ByDaryl Austin
Published November 21, 2023
• 7 min read
It’s a sneaky, nasty illness that strikes two of society’s most vulnerable groups and kills some 160,000 people a year. Finally, vaccines and drugs have arrived to thwart it. That means new hope for children under 5 and adults 60 and older.
“After decades of work, there are now three new products available for prevention of RSV (respiratory syncytial virus),” says Laura Hammitt, a physician and director of the infectious disease prevention program at the Center for Indigenous Health at Johns Hopkins Bloomberg School of Public Health.
Nearly all children are infected with RSV by age 2, but for many, its symptoms are no worse than ones associated with the common cold. For others, RSV can be deadly. The U.S. Centers for Disease Control and Prevention (CDC) estimates that, in the United States, some 58,000-80,000 kids under age 5 and some 60,000-160,000 adults ages 65 and older are hospitalized annually because of the virus. Globally, the National Institute of Allergy and Infectious Diseases notes that RSV impacts both these groups—and individuals who have a weakened immune system—altogether affecting about 64 million people and causing some 160,000 deaths every year.
“RSV can be a nasty respiratory virus,” says Bill Hanage, associate director at the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health. It “can cause very serious illness, hospitalization, and death.”
While these three new products can help, news reports of shortages have triggered widespread confusion and concerns. Here’s what the experts say about which new vaccine or drug may be right for you or your loved one.
Understanding the virus
RSV is an airborne respiratory virus that typically circulates in the winter months of November to March. The virus is spread by respiratory droplets transferred from a sick person to well person or by touching a surface where the droplets are present, then touching one’s eyes, nose, or mouth.
When contained to one’s upper respiratory tract (nose, throat, and mouth), RSV symptoms include a cough, nasal congestion, or a mild sore throat. “The real problem arises when RSV attacks the lower respiratory tract,” explains Trahern Jones, an emergency medicine pediatrician who specializes in infectious diseases at Intermountain Primary Children’s Hospital in Salt Lake City.
In this situation, RSV replicates inside the large and small air passages of the lungs, especially the bronchioles. As these passages become inflamed and swollen, the person’s airway becomes congested with mucus. “Many of us physicians have seen it hundreds of times: a small baby, their belly and chest pumping up and down, nostrils flaring as they struggle with each gasp of air,” Jones explains.
He says that doctors often feel helpless when treating these small patients because there are no effective treatments for RSV in the traditional sense. Antibiotics and antimicrobials can’t kill the virus so all physicians can usually do is provide supportive care like oxygen and fluids until the infected person’s immune system eliminates the virus.
This is why preventive medicines for RSV have been so eagerly anticipated.
Preventing RSV in the elderly and immunocompromised
Of the three new RSV-related preventive products, two are vaccines. Both are available for adults 60 years and older and for people who suffer from chronic heart or lung conditions or are otherwise immunocompromised.
One vaccine is Arexvy, manufactured by GSK; the other is Abrysvo, manufactured by Pfizer. The U.S. Food & Drug Administration (FDA) approved both vaccines for this age group in May of 2023.
Both vaccines have a strong safety profile and are proven to provide protection against RSV for at least two winter seasons. In clinical trials, Arexvy was shown to be 83 percent effective and Abrysvo was shown to be 89 percent effective.
“These are excellent effectiveness rates for a respiratory virus vaccine – even better than the yearly flu shot, which I would never go without,” says Jones.
Preventing RSV in infants
Abrysvo is unique, however, because 3 months after it was approved for the elderly, it was also approved for pregnant women to take during their third trimester of pregnancy to pass protection in the form of RSV antibodies along to their unborn baby.
In clinical trials, Abrysvo was shown to be 82 percent effective at preventing severe RSV infections in baby for 90 days after birth and 69 percent effective for 180 days.
“This form of protection is called passive immunization because the infant is relying on antibodies produced by the mother before their birth and not their own immune cells,” says Shweta, an infectious disease physician and assistant professor of medicine at Mayo Clinic College of Medicine and Science, who uses one name.
In addition to the protection provided through their mother’s antibodies, infants can also be shielded from RSV through a non-vaccine drug injection called Beyfortus.
It’s manufactured by AstraZeneca and Sanofi and was approved by the FDA in July of 2023. “Beyfortus targets specific parts of the virus, preventing it from entering our cells and causing infection,” explains Jason Nagata, a pediatrician at UCSF Benioff Children’s Hospital in San Francisco. The drug has been shown to reduce the risk of RSV-related hospitalizations and healthcare visits in infants by about 80 percent.
The CDC recommends one dose of Beyfortus for all infants younger than 8 months that are born during–or entering–their first RSV season. For a small group of 8- to 19-month-olds, another dose is recommended in their second RSV season.
What’s behind the shortages?
Soon after its approval, however, shortages of Beyfortus began. Its manufacturer issued a statement citing “unprecedented demand” that depleted much of the drug’s supply.
In addition to shortages, Nagata says there have also been “financial barriers” for many families to be able to get the shot. While most health insurance plans are required to cover the cost of preventive medicines like Beyfortus, a legal loophole in the Affordable Care Act allows insurers a year to add new products to policies, and some companies have been dragging their feet.
“Beyfortus could have been rolled out with an allocation plan to ensure equitable access and to ensure that children at greatest risk would be able to be protected,” says Hammitt. “This didn’t happen initially, so availability of the RSV shot for babies differs widely across the country.”
Elizabeth Mack, a pediatric critical care physician at MUSC Children’s Health in Charleston, says the CDC is aware of the issues and has updated their guidance accordingly “to focus on infants 6 months and younger and those with underlying health conditions.”
Preventive care at home
While Shweta says it’s “unknown when this supply deficit will end,” vulnerable families and others should implement preventative measures to limit the spread of RSV infection. Such measures include washing hands frequently, covering one’s cough or sneeze, staying home when sick, and frequently sanitizing high-contact surfaces.
And because RSV is just one serious respiratory virus that circulates this time of year, staying up to date on annual vaccines can also be helpful in enhancing immunity. Mack says that “the recipe for success is to vaccinate everyone 6 months and older for influenza and COVID-19, and everyone that’s eligible for RSV.”
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