Respiratory syncytial virus (RSV): New vaccines, shortages and protecting those at risk

Respiratory syncytial virus (RSV) has received a lot of attention lately, but this common respiratory virus has been around for a long time. Symptoms are usually mild in children and adults and can be easily mistaken for allergies or a cold. But for some people, such as infants and older adults, RSV can be serious and lead to hospitalization. Andrea Mora, PharmD, a clinical associate professor of pharmacy practice at the Texas A&M University Irma Lerma Rangel School of Pharmacy, explains how to protect those at risk for severe RSV.

RSV can be contracted when an infected person coughs or sneezes and infected respiratory droplets come in contact with a non-infected person’s mouth, nose or eyes. It can also be contracted by touching an infected surface and then touching your mouth, nose or eyes. According to the Centers for Disease Control and Prevention, CDC, symptoms such as a runny nose, coughing, sneezing, fever and wheezing typically appear four to six days after being infected. An infected person is usually contagious for three to eight days; however, some infants and those with weakened immune systems can still spread the virus for as long as four weeks after symptoms have subsided.

Although RSV is very common, it can be serious. “Older adults with chronic conditions, such as lung or heart disease, are at higher risk of severe infection. Age-associated declines in immune function may also contribute to the severity of infection,” Mora said. “Infants are also at increased risk for severe disease because of their immune systems not being fully developed and their very small respiratory anatomy, making it difficult to breathe and function properly when inflamed.”

 The best way to protect those who are most vulnerable from a severe case is to get vaccinated. There are currently two Food and Drug Administration-approved RSV vaccines for adults aged 60 and older, RSVPreF3 (AREXVY) and RSVpreF (ABRYSVO). ABRYSVO is also approved to be given to pregnant women at 32 to 36 weeks of pregnancy to protect babies in the first six months of life.

Also approved this year is nirsevimab (BEYFORTUS), a monoclonal antibody immunization product produced by Sanofi and AstraZeneca, which the CDC recommends for infants under 8 months old and some children between 8 and 19 months old who have underlying conditions that put them at risk for a severe case of RSV.

Beginning in October, the demand for nirsevimab was higher than the manufacturer expected, causing a worldwide shortage that continues today. Although other RSV vaccines are available, Mora says the shortage of nirsevimab is worrisome because it is the only single dose option to protect infants if the mother did not get vaccinated while pregnant.

In response to the current shortage, the CDC issued an alert on Oct. 23 recommending that health care providers reserve nirsevimab for babies at the highest risk of severe RSV, including those 6 months old or younger and those with heart and lung conditions. The interim CDC recommendation also states that children 8 to 18 months old should receive pavalizumab (SYNAGIS), another monoclonal antibody. The major difference is that pavalizumab (SYNAGIS) is given monthly during the RSV season, which usually begins in the fall and peaks during winter.

Mora advises, as with the flu and common cold, to practice the mainstays of infection prevention: hand washing and avoiding close contact with others when you are sick. She also suggests parents stay in contact with their child’s pediatrician regarding their office’s availability of nirsevimab, especially as the supply issues begin to resolve.