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Polack FP, Alvarez-Paggi D, Libster R, Caballero MT, Blair RV, Hijano DR, de la Iglesia Niveyro PX, Menendez DR, Gladwell W, Avendano LM, Velozo L, Wanek A, Bergel E, Prince GA, Kleeberger SR, Johnson J, Pociask D, Kolls JK. Fatal enhanced respiratory syncytial virus disease in toddlers. Sci Transl Med 2021; 13:eabj7843. [PMID: 34669442 PMCID: PMC10712289 DOI: 10.1126/scitranslmed.abj7843] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 1967, two toddlers immunized with a formalin-inactivated vaccine against respiratory syncytial virus (FIRSV) in the United States died from enhanced RSV disease (ERD), a severe form of illness resulting from aberrant priming of the antiviral immune response during vaccination. Up to 80% of immunized children subsequently exposed to wild-type virus were hospitalized. These events hampered RSV vaccine development for decades. Here, we provide a characterization of the clinical, immunopathological, and transcriptional signature of fatal human ERD, outlining evidence for safety evaluation of RSV vaccines and a framework for understanding disease enhancement for pathogens in general.
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Affiliation(s)
- Fernando P. Polack
- Fundación INFANT, Buenos Aires, Argentina
- Vanderbilt University, Nashville, TN, USA
| | - Damián Alvarez-Paggi
- Fundación INFANT, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Mauricio T. Caballero
- Fundación INFANT, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | | | - Diego R. Hijano
- Fundación INFANT, Buenos Aires, Argentina
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Daniel R. Menendez
- National Institute of Environmental Health Sciences (NIEHS), Raleigh, NC, USA
| | - Wes Gladwell
- National Institute of Environmental Health Sciences (NIEHS), Raleigh, NC, USA
| | | | - Luis Velozo
- Universidad Nacional de Chile, Santiago, Chile
| | | | - Eduardo Bergel
- Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
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