The Changing Landscape of RSV Prevention: What Pediatricians Need to Know
Michael Greenberg, MD, MPH
Vice President, Medical Head Vaccines, North America
Sanofi
Respiratory syncytial virus (RSV) is a common respiratory illness that affects two out of three infants in their first year of life.1 Although it typically causes mild cold-like symptoms, it can be severe in infants and young children, including those born full-term and considered healthy.2 In fact, RSV is the leading cause of hospitalization in infants in the United States; it also accounts for 2.1 million outpatient visits in children under 5 annually.3,4 As those who have been on the front lines of RSV, what pediatricians know is this: RSV is a pernicious virus whose burden on babies, families, healthcare providers and health systems has been at best unruly, at worst, alarming.
The most recent winter virus season reflected the worst of what we can expect with RSV left unfettered. We all saw the headlines, or experienced it firsthand with our patients, even our families and friends: hospitals across the nation overwhelmed by the surge of sick infants, providers stretched thin, parents and caregivers completely depleted by yet another virus onslaught, and far too many devasted by the experience of their baby hooked up to oxygen and tubes. The need for direct protection from RSV for all infants is clear and urgent.
Fortunately, recent developments in RSV prevention offer hope: earlier this year, the FDA accepted the application for nirsevimab, an investigational monoclonal antibody that, if approved, would be the first protective option for the broad infant population, including those born healthy, at term or preterm, or with specific health conditions. A recent correspondence in the New England Journal of Medicine (NEJM) spotlights the results from full enrollment in its Phase 3 study, expanding upon data from the trial’s primary cohort. The potential for a preventive strategy that could provide a direct, first line of protection to all infants for the entire RSV season – even if it starts early or late – feels incredibly promising.
We are on the cusp of a major opportunity to shift the focus of RSV care from reactive, supportive care, to primary prevention. But, as we know all too well from recent years, introducing a new immunization can come with barriers and challenges.
To effectively protect all infants from serious RSV disease, new preventive options are just the beginning. Pediatricians of course play a critical role in the implementation and uptake of these new options that will help protect babies and support the families that care for them. As trusted advisors, pediatricians can:
- Help educate families: Understandably, parents may have concerns regarding RSV and emerging preventive options. Pediatricians can not only provide the latest information to help them make informed decisions, but do so in consumer-friendly terms, without judgement and with the acknowledgement that parents truly want to do their best to protect their baby. And not just after the baby is born – those prenatal visits are a great opportunity to let parents know what to expect, including where they should (and should not) go for trusted health information, especially about immunizations.
- Advocate for all infant protection: We can also play a role in ensuring all families, regardless of socioeconomic status, location, race, or language, have access to accurate information about RSV, its severity, and any potential management options. We can’t expect that every family will immediately embrace a new preventive modality, and we need to meet people where they are. But it is possible to build trust and promote access through culturally relevant education and resources, to help overcome barriers like language, mistrust and transportation.
- Collaborate with other healthcare providers: As the old adage goes, it takes a village to raise and protect a child. Pediatricians can collaborate with other healthcare providers, including nurses, respiratory therapists, OBGYNs, and hospital staff, to ensure there is comprehensive and coordinated education and implementation around RSV prevention moving forward.
During my time as a pediatrician and throughout my career, I have seen first-hand the vast impact of RSV. As we stand at the precipice of change, I encourage my fellow pediatricians and pediatric healthcare providers to prepare for this new era of RSV prevention, and to help make the possibility of direct protection a reality for all infants.
References:
- Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140(6):543-546. doi:10.1001/archpedi.1986.02140200053026
- Symptoms and Care of RSV (Respiratory Syncytial Virus) | CDC. https://www.cdc.gov/rsv/about/symptoms.html. Accessed April 19, 2022.
- Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children.New Engl J Med. 2009;360(6):588–98.
- Leader S, Kohlhase K. Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. J Pediatr. 2003;143(5):127-132. doi:10.1067/s0022-3476(03)00510-9
