Brief History and Characterization of Enhanced Respiratory Syncytial Virus Disease

In 1967, infants and toddlers immunized with a formalin-inactivated vaccine against respiratory syncytial virus (RSV) experienced an enhanced form of RSV disease characterized by high fever, bronchopneumonia, and wheezing when they became infected with wild-type virus in the community. Hospitalizati...

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Bibliographic Details
Published in:Clinical and vaccine immunology 2016-03, Vol.23 (3), p.189-195
Main Authors: Acosta, Patricio L, Caballero, Mauricio T, Polack, Fernando P
Format: Article
Language:English
Subjects:
Antibodies, Viral - immunology
Child, Preschool
Eosinophilia - immunology
Eosinophils - immunology
History, 20th Century
History, 21st Century
Humans
Immunologic Memory - immunology
Infant
Lung - pathology
Minireview
Respiratory syncytial virus
Respiratory Syncytial Virus Infections - immunology
Respiratory Syncytial Virus Infections - pathology
Respiratory Syncytial Virus Vaccines - immunology
Respiratory Syncytial Virus, Human - immunology
Th2 Cells - immunology
Vaccination - adverse effects
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Summary:In 1967, infants and toddlers immunized with a formalin-inactivated vaccine against respiratory syncytial virus (RSV) experienced an enhanced form of RSV disease characterized by high fever, bronchopneumonia, and wheezing when they became infected with wild-type virus in the community. Hospitalizations were frequent, and two immunized toddlers died upon infection with wild-type RSV. The enhanced disease was initially characterized as a "peribronchiolar monocytic infiltration with some excess in eosinophils." Decades of research defined enhanced RSV disease (ERD) as the result of immunization with antigens not processed in the cytoplasm, resulting in a nonprotective antibody response and CD4(+) T helper priming in the absence of cytotoxic T lymphocytes. This response to vaccination led to a pathogenic Th2 memory response with eosinophil and immune complex deposition in the lungs after RSV infection. In recent years, the field of RSV experienced significant changes. Numerous vaccine candidates with novel designs and formulations are approaching clinical trials, defying our previous understanding of favorable parameters for ERD. This review provides a succinct analysis of these parameters and explores criteria for assessing the risk of ERD in new vaccine candidates.
ISSN:1556-6811
1556-679X
DOI:10.1128/CVI.00609-15