Keeping Our Infant and Older Adult Populations RSV-Free This Season

Respiratory syncytial virus (RSV) is a respiratory virus that is quite common, typically manifesting as an upper respiratory tract infection with symptoms including sneezing, cough, nasal congestion, and rhinorrhea. In these cases, symptoms typically resolve in 1 to 2 weeks.^1-3

Image credit: photoopus | stock.adobe.com

However, RSV can be serious, especially for infants and the elderly, progressing to involvement of the lower respiratory tract and presenting as more of a bronchiolitis picture, sometimes requiring hospitalization for these populations.^2,3 If severe enough, RSV can go on to result in hypoxia, apnea, and acute respiratory failure. In the United States, it is estimated that between 60,000-160,000 of those adults 65 years of age and older are hospitalized due to RSV each year, while between 58,000 and 80,000 of those younger than 5 years are hospitalized.² Table 1 includes risk factors for both children and adults.

Table 1: RSV Risk Factors

Annual outbreaks of RSV tend to start in the fall, with the peak occurring during the winter months. The spread of RSV occurs through respiratory droplets. Following infection, individuals will remain contagious for roughly 3 to 8 days. Interestingly, there is no long-term immunity produced following infection, thereby increasing vulnerability for reinfection. It is thought that nearly 90% of children will have been infected within their first 2 years of life and RSV will continue to reinfect older children and adults.^2,3

When it comes to RSV season, prevention is key. There have been several new advances in terms of RSV vaccine and monoclonal antibody development in this year alone, adding to palivizumab (Synagis; Sobi) which is the monoclonal antibody currently on the market for the prevention of severe RSV disease in select pediatric populations.⁴ On May 3, 2023, the FDA approved the first RSV vaccine, Arexvy, for those 60 years of age and older.⁵ Then, on May 31, 2023, the FDA approved the second RSV vaccine, Abrysvo, for those 60 years of age and older.⁶ Additionally, on August 21, 2023, the FDA approved Abrysvo as a maternal RSV vaccine, administered to pregnant women who are 32 to 36 weeks along in pregnancy in order to provide an expected 6 months of protection for their infant.⁶ Lastly, on July 17, 2023, Beyfortus, the second monoclonal antibody targeted against RSV, was approved by the FDA.⁷ Table 2 includes indications, administration schedules, and efficacy data for all 4 of these options.

Indications, Administration Schedules, and Efficacy Data

It will be interesting to see RSV hospitalization rates over this upcoming season following the rollout of RSV vaccines and monoclonal antibody administration.

References

1. Jain H, Schweitzer JW, and Justice NA. Respiratory Syncytial Virus Infection. StatPearls [Internet]. Updated June 20, 2023.

2.Respiratory Syncytial Virus Infection (RSV). Centers for Disease Control and Prevention (CDC). Reviewed August 4, 2023.

3. Vaccines and Preventable Diseases – RSV. Centers for Disease Control and Prevention (CDC). Reviewed September 28, 2023.

4. Synagis (palivizumab) [Package Insert]. MedImmune. March 2014.

5. Arexvy – Respiratory Syncytial Virus Vaccine, Adjuvanted [Package Insert]. GlaxoSmithKline. May 2023.

6. Abrysvo – Respiratory Syncytial Virus Vaccine [Package Insert]. Pfizer Laboratories Div Pfizer Inc. August 2023.

7. Beyfortus (nirsevimab-alip) [Package Insert]. AstraZeneca. July 2023.