RSV (Respiratory Syncytial Virus) is a very common respiratory virus that typically causes mild, cold-like symptoms in most infants and children (runny nose, fever and cough).
However, when RSV becomes a lower respiratory tract infection (affecting the lower part of the lungs) it can progress to a more severe infection that requires supportive care.
In young infants and children, RSV often affects the small airways of the lungs (bronchioles) and hence the term “Bronchiolitis”. Bronchiolitis refers to inflammation of the small airways. Many infants and children will present with a worsening harsh cough, wheezing and in some cases respiratory distress. Infants and children younger than 5 years old tend to be at highest risk for complications from RSV.
RSV can be year round in Texas, but peak season typically is October (Fall) through March (Spring).
RSV is highly contagious. RSV is spread by droplets in the air and can last on surfaces for weeks. Most children will contract RSV by the time they turn 2 years old.
Who is most at risk?
Infants are particularly susceptible to RSV because their immune systems are still developing. The risk of RSV-associated lower respiratory tract disease (LRTD) is highest during the first 12 months of life.
According to the CDC (Centers for Disease Control), RSV is the leading cause of infant hospitalization in the U.S.
Each year RSV causes up to approximately 80,000 hospitalizations, 520,000 emergency department visits and 300 deaths in children under 5 years old.
RSV can lead to respiratory distress, bronchiolitis and life threating pneumonia requiring hospitalization and even ICU admission with mechanical ventilator support.
RSV is a threat to both young and old. The CDC reports up to 160,000 hospitalizations among older adults and up to 10,000 deaths each year because of RSV infections.
How is RSV treated?
There is no cure for RSV. RSV is a virus and needs to run its course. It typically worsens in the first 3-7 days of illness then progressively gets better over 2-3 weeks. Yes, the RSV cough can last 2-3 weeks! The treatment of RSV is primarily supportive meaning, rest and fluids. Antibiotics are not typically prescribed, unless your child has a true secondary infection i.e. ear infection, secondary pneumonia, UTI etc.
In infants <1 year we typically recommend:
- Nasal saline and suction prior to feeds
- Smaller more frequent feeds (more frequent breast feeding or formula feeding)
- Pedialyte 30-60 mL (1-2 ounces) after feeding or in between feeds to help thin the mucous and ensure hydration.
- Water may be given to infants over 6 months old.
- A cool or warm mist humidifier
- Baby Vicks in infants > 6months to the chest under the shirt (avoid the mouth, nose and eye area)
- Your doctor may prescribe breathing treatments if indicated. However, breathing treatments (nebulizers) often do not work or help in RSV.
- Plenty of rest. Your infant may want to be held upright a lot on your chest. Remember, always place your infant on his/her back to sleep in the crib/bassinet.
In children > than 1 year:
- Increase fluids; water, Pedialyte, honey to soothe the throat and cough. I typically recommend decreasing milk products which can thicken the mucous.
- Nasal saline and suction or a steamy bathroom
- Humidifier
- Breathing treatments if indicated and prescribed by your child’s doctor.
Reasons to call your Pediatrician / Warning signs:
- Call immediately if your infant is under 2 months old and has a fever greater than or equal to 100.4 F (38 degrees Celsius).
- if your child (over 2 months) has a fever > 4 days
- if your infant or child has decreased urine output (decreased wet diapers or not peeing a minimum of every 4-6 hrs.)
- Infants and children often vomit up mucous with RSV after a coughing fit. This is ok if it happens occasionally. However, if it is recurrent, they cannot feed without vomiting or spitting up mucous or you notice decreased wet diapers/urine output as noted above please call your doctor ASAP.
- If your infant or child has labored breathing i.e. a respiratory rate > 60 breaths per minute in infants or is visibly tugging in the chest (retractions), flaring of the nostrils, grunting, short of breath or you can hear audible wheezing or stridor.
- Your child is less active or not responding/interacting with you like they normally would
- Your child is not feeding well (decreasing amounts, weak suck, decreased wet diapers).
- Your infant/ child is inconsolable over 1-2 hours no matter what you do to soothe him/her
RSV Vaccination and what you need to know
- Severe RSV lower respiratory tract infections in infants can be prevented by either administering monoclonal antibody products to infants and young children, or by administering RSV vaccine during pregnancy.
“Out with the old and in with the new!”
- Palivizumab (SYNAGIS) aka the “old monoclonal antibody” was all that was available to us in the past and only available for a narrow subset of children who were at high risk of disease.
The New Monoclonal Antibody:
- July 2023, the FDA approved Beyfortus, a new monoclonal antibody developed by Sanofi and AstraZeneca = the first new RSV monoclonal antibody developed in over 20 years!
- Monoclonal antibodies are laboratory made proteins that mimic the immune system’s ability to fight off pathogens that help protect infants and young children from lower respiratory tract infection caused by RSV.
Nirsevimab, also known as Beyfortus, is a long-acting monoclonal antibody that protects infants and young children from respiratory syncytial virus (RSV). The CDC recommended Nirsevimab in August 2023 for infants under 8 months old in their first RSV season. Nirsevimab is also used for children up to 24 months old who are still at risk for severe RSV disease in their second RSV season. According to the CDC, Nirsevimab was 90% effective at preventing RSV-associated hospitalizations in infants during their first RSV season.
Three clinical trials supported the safety and efficacy of Beyfortus. A phase 3 trial showed that it reduced RSV-triggered lower respiratory tract infections that require medical care by 76.4% and cut RSV hospitalizations by 76.8 %.
RSV vaccine for pregnant women
- There is one RSV vaccine (Abrysvo, Pfizer) recommended for pregnant women. Abrysvo will be given to pregnant women in their late second or third trimester of pregnancy to pass on RSV protection to their fetuses and the antibodies will continue to provide protection to babies for up to six months after delivery.
- The safety and effectiveness of Abrysvo for immunization of pregnant women to prevent lower respiratory tract disease (LRTD) and severe LRTD caused by RSV in infants were evaluated in multiple clinical studies. Abrysvo reduced the risk of severe LRTD by 81.8% within 90 days after birth, and 69.4% within 180 days after birth.
- If you are currently pregnant, we encourage you to discuss the timing of the RSV vaccination for you and your baby with your Obstetrician.
How does it work?
As noted above, Nirsevimab (Beyfortus) is an injectable monoclonal antibody that prevents severe RSV disease in infants under 8 months old entering their first RSV season and in high risk infants and young children under 24 months old entering their second RSV season.
Monoclonal antibodies do not activate the immune system, as would occur with natural RSV infection or vaccination (active immunization). Nirsevimab (Beyfortus), works by providing passive immunity, which means it protects the body with antibodies produced outside of the body, rather than the body’s own immune system. The antibodies protect against disease. The key advantage is that the monoclonal antibody is injected directly into the body conferring protection right away. With vaccines, it takes time to produce antibodies to protect you against whatever a specific vaccine is for.
***Note- Nirsevimab (Beyfortus) is NOT to be confused with mRNA technology used in COVID-19 vaccines introduced by Pfizer and Moderna. It works by introducing RSV protein into the body to stimulate an immune response.
Since Nirsevimab (Beyfortus) does not activate the immune system, protection is likely highest the first several weeks after Nirsevimab is given and wanes over time. Nirsevimab does not provide long-term immunity to RSV disease but provides protection to infants when they are most at risk of getting severe RSV disease.
One can contract RSV multiple times in the same season, but as children get older, they are less likely to get severe symptoms from RSV infection.
RSV vaccines can be administered at the same time as other vaccines.
OFFICIAL RECOMMENDATIONS / NIRSEVIMAB
One dose of Nirsevimab is recommended for infants younger than 8 months of age who were born shortly before or are entering their first RSV season (fall through spring) if:
- The mother DID NOT receive RSV vaccination during pregnancy
- The mother’s RSV vaccination status is unknown
- The infant was born within 14 days of maternal RSV vaccination
Additionally, a dose of Nirsevimab is recommended for some children aged 8-19 months old who are at increased risk for severe RSV disease and entering their second RSV season. Discuss with your Pediatrician if these criteria apply to your child. Per the CDC high risk 8-19 month old infants and children are:
- American Indian/ Alaska Native children
- Children with chronic lung disease of prematurity who require medical support during the six months before the start of their second RSV season
- Children with severe immunocompromise
- Children with severe cystic fibrosis
Who should not receive the RSV vaccine?
- Nirsevimab is contraindicated in infants and children with a history of severe allergic reactions (i.e. anaphylaxis) to Nirsevimab or to any of its components. See nirsevimab FDA package insert.
- Nirsevimab should be given with caution to infants and children with bleeding disorders. See General Best Practice Guidelines for Immunization
- Children who have a moderate or severe acute illness should usually wait until they recover before getting the RSV vaccination.
***The doctors and staff at West Plano Pediatrics truly wish that all our infants and young children could receive the RSV vaccination for the 2024-2025 season.
However, per the current guideline children ages 8 months and older who are not at increased risk of severe RSV disease should not receive Nirsevimab.
We hope that as the vaccine becomes more widely available these recommendations will be expanded in the coming RSV seasons.
This blog is intended as a reference guide. If you ever have concerns about your baby/child, please call us at 972-608-0774 or call 911 if your child is acting sick and in distress
Wishing you good health,
Drs. Berger, Gair, Mix, Prengler, Reed, Schultz and the entire West Plano Pediatrics staff