RSV prophylactics for pediatric populations: A product review and meta-analysis of real-world effectiveness

Figures

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  Figure 1.. Timeline of major milestones in RSV research and preventive product development.

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  Figure 2.. Structure-based design of current pediatric RSV prophylactics. Crystal structures of the RSV fusion (F) glycoprotein in prefusion (left) and postfusion (right) conformations are shown; these structures do not include the transmembrane or intracellular portions of F. Major antigenic sites are indicated: site Ø (green) and site V (red) are prefusion-exclusive and contain the most potent neutralizing epitopes; site II (pink) and site IV (orange) are present in both conformations but are substantially more immunogenic when displayed on prefusion F. All three interventions currently used to prevent severe RSV disease in infants target prefusion-preferred or prefusion-specific epitopes: nirsevimab binds site Ø, clesrovimab binds site IV, and the maternal bivalent prefusion-stabilized F subunit vaccine (RSVpreF; RSV-A + RSV-B) elicits high-titer polyclonal neutralizing antibodies across all prefusion domains and directed predominantly against sites Ø and V. in contrast, palivizumab, which targeted only the lower-potency site II, has been largely superseded by these next-generation interventions.

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  Figure 3.. PRISMA flow diagram of study selection.

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  Figure 4.. Random-effects meta-analysis of nirsevimab effectiveness against RSV-associated hospitalization.

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  Figure 5.. Random-effects meta-analysis of maternal RSVpreF vaccination effectiveness against RSV-associated hospitalization.