Karen Capusan, DNP, CPNP-PC, discusses the current landscape of RSV
Karen Y. Capusan, DNP, CPNP-PC, explored RSV’s shifting epidemiology, seasonal trends, and new vaccines’ role in reducing hospitalizations at the 2025 NAPNAP National Conference.
At the 2025 NAPNAP National Conference in Chicago, Illinois, Karen Y. Capusan, DNP, CPNP-PC, of Cohen Children's Medical Center, Northwell Health, discussed the evolving epidemiology and burden of respiratory syncytial virus (RSV) in her session, "Lions, Tigers and RSV Bronchiolitis: Health Care Burden, Changing Epidemiology, New Vaccines and the Future."1
The Changing Epidemiology of RSV
"[RSV] has an expected seasonality. So in the Northern Hemisphere, it’s typically late fall into early spring,” Capusan explained while noting that the COVID-19 pandemic altered this pattern.
“In 2021, when we all started to emerge out of our bubbles from quarantine and lockdown, we started to see it emerge again in the spring, like March and April, and then peak in the summer, which we had never seen before,” said Capusan. “Then that subsequent year, 2022, it really peaked again in the summer, like July.”
Capusan noted that RSV is now trending back to pre-pandemic seasonality, but ongoing monitoring remains necessary.
Association with preschool wheezing
“There’s definitely a lot of literature out there about RSV infection, especially severe RSV infection, so that would mean hospitalization and subsequent wheezing in preschool children,” stated Capusan. “We can’t say there’s a causality, but there’s certainly a relationship, because a lot of studies show that after you get RSV, it seems to induce asthma-like symptoms.”
According to the CDC, RSV can become more severe after a few days of onset, leading to early symptoms such as eating or drinking less, runny nose, and coughing, which "may progress to wheezing or difficulty breathing."2
Capusan highlighted the need for further research into whether reducing RSV cases could lead to fewer children developing recurrent wheezing and asthma.
Advances in RSV Prevention
New preventative measures, including monoclonal antibodies and vaccines, have expanded the options for protecting infants and high-risk populations.
“Nirsevimab, very exciting, also known as Beyfortus, is a monoclonal antibody. It is recommended for infants under the age of 8 months entering their first RSV season,” Capusan explained.
While supply issues limited availability during the 2023 season, access has since improved, with vaccination rates for infants now at 46%, she stated.
“The other exciting news is that there are adult vaccines for RSV, specifically for maternal vaccination,” added Capusan. “It is recommended if you’re pregnant between 32 to 36 weeks gestation, and the efficacy is pretty good; 69% efficacy in preventing severe RSV infection in infants up to 6 months after birth.”
Debunking RSV Myths
Despite speculation, there is no evidence that RSV has mutated into a more virulent strain, a question Capusan has received from parents.
“They did serotypes, they typed all the strains during 2022, and all the strains we saw of RSV we have seen before, dating back from 2014 to 2019,” Capusan stated. “So no super strain there.”
She also addressed theories suggesting co-infections could increase RSV severity.
“They did experimental studies in human and bronchial epithelial cells and found that specifically, COVID-19 paired with RSV does not increase virulence,” she clarified.
Preparing for the Future
Understanding RSV seasonality and transmission is crucial for future pandemic preparedness. Capusan highlighted the theory of “immune debt” to explain the post-pandemic surge in RSV cases.
“We were not immunologically challenged during COVID-19, when we were on lockdown and quarantined,” she explained. “Now we’re immunologically naive, and so when we come back to work and school, we’re more susceptible to viruses.”
With ongoing surveillance, improved vaccination strategies, and continued research, health care providers can better manage RSV and mitigate its impact on pediatric populations.
References:
1. Capusan K. Lions, Tigers and RSV Bronchiolitis: Health Care Burden, Changing Epidemiology, New Vaccines and the Future. Presented at: 2025 NAPNAP National Conference. March 10-13, 2025. Chicago, Illinois.
2. RSV in infants and young children. CDC. Updated August 30, 2024. Accessed March 17, 2025. https://www.cdc.gov/rsv/infants-young-children/index.html
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