Over the next few months, most of the U.S. will experience the annual explosion of respiratory infections in children from respiratory syncytial virus (RSV). There will be 1.5 million pediatrician visits and nearly 80,000 hospitalizations of children because of this virus.
As a pediatrician and neonatologist, I have cared for many infants who require hospitalization from RSV infections, with some requiring a breathing tube and care in an intensive care unit (ICU). Parents are surprised to learn that most infants hospitalized for RSV infection are otherwise healthy, and half of those children are under the age of 6 months.
I also have a personal connection to the potentially devastating effects of RSV infections in young children. I am the oldest of six children, and my brother Kevin was born when I was 9 years old. He was born with a serious congenital heart defect called transposition of the great arteries. Shortly after birth, he was transferred to a neonatal ICU (NICU) and required life-saving surgery. At 10 months old, he was infected with RSV while living at home. Despite extensive efforts, he passed away in a pediatric ICU.
Infants at highest risk for the most severe complications of RSV infection are those with congenital heart disease like my brother, formerly premature infants that I now care for in the NICU, and those with chronic lung disease. These medically fragile patients account for many of the roughly 250 annual U.S. deaths in infants from RSV.
Unlike when my brother was born, there are now two new tools that significantly reduce the severity of RSV infection in children under 2 years old.
One option is Pfizer’s bivalent RSV prefusion F protein vaccine (Abrysvo), a vaccine for pregnant individuals that generates protective antibodies that cross the placenta and ultimately protect infants. Clinical studies demonstrate strong protection by these antibodies against severe RSV infection for the first 6 months of a child’s life. While the trial, which enrolled women at 24 weeks’ gestation and beyond, found a potential signal that the vaccine is associated with a higher rate of preterm births, the difference was not statistically significant. However, in an effort to reduce any potential risk, the FDA specified in its approval that the vaccine be given at 32 to 36 weeks’ gestational age.
The second tool to prevent severe RSV infection is a monoclonal antibody called nirsevimab (Beyfortus). The single long-acting injection functions similarly to traditional childhood vaccines and can be given in the first week of life. Specially formulated antibodies generate long-lasting protection from severe RSV infection, more so than any other previously offered monoclonal antibody. It is approved for all infants in or entering their first RSV season and for high-risk children entering a second RSV season, like my brother Kevin. CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended both the maternal vaccine or nirsevimab as good options to protect infants against serious RSV-related outcomes.
These two strategies have shown a greater than 70% reduction in severe respiratory infections like pneumonia in children, which typically requires hospitalization. Furthermore, new research suggests that widespread (100%) uptake of the maternal vaccine has the potential to cut annual hospitalizations in half and reduce emergency department visits by 31.8% among the nations 3.7 million newborns each year. It could also lead to $691.8 million in direct medical cost-savings and up to $110 million in indirect cost-savings.
Given recent reports of access concerns and questions about insurance coverage of these interventions, it is imperative that expectant mothers and families with young children, particularly those with chronic health issues, discuss with their healthcare providers the anticipated availability of these tools. Pediatricians, obstetricians, and family medicine physicians must act now and disseminate both education about the benefits of these interventions and how to receive them when available. They should encourage vaccination in pregnant people or monoclonal antibodies for their qualifying children.
There must now be concerted efforts from governmental agencies, public health institutions, and healthcare providers to disseminate information about both the availability and benefits of these protective interventions to the public. These advocacy efforts for improving children’s health are vital given public concerns regarding the safety of new vaccines and drugs.
I will never forget walking downstairs on March 15, 1995, and the confusion of seeing my relatives sitting around our kitchen table. My parents took me into our living room and explained that my younger brother Kevin, whom I’d seen just the day before, had died while I was sleeping. They had to repeat the same heart-wrenching talk as each of my three younger sisters woke up that morning.
As a pediatrician now, I will advocate for the widespread, equitable use of these new tools to ensure that fewer families have similar devastating conversations with their loved ones. While telling my family about the new preventive vaccine and nirsevimab for RSV, my sister Erin — now 31 but only 4 years old when Kevin passed — put it best, “What an amazing gift that is for families like ours to now have.”
Sean Cullen, MD, PhD, is a neonatologist and a Pediatric Scientist Development Program research fellow at Weill Cornell Medicine in New York City. He practices at NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns. You can find him on X @seanmcullen.
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