Respiratory Syncytial Virus Prevention In Infants: Maternal Vaccination, Long-Acting Monoclonal Antibodies, And Equity Of Access

Abstract

Introduction:

RSV is a major cause of acute lower respiratory tract infection, hospitalization, and infant mortality, particularly during the first months of life.

Objectives: To review the current strategies to prevent respiratory syncytial virus (RSV) infection in infants that include maternal vaccination and long-acting monoclonal antibodies with equity of access.

Methodology:

A narrative review of key selected clinical trials was conducted, mostly published in the 2020-2026 range, recommendations by WHO, guidance by the Advisory Committee on Immunization Practices and related public health literature.

Results:

RSV is associated with substantial incidence of ALRI-related hospitalization and death in young infants and is more frequent in low- and middle-income countries. Maternal immunization with perfusion F protein vaccine can confer passive protection, through transplacental transfer of antibody, during the initial months of life. Monoclonal antibodies against RSV, such as nirsevimab and clesrovimab, provide direct passive protection to infants who are at a high risk of developing RSV infection, particularly in cases where their mothers were either unvaccinated, vaccinated too close to delivery, or have had impaired antibody transfer to the infant.

Conclusion:

Recent advancements have changed the RSV prevention strategy for infants from support care into immunization. Today's biggest challenge is not proving scientific feasibility, but ensuring fair and effective delivery. Nations must devise context-specific strategies to integrate maternal vaccination, monoclonal antibodies in infants, surveillance, financing, and equity monitoring to shield all infants, particularly those at highest risk.