RSV
Respiratory syncytial virus
Cold, flu, and RSV season is here!
Respiratory infections are spreading in our schools and communities. COVID-19 is still with us. Respiratory syncytial virus (RSV) infections are on the rise. And we're just now entering flu season.
As these viruses spread, families and providers need to prepare.
​
Last year's cold and flu season was especially dangerous for vulnerable babies and families as we saw an unprecedented tripledemic of flu, COVID, and RSV. This year we have some promising new tools and interventions, including new vaccines for adults and new protective injections for infants.
​
What's different this season?
After a busy RSV season last year, new strategies are available now to help prevent RSV infection in infants.
The FDA has approved a new RSV monoclonal antibody, nirsevimab, brand name Beyfortus™, which can provide protection from RSV infection or reduction in severity of RSV infection.
-
See the FDA's full prescribing information.
-
See Nirsevimab Frequently Asked Questions from the American Academy of Pediatrics (AAP)
The CDC has recommended this vaccine for all infants less than 8 months of age during their first RSV season. It also recommends this vaccine for infants up to 24 months with certain medical conditions including chronic lung and cardiac disease as well as immunodeficiency.
See RSV Vaccination: What Parents Should Know
Nirsevimab, similar to Synagis™, does not trigger the infant’s immune system like a typical vaccine. Rather, it is an injection of lab-made antibodies that provides passive immunity by targeting a protein which allows the respiratory syncytial virus (RSV) to infect cells.
​
-
Learn more about active immunity and passive immunity.
​
While Synagis™ lasts only 28 days, requiring monthly vaccination for optimum protection, nirsevimab lasts up to 5 months meaning infants should require only one dose if given during the RSV season.
​
​
​
From the AAP: Children who receive nirsevimab should not get palivizumab. However, if your child did not get all doses of palivizumab, they may be eligible for nirsevimab. Children who received palivizumab in their first season can get nirsevimab in their second season if they are eligible.
NEW If you're pregnant.
2023 -2024 is an exciting year! This is the first respiratory virus season where we have vaccines to protect babies from all three major respiratory viruses – COVID-19, RSV, and flu.
​
Pfizer’s new bivalent RSVpreF vaccine (Abrysvo™) is the first respiratory syncytial virus (RSV) vaccine for pregnant people that protects both them and their newborn from severe RSV illness.
​
The CDC recommends seasonal administration of one dose of RSV vaccine for pregnant people during weeks 32 through 36 of pregnancy.
See Frequently Asked Questions About RSVpreF (Abrysvo) Vaccine for Pregnant People
​
“This is another new tool we can use this fall and winter to help protect lives,” said CDC Director Dr. Mandy Cohen. “I encourage parents to talk to their doctors about how to protect their little ones against serious RSV illness, using either a vaccine given during pregnancy, or an RSV immunization given to your baby after birth.”
​
To prevent RSV-associated lower respiratory tract infections (LRTIs) in infants, the CDC recommends either:
-
administering RSVpreF (Abrysvo™) vaccine during pregnancy
or
-
administering RSV monoclonal antibody, nirsevimab (Beyfortus™) to the infant after birth
​
NOTE: Most infants will not need protection from both products.
RSVpreF (Abrysvo™) should be administered during weeks 32 through 36 of pregnancy (i.e., 32 weeks 0 days through 36 weeks 6 days). In most of the continental United States, the vaccine should be administered from September through January.
​
​
In order to empower patients and promote shared decision-making, pregnant people and their providers should talk about the benefits of vaccination during pregnancy and the decision whether to get vaccinated now to provide immunity to their newborn or to give their baby protective antibody shots after they're born.
Things Pregnant People May Want to Consider:
​
-
The RSV vaccine gives your baby protection right after birth.
-
If you get the RSV vaccine, there is one less injection for your baby to get after birth.
-
Nirsevimab may provide your baby with longer-lasting protection.
-
It may be hard to get nirsevimab this fall and winter. Your ob-gyn may be able to help you find out if nirsevimab will be available for your baby after birth.
In October the Centers for Disease Control and Prevention (CDC) is issued this Health Alert Network (HAN) Health Advisory to provide options for clinicians to protect infants from respiratory syncytial virus (RSV) in the context of a limited supply of nirsevimab.
RSV is a Troublemaker!
WATCH: General pediatrician Lynn Smitherman, MD, explains how the burden of RSV weighs heavily on babies, children and their families.
Recognizing RSV.
Respiratory Syncytial Virus (RSV) is one version of the common cold.
For most healthy children and adults it will cause a slight cough, watery nasal congestion, and mild fever. But for many infants - including babies who were born prematurely or have certain health conditions - RSV can be much more serious and have devastating health consequences.
-
Some babies who get infected with RSV are sick for weeks - and quickly develop bronchiolitis or pneumonia
-
They may wheeze for months - or even years - and can go on to develop chronic lung disease.
-
Because it clogs their airways, many babies cannot get enough oxygen and must be admitted to the hospital for respiratory support.
-
Hospital admissions can last a week or longer.
WATCH: How To Recognize RSV Symptoms: Scarlett's Story
WATCH: Example of Wheezing, Grunting, and Squeaking in Infant in Respiratory Distress
WATCH: Nasal Flaring and Substernal/Subcostal Retractions in Infant
​
-
The sickest babies may even need to be placed on a breathing machine or heart lung bypass.
-
Tragically, some babies infected with RSV die from its effects.
It may be the common cold for you...
but it can be life-threatening for some babies.
We love these resources from Sobi, the makers of Synagis™ (palivizimab).
The Dangers of RSV
Neonatologist Vincent Smith, MD, explains why RSV can be dangerous for infants and young children.
What we can do.
We know that taking these steps will help us reduce the risks of respiratory infections:
​
-
If you're pregnant, get vaccinated against RSV - ACOG recommends the Pfizer RSV vaccine if you are 32 to 36 weeks pregnant from September to January. The vaccine creates antibodies that pass to your fetus. This means the baby will have some antibodies to protect them from RSV for the first 6 months after birth. Read about Vaccine Safety During Pregnancy
-
Get your flu shot. Stay up-to-date with your family's immunizations.
-
Stay home when you can.
-
When you have to go out, wear a mask and stay at least six feet apart from people who are not a part of your household.
-
Change your clothes when you get home.
-
Practice good hand hygiene. Wash your hands with soap and water for more than 20 seconds. Use an alcohol-based hand sanitizer when you can't.
We love these resources from Sesame Street in Communities
Understanding RSV
RSV is a really serious virus.
Spread the word - not the infection.
​
Share this video from the American Lung Association with people you care about.
How providers can help.
Providers can help reduce the burden of RSV infections in our communities by:
​​
​
-
Knowing the signs and symptoms of severe respiratory infection
​
-
CDC: Respiratory Syncytial Virus Infection (RSV) for Healthcare Providers.
-
Infant distress warning signs Watch this video
-
Talking to patients about the benefits of vaccinations during pregnancy.
-
Tracking national data and trends at the CDC's website
-
Educating ourselves about Nirsevimab (Beyfortus) Product & Ordering Information and Nirsevimab Coding & Payment - especially during what will be a challenging in the first year of implementation.
-
Providing families and insurers with the information they need to access Synagis (palivizumab) protective therapies
Advocating for evidence-based care for vulnerable infants.
Babies who were born prematurely or who have compromised respiratory or immune systems may benefit from the monthly antibody injections of Synagis™ (palivizimab). When given as prophylaxis monthly during the RSV season these injections of monoclonal antibodies are an effective way to significantly decrease the risks of RSV infection for this vulnerable population. There is solid evidence that babies who were born prematurely or have compromised respiratory or immune systems benefit from these antibody injections.
The National Perinatal Association
supports access to this much-needed therapy.
See our Evidence-Based Interdisciplinary Collaboration:
​
Respiratory Syncytial Virus (RSV) Prevention Clinical Practice Guideline
Read our 2022 UPDATE and Call to Action
The good news is that we have a proven, effective therapies and there are FDA-approved, evidence-based guidelines that describe which babies should have access to these medications.
​
The FDA has approved a new RSV monoclonal antibody, nirsevimab, brand name Beyfortus™, which can provide protection or reduction in severity of RSV infection. The CDC has recommended this vaccine for all infants less than 8 months of age during their first RSV season. NOTE: See this Health Alert Network (HAN) bulletin on Limited Availability of Nirsevimab in the United States - Interim CDC Recommendations to Protect Infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 Respiratory Virus Season
​
See NPA's statement,
New Advances in the Prevention of RSV Infection.
Currently the NPA supports several initiatives to address this issue, including the following:​
-
The creation of resources for parents and professionals that highlight current information about RSV and how to appeal insurer's decisions to deny access to RSV prophylaxis for a child who is at high risk.
-
Partnering with organizations to collaborate on effective ways to educate and inform the public, healthcare providers, payers and policy makers about this issue.
READ: WHO preferred product characteristics of monoclonal antibodies for passive immunization against respiratory syncytial virus (RSV) disease June 2021 l Meeting Report
READ: Monoclonal Antibodies Inclusion in the Vaccines for Children Program - National Coalition for Infant Health, March 2022
The Gap Baby: An RSV Story
Most young children encounter what’s known as Respiratory Syncytial Virus, or RSV, before age two. It’s a common seasonal virus with flu-like symptoms. But as this video from the National Coalition for Infant Health explains, premature infants whose health plans don’t cover preventive RSV treatment may suffer – and unnecessarily so.
Reliable Resources.
​
-
Up to Date: Patient Education: Bronchiolitis (and RSV) in infants and children (Beyond the Basics)
-
American Academy of Pediatrics (AAP) RSV: When It's More Than Just a Cold español
-
Signs and Symptoms of RSV and Bronchiolitis: What parents should know about this common childhood infection from VeryWellHealth
-
​Protect your most vulnerable patients when it matters most from Sobi, the makers of SYNAGIS® (Palivizumab) Consumer information for families