RSV prophylactics for pediatric populations: A product review and meta-analysis of real-world effectiveness

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection and hospitalization in infants and young children worldwide. Clinical management in infants remains primarily supportive, and natural infection provides incomplete and transient immunity. For decades, prophylaxis was limited to monthly palivizumab for selected high-risk infants. Recent advances in prefusion F structural biology, antibody engineering, and maternal immunization have transformed RSV prevention. This review summarizes the biologic and clinical rationale for preventing RSV disease in pediatric populations, with emphasis on currently licensed long-acting monoclonal antibodies and maternal RSVpreF vaccination. We integrate a meta-analysis of real-world effectiveness data and discuss implementation of these novel immunoprophylactic strategies in clinical practice. Across 43 observational studies, pooled effectiveness against RSV-associated hospitalization was 80.9% for nirsevimab and 79.1% for maternal RSVpreF vaccination, demonstrating substantial real-world protection during early infancy. Success now depends on optimizing implementation and achieving equitable access.