Balancing Potential Prevention Strategies for Respiratory Syncytial Virus With Continued Emphasis on Supportive Care as Optimal Treatment

Specific therapies are lacking for treating respiratory syncytial virus (RSV), and while current prevention strategies offer great potential, supportive care remains the best treatment, according to a study published in Pathogens.

“Despite tremendous progress in our understanding of respiratory viral infections, these pathogens remain a significant cause of morbidity and mortality around the world,” wrote Dvir Gatt, Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, in Toronto, ON, and coauthors. “In general, there are limited specific therapies for any respiratory virus, and the mainstay of management focuses on prevention.”

Specific treatment options for RSV that have been studied include ribavirin, palivizumab, motavizumab, and RSV-immune globulin (RSV-IVIG). However, studies have shown many issues with these therapies, including high cost of administration, ineffective in reducing the severity of the virus, no difference in hospitalization, no differences in clinical outcomes, and potential adverse side effects. Non-specific treatments for RSV include mucus therapies, bronchodilators, therapies targeting inflammation, and manual therapies like chest physiotherapy. However, many non-specific treatments are not recommended or need more data supporting their use.

Since the main therapeutic approach for RSV is supportive care, emphasis remains on the prevention of severe disease and hospitalization. The current vaccines are divided into live-attenuated (LAV) or chimeric, protein-based, recombinant-vector-based, and nucleic-acid-based. Currently, several clinical trials are underway for maternal and infant RSV vaccines. In addition, newer mABs are being continuously evaluated, and some of these studies have shown promising results. In the future, the prevention of RSV will likely involve a combination of different strategies, including active and passive immunization. During the neonatal and early infancy periods, passive mAB administration or maternal vaccinations, or both, may achieve the immunization goals. Active immunization through vaccines provides complementary protection for older pediatric and adult age groups as passive immune responses weaken over time.

“Finally, from this review, it is clear that while specific therapies are lacking and the current prevention strategies offer great potential, the best treatment for RSV infection remains supportive care,” wrote the study authors.

The mortality gap for RSV between low- and middle-income countries suggests that current methods can reduce death. RSV results in more than 100,000 infant deaths around the world, and 97% of them are in low- and middle-income countries.

“In order to maximize the impacts on RSV morbidity and mortality, rather than investing in the development of novel (and often expensive) therapies, resources should be better and more ethically spent on improving the current situation in low- and middle-income countries,” the study authors added.

Reference

Gatt D, Martin I, AlFouzan R, Moraes TJ. Prevention and treatment strategies for respiratory syncytial virus (RSV). Pathogens. 2023;12(2):154. doi:10.3390/pathogens12020154