{
  "abstract": "Background The long-acting monoclonal antibody nirsevimab and respiratory syncytial virus (RSV) vaccines became available for prevention of severe RSV-associated disease in 2023. While clinical trials showed good efficacy and safety, their restrictive inclusion criteria, small sample sizes and short follow-up limit generalisability. We aimed to summarise real-world evidence on the effectiveness and safety of nirsevimab, RSV maternal vaccine and RSV vaccines for older adults.Methods A living systematic review and meta-analysis, with 5 monthly updated searches in three databases was performed. Eligible studies were published from 1 December 2022 to 10 March 2025. Meta-analyses for the effectiveness of nirsevimab and RSV vaccines were carried out using random-effects model. Safety data were summarised narratively.Results A total of 50 publications, covering approximately 7.6 million people, were included. Nirsevimab showed 80.7% effectiveness (95% CI: 75.7% to 85.7%; seven studies) against RSV-related emergency department visits, 80.7% (95% CI: 76.1% to 85.2%; 17 studies) against hospital admissions and 75.6% (95% CI: 63.3% to 87.9%; eight studies) against intensive care unit admissions. The effectiveness of RSV vaccines for older adults against RSV-related hospital admissions was 79.6% (95% CI: 73.8% to 85.3; three studies). No effectiveness data were available for RSV maternal vaccine. No severe adverse events were reported for nirsevimab, while RSV vaccines in older adults had fewer than 10 Guillain-Barré syndrome cases per million doses. No severe adverse events were reported for RSV maternal vaccine, although evidence was limited.Conclusions Our review demonstrated high effectiveness of nirsevimab in reducing RSV-related healthcare utilisation in infants and a favourable safety profile. More evidence is needed for evaluating RSV vaccines in pregnant people and older adults.PROSPERO registration number CRD42025643585.",
  "authors": [
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Bohee Lee"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Daira Trusinska"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Sohail Ferdous"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Ruonan Pei"
    },
    {
      "affiliations": [
        "School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Harley H Y Kwok"
    },
    {
      "affiliations": [
        "Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Jürgen Schwarze"
    },
    {
      "affiliations": [
        "Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Thomas Christie Williams"
    },
    {
      "affiliations": [
        "Vaccination and Immunisation Division, Clinical and Protecting Health Directorate, Public Health Scotland, Edinburgh, UK"
      ],
      "name": "Cheryl Gibbons"
    },
    {
      "affiliations": [
        "School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Jennifer K Quint"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK",
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Aziz Sheikh"
    },
    {
      "affiliations": [
        "Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK",
        "NIHR Oxford Biomedical Research Centre, Oxford, UK"
      ],
      "name": "Simon B Drysdale"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Ting Shi"
    }
  ],
  "title": "Real-world effectiveness and safety of nirsevimab, RSV maternal vaccine and RSV vaccines for older adults: a living systematic review and meta-analysis",
  "uid": "35e91429-a73f-5120-8815-ac8e2dab267f"
}