Systematic review of the mutations in the active antigenic site Ø of the prefusion F protein of the Respiratory Syncytial Virus (RSV) following the implementation of monoclonal antibody prophylaxis.
VaccineAug 22, 2026 (epub)
Maria M Berikopoulou, Elizabeth-Barbara Tatsi, Tania Siahanidou et al.
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In 30 seconds
This systematic review analyzed mutations in the antigenic site Ø of the RSV prefusion F protein following the introduction of the monoclonal antibody nirsevimab in children with confirmed RSV infections. Among 2156 samples, resistance-associated variants were found in 1.3%, primarily in RSV-B strains, with a significant difference in frequency between RSV-B and RSV-A (9.8% vs 0.5%; p < 0.001).
Key findings
- Resistance-associated variants were detected in 1.3% of RSV-positive samples, exclusively in nirsevimab breakthrough infections.
- In nirsevimab-treated individuals, resistance variants were significantly more frequent in RSV-B than RSV-A (9.8% vs 0.5%; p < 0.001).
- Most substitutions in RSV-A showed limited variability, with K65R being the most common.
- RSV-B strains exhibited higher substitution frequencies, particularly I206M, Q209R, and S211N.
Why it matters
Understanding the mutations in RSV strains following monoclonal antibody prophylaxis is crucial for monitoring treatment efficacy and guiding future therapeutic strategies. Continuous surveillance can help identify emerging resistance patterns.