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New medicines could tame RSV threat for babies and older adults
No one looks forward to cold and flu season, but this year there is some good news that could mean much less severe illness from one respiratory virus: RSV. For the first time, there are approved medicines that can protect both babies and older adults from RSV.
It’s almost impossible to avoid catching RSV, or respiratory syncytial virus, which is a very common, highly infectious respiratory virus. However, for most healthy adults and older children, it causes only mild cold-like symptoms. Unfortunately, the virus is a much bigger threat for people at either end of the age spectrum. RSV typically causes tens of thousands of hospitalizations annually in infants and older adults, and every year in the U.S., 100 to 300 children under age 5, and between 6,000 and 10,000 people over the age of 65 die from RSV.
With the arrival of the new medicines—two new vaccines for adults over age 60, a vaccine for pregnant mothers that protects newborn babies, and an antibody medicine for babies and at-risk toddlers—doctors finally have tools to tame the threat of severe RSV.
Vaccines for older adults
“The vaccines studied in adults over age 60 were very effective,” says Patricia Winokur, MD, professor of internal medicine and executive dean of the UI Carver College of Medicine. “They were tested in really big clinical trials, with about 40,000 people in each of the trials for the two vaccines, and about 85% of people were protected from having serious RSV disease. That is a pretty good track record! In addition, the immunity seemed to last pretty well for two years, which is really encouraging.”
The UI participated in the clinical trial for the Pfizer vaccine for older adults, and Winokur was the lead investigator for the UI site, which enrolled about 150 Iowans in the study. Winokur notes that vaccine might be particularly beneficial for older adults who also have underlying conditions, like lung and heart disease, which put them at higher risk for bad outcomes from RSV.
“There are about 100,000 to 150,000 hospitalizations a year in the United States, and about 10,000 deaths among older people due to RSV. This is predominantly in people who are over 65 and people who have other conditions like asthma, COPD, heart failure, and diabetes—conditions that make their immune system just less strong or their respiratory tract less robust.” she says.
The Centers for Disease Control and Prevention (CDC) recommends that adults over age 60 should talk to their doctor to decide if getting the vaccine is a good choice for them.
Two ways to protect babies from RSV
With no treatment and little hope of avoiding infection, RSV season has always filled pediatricians and parents of new babies with dread. RSV is the leading cause of hospitalization in infants. Moreover, a recent study involving UI Health Care researchers found that for little kids, being healthy with no underlying medical conditions does not seem to provide protection against hospitalization. The study found that most of the children under age 5 who were hospitalized with RSV in the 2022 seasonal peak of the illness were healthy, full-term babies.
However, approval for new medicines in just the past few months has the potential to change that situation for the better.
The Pfizer vaccine available to older adults is also now recommended for pregnant women in their third trimester (between 32 and 36 weeks of pregnancy during September through January), because the immunity it generates has been proven to protect babies after they are born. The protection lasts for about six months, which is sufficient to cover the RSV season for babies born in late summer through the winter.
Also approved this year, is a new medicine called Nirsevimab or Beyfortus, which can be given directly to infants and toddlers to protect them against severe RSV disease. This single-dose medicine delivers ready-made, long lasting antibody protection against RSV. The CDC recommends that babies get this medicine to protect them for their first respiratory season, which is usually the most severe.
This is a great opportunity for us to protect some of our most vulnerable babies from this serious disease.
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Patricia Winokur, MD
“This was a very strong recommendation, and our pediatricians, who have seen a lot of serious RSV disease, especially in the last three years, are very in favor of this monoclonal antibody,” Winokur says. “This is a great opportunity for us to protect some of our most vulnerable babies from this serious disease."
"However, there is currently a limited supply of the Nirsevimab doses for infants over 11lbs and those doses will be prioritized for babies at highest risk from RSV, which makes it even more important for us to enhance RSV vaccination rates for women in the third trimester of pregnancy,” she adds.
The RSV vaccines for older adults and for pregnant women are available through UI Health Care. The monoclonal antibody medicine is also available, but supply may be limited.