An obstacle to developing a vaccine against human respiratory syncytial virus (RSV) is that natural infection typically does not confer solid immunity to reinfection. To investigate methods to augment the immune response, recombinant RSV (rRSV) was constructed that expresses murine granulocyte-macrophage colonystimulating factor (mGM-CSF) from a transcription cassette inserted into the G-F intergenic region. Replication of rRSV/mGM-CSF in the upper and lower respiratory tracts of BALB/c mice was reduced 23-to 74-and 5-to 588-fold, respectively, compared to that of the parental rRSV. Despite this strong attenuation of replication, the level of RSV-specific serum antibodies induced by rRSV/mGM-CSF was comparable to, or marginally higher than, that of the parental rRSV. The induction of RSV-specific CD8 ؉ cytotoxic T cells was moderately reduced during the initial infection, which might be a consequence of reduced antigen expression. Respiratory syncytial virus (RSV) is the most important viral etiologic agent of serious pediatric respiratory tract disease worldwide. RSV also is receiving increasing recognition as an important cause of respiratory tract disease in the elderly; in immunocompromised patients, such as bone marrow transplant recipients; and in the general population (reviewed in reference 16). Reinfection by RSV is common, although disease is less severe. A licensed RSV vaccine is not available, but passive immunoprophylaxis with RSV-neutralizing antibody is now available for high-risk infants (2).RSV is a nonsegmented negative-strand RNA virus of the family Paramyxoviridae. RSV encodes 11 proteins (reviewed in references 8, 15, and 16), namely, three transmembrane surface proteins (G, F, and SH); the virion matrix protein M; the nucleocapsid and polymerase proteins N, P, M2-1, and L; the putative transcription-replication regulatory factor M2-2; and two nonstructural proteins, NS1 and NS2, that have been implicated as antagonists of the type I interferon antiviral state (31). While many components of the innate and adaptive immune systems contribute to restricting and resolving an RSV infection, the increased resistance to reinfection that is conferred by prior infection appears to be mediated primarily by RSV-specific secretory and serum antibodies (16,17,27). The F and G glycoproteins are the major RSV neutralization antigens (17).In the 1960s, a formalin-inactivated RSV vaccine evaluated in infants and children was not protective and, paradoxically, was associated with increased frequency and severity of disease during subsequent natural RSV infection (26). It is now understood that the initial vaccination primed for an immunemediated pathogenic response that occurred upon reexposure to viral antigen during the subsequent natural infection, although the details of this phenomenon have not been completely elucidated. One element appears to involve the disproportionate induction of the Th2 subset of CD4 ϩ T helper lymphocytes, characterized by increased secretion of interleukin 4 (IL-4) and . Subunit...