RSV vaccine on the horizon

Several counties across the country have reported staggering case numbers of respiratory syncytial virus (RSV), a common respiratory virus, as flu and COVID-19 continue to spread. RSV usually causes cold-like symptoms, but it can cause serious illness in young children and older adults. In fact, California recently reported the season’s first death of a child under 5 due to complications of flu and RSV.

While there are safe and effective vaccines for the flu and COVID-19, there is not yet an approved vaccine to prevent RSV. Drugmaker Pfizer is working to change that.

In early November, Pfizer announced encouraging results in clinical trials of their new vaccine that protects against RSV in infants. The vaccine is administered to a pregnant woman, their body produces antibodies against RSV, and antibodies are then transferred through the placenta to their fetus.

Early trial results found the vaccine had an efficacy of nearly 82% against severe illness within a newborn’s first 90 days. At 6 months after birth, the vaccine was more than 69% effective. Preventing severe illness greatly reduces the risk of hospitalization and also improves infants’ lung development and health.

“The promising outcomes of this trial are revolutionary in protecting our most vulnerable population, infants less than 6 months with weakened immune systems and chronic health conditions from RSV,” says Dr. Joanna Adamczak, a perinatologist and chief medical officer at Sharp Mary Birch Hospital for Women & Newborns. “Thousands of infants are hospitalized each year due to RSV, and this vaccine administered during pregnancy will allow antibodies to pass from mom to baby, enhancing protection from the virus.”

Pfizer reports it plans to file for Food and Drug Administration (FDA) approval of the vaccine, which was determined to be safe and well tolerated by pregnant women and their babies, by the end of the year. It is expected to be available for use in 2023.

Steps to prevent RSV now
Until the vaccine is approved and available for parents, Dr. Adamczak joins the Centers for Disease Control and Prevention (CDC) in recommending parents of young children take the following precautions:

• Avoid close contact with sick people.

• Wash your hands and your child’s hands often with soap and water for at least 20 seconds.

• Avoid touching your child’s face with unwashed hands.

• Clean frequently touched surfaces, such as doorknobs and mobile devices.

• Limit the time your child spends in childcare centers or other potentially contagious settings during periods of high RSV activity.

If you are sick, always cover your coughs and sneezes with a tissue or your upper shirt sleeve — never your hands. And avoid close contact, such as kissing, touching your child’s hands, and sharing cups and eating utensils with your child.

Experts also recommended you cover your baby’s carrier with a blanket when out in public. This serves as a physical barrier to others’ respiratory droplets from sneezes, coughs, drips or exhalations.

Protecting infants at greatest risk
For infants at greater risk of severe RSV illness, such as bronchiolitis (inflammation of the small airways in the lung) or pneumonia (infection of the lungs), doctors can prescribe a medicine called palivizumab to help protect them. Individuals at high risk of severe RSV illness include:

• Premature infants

• Infants, especially those 6 months and younger

• Children younger than 2 years old with chronic lung disease or congenital heart disease

• Children with weakened immune systems

• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Palivizumab is not a vaccine. It is a monoclonal antibody given to very young children at high risk as a series of five consecutive monthly shots during RSV season. It targets a protein within the virus and can help prevent the virus from entering cells and causing severe infection.

If your child has RSV
Most children will have RSV at least once before they turn 2 years old. Symptoms of RSV are usually mild and show within 4 to 6 days after infection. Not all children will have all of the following symptoms of RSV, which can appear in stages:

• Runny nose

• Decrease in appetite

• Coughing

• Sneezing

• Fever

• Wheezing

There is no specific treatment for RSV, though it is important to keep sick children well-hydrated and manage their fever and discomfort. Always consult your child’s doctor before giving them medications, both prescription and over the counter.

In severe cases, very young children with RSV may require hospitalization if they are having trouble breathing or are dehydrated. In-hospital treatments include additional oxygen, IV fluids and mechanical ventilation.

Talk with your child’s doctor if they are showing signs of RSV or if you are concerned about their risk for severe RSV illness. Call 9-1-1 or go immediately to an emergency room if your baby shows signs of labored or rapid breathing; dehydration; high fever; lethargy; blue skin, lips or fingernails; or unresponsiveness.

And once the RSV vaccine is approved by the FDA, Dr. Adamczak advises women to talk with their doctors regarding vaccine benefits during pregnancy.

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