Reviewing the 2023 RSV season and an outlook on 2024

In this video interview, Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago, recaps 2023 with regard to respiratory syncytial virus (RSV).

Tan breaks down the severity of the RSV season in 2023, how newly FDA approved preventive tools have changed the treatment landscape, and what could be in store for 2024.

Interview transcript (edited for clarity):

Contemporary Pediatrics:

Hello and thanks for watching. I'm Joshua Fitch, editor of Contemporary Pediatrics. Today I'm joined by Dr. Tina Tan, editor in chief of Contemporary Pediatrics and a pediatric infectious disease attending at Ann and Robert H. Lurie Children's Hospital in Chicago. Dr. Tan, thank you for being here. First, let's talk about what a year it's been when it comes to RSV. Going back to about a year ago, when it was a very difficult RSV season, can you take us back and recap that a little bit, and really the urgent need for some some new treatment for this obviously, very young population?

Tina Tan, MD, FAAP, FIDSA, FPIDS:

Yeah, absolutely. So RSV causes annual epidemics, but last year, what we were noticing is that there wasn't just 1 epidemic, but there were actually several surges of RSV that occurred out of its normal season. So RSV normally occurs between October and March here in the United States and for reasons that are still not understood, we actually had several surges last year with 1 surge actually occurring during the summer. But it was the fall surge, which started earlier, that really was incredible, because we also were having surges of influenza, as well as COVIDa nd what that ended up doing was it overwhelmed the pediatric health care system so that there really were few to no hospital beds that were available at any given time. There were children that actually had to be transported either by ambulance or helicopter to other states in order to be treated and hospitalized for complications that they were having from RSV. It really did point out the fact that we did not have any way of preventing RSV disease, and that we really needed to have other tools in order to decrease the amount of severe RSV that we were seeing that was placing kids and infants in the hospital.

Contemporary Pediatrics:

Thank you Dr. Tan, of course, like you just mentioned, that harsh of an RSV season then turned into those new tools and vaccines to prevent the disease, including nirsevimab approved in July 2023 and Pfizer's maternal vaccine approved in August. Obviously, this was an exciting time looking back, can you kind of discuss what these approvals meant at that time, and really still mean now for RSV disease?

Tan:

That was fantastic news, because it really put other tools in our toolbox that we could use to prevent the severe complications that were being seen with RSV, especially in the younger infants under 6 months of age. And not only were we able to give a monoclonal antibody to the infants under 8 months of age, but we also were able to vaccinate pregnant women between 32 and 36 weeks so that they would be able to pass antibody on to their babies during a time when the baby would be at greatest risk for having complications should they get RSV, so it was really fantastic news that we had 2 different tools available that could decrease the amount of severe RSV disease that was being seen.

Contemporary Pediatrics:

To quickly follow up on that, you explained it from the health care professional standpoint. In your day-to-day, talk about kind of a sense of relief, if there was one from the parents standpoint, as they were the ones also dealing with their child having RSV disease, the cause for concern. Can you touch on that, what you've seen and what kind of relief these these approvals have brought?

Tan:

When nirsevimab was first approved, there were parents that were literally calling and clamoring to try and get the vaccines for their babies or the monoclonal antibody for their babies. Talking to some of my ob-gyn colleagues, there were women that were asking for RSV vaccine because they understood, because many of them had other children that this could be a potentially severe infection that their younger baby could get, and so they were actually asking the ob-gyn for the vaccine. So, I think that the word has gotten out that we do have something that can prevent hospitalization and other complications in these very young babies.

Contemporary Pediatrics:

You mentioned the word getting out. Well, recently following the approvals, the next question heading into September and October was availability, mainly with nirsevimab as it turned out. In October, the CDC recommended it'd be prioritized for the highest risk infants, amid some limited availability. Can you talk about some of the rollout challenges you've noticed, and availability now that we're into the RSV season and the winter months?

Tan:

It really has been a challenge for individuals to get an adequate supply of nirsevimab. Nobody has an adequate supply. People are prioritizing their 100 mg doses, which is recommended for infants that are 5 kilos and greater in weight to those infants that are under 6 months of age, infants that have underlying conditions, and infants that are Alaskan Native, American Indian infants, because we know that these are infants that are at the greatest risk for complication, should they get RSV.

Contemporary Pediatrics:

Is that kind of an unprecedented situation to where here's the brand new tool we've been talking about for so long, but now, how do we get it to everyone? Have we seen this before on such a large nationwide scale.

Tan:

We've seen this before, in some of the severe influenza seasons, where individuals were not able to get enough influenza vaccine to vaccinate their patients. So it's not unheard of that this happened and I think what probably occurred is that there was an underestimation of the demand that would happen once the product was released.

Contemporary Pediatrics:

Thank you, Dr. Tan. Lastly, we've kind of reviewed start of 2023 to now, looking ahead in your opinion, where do you think we stand when it comes to these preventative treatments? What trends have you noticed this RSV season, and if you can speak to any national trends as well, that'd be great, as we close out 2023 and really look into 2024's winter months.

Tan:

Right now we are starting to see a surge in RSV in many different areas of the country. It still remains to be seen how effective the limited amount of nirsevimab being given and maternal immunization being uptaken will have in terms of impacting the amount of severe RSV disease that we're seeing. My hope is that there is going to be some impact it might not have been as great as we would have liked to seen, but I would hope that there would be some impact with the use of the nirsevimab available and the maternal vaccination on the amount of severe RSV disease that may occur.

Contemporary Pediatrics:

Dr. Tan thank you so much for speaking with us.

Tan:

My pleasure.