Respiratory syncytial virus (RSV): recent advances in preventative strategies and visions for the future

Respiratory syncytial virus (RSV) has a significant global impact, especially amongst vulnerable infants with immature immune systems. Elevated hospitalization and mortality rates within this group underscore this substantial risk. Until 2022, the only available preventive was the costly monoclonal antibody, palivizumab, which requires monthly winter injections, limiting its use to high-risk infants. Significant progress has led to the recent ground-breaking approval of two further RSV preventatives for infants: an extended half-life monoclonal antibody, nirsevimab (Beyfortus®) and a protein-based maternal vaccine, RSVpreF (Abrysvo®). Following authorization, several European countries, including Spain, France and Italy introduced nirsevimab during the 2023/24 RSV season. In contrast, the maternal RSV vaccine was integrated into antenatal immunization programmes within the United Kingdom and Argentina. Given the swiftly changing landscape of RSV prevention, this review offers timely insights into significant clinical trials and emerging real-world evidence; emphasizing the considerable effectiveness of current preventatives, as well as considering those under development. We also consider the potential impact on the National Health Service (NHS), including a changing disease burden, and the role of the paediatrician and broader multidisciplinary team in enhancing public health policy, supporting immunization campaigns and contributing to future research.