The World Health Organization (WHO) recently released its first position paper on immunization products for respiratory syncytial virus (RSV) infection, providing authoritative guidance for global prevention and control of this “killer of infant health”. As the leading pathogen causing acute lower respiratory tract infections in children, RSV leads to approximately 100,000 deaths and over 3.6 million hospitalizations among children under the age of 5 each year. Among these, nearly half of the deaths occur in infants under 6 months of age, and 97% of fatal cases are concentrated in low-income and middle-income countries with scarce medical resources. The release of this significant document is regarded as a key milestone in reversing the burden of RSV-related diseases.
The symptoms of RSV infection are usually similar to those of the common cold, but for infants whose immune systems are not yet fully developed, it can trigger fatal complications such as pneumonia and bronchiolitis. “The risk of severe illness increases exponentially for high-risk groups such as premature infants and low-birth-weight infants once they are infected,” emphasized Dr. Kate O’Brien, Director of the Immunization, Vaccines and Biological Products Department at WHO. The high transmissibility of RSV and the physiological fragility of infants combine to make it a major challenge to global child health. In sub-Saharan Africa and South Asia, medical shortcomings such as insufficient oxygen supply and the lack of fluid therapy treatment further increase the mortality rate of RSV infections.
To address the global crisis of RSV, WHO recommends two immunization products: the maternal vaccine RSVpreF and the long-acting monoclonal antibody nirsevimab (Nirsevimab). The former is administered to pregnant women in the late stage of pregnancy (from the 28th week onwards) through the placenta to transfer antibodies to the newborn, building a congenital immune barrier; the latter adopts a single-dose injection design, which can be administered to infants after birth and takes effect within one week, with a protection efficacy that lasts for 5 months, precisely covering the high-incidence period of RSV seasonal epidemics.”The maternal vaccine can seamlessly integrate into the routine prenatal check-up process, while Nirsevimab supports multiple vaccination scenarios – immediate after birth, before discharge, or during the first health check-up.” O’Brien explained. Although the benefits are greatest for infants under 6 months of age, supplementary vaccination within 12 months can still significantly reduce the risk of severe illness. It is worth noting that RSVpreF has been pre-certified by the WHO, meaning that the UN agency can quickly purchase and accelerate the introduction of the vaccine in low- and middle-income countries.
“If both products are fully promoted, it could prevent tens of thousands of infant deaths each year.” O’Brien expressed high hopes for the new plan. However, from the paper-based guidelines to actual prevention and control, multiple obstacles still need to be overcome: financial burdens in low- and middle-income countries, insufficient cold chain transportation capacity, and weak coverage of the grassroots vaccination network. WHO suggests that countries combine the capacity of their health systems, cost-benefit analysis, and expected coverage to introduce the vaccines in a phased manner, and calls on the international community to increase financial and technical assistance to ensure that resources are directed to high-demand regions.This position paper not only provides scientific basis for policy makers and immunization program managers of various countries, but also sends a signal of collaboration to the world: combating RSV requires a full-chain breakthrough from vaccine research and development, supply chain optimization to strengthening grassroots medical care. In this battle concerning the right to life of children, the speed and effectiveness of the implementation of this new guideline may become a test of the resilience of the global public health system.
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