Now is the winter of our discontent

Or at least of the usual influx of respiratory syncytial virus positive infants needing ventilation or worse into our pitifully inadequate numbers of paediatric intensive care beds. Understanding the pathophysiology of the disease is a high priority; efforts to find a vaccine have failed, pharmacotherapy is non-existent and prevention with Palivizumab is so expensive and inconvenient that it will never be offered to low-risk babies, who form the bulk of the numbers of patients. Two manuscripts in this issue of Thorax address novel mechanisms of disease. McNamara et al showed that BAFF (B cell activating factor of the tumour necrosis factor family) was increased in bronchoalveolar lavage in severe RSV disease, and was produced in vitro by epithelial cells via an interferon-β dependent pathway (see page 76). Appropriately enough for a winter disease, APRIL was nowhere to be found. In a second manuscript, Triantafilou et al demonstrated that the creation …