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Emerging Interventions for Respiratory Syncytial Virus (RSV)-associated Acute Lower Respiratory Infections (ALRI)

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More Intervention Effect Estimate Summaries

Reference
Nair H, Verma VR, Theodoratou E, Zgaga L, Huda T, Simoes EA, Wright PF, Rudan I, and Campbell H. An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections (ALRI) in children. BMC Public Health 2011 11 (Suppl 3):S30.

Background

  • Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children annually, and is estimated that RSV results in about 53,000 to 199,000 deaths annually in young children. (1)
  • RSV is thought to account for approximately 85% of cases of bronchiolitis and approximately 20% of cases of childhood pneumonia. (2)
  • Currently there are several vaccine and immunoprophylaxis candidates against RSV in developmental phase targeting active and passive immunization
  • Nair et al. summarized findings from a modified Child Health and Nutrition Research Initiative (CHNRI) process whereby a systematic literature review related to emerging RSV vaccines was conducted, and the findings were presented to a group of 20 experts who then rated their degree of optimism (0-100%) on several criterion.


CHNRI Criterio

Answerability: is the science behind the research viable?

  • Active Immunization (infants < 6 months) – moderate level of optimism (60%)
  • Active Immunization (maternal) – low level of optimism (40%)
  • Passive Immunization (monoclonal antibodies) – moderate to high level of optimism (70%)

Efficacy: the impact of the vaccines under ideal conditions

  • Active Immunization (infants < 6 months) – moderate level of optimism (60%)
  • Active Immunization (maternal) – moderate level of optimism (60%)
  • Passive Immunization (monoclonal antibodies) – moderate level of optimism (60%)

Effectiveness:  maximum burden reduction potential

  • The panel was of the opinion that candidates for all three interventions are likely to have low levels of maximum impact on overall pneumonia disease

Low Product Cost

  • Active Immunization (infants < 6 months) – very low level of optimism
  • Active Immunization (maternal) – very low level of optimism 
  • Passive Immunization (monoclonal antibodies) – no optimism at all

Affordability

  • Active Immunization (infants < 6 months) – very low level of optimism
  • Active Immunization (maternal) – very low level of optimism 
  • Passive Immunization (monoclonal antibodies) – very low level of optimism

Low Cost of Development

  • Active Immunization (infants < 6 months) – low level of optimism (< 60%)
  • Active Immunization (maternal) – low level of optimism (50%) 
  • Passive Immunization (monoclonal antibodies) – high level of optimism

Deliverability

  • Active Immunization (infants < 6 months) – moderate level of optimism (60%)
  • Active Immunization (maternal) – moderate level of optimism (60%)
  • Passive Immunization (monoclonal antibodies) – low level of optimism (20%)

Acceptability: among end-users and health workers 

  • Active Immunization (infants < 6 months) – moderate to high optimism (60% end users & >80% health workers)
  • Active Immunization (maternal) – high level of optimism (80%) 
  • Passive Immunization (monoclonal antibodies) – moderate level of optimism (60%)

Sustainability

  • Active Immunization (infants < 6 months of age) – moderate level of optimism (60%)
  • Active Immunization (maternal) – moderate level of optimism (60%)
  •  Passive Immunization (monoclonal antibodies) – low level of optimism (20%)

Equity: impact on decreasing child health inequity

  • Active Immunization (infants < 6 months of age) – moderate level of optimism (70%)
  • Active Immunization (maternal) – moderate level of optimism (70%)
  • Passive Immunization (monoclonal antibodies) – low level of optimism (40%)

Intervention Recommendation 

  • Vaccines for active immunization of infants appear to be the most promising, as it appears unlikely that maternal immunization would provide sufficient protection to infants. Monoclonal antibodies are proven effective in providing protection to high-risk infants, but their generalizability is limited.
  • While it is not only important that investments are made in researching new vaccines, adequate emphasis must be made and resources allocated for proper distribution of the vaccine.

References from Webster Paper Cited Here

  1. Nair H, Nokes D, Gessner B, Dherani M, Madhi S, Singleton R, O'Brien K, Roca A, Wright P, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih E, Ngama M, Munywoki P, Kartasasmita C, Simoes E, Rudan I, Weber M, Campbell H. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010; 375(9725):1545–1555.
  2. Wright PF, Cutts FT. Generic protocol to examine the incidence of lower respiratory infection due to respiratory syncytial virus in children less than 5 years of age. Geneva: World Health Organization; 2000. p. 34.



Background

  • Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children annually, and is estimated that RSV results in about 53,000 to 199,000 deaths annually in young children. (1)
  • RSV is thought to account for approximately 85% of cases of bronchiolitis and approximately 20% of cases of childhood pneumonia. (2)
  • Currently there are several vaccine and immunoprophylaxis candidates against RSV in developmental phase targeting active and passive immunization
  • Nair et al. summarized findings from a modified Child Health and Nutrition Research Initiative (CHNRI) process whereby a systematic literature review related to emerging RSV vaccines was conducted, and the findings were presented to a group of 20 experts who then rated their degree of optimism (0-100%) on several criterion.


CHNRI Criterio

Answerability: is the science behind the research viable?

  • Active Immunization (infants < 6 months) – moderate level of optimism (60%)
  • Active Immunization (maternal) – low level of optimism (40%)
  • Passive Immunization (monoclonal antibodies) – moderate to high level of optimism (70%)

Efficacy: the impact of the vaccines under ideal conditions

  • Active Immunization (infants < 6 months) – moderate level of optimism (60%)
  • Active Immunization (maternal) – moderate level of optimism (60%)
  • Passive Immunization (monoclonal antibodies) – moderate level of optimism (60%)

Effectiveness:  maximum burden reduction potential

  • The panel was of the opinion that candidates for all three interventions are likely to have low levels of maximum impact on overall pneumonia disease

Low Product Cost

  • Active Immunization (infants < 6 months) – very low level of optimism
  • Active Immunization (maternal) – very low level of optimism 
  • Passive Immunization (monoclonal antibodies) – no optimism at all

Affordability

  • Active Immunization (infants < 6 months) – very low level of optimism
  • Active Immunization (maternal) – very low level of optimism 
  • Passive Immunization (monoclonal antibodies) – very low level of optimism

Low Cost of Development

  • Active Immunization (infants < 6 months) – low level of optimism (< 60%)
  • Active Immunization (maternal) – low level of optimism (50%) 
  • Passive Immunization (monoclonal antibodies) – high level of optimism

Deliverability

  • Active Immunization (infants < 6 months) – moderate level of optimism (60%)
  • Active Immunization (maternal) – moderate level of optimism (60%)
  • Passive Immunization (monoclonal antibodies) – low level of optimism (20%)

Acceptability: among end-users and health workers 

  • Active Immunization (infants < 6 months) – moderate to high optimism (60% end users & >80% health workers)
  • Active Immunization (maternal) – high level of optimism (80%) 
  • Passive Immunization (monoclonal antibodies) – moderate level of optimism (60%)

Sustainability

  • Active Immunization (infants < 6 months of age) – moderate level of optimism (60%)
  • Active Immunization (maternal) – moderate level of optimism (60%)
  •  Passive Immunization (monoclonal antibodies) – low level of optimism (20%)

Equity: impact on decreasing child health inequity

  • Active Immunization (infants < 6 months of age) – moderate level of optimism (70%)
  • Active Immunization (maternal) – moderate level of optimism (70%)
  • Passive Immunization (monoclonal antibodies) – low level of optimism (40%)

Intervention Recommendation 

  • Vaccines for active immunization of infants appear to be the most promising, as it appears unlikely that maternal immunization would provide sufficient protection to infants. Monoclonal antibodies are proven effective in providing protection to high-risk infants, but their generalizability is limited.
  • While it is not only important that investments are made in researching new vaccines, adequate emphasis must be made and resources allocated for proper distribution of the vaccine.

References from Webster Paper Cited Here

  1. Nair H, Nokes D, Gessner B, Dherani M, Madhi S, Singleton R, O'Brien K, Roca A, Wright P, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih E, Ngama M, Munywoki P, Kartasasmita C, Simoes E, Rudan I, Weber M, Campbell H. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010; 375(9725):1545–1555.
  2. Wright PF, Cutts FT. Generic protocol to examine the incidence of lower respiratory infection due to respiratory syncytial virus in children less than 5 years of age. Geneva: World Health Organization; 2000. p. 34.

 

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