Fighting RSV: The Latest on Vaccines and Treatments

Respiratory syncytial virus (RSV) got a lot of attention late last year as part of a “tripledemic” with the flu and COVID-19, and though it’s unclear if a three-peat is in our future, protections against RSV-related hospitalizations have improved.

The Food and Drug Administration (FDA) on Aug. 21 approved the first RSV vaccine for pregnant women to prevent lower respiratory tract disease (LRTD) caused by RSV in infants from birth through 6 months of age. Abrysvo, made by Pfizer, is given as a single dose injection to expectant moms from 32 through 36 weeks of pregnancy.

Tibisay Villalobos, MD, Chief, Section of Infectious Diseases, Department of Pediatrics, Lehigh Valley Reilly Children’s Hospital, says the antibodies in the vaccine are transferred to the baby before it’s born, providing protection.

The FDA in May approved both Abrysvo and Arexvy – made by GlaxoSmithKline – as vaccines for the prevention of LRTD caused by RSV in people 60 and older. Each year in the U.S., 60,000 to 160,000 adults 65 and older are hospitalized and as many as 10,000 die from RSV infection, according to the Centers for Disease Control and Prevention (CDC).

The CDC says the RSV vaccine can be given at the same time as flu and COVID-19 vaccines.

“We encourage those 60 and older, as well as pregnant women, to speak with their clinician about the RSV vaccine,” says Jarrod Kile, clinical pharmacy specialist-infectious disease and director of LVHN’s Antimicrobial Stewardship Program.

In July, the FDA approved AstraZeneca and Sanofi’s Beyfortus – a monoclonal antibody, also known as Nirsevimab – for the prevention of RSV lower respiratory tract disease in newborns and infants born during or entering their first RSV season, and in children up to 2 years old who remain vulnerable to severe RSV disease through their second RSV season. Nirsevimab is not an RSV vaccine.

Monoclonal antibodies are laboratory made proteins that mimic the immune system’s ability to fight off health threats such as viruses. One dose of Nirsevimab, administered prior to or during RSV season, may provide protection during the RSV season, according to the FDA.

Before the approval of Nirsevimab, Dr. Villalobos says doctors had another monoclonal antibody, Synagis, but she notes that treatment had to be given monthly and was reserved for very high-risk infants and toddlers. “We knew the at-risk kids were being protected with the available antibody,” says Dr. Villalobos. “But there was still a significant number of healthy kids being hospitalized during the season because of RSV.”

Dr. Villalobos says the newest antibody treatment is another tool against RSV. An antibody shot may be given as early as birth or soon after if a child is born during the RSV season. Babies with older siblings in day care or school may also want to consider an antibody treatment because of the potential for those siblings to bring the virus home.

Nirsevimab is available in limited supplies now and is being used for infants at higher risk for RSV complications. Parents can check with their child's LVPG pediatrician or primary care doctor about whether their baby needs this shot, and are advised to connect with their insurance provider concerning coverage. As the product becomes more readily available, it will be offered to more infants.

Before antibody treatments and vaccines were available, Dr. Villalobos says supportive care, including supplemental oxygen and intravenous fluids, were standard care.

RSV is the most frequent cause of lower respiratory tract illness in infants worldwide and the most common cause for infant hospitalizations in the U.S. About 1-3% of children under a year old in the U.S. are hospitalized each year due to RSV, according to the American Academy of Pediatrics. 

Most babies will be infected with RSV at least once by the time they’re 2 years old and the risk of severe complications is highest in the first year. In most cases, RSV results in cold symptoms, but can cause lower respiratory tract illnesses such as pneumonia and bronchiolitis.

Newborns and very young children are more susceptible to RSV because their systems are immature, they lack antibodies and they’re not big enough to clear mucus secretions on their own as older children, teens and adults can.

More RSV vaccines are currently in the works, including for those 18-60 with underlying medical conditions, such as asthma.

Speak with your doctor about whether any of the new RSV vaccines or preventive treatments can help you or your baby.

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