title: Evaluating vaccination strategies for reducing infant respiratory syncytial virus infection in low-income settings.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease and related hospitalization of young children in least developed countries. Individuals are repeatedly infected, but it is the first exposure, often in early infancy, that results in the vast majority of severe RSV disease. Unfortunately, due to immunological immaturity, infants are a problematic RSV vaccine target. Several trials are ongoing to identify a suitable candidate vaccine and target group, but no immunization program is yet in place.
  
  
  METHODS
  In this work, an individual-based model that explicitly accounts for the socio-demographic population structure is developed to investigate RSV transmission patterns in a rural setting of Kenya and to evaluate the potential effectiveness of alternative population targets in reducing RSV infant infection.
  
  
  RESULTS
  We find that household transmission is responsible for 39% of infant infections and that school-age children are the main source of infection within the household, causing around 55% of cases. Moreover, assuming a vaccine-induced protection equivalent to that of natural infection, our results show that annual vaccination of students is the only alternative strategy to routine immunization of infants able to trigger a relevant and persistent reduction of infant infection (on average, of 35.6% versus 41.5% in 10 years of vaccination). Interestingly, if vaccination of pregnant women boosts maternal antibody protection in infants by an additional 4 months, RSV infant infection will be reduced by 31.5%.
  
  
  CONCLUSIONS
  These preliminary evaluations support the efforts to develop vaccines and related strategies that go beyond targeting vaccines to those at highest risk of severe disease.
authors: Piero
authors: P
authors: Poletti
authors: Stefano
authors: S
authors: Merler
authors: Marco
authors: M
authors: Ajelli
authors: Piero
authors: P
authors: Manfredi
authors: Patrick K
authors: PK
authors: Munywoki
authors: D
authors: D
authors: Nokes
authors: Alessia
authors: A
authors: Melegaro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011203:Poverty; D011247:Pregnancy; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D022261:Respiratory Syncytial Virus Vaccines / Q000008:administration & dosage*; D012424:Rural Population
chemical_list: D022261:Respiratory Syncytial Virus Vaccines