PREVENTION AND TREATMENT RECOMMENDATIONS FOR RESPIRATORY SYNCYTIAL VIRUS-INFECTION - BACKGROUND AND CLINICAL-EXPERIENCE 40 YEARS AFTER DISCOVERY

Though 40 years have passed since its discovery, respiratory syncytial virus (RSV), one of the most ubiquitous viruses known, continues to e vade most of our efforts to prevent or treat the clinical disease it c auses. Long recognised as the most common cause of lower respiratory t ract infections in virtually all children in the first 2 years of life , it has been increasingly recognised as a cause of more serious disea se in several 'high risk' populations. These populations include infan ts with cardiac or pulmonary disease and infants and adults with immun odeficiencies, particularly those undergoing bone marrow transplantati on. Early attempts to immunise children with a simple formalin-inactiv ated vaccine led tu severe disease in vaccinated children who subseque ntly were infected with RSV from the community. Other vaccine construc ts have failed for a variety of reasons, although surface glycoprotein subunit vaccines may hold promise. For years, ribavirin, a synthetic nucleoside analogue administered by constant aerosol, has been felt by many to lead to more rapid improvement in clinical disease caused by RSV, but it is still unclear whether its benefits are truly significan t. An intravenous immunoglobulin product prepared from donors screened for the presence of high titres of RSV neutralising antibody (known a s RSVIG) appears to be well tolerated and relatively effective in prot ecting high-risk infants against serious RSV disease, although therape utic use has proven less dramatic. At least one monoclonal antibody un dergoing current testing may prove easier to use in similar immunoprop hylactic use. Results on the use of corticosteroids as supportive ther apy have not been conclusive. In short, RSV will continue to be a chal lenge for clinicians and researchers well into the next century.