Terstappen J
Hak SF
Bhan A
Bogaert D
Bont LJ
Buchholz UJ
Clark AD
Cohen C
Dagan R
Feikin DR
Graham BS
Gupta A
Haldar P
Jalang'o R
Karron RA
Kragten L
Li Y
Lowensteyn YN
Munywoki PK
Njogu R
Osterhaus A
Pollard AJ
Nazario LR
Sande C
Satav AR
Srikantiah P
Stein RT
Thacker N
Thomas R
Bayona MT
Mazur NI
Lancet Infect Dis. 2024;24e747-e761
Respiratory syncytial virus (RSV) is the second most common pathogen causing infant mortality. Additionally, RSV is a major cause of morbidity and mortality in older adults (age >/=60 years) similar to influenza. A protein-based maternal vaccine and monoclonal antibody (mAb) are now market-approved to protect infants, while an mRNA and two protein-based vaccines are approved for older adults. First-year experience protecting infants with nirsevimab in high-income countries shows a major public health benefit. It is expected that the RSV vaccine landscape will continue to develop in the coming years to protect all people globally. The vaccine and mAb landscape remain active with 30 candidates in clinical development using four approaches: protein-based, live-attenuated and chimeric vector, mRNA, and mAbs. Candidates in late-phase trials aim to protect young infants using mAbs, older infants and toddlers with live-attenuated vaccines, and children and adults using protein-based and mRNA vaccines. This Review provides an overview of RSV vaccines highlighting different target populations, antigens, and trial results. As RSV vaccines have not yet reached low-income and middle-income countries, we outline urgent next steps to minimise the vaccine delay.
