Immunogenicity of purified F glycoprotein of respiratory syncytial virus: clinical and immune responses to subsequent natural infection in children.

Purified F glycoprotein from respiratory syncytial virus (RSV, subgroup A antigenic type) was evaluated in 18- to 36-month-old children as a vaccine. Children had been previously infected with RSV during natural outbreaks of the virus. Single injections of 5, 20, or 50 micrograms of protein resulted in greater than eightfold increases in ELISA and neutralizing antibodies. Second doses of vaccine did not result in further boosts in antibody. Neutralizing antibodies increased not only to the A2 and Long strains (subgroup A strains) but also to strain 18537 (subgroup B). Four of 11 vaccinees became naturally infected during the subsequent RSV outbreak, suggesting that the vaccine was not effective in preventing recurrent RSV infections. Severe illnesses did not occur, indicating that there was not an increase of severity of infection following vaccine in seropositive children. Only 1 of 8 vaccinees tested had fourfold increases in nasal wash IgA to RSV after immunization. Vaccine strategies to stimulate secretory antibodies as well as circulating neutralizing antibodies to RSV need to be developed.