Respiratory Syncytial Virus
Control strategies and policies for a global cause of severe childhood pneumonia
Respiratory syncytial virus (RSV) is the main cause of early childhood severe pneumonia across the world, particularly affecting children in the world’s poorest nations. Without a successful vaccine, new strategies are urgently needed to help prevent infection. Professor James Nokes and his team have influenced vaccine design and preparedness against infection. Their research has characterised the disease burden and infection dynamics of the virus and immune response of the host which has influenced control effects on an international scale.
Although over 90% of cases of RSV occur in the world’s poorest nations, until Professor Nokes’ research in 2013, there was little focus on RSV vaccine control for low and lower-middle income country settings. In some countries, such as Kenya, there can be 30,000 severe hospitalised RSV cases in children each year, and globally only 10% of children receive hospital treatment when suffering from RSV induced pneumonia. An acute lack of data has hindered many efforts to reduce infection rates and create new strategies to tackle RSV in low income settings.
Aiming to create new strategies of control for national health systems, international agencies and pharmaceutical companies, Professor Nokes explored a set of key questions:
Who brings RSV into the home and who infects the most vulnerable member of the family - the infant?
How effective is maternal immunisation at protecting the newborn child
What are the optimal strategies for RSV vaccine intervention?
What properties should be enhanced for RSV vaccines?
Through long term work in rural Kenya, working with organisations including the Kenya Medical Research Institute and Health Ministry and the World Health Organisation (WHO), Professor Nokes’ research has characterised RSV transmission through intensive hospital and community studies. This research has resulted in innovative routes to control transmission within the household, insight into maternal immunisation procedures, and vaccine intervention.
Professor Nokes’ work is already having an impact on RSV sufferers in the poorest parts of the world. In 2013, Professor Nokes held discussions with the WHO Initiative for Vaccine Research on the delays or absence of trials of RSV vaccines in low income countries, which catalysed the 2017 WHO RSV vaccine ROADMAP and subsequent work-stream on RSV that brought broad awareness to the problem and involved organisations such as the Bill and Melinda Gates Foundation, PATH and the National Institutes for Health.
Professor Nokes’ mathematical modelling has helped to track virus transmission, which has shown that immunising older siblings, or schools-based interventions, can shield the youngest family members from infection. Professor Nokes has provided evidence to the Kenya Medical Research Institute and Health Ministry and Kenya National Immunisation Technical Advisory Group to support policy development. In addition, the team has been working with pharmaceutical companies to examine the optimal properties of vaccines and advised on future RSV vaccine trials. The data that has been collected during the project is closing the knowledge gap about the effects of RSV on low income countries, which is vital for future vaccine innovations and continuing intervention, and awareness, in this area.