Respiratory syncytial virus (RSV) is an enveloped, non-segmented, negative-sense RNA virus with a spherical or filamentous shape and a helical ribonucleoprotein core[1]. RSV genome is approximately 15.2 kb in length. RSV contains 10 genes encoding 11 proteins, including three structural proteins fusion protein (F), attachment glycoprotein (G), small hydrophobic protein (SH), as well as six nucleocapsid-associated proteins: nucleoprotein (N), phosphoprotein (P), large polymerase protein (L), matrix protein (M), matrix protein 2-1 (M2-1) and M2-2, and two non-structural proteins (NS), NS1 and NS2[2, 3]. RSV is classified into two major subgroups, RSV A and RSV B, initially based on antigenic differences using G protein-specific many monoclonal antibodies[4]. Within each of these two subgroups, several genotypes have been further identified and described. Although there are no criteria for genotype definitions that reach consensus, 15 distinct genotypes have been described for RSV B[5] and nine distinct genotypes for RSV A[6, 7].
RSV typically demonstrates a clear seasonality of circulation in most regions of the world, with more than three-quarters of annual cases occurring within a five-month period of the year. In China, RSV circulation usually occurs from November to March of the following year in most provinces. Provinces located on or near the Tropic of Cancer (such as Fujian, Guangdong, Yunnan, and Hunan) have more extensive RSV circulating duration and less clear RSV seasonality[8].
RSV has a broad range of pathological impacts that extend beyond the respiratory system, potentially affecting multiple organs and leading to various complications[3]. Respiratory complications may include respiratory failure, atelectasis, pulmonary consolidation, and acute respiratory distress syndrome. Additionally, RSV can affect the cardiovascular system, causing myocardial damage and heart failure, among other severe conditions. Some cases may also present with rashes, conjunctivitis, and immunocompromising conditions[9]. Although RSV can infect individuals of all ages, its disease burden is most significant among the very young and the elderly, with infants and adults aged 75 years or older having the highest hospitalization and mortality rates[10].
Treatment options for RSV are largely supportive. To date, three RSV vaccines have been approved for active immunization among individuals aged 60 years and older. For children who are ineligible for these vaccines, passive immunization is recommended[3, 11, 12].
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[8] GUO L, DENG S, SUN S, et al. Respiratory syncytial virus seasonality, transmission zones, and implications for seasonal prevention strategy in China: a systematic analysis [J]. Lancet Glob Health, 2024, 12(6): e1005-e16.
[9] KALER J, HUSSAIN A, PATEL K, et al. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation [J]. Cureus, 2023, 15(3): e36342.
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[11] PIñANA M, GONZáLEZ-SáNCHEZ A, ANDRéS C, et al. Genomic evolution of human respiratory syncytial virus during a decade (2013-2023): bridging the path to monoclonal antibody surveillance [J]. J Infect, 2024, 88(5): 106153.
[12] RALSTON S L, LIEBERTHAL A S, MEISSNER H C, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis [J]. Pediatrics, 2014, 134(5): e1474-502.