Respiratory syncytial virus, or RSV, is one of the most common and deadly respiratory illnesses. It typically affects the most vulnerable people – the very young and the very old. Due to few treatment options, many patients get severely ill and require hospitalization. Now, for the first time ever, we have multiple options for prevention; a monoclonal antibody treatment has been approved for infants, and vaccines are available for adults 60 and older and for pregnant women.
Dr. Michael Colli, Chief Medical Officer and Pediatrician at Keystone Health, explains these new prevention options and who are good candidates for them, in today’s article.
What is RSV?
RSV causes severe illnesses of the respiratory tract in people of all ages. For most healthy older children and younger adults, it causes a mild upper respiratory infection with symptoms including runny nose, congestion, sore throat and mild cough. However, in young children and older adults, it can cause more severe symptoms of the lower respiratory tract, including wheezing, shortness of breath, pneumonia and severe cough. The virus tends to follow a seasonal pattern, with most cases occurring in the winter months.
Who is at risk?
The virus is extremely contagious, so anyone can contract it. By the age of 2, almost all children have been exposed and infected. Unfortunately, contracting RSV does not prevent future infections, but future infections do tend to be less severe. The most vulnerable are infants, the elderly, and those with certain risk factors like prematurity or chronic lung conditions. Approximately 18 out of every 1,000 healthy, full-term infants are hospitalized with RSV during their first year of life. For premature infants, the hospitalization rate in the first year of life increases to 64 out of every 1,000. We know the risk to the elderly is high also. 60,000 to 160,000 elderly Americans are hospitalized each year with RSV and nearly 10,000 die.
What is a monoclonal antibody treatment?
A monoclonal antibody (MAB) is a medication and not a vaccine. With vaccines, a killed or inactive version of a virus or bacteria is given to the patient, tricking their immune system to respond against it. With MAB, the immunity cells against the virus or bacteria are manufactured in a lab and then administered to the patient. The host’s immune system is not activated at all with MAB; all the immunity is given from the MAB itself. Because they bypass the recipient’s immune system, MABs tend to have less side effects and are extremely well-tolerated. The immunity they give is anticipated to last five months, which should get the recipient through peak RSV season.
Who should receive the MAB treatment?
All children under 8 months should receive the RSV MAB during the winter season, which the CDC defines as October 1 through March 31. High-risk children ages 8-19 months with pre-defined medical conditions should also receive the RSV MAB. For infants it prevents about 80% of all hospitalizations associated with RSV and about 90% of ICU admissions. It has very few side effects and is extremely safe and effective.
Who is a good candidate for the 60 and older vaccine?
This winter there are now two RSV vaccines for individuals 60 and older – Abrysvo and Arvexy. If you’re in this age group, talk to your medical team so you can decide together if vaccination is right for you. Vulnerable older individuals such as those with asthma, COPD or congestive heart failure are at high risk for severe complications and are strongly advised to receive an RSV vaccine. It is nearly 80% effective against preventing severe disease and was generally well-tolerated. The most common side effects were pain at the injection site, fatigue and headache.
What are the recommendations for RSV vaccination during pregnancy?
On September 22, the vaccine sub-committee of the CDC met and recommended approval of one of the adult RSV vaccines, Abrysvo, to be administered to pregnant women 32-36 weeks gestation. Interestingly, the vaccine is recommended to be given to protect their young infant after birth, not necessarily to protect the pregnant woman herself. Babies born to women who received the vaccine would not necessarily need to receive the monoclonal antibody discussed above, because the maternal antibodies that they received when mom was vaccinated would keep them protected throughout early infancy. This is hot off the press and may evolve once the CDC publishes their final recommendations.
These vaccines and MAB are extremely effective and safe and will be available in our area in the coming weeks. Thankfully, they will help us see fewer cases of severe infection this winter. Speak with your healthcare provider about whether these options are right for you or your child.
This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.