RSV

Question 1

RSV
- Baltimore Class
- RNA/DNA
- ss/ds

Answer 1

Baltimore class V
negative sense RNA

Question 2

At risk of severe disease from RSV

Answer 2

• <6/12
• infants with immunodeficiency, neuromuscular conditions, congential cardiac abnormalities and severe lung disease
• Frail elderly
• Immunocompromised

Question 3

incubation and likely infectious period of RSV. Classical presentation in young

Answer 3

• 4-7 days incubation
• Contagious for 1 - 2 days prior to symptoms
• Virus disappearing from system by the time symptoms arrive
• Symptoms start in UTRI
  â—‹ Nasal congestion, rhinorrhoea
• Progress to lower resp tract
  â—‹ Bronchiolitis
  â—‹ Wheeze

Question 4

RSV antigenic vaccine/MAB target

Answer 4

F protein (both pre and post fusion forms targeted)

Question 5

RSV - who gets vaccinated in the UK

Answer 5

Pregnant women at 28 weeks gestation
Adults at 75 (single dose)

Question 6

RSV - who gets MAB prophylaxis

Answer 6

• MAB immunisation
  â—‹ Mod or severe chronic lung disease of prematutity (AKA bronchopulmonary dysplasia)
  â—‹ High risk infants at the start of RSV season (usually on o2)
  § Pulmonary hypoplasia
  § Interstital lung disease
  § Congenital lung

Question 7

If a baby’s mother was immunised in pregnancy but the baby was in a high risk category, would it still receive MAB prophylaxis?

Answer 7

yes - “this should be offered regardless of whether the mother was vaccinated during pregnancy”

Question 8

Treatment of severe RSV

Answer 8

Supportive
Nebulised ribavirin (v poor evidence)
IVIG (even poorer evidence)

Question 9

What are the two distinct subgroups of RSV? And which is most transmissible?

Answer 9

RSV-A (most transmissible) and RSV-B

Question 10

What are three surface glycoproteins of RSV and what are their basic roles?

Answer 10

G protein - glycosylated attachment protein

F protein - membrane fusion protein

Small hydrophobic region - role unclear

Question 11

What other types of vaccine are in development for RSV?

Answer 11

Particle based (nano particle)

Live attenuated or chimeric

Vector based (adeno and vaccinia)

Subunit vaccines

Question 12

When are RSV monoclonal Abs usually given?

Answer 12

From week 40 in October

Question 13

What is nirsevimab?

How long does it offer protection?

What is the effectiveness?

Approved for what age?

Answer 13

Recombinant MAb engineered to bind prefusion RSV F protein, with Fc region to prolong half life

Single dose - 5 months protection

80% reduction in hospitalisation

Up to 24 months

Question 14

What is palivizumab?

How long does it offer protection?

What is the effectiveness?

When should it be used?

Answer 14

Humanised murine MAb with activity against RSV F protein

Half life of 18-21 days, dosed monthly for 5 months

50% reduction in hospitalisation

For use where nirsevimab is indicated but not available

Question 15

When should RSV vaccine be give to pregnant women?

Answer 15

From week 28 (earlier the better to allow high tire of Ab to cross placenta)

Can even give shortly after delivery as can provide passive protection via breast milk

Question 16

Treatment of HSCT patients with LRTI with RSV

Answer 16

Aerosolised or systemic ribavirin plus IVIG

Question 17

What was the JCVI recommendations for RSV immunisation?

Answer 17

High risk infants - nirsevimab (or palivizumab if not available)

Universal infant programme - Abrysvo vaccine of pregnant mothers OR national role out of nirsevimab

Older adults - Abrysvo, Arexvy or mResvia