Dr Hannah Moore, Dr Mejbah Bhuiyan and Professor Peter Richmond
Despite respiratory syncytial virus (RSV) being the leading cause of hospitalisations in the first year of life, there is currently no routine preventative option for otherwise healthy babies. Telethon Kids Institute researchers are working to change that.
A serious respiratory infection, RSV is a leading cause of morbidity and mortality in children globally, causing 3.2 million hospitalisations every year – including 1,000 Western Australian children. Treatment often sees babies hooked up to oxygen and feeding tubes, meaning that for families of hospitalised babies, RSV can be terrifying.
“With no drug to treat the virus, the need for prevention therapies including vaccines is urgent. The World Health Organization agrees, recognising the development of an RSV vaccine as a global priority.”
Telethon Kids researchers have responded to the call, with four clinical trials targeting RSV under way at the Institute, including one which is on track to create the first comprehensive model of the burden of RSV strains. Others under way include two phase three trials testing maternal vaccines – where mums receive the vaccine rather than the baby – and a phase three trial of an RSV antibody treatment in babies.
Professor Peter Richmond, Head of the Vaccine Trials Group at the Wesfarmers Centre of Vaccines and Infectious Diseases, said the studies followed two successful international trials involving Telethon Kids researchers – published in the New England Journal in 2020 – that provided the proof of principle for these approaches.
“By having the vaccine during pregnancy, mums are protected from RSV and those antibodies are passed to their babies in utero, protecting the baby for their first few months while those antibodies persist and while babies are most at risk for severe RSV infection,” Professor Richmond said.
In parallel with global clinical trials, the Wesfarmers Centre is improving our understanding of RSV and its impact through epidemiological studies, modelling and genomic identification.
“To help design the right prevention program for RSV, we need to have better information about the true infection rate in young babies and in particular, those at highest risk, such as those born pre-term, as well as the long-term impacts of RSV infection,” said Dr Hannah Moore, who is Co-Head of the Infectious Diseases Epidemiology team.
“We are well on the way to be able to predict the likely impact of future prevention measures using dynamic transmission models which will enable us to advise on the best future vaccine policy.”
Dr Moore’s study is part of a broader research picture that is providing contemporary data on the preventable RSV burden in at-risk groups, understanding the changes over time with genetic variations of RSV strains in Australia, and examining long-term impacts of RSV infection.
“The nett result of all this work will be to provide information that will be critical to inform and implement effective prevention policy for Australia and importantly, is relevant for children and their families in WA,” Professor Richmond said.
2020 Saw RSV Rates Rollercoaster – Scientists are still working out why
Winter typically brings a surge in respiratory viral infections, but the 2020 Australian winter was very different. Public health measures in place to control the spread of COVID-19 saw a major shift in the typical seasonal pattern of other respiratory viruses.
Following an abnormal winter that saw a significant drop in rates of RSV (98 per cent fewer winter cases in Western Australian children than a typical season), the 2020 summer saw unexpectedly large numbers of children presenting to paediatric hospitals around Australia. In all, hospitals experienced a more than 600 per cent increase in admissions for respiratory infections – mainly from RSV.
“The speed and magnitude of this increase was greater than the usual winter peak of RSV. Weekly detections in December 2020 were 2.5 times higher than the normal winter weekly peak,” Dr Hannah Moore said.
Studies seeking to understand exactly why we’ve seen such a significant rise in RSV cases are ongoing and involve Telethon Kids researchers, national and international collaborators.
“Further research will help us learn potential ways to reduce the spread of infection when it is circulating in the community and minimise the number of kids experiencing severe, life-threatening illnesses,” Dr Moore said.
“Anomalies in infectious disease behaviour like the recent summer surge show how unpredictable transmission dynamics can be and how important robust data are.”
Baby George joins the RSV fight
With a toddler at day care, a newborn at home and an RSV season around the corner, enrolling in a Telethon Kids RSV study was a no brainer for Perth Mum Jessica Fitzpatrick.
Having already taken part in Telethon Kids research with her older child, Austin, Jessica was keen to contribute further.
“When I was pregnant with Austin, I was part of a Telethon Kids study that tested whether vaccinated women pass on their antibodies. That meant I was protected in pregnancy and Austin was protected over his first winter,” Jessica said.
Her second baby, George, is now helping researchers find answers to RSV.
“Our friends’ son was hospitalised twice with RSV when he was a baby so we know the effect it can have – we’ll do what we can to protect George from that,” Jessica said.
As someone who works in a medical field, I understand the benefits of early vaccination. It’s a win-win situation – we’re protecting George and playing a part in helping other newborn babies avoid serious illnesses in the future
The study George is enrolled in will determine whether a monoclonal antibody treatment specific for RSV, given as a single injection, will protect babies for five months over the winter season. Already shown to protect preterm babies, it is now being evaluated in babies born at term.