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Respiratory syncytial virus in Indonesian children.

G respiratory syncytial virus (RSV) is estimated to cause between 66,000 and 199,000 deaths among young children every year. Several factors, including a better understanding of RSV disease burden, improvements and vaccine technology and the remarkable success of vaccines such as rotavirus vaccines, have led to a renaissance in interest in RSV vaccine development. Currently, there are more than a dozen RSV vaccine candidates in preclinical or early clinical development. One of the critical questions about RSV vaccines is whether they can be effective early enough in life to prevent the most severe disease. Studies in industrialized as well as developing nations suggest that the highest incidence of hospitalization for RSV is in the first 6 months of life, and in particular, during the second and third month of life. Developing vaccines to induce active immunity at such a young age would be challenging. The study by Simões et al in September’s Pediatric Infectious Disease Journal presents an intriguing finding from a study conducted in Indonesia a decade earlier—that fewer than 5% of cases of RSV lower respiratory infection among periurban and semirural Sundanese infants occur in the first 6 months of life. If true, and if this pattern occurs in other developing world settings, this opens the possibility that an RSV vaccine that does not become effective until age 6 months could prevent the bulk of serious RSV-related disease in those settings. Given this remarkable finding and implications for RSV vaccination, some additional clarification would help readers to better evaluate the study: