RSV Illness in the Young and the Old — The Beginning of the End?

This editorial reviews two phase 3 trials evaluating the RSVpreF vaccine, a bivalent RSV fusion (F) protein vaccine in prefusion conformation. The RENOIR trial, involving adults 60+, showed high vaccine efficacy (up to 85.7%) against RSV lower respiratory tract illness, though cases of severe illness were too few to assess hospitalization or death outcomes. The MATISSE trial, enrolling pregnant women, found the vaccine effective against severe RSV illness in infants within 180 days of birth (efficacy 81.8% within 90 days and 69.4% within 180 days), despite not meeting the primary endpoint for mild RSV illness. RSVpreF exhibited acceptable safety profiles with isolated neurologic events. The piece contextualizes these advances among other recent RSV vaccine and antibody trials (e.g. nirsevimab) and discusses policy, equity, and scientific questions surrounding implementation in high-risk groups and resource-limited settings. The editorial concludes we are at “the beginning of the end” for RSV illness, while emphasizing the need for continued research and equitable distribution.

This editorial reviews two phase 3 trials evaluating the RSVpreF vaccine, a bivalent RSV fusion (F) protein vaccine in prefusion conformation. The RENOIR trial, involving adults 60+, showed high vaccine efficacy (up to 85.7%) against RSV lower respiratory tract illness, though cases of severe illness were too few to assess hospitalization or death outcomes. The MATISSE trial, enrolling pregnant women, found the vaccine effective against severe RSV illness in infants within 180 days of birth (efficacy 81.8% within 90 days and 69.4% within 180 days), despite not meeting the primary endpoint for mild RSV illness. RSVpreF exhibited acceptable safety profiles with isolated neurologic events. The piece contextualizes these advances among other recent RSV vaccine and antibody trials (e.g. nirsevimab) and discusses policy, equity, and scientific questions surrounding implementation in high-risk groups and resource-limited settings. The editorial concludes we are at “the beginning of the end” for RSV illness, while emphasizing the need for continued research and equitable distribution.