The following piece was written by Nicholas Schey, MD, a pediatrician at Bon Secours Pediatrics of Mechanicsville.
As the winter and cold season approach, it’s hard to browse a news website without seeing a headline relating to RSV, also known as respiratory syncytial virus. And for good reason – last year was one of the worst for RSV on record, and there are currently multiple new products available to help protect people against RSV.
Hopefully, armed with the information in this article, you can avoid panicking when you get that seemingly inevitable call from your child’s preschool that they were exposed to RSV.
Is RSV as scary as it’s cracked up to be?
While RSV can potentially be dangerous, the vast majority of babies that acquire RSV will have a mild illness and recover fully. Around 1 to 2 percent of babies with RSV require hospitalization, which means that at least 98 percent will have a milder illness.
Almost all babies that are hospitalized due to RSV recover fully as well. In recent years, the overall risk of a child dying from RSV is roughly the same as it is for influenza. The highest risk is in very young infants, infants born prematurely and those with underlying health problems.
RSV is one of dozens of viruses that affect the respiratory tract. These viruses are commonly referred to as “cold viruses,” usually infecting the nose, throat and larger air passages in the chest, causing a cold or flu-like illness. They are sometimes called upper respiratory infections, or URIs.
In rare cases these viruses can travel lower into the respiratory tract and affect the lungs, sometimes called lower respiratory tract infections, or LRTIs, occasionally causing more serious illness.
Because of differences in the shape of their air passages and in their immune systems, young children and infants are particularly susceptible to a specific type of LRTI called bronchiolitis. This is different from bronchitis, which is common in older people. Many cold viruses can cause bronchiolitis, but RSV is most likely to do so. In fact, in children under 5 years old, RSV causes about 20 percent of hospitalizations for LRTIs, most of which is from bronchiolitis.
How do I know if my child has RSV, and what should I do?
The symptoms of RSV are the same as those of other cold viruses. This includes cough, nasal congestion, runny nose, fever, red eyes with discharge, vomiting and diarrhea. In fact, the only way to distinguish RSV from other cold viruses is by testing, which is done through a nasal swab similar to a COVID test.
However, as with most cold viruses, there is no specific treatment available for RSV, so in many cases a test is not necessary. In fact, if your child is breathing and drinking well, and not having fevers, you may be able to just monitor them at home. If you have any doubts, however, you should always consult with your pediatrician.
The main reasons for hospitalization due to an RSV infection are respiratory distress and dehydration. Therefore, if you see the following signs you should seek care right away:
- For respiratory distress: Rapid breathing, chest or belly forcefully moving with breaths, flaring of the nostrils or sucking in of the skin between the ribs during breaths (retractions)
- For dehydration: Decreased urinating combined with pale skin, dry mouth, sunken eyes, lethargy or listlessness
Fever is not dangerous in itself, but any infant under 2 months of age with a fever (100.4 or higher) should be taken to an emergency room right away to evaluate for a serious underlying infection. For older children, consider scheduling an appointment with the pediatrician if you’re worried, your child is very fussy or if fever lasts more than a day or two.
Should my baby get a vaccine against RSV?
There are two new products on the market specifically for kids to help prevent RSV disease in children:
- The RSV vaccine (brand name AbrysvoTM): This is the first-ever approved traditional vaccine against RSV. Like all vaccines, it works by stimulating the body’s immune system to be able to fight off the real infection if it is exposed.The RSV vaccine is not given directly to infants, as it’s been difficult for scientists to develop an RSV vaccine the works well in an infant’s young immune system. Rather, when given to a pregnant woman at the right time of pregnancy, the mother creates antibodies that pass to the infant and provide protection for the first few months of life, when the risk is highest.
- Nirsevimab (brand name BeyfortusTM): This treatment contains already-formed antibodies against RSV. Thus, it is not technically a “vaccine” in the traditional sense, and the protection it provides is usually shorter-lived than a traditional vaccine. Scientists refer to this type of treatment as a “passive immunization.”Nirsevimab is recommended for any baby from birth to 8 months old whose mother did not receive the RSV vaccine, as soon as possible during their first RSV season (October to March). One dose provides protection for the entire season.
As with any immunization, these are not 100 percent protective against RSV, but they are very effective in preventing serious disease. Nirsevimab appears to decrease the chance of hospitalization due to RSV by about 80 percent, which is very effective for any immunization.
Both also appear to be extremely safe in the thousands of patients that received them in the studies prior to their approval.
So, which option is best for your baby?
Both new products seem to be equally effective, so you should strongly consider whichever mother or baby have the opportunity to get. Receiving both doesn’t seem to increase protection, so at this point, experts are recommending one or the other.
How do I get an RSV immunization?
Now that you’re all reared up to go out and get your baby protected against RSV, I regret to have to bring one final bit of reality to the discussion. Despite being recommended for all babies, there will likely be a delay before they are covered by many health insurance plans.
It has been announced that nirsevimab will be covered under babies eligible for Medicaid coverage for this season. However, most private plans have not yet announced whether they will cover the treatments. As of the writing of this article in early October of 2023, our pediatric offices are hoping to have nirsevimab available for Medicaid-eligible patients very soon, but we do not know when we will begin having it available for the various private plans.
If you want to be proactive, you can reach out to your obstetrician, pediatrician or health plan periodically to see if they have these treatments available and if they are covered.
Here’s wishing you and your family a healthy and safe fall season, with many more pumpkin-spiced treats than sniffles!
Learn more about the pediatric services we provide at Bon Secours.
