The national drug regulator, the Food and Drug Administration (FDA), recently approved the world’s first vaccines to prevent RSV, or respiratory syncytial virus, for infants and the elderly.
This disease is the leading cause of hospitalization in children under the age of 1 year, and almost everyone will have RSV by the age of 2 years. Every year, the virus kills up to 10,000 elderly people in the United States. UCSF infectious disease expert Peter Chin-Hong, MD, explains the breakthrough in RSV prevention as we head into the fall when infections are expected to rise.
What is RSV?
Respiratory syncytial virus (RSV) is a virus that can cause lung and respiratory infections such as bronchiolitis and pneumonia. Most RSV infections resolve on their own within two weeks, but for some people at high risk, it can cause serious illness, leading to hospitalization or death.
Who is most at risk of contracting the dangerous RSV virus?
- Anyone with a weak immune system
- Infants younger than 1 year, especially those 6 months or younger who are born prematurely
- Children under 2 years of age who suffer from chronic lung or heart disease
- Children with neuromuscular disorders, including those who have difficulty swallowing
- Adults over 60 years old
- Adults with chronic heart or lung disease
- Adults living in nursing homes or long-term care facilities
How do people get infected with RSV?
Respiratory syncytial virus is spread similarly to the common cold by droplets of saliva released into the air when sick people cough or sneeze. These droplets carry the virus, and spread it when they come into contact with our eyes, nose, or mouth. These same droplets also land on surfaces, contaminating them and also making them infectious for some time.
What are the symptoms of RSV?
The symptoms of respiratory syncytial virus are similar to those of the common cold: congestion, fever, cough, wheezing, and sore throat. In young children, the only signs of respiratory syncytial virus may be difficulty breathing, irritability, and decreased activity. Older adults and children younger than 6 months may need to be hospitalized if they have trouble breathing, become dehydrated or their symptoms worsen.
Can vaccines protect against RSV?
Yes, this year, the FDA approved the first two respiratory syncytial virus vaccines, Abrysvo and Arexvy, to protect people ages 60 and older from serious illness. Recently, the Food and Drug Administration also approved Apresvo for pregnant women to help protect infants from the virus.
Who should get vaccinated against RSV?
People 60 years of age or older or pregnant women in the last three months of pregnancy should talk with their health care provider about whether vaccination is right for them.
What should I know about RSV vaccinations for infants?
In late August, the FDA approved Apresvo for infants, but there’s a catch: We don’t give it directly to infants. Instead, the vaccine is given to those in the last three months of pregnancy to help them produce antibodies – or defenses – against the RSV virus. Pregnant women transfer antibodies to their fetuses in the womb and to their babies while breastfeeding or breastfeeding.
In large clinical trials, babies born to mothers who received the shot were approximately 82% less likely to develop severe RSV during the first three months after birth. Although this protection decreases slightly as infants grow, they are still about 70% less likely to develop severe RSV infection at six months of age. The vaccine provides children with strong protection against RSV during one of the most critical times in their lives, and is expected to be available in late October or early November.
What can I do to protect my child now from RSV?
Let’s say your baby is younger than 8 months. In this case, they may be eligible for another new preventive method: a single injection of a monoclonal antibody. This injection, called Beyfortus, reduces a baby’s risk of contracting the dangerous RSV virus by about 75%. Beyfortus will likely become available in October.
If your child is between 8 and 19 months old and at increased risk for RSV infection, he or she may still be eligible for Beyfortus, so you should ask your doctor. There is also an older monoclonal antibody injection already available called Palivizumab for high-risk infants, although it is expensive and must be taken monthly (five times during the RSV season).
What are monoclonal antibodies?
Normally, we have to wait to get sick for our bodies to produce the antibodies we need to fight off invading germs. Monoclonal antibodies are ready-made antibodies produced in a factory that target and neutralize a virus – in this case, respiratory syncytial virus. By taking a monoclonal antibody, children’s immune systems are prepared to fight RSV before it attacks.
How effective is the RSV vaccine for seniors?
For people 60 and older, vaccines reduced the risk of severe RSV infection by about 86%.
How long will the new RSV vaccine protect older adults and infants from RSV?
For adults 60 years of age or older, RSV vaccines show persistent protection even 2 years after vaccination. Accordingly, the US Centers for Disease Control and Prevention recommends only one dose of RSV vaccines for older adults at present but this may change.
For infants, we know that the vaccine given to pregnant women protects babies during the first six months of life when they are most at risk of contracting the virus. Likewise, Beyfortus, a monoclonal antibody injection, reduces the risk of RSV infection in infants for about five months — or for one RSV season.
Does the new RSV vaccine have any side effects?
In adults, the most common side effects were pain at the injection site, muscle pain, fatigue, headache, and joint pain. In pooled clinical trials of the vaccine, 20 out of more than 38,000 people who received the vaccine reported abnormal heart rates about two weeks after vaccination. Eight people out of a similar number of people in the trials who did not take the vaccine said the same thing. In addition, six people developed rare neurological complications.
Scientists are still discovering whether cardiac arrhythmia or neurological complications are linked to the vaccine, but if you have concerns, talk to your doctor. What is clear is that the benefit of protection against RSV for many people far outweighs this potential risk because we do not have good treatments once people become seriously ill with RSV.
It’s a no-brainer to me for those who are immunocompromised, or have underlying medical conditions like lung and heart disease. For others, you may want to discuss it with your healthcare provider first.
Can I take the respiratory syncytial virus vaccine alongside flu or COVID-19 vaccines?
You can get the COVID-19 vaccine and the flu vaccine at the same time, but now it’s best to wait a few weeks before getting the RSV vaccine – and vice versa.
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