Office News & Updates

Information About RSV

Background

RSV transmission occurs primarily via respiratory droplets when a person coughs or sneezes or through direct contact with a contaminated surface. Infants and young children are at increased risk of severe disease from RSV infection. Every year RSV causes approximately 58,000–80,000 hospitalizations and 100–300 deaths in children less than five years of age.

The annual RSV season in the US has historically started in the fall and peaked in winter. This pattern was disrupted during the COVID-19 pandemic because public health measures to reduce the spread of COVID also reduced the incidence of RSV. As a result, RSV activity was limited between May 2020 and March 2021, followed by an atypical season with onset in May 2021 that peaked in July and August and continued through the end of 2021. In 2022, RSV activity began in the summer, peaking across the United States in October and November, and rapidly declining by winter. There is currently increased RSV activity in the lower East Coast of the country.

New RSV Vaccine

The FDA and CDC recommend the use of nirsevimab (brand name, Beyfortus), a long-acting monoclonal antibody product, which has been shown to reduce the risk of both RSV-related hospitalizations and RSV-related doctor’s visits in infants by 80%. Nirsevimab is safe and effective. In clinical trials, one dose protected infants for at least 5 months, the length of an average RSV season. The incidence of serious adverse events was not increased among nirsevimab recipients compared with placebo recipients in the clinical trials. The CDC recommends one dose of nirsevimab for all infants younger than 8 months born during – or entering – their first RSV season. For a small group of children between 8 and 19 months who are at increased risk of severe RSV disease (see below), a dose is recommended in their second RSV season.

What Is the Difference Between Standard Vaccinations and a Monoclonal Antibody?

When someone receives a traditional vaccine, they’re injected with a dead or severely weakened virus or bacteria. The body’s immune system makes antibodies to the infectious agent that neutralize the virus or bacteria if the person is exposed to the infection. Because the body manufactures the antibodies, this is called “active immunity.” When someone receives a monoclonal antibody, they’re injected with a molecule that mimics natural antibodies to neutralize a virus. This is called “passive immunity.”

How Long Does It Take Vaccines and Monoclonal Antibodies to Work?

The immune response to a vaccine starts within days and develops over a few weeks. While a vaccine will train the immune system to battle future infections, monoclonal antibodies have the potential to provide almost immediate effect, neutralizing intruders. The downside of monoclonal antibodies, given current technology, is that the protection they provide does not last as long as that conferred by standard vaccines.

General Recommends for Beyfortus

• All infants ages <8 months born during or entering their first RSV season should receive 1 dose of nirsevimab.
• Infants born shortly before or during the RSV season can receive nirsevimab within their first week of life.

Children Ages 8 to 19 Months At High Risk for Serious RSV

• Children with chronic lung disease of prematurity who required medical support (chronic steroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before the start of the second RSV season.
• Children who are severely immunocompromised.
• Children with cystic fibrosis who have either (1) manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) or (2) weight-for-length <10th percentile.
• American Indian or Alaska Native children

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