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Published Jan 05, 2024 • 3 minute read
It is the leading reason babies under six months of age land in the hospital but, until now, there have been few options to protect infants from serious RSV (respiratory syncytial virus) infections. That is changing.
Last week, Health Canada approved a new vaccine aimed at protecting two of the groups most vulnerable to serious outcomes from the common virus – infants and older adults. The Pfizer Canada vaccine, called Abrysvo, is the second approved vaccine to target seniors aged 60 and older – the first, produced by GSK, was approved by Health Canada last year.
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But Abrysvo is also approved for pregnant people — the first vaccine that is aimed at protecting young babies through maternal vaccination.
“This is the first time we can help infants,” said Dr. Darine El-Chaar, a maternal-fetal medicine physician at The Ottawa Hospital. “It is exciting.”
It works the way other vaccines — including one for whooping cough — work, by passing maternal antibodies to the fetus through the placenta, something that offers protection early in the newborn’s life.
That could be a game-changer, especially in parts of Canada’s North that have among the highest rates of RSV in the world, said El-Chaar. While there is usually a specific season for RSV in southern Canada (although the pandemic has shifted it slightly), RSV can circulate throughout the year in the Far North, El-Chaar said.
“It can be quite devastating. Patients are often on oxygen support and need support for feeding. It can mean a stay in the hospital for a young family until their baby recovers from the lung infection.”
El-Chaar, who was on the advisory board for the vaccine in Canada, said she would like to see its cost covered for all pregnant people in Canada’s Far North. Some of the sickest babies from Nunavut end up hospitalized in Ottawa, which is a tertiary health centre for parts of Nunavut.
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The Abrysvo vaccine has yet to be recommended by NACI (the National Advisory Committee on Immunization), a necessary step before provinces would make it available. El-Chaar said she expects it to be available well in advance of next year’s RSV season, and maybe as soon as later this month.
It is part of a revolution in the treatment of RSV, a virus many people had never heard of before 2022 when a spike in severe cases overwhelmed some pediatric hospitals and made headlines. When an adult gets RSV, they typically have a mild cold-like illness, but for babies, with tiny airways, an initial infection can be severe.
In the fall of 2022, CHEO was among hospitals overwhelmed by the number of very sick infants, which forced it to create temporary critical care units around the hospital. President and CEO Alex Munter has previously said he visited one of those pop-up critical care units and was stunned to learn that the oldest child there was just eight weeks old.
Until now, there has been one antibody treatment for babies at the highest risk of poor outcomes from RSV, including premature babies with underdeveloped lungs and children with other health issues. That treatment, Palivizumab, is a monoclonal antibody that offers short-term protection to the most vulnerable. It is injected monthly during RSV season.
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Health Canada authorized another monoclonal antibody last April. Nirsevimab also offers passive immunity to babies and only needs to be given once a season, but is not yet available in Canada. In the United States, where it has been used, it is in short supply, said El-Chaar. It is both longer lasting and less expensive than Palivizumab, she said.
El-Chaar said the attention RSV has had in recent years will make it easier for her to talk to pregnant patients about getting vaccinated to protect their newborns when the vaccine is available. That is largely thanks to the recent “triple-demics” of RSV, COVID and flu in 2022, and 2023, to a lesser extent.
“We didn’t used to talk about it a lot. People only got to know about it if they had an infant infected. But last year, there was a lot of buzz about RSV because of the triple-demic. It is unfortunate we needed to go through that, though.”
Details about who will be eligible for the vaccine and who will pay for it are not yet known.
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