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Appendix N
PROSPECTS FOR IMMUNIZING AGAINST RESPIRATORY SYNCYTIAL VIRUS

Disease Description

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract illness in infants and young children. It is the pathogen most often associated with bronchiolitis and pneumonia, and also causes bronchitis and croup. RSV produces sizable epidemics every two years in large urban centers, resulting in increased hospitalizations and some fatalities (Chanock et al., 1982). The severity of the disease appears to decrease with age and asymptomatic infections can occur.

Pathogen Description

RSV is a lipoprotein-enveloped RNA virus of medium size (120–200 nm). The outer envelope contains glycoprotein. The virus is heat labile, which complicates its isolation and study. RSV is considered by most to be a single serotype, but the evidence for this is not conclusive. Early studies described aberrant strains that were poorly neutralized by post-infectious ferret sera (Coates et al., 1966). Although human convalescent sera did not distinguish these differences, the frequency of such aberrant strains and their contribution to the problem of reinfection has never been entirely explained.

Recent studies of the proteins of RSV have produced new information on the surface structure of the virus and on the antigens that may be important for vaccine development. There are two surface glycoproteins. Neither of them has hemagglutinating or neuraminidase activity; however, one of them is probably responsible for fusion of the viral membrane to infected cells and for fusion of an infected cell to neighboring cells (Walsh and Hruska, 1983). This protein, in an unreduced state, has a molecular weight of 66,000–68,000 (Bernstein and Hruska, 1981).

The advice and assistance of W.P.Glezen in the preparation of this appendix is gratefully acknowledged. The committee assumes full responsibility for any judgments or assumptions.



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