Respiratory Syncytial Virus Pneumonia Among Nigerian Children: Is it Time to Advocate for Routine RSV Vaccine Inclusion into the National Programme on Immunisation?

Abstract

Respiratory syncytial virus (RSV) is a leading contributor to severe and very severe pneumonia in African children, ahead of Streptococcus pneumoniae and Haemophilus influenzae type b, which are now largely preventable by virtue of routine immunisation. Studies in Nigeria have suggested that RSV transmission is consistently linked to the rainy season rather than the temperature-driven winter seasonality of temperate countries. RSV is transmitted through respiratory droplets and contact with contaminated secretions or surfaces. The infection progresses from the upper airway to the lower respiratory tract, where inflammatory changes lead to bronchiolitis and pneumonia, with airway obstruction and air-trapping. The clinical pattern of RSV pneumonia in Nigerian children ranges from mild upper respiratory illness to severe bronchiolitis and pneumonia requiring hospitalisation, with infants under six months at greatest risk of severe disease and death. While clinical management is basically pivoted on supportive care with adequate hydration, oxygen therapy and non-invasive respiratory supports, Palivizumab, an RSV-specific monoclonal antibody, may offer a more specific prevention of RSV infections. This agent is administered intramuscularly to infants and young children at risk of RSV. It is recommended for monthly intramuscular administration during the RSV season. This agent has consistently demonstrated significant efficacy and safety in the prevention of severe RSV. Vaccination of the mother to achieve transplacental transfer of antibodies is also achievable but may be costly for a developing economy. The existing clinico-economic gaps in the prospects of RSV can be closed through collaborations between major international and local stakeholders. Ultimately, there is a need for focused investment in RSV surveillance before, during and after implementation of any intervention for the purpose of effective advocacy, monitoring of efficacy and safety.