RSV Prevention

RSV is a major cause of hospitalization for infants. Every year, multiple infants from Heritage Pediatrics are hospitalized due to this infection. Thankfully, there are now ways to reduce the risk of severe RSV infections in infants. This is FAQ is intended to educate your family about this new product and help you decide if it’s a good option for your child.

What is RSV and who gets it?

RSV (respiratory syncytial virus) is a seasonal respiratory virus. It is a common virus — most children (~70%) are infected in the first year of life and almost all children (~97%) are infected by 2 years of age. Thereafter, recurrent infections occur throughout life — these are typically mild due to immunity that the body’s developed from the earlier infections.

Who is at risk for severe RSV infections?

RSV is the leading cause of hospitalization in infants in the United States. Two to three percent of infants are hospitalized with RSV. The risk of hospitalization is the greatest in the first months of life; risk declines with increasing age. Infants with the following medical conditions are at greatest risk of hospitalization from RSV: prematurity, congenital heart disease, chronic lung disease, and immunocompromising conditions.

When is RSV season?

The RSV season in Texas generally runs from October through March, with a peak in December or January. The peak of RSV season usually precedes the peak of flu season by 1 to 2 months. The Texas Health Department releases information about RSV cases throughout the state on their website (https://www.dshs.texas.gov/respiratory-syncytial-virus-rsv/respiratory-syncytial-virus-rsv-data) .

What are the symptoms of an RSV infection in infants and young children? What is the treatment?

RSV causes a lower respiratory infection called “bronchiolitis”. Young children with bronchiolitis will typically have mild runny nose and cough at the beginning of the illness, followed by cough and respiratory distress. They will often breathe faster than normal and have retractions; doctors will hear certain sounds with their stethoscope during the exam (wheezing, crackles).

There is no routinely recommended antiviral treatment for RSV bronchiolitis. Infants with RSV are helped by supporting their body while their immune system clears the virus. Frequent nasal suctioning, hydration, and monitoring the child’s breathing are the hallmark of caring for infants with bronchiolitis at home. Hospitalized infants with RSV are often given oxygen and IV hydration. Some hospitalized infants with RSV are given breathing treatments.

What is the new RSV prevention product? Is it effective? Is it safe?

Beyfortus (nirsevimab) is a new product developed after decades of research. It contains preformed antibodies that attach to a protein (the F protein) on the outside of the RSV virus. For infants entering their first RSV season, Beyfortus is given as one intramuscular shot. Eligible children entering their second RSV season receive two shots at the same visit. Ideally, eligible infants receive it shortly before RSV season begins. Infants born during RSV season should generally receive it within their first week of life. Protection begins immediately and lasts at least 5 months. Beyfortus provides longer protection per dose than Synagis, an older RSV prevention product that required monthly injections and is no longer available in the United States.

Clinical trials in both term and preterm infants have evaluated the safety and effectiveness of Beyfortus. Pooled results from the pivotal trials showed a 79% reduction in RSV lower respiratory tract infections requiring medical attention and approximately an 81% reduction in RSV-related hospitalizations over 5 months.

Protection lasts at least 5 months. Side effects were uncommon and generally mild. The most commonly reported reactions were rash and injection-site reactions, such as pain, redness, or swelling. Serious allergic reactions have also been reported.

Beyfortus was approved in Europe in November 2022 and by the US FDA in July 2023. The CDC provided recommendations for its use in August 2023.

How do I know if my child is eligible for Beyfortus?

The AAP and CDC recommend Beyfortus as an option for infants under 8 months of age who are born during or entering their first RSV season if their mother did not receive an RSV vaccine during that pregnancy, her vaccination status is unknown, or the infant was born fewer than 14 days after her vaccination.

For children 8 through 19 months of age entering their second RSV season, the AAP recommends Beyfortus for those with the following risk factors: birth before 32 weeks of pregnancy; chronic lung disease caused by prematurity or another significant newborn condition that required supplemental oxygen, diuretics, or chronic corticosteroid treatment during the 6 months before the season; hemodynamically significant congenital heart disease; lung abnormalities or neuromuscular disorders that increase the risk of severe RSV disease; severe immunocompromise; Down syndrome or another chromosomal condition that increases the risk of severe RSV disease; or cystic fibrosis with severe lung disease or weight-for-length below the 10th percentile. American Indian and Alaska Native children are also eligible.

What if the infant’s mother received an RSV vaccine during pregnancy?  Does the infant still benefit from Beyfortus?

Infants whose mothers received Abrysvo during that pregnancy at least 14 days before delivery generally do not need Beyfortus. Vaccination during a previous pregnancy does not replace the current infant’s need for RSV antibody protection.   Make sure you notify your pediatrician if your infant falls in this category.

Does Heritage Pediatrics recommend Beyfortus?

The doctors at Heritage Pediatrics recommend the use of Beyfortus for all infants who are eligible. Every year we see patients with both mild and severe RSV infections. Every year we have patients that are hospitalized from this virus. We are confident that the research conducted on Beyfortus demonstrate that it is effective and safe. We have seen this medicine significantly reduce the burden of RSV infections in infants since it’s use began.

We also understand that Beyfortus is a newer medicine and that families will have varying degrees of comfort with accepting a new medication. We are here to answer any questions you have regarding this product and hope the above FAQ document will help your family make an informed decision.

Is my child required to receive Beyfortus by the State of Texas or Heritage Pediatrics?

Beyfortus is not a required immunization for Texas nor Heritage Pediatrics.  It is optional risk reduction.

References:

• Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child 1986 140:543-546.
• Suh M, Movva N, Jiang X, et al. Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. J Infect Dis 2022 226(Suppl 2):S154-S163.
• Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics 2013 132:e341-348.