RESPIRATORY-SYNCYTIAL-VIRUS INFECTIONS, RE-INFECTIONS AND IMMUNITY - PROSPECTIVE, LONGITUDINAL-STUDY IN YOUNG-CHILDREN

To better understand acquired immunity to respiratory-syncytial-virus infections, we analyzed data from a 10-year study of respiratory illness in normal children who were followed longitudinally from early infancy. Immunity was measured in terms of failure to become infected or reduction in severity of clinical illness upon reinfection. Outbreaks of infections occurred seven times over the 10-year period. During epidemics the attack rate for first infection was 98 per cent. The rate for second infections (75 per cent) was modestly reduced (P<0.001); that for third infections was 65 per cent. Age and history of infection both influenced illness. Immunity induced by a single infection had no demonstrable effect on illness associated with reinfection one year later; however, a considerable reduction in severity occurred with the third infection. These observations suggest that amelioration of illness — rather than prevention of infection — may be a realistic goal for immunoprophylaxis. (N Engl J Med 300:530–534, 1979) THE susceptibility of the human host to repeated infections with respiratory syncytial virus was recognized soon after the agent was identified as an important cause of acute respiratory disease. In early studies Kravetz and Johnson showed that adults with pre-existing serum neutralizing antibody could be infected in experimental and natural settings,1 2 3 and Beem reported identifying repeated infection in children by isolation of the virus.4 Serologic surveys in communities have demonstrated infections in persons of all ages during epidemics and have allowed approximation of age-related attack rates.5,6 Age-specific infection rates for members of infected families have been derived but not correlated. © 1979, Massachusetts Medical Society. All rights reserved.