This paper reviews current and emerging vaccines and antibody therapies for preventing RSV infections, focusing on their mechanisms, efficacy, and challenges in different populations.

## Contribution

The paper provides a comprehensive review of RSV prevention strategies, emphasizing the need for equitable access and safety monitoring.

## Key findings

- mRNA, protein-based, and viral vector vaccines, along with monoclonal antibodies, effectively reduce RSV-related hospitalizations.
- RSV vaccine efficacy varies by age group due to differences in immune response.
- Post-market surveillance is essential to ensure vaccine safety and address risks like VAERD and GBS.

## Abstract

Respiratory syncytial virus (RSV) exerts a profound influence on public health worldwide, particularly affecting vulnerable groups such as infants, the elderly, and those with compromised immune systems. Furthermore, RSV presents notable challenges in vaccine development and distribution, underscoring the importance of ensuring equitable access to preventative solutions. The virus's capacity to evade immune defenses complicates both treatment and prevention, emphasizing the critical need for continued research and the implementation of effective vaccination programs. RSV vaccines, such as Arexvy, Abrysvo, and mRESVIA, as well as monoclonal antibodies, such as nirsevimab and clesrovimab, have been developed using platforms like mRNA technology, protein subunits, and viral vectors, each with unique mechanisms of action, immunogenic properties, and safety profiles. Clinical research demonstrates that mRNA-based vaccines, protein-based vaccines, viral vector vaccines, and monoclonal antibodies effectively reduce hospital admissions and the risk of lower respiratory tract disease from RSV.

However, RSV vaccine efficacy varies across age groups due to differences in immune system development and response. RSV vaccine implementation requires rigorous safety monitoring due to concerns over vaccine-associated enhanced respiratory disease (VAERD) and rare adverse effects, such as Guillain-Barré Syndrome (GBS). Comprehensive post-market surveillance and ongoing pharmacovigilance are vital to refining vaccine strategies, ensuring safety for high-risk groups like infants, the immunocompromised, and the elderly, while confirming that the benefits outweigh potential risks. Healthcare providers play a crucial role in advocating for RSV vaccination, and the development of universal RSV vaccines has become a research priority, aiming to deliver broad protection across various populations and strains. As technological advancements continue, the future of preventative measures, including vaccines and monoclonal antibodies, is poised to bring transformative solutions, ultimately reducing the burden of RSV and improving public health worldwide.