Nasal Mucosal Immunity is Associated with Protection against RSV Illness in Infants

Abstract

BackgroundDespite advances in respiratory syncytial virus (RSV) immunoprophylaxis, RSV remains a leading cause of severe respiratory illness in infants. Immunity at the site of infection is potentially important yet airway mucosal immunity against RSV infection remains poorly defined.

MethodsWe collected nasal and blood samples across three pediatric cohorts: 1) children presenting to the emergency department with respiratory symptoms; 2) infants and mothers presenting to an urban hospital system across the RSV season; 3) infants born to mothers vaccinated with maternal pre-Fusion (F) vaccine. We analyzed mucosal and serologic anti-RSV antibodies and assessed for factors impacting titer magnitude and durability.

ResultsSpecimens from 285 infants/young children and 39 mothers were analyzed. Mucosal anti-RSV antibody levels were lower in infants presenting with RSV infection compared to age-matched controls both in infants experiencing their first viral season (p = 0.0011) and older children (p < 0.0001). Higher levels of mucosal antibodies were seen in infants whose mothers received maternal pre-F vaccination, with IgG against RSV fusion protein tightly correlating between infants serum and nasal compartments (p < 0.0001). However, mucosal anti-RSV IgG waned significantly by 6 months of age (p < 0.0001).

ConclusionsHigher mucosal anti-RSV antibody levels are associated with protection against RSV-related illness. Current immunoprophylactic strategies drive robust anti-RSV IgG responses in the infant mucosal and serological compartments; however, passive immunity wanes over 6 months. These results suggest that RSV immunization strategies optimizing durable mucosal immunity may protect infants from RSV-related respiratory illness.

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BibTeX RIS

BibTeX

@misc{taliaferro2026nasal,
  title = {{Nasal Mucosal Immunity is Associated with Protection against RSV Illness in Infants}},
  author = {F. Taliaferro and Y. Tang and S. Monares Ortiz and O. Jasset and C. Bald and A. Araten and C. Fairbourn and W. I. Gonzalez and P. Moschovis and K. E. Stephenson and A. G. Edlow and B. H. Horwitz and L. M. Yonker},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.22.26366243},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366243v1},
  note = {CC BY-NC-ND},
}

RIS

TY  - UNPB
TI  - Nasal Mucosal Immunity is Associated with Protection against RSV Illness in Infants
AU  - F. Taliaferro
AU  - Y. Tang
AU  - S. Monares Ortiz
AU  - O. Jasset
AU  - C. Bald
AU  - A. Araten
AU  - C. Fairbourn
AU  - W. I. Gonzalez
AU  - P. Moschovis
AU  - K. E. Stephenson
AU  - A. G. Edlow
AU  - B. H. Horwitz
AU  - L. M. Yonker
PY  - 2026
DA  - 2026/10/22
PB  - medRxiv
DO  - 10.64898/2026.10.22.26366243
UR  - https://www.medrxiv.org/content/10.64898/2026.10.22.26366243v1
AB  - BackgroundDespite advances in respiratory syncytial virus (RSV) immunoprophylaxis, RSV remains a leading cause of severe respiratory illness in infants. Immunity at the site of infection is potentially important yet airway mucosal immunity against RSV infection remains poorly defined.  MethodsWe collected nasal and blood samples across three pediatric cohorts: 1) children presenting to the emergency department with respiratory symptoms; 2) infants and mothers presenting to an urban hospital system across the RSV season; 3) infants born to mothers vaccinated with maternal pre-Fusion (F) vaccine. We analyzed mucosal and serologic anti-RSV antibodies and assessed for factors impacting titer magnitude and durability.  ResultsSpecimens from 285 infants/young children and 39 mothers were analyzed. Mucosal anti-RSV antibody levels were lower in infants presenting with RSV infection compared to age-matched controls both in infants experiencing their first viral season (p = 0.0011) and older children (p < 0.0001). Higher levels of mucosal antibodies were seen in infants whose mothers received maternal pre-F vaccination, with IgG against RSV fusion protein tightly correlating between infants serum and nasal compartments (p < 0.0001). However, mucosal anti-RSV IgG waned significantly by 6 months of age (p < 0.0001).  ConclusionsHigher mucosal anti-RSV antibody levels are associated with protection against RSV-related illness. Current immunoprophylactic strategies drive robust anti-RSV IgG responses in the infant mucosal and serological compartments; however, passive immunity wanes over 6 months. These results suggest that RSV immunization strategies optimizing durable mucosal immunity may protect infants from RSV-related respiratory illness.
ER  -

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