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RSV Is A Serious Heath Threat, But The Public Knows Little About It
As the Centers for Disease Control and Prevention (CDC) determines whether to approve a vaccine against RSV for adults 60 and older, a new survey from the Annenberg Public Policy Center finds that the American public is ill-informed about the virus, unfamiliar with its most common symptoms, and more hesitant to recommend the vaccine to pregnant people than to older adults.
Worldwide, RSV is the leading cause of lower respiratory tract infections in babies. Though its symptoms are typically mild, the highly contagious RSV, or respiratory syncytial virus, can cause serious illness, hospitalization, and even death among infants and the elderly. By the age of 2, nearly all children get sick from RSV, which was one of three illnesses -- with the flu and Covid-19 -- contributing to last winter's "tripledemic" that overwhelmed some health care facilities. The CDC estimates that 58,000 to 80,000 children under age 5 are hospitalized annually because of it.
After decades of research, scientists have developed vaccines against RSV. In May, the Food and Drug Administration (FDA) approved two RSV vaccines for older adults, and this summer is likely to approve a maternal RSV vaccine for pregnant people to pass antibodies on to fetuses to prevent RSV in infants from birth up to at least six months of age.
The survey of more than 1,600 adults finds that less than half of Americans (49%) were likely to recommend the vaccine against RSV, if approved by the FDA, to a pregnant friend or family member. By contrast, most Americans (63%) would recommend a vaccine against RSV to a friend or family member aged 65 or older. (When the survey was fielded, the FDA had already approved the vaccine for adults 60 and older, although the shots were not yet available.)
"Those who recall the stress that the tripledemic placed on the nation's hospitals last fall will understand why older individuals and those who are pregnant should discuss the advisability of RSV vaccination with their health care providers," said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania and director of the study.
APPC's Annenberg Science and Public Health Knowledge survey
The survey data come from the 11th wave of a nationally representative panel of 1,601 U.S. Adults, first empaneled in April 2021, conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded May 31-June 6, 2023, and has a margin of sampling error (MOE) of ± 3.3 percentage points at the 95% confidence level.
Download the topline and the methodology.
Data from earlier waves on Covid-19, society's "return to normal," vaccination, monkeypox, the seasonal flu, health misinformation, and related topics can be found here.
Underestimating the prevalence of RSV -- but awareness of potential severity
A quarter of the public (27%) expresses worry about contracting or having a family member contract RSV, less than the one-third (33%) who were worried in our January survey, which was conducted during the tripledemic. The decrease in concern is not surprising given that RSV circulates during the fall and winter, and there was media coverage of the surge of cases last winter that, combined with flu and Covid-19 cases, filled some hospitals.
The prevalence of this common illness is vastly underestimated by the public. Only 22% in the current survey say they know children who have had RSV -- and among these respondents, over half say they have known just one child or two children who have had it. Asked how many children contract RSV before the age of two, 2% of respondents say, "virtually all." According to the CDC, "Almost all children will have had an RSV infection by their second birthday."
But among the people who say they know children who have had RSV, its potential severity is clear. Among these respondents, over half (54%) say the illness was somewhat or very serious. "Most children with cold-like symptoms are not tested for RSV, but when a child becomes severely ill, it's more likely that child will undergo diagnostic testing," Jamieson said. While RSV can cause severe illnesses such as bronchiolitis and pneumonia, the CDC says it usually causes mild, cold-like symptoms -- like runny nose, coughing, sneezing, fever, wheezing, and decreased appetite -- and is often mistaken for cold or flu.
This does not mean, however, that some do not experience serious illness. Among 100 babies under the age of six months who get RSV, 1 to 2 may require hospitalization, the CDC says. Although RSV-associated deaths are "uncommon" in the United States, they nonetheless do occur at an estimated rate of 100 to 500 per year for children under five, according to the CDC. Worldwide deaths of children under 5 years old attributable to RSV exceed 100,000 annually.
Far fewer people say they know older adults who have had RSV. Only 6% of those surveyed say they know someone age 65 or older who has had RSV. Among this group of respondents, most (71%) say they know one or two people who have had it and most (72%) say the infection was somewhat or very serious. The CDC reports that among adults 65 and older, there are 60,000 to 160,000 hospitalizations per year from RSV, and 6,000 to 10,000 deaths.
Great uncertainty about RSV
Only small segments of the American public correctly answer questions about RSV. Most people say they are not sure. The survey found that:
Fewer than half recognize the symptoms of RSV
Fewer than half of those surveyed recognized some of the most common symptoms of RSV (respondents were asked to select all that applied):
Very few people incorrectly selected non-respiratory symptoms as associated with RSV:
The Annenberg Public Policy Centerwas established in 1993 to educate the public and policy makers about communication's role in advancing public understanding of political, science, and health issues at the local, state, and federal levels. Read more about our science and health surveys here.
FDA Approves Pfizer's RSV Vaccine For Older Adults
CNN —
The US Food and Drug Administration on Wednesday approved Pfizer's RSV vaccine for older adults, the second such shot approved for the common virus.
Earlier in May, the agency approved the world's first RSV vaccine for older adults, made by GSK. The vaccines could be available for seniors by fall, pending recommendations from the US Centers for Disease Control and Prevention and its vaccine advisers, who are scheduled to meet in June.
Respiratory syncytial virus, known as RSV, is a highly contagious virus that causes flu-like illness in people of all ages. Although RSV is often associated with babies and young children, it can also be dangerous for seniors. In the US, an estimated 159,000 adults 65 and older are hospitalized each year with RSV, and an estimated 10,000 to 13,000 die as a result of their infection.
In a clinical trial, the Pfizer vaccine – which will be marketed under the brand name Abrysvo – was 66.7% effective at preventing moderated lower respiratory tract illness with two or more symptoms and 85.7% effective at preventing illness with three or more symptoms in people 60 and older, according to Pfizer.
Members of the FDA's Vaccines and Related Biological Products Advisory Committee voted 7-4 with one abstention in February that there was adequate data to support the vaccine's safety and effectiveness.
The FDA is also reviewing Pfizer's maternal vaccine to protect infants and is expected to make a decision by the end of August.
More RSV vaccines may be on the way, too. Moderna is finishing its Phase 3 trial for an mRNA vaccine for RSV in older adults and expects to submit results to the FDA within the next few months. Bavarian Nordic also said it will report results from a Phase 3 trial of its RSV vaccine for older adults this year.
What Are The Side Effects Of The New RSV Vaccines?
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Fact checked by Nick Blackmer
Key Takeaways
The FDA has approved two RSV vaccines for those aged 60 and up, a group that is at a higher risk of developing severe disease, hospitalization, or death from the seasonal respiratory virus.
The most common side effects reported in clinical trials were relatively mild and similar to other vaccines.
Clinical trials show these vaccines are extremely effective at preventing severe RSV in older adults.
The Food and Drug Administration (FDA) has approved two separate vaccines to prevent respiratory syncytial virus (RSV) in older adults aged 60 and up.
GSK's vaccine, Arexvy, was the first-ever RSV vaccine to be approved in the United States when it earned approval in early May. Pfizer's RSV vaccine, called Abrysvo, followed suit just a month later.
Both vaccines show promising results in preventing severe RSV—a highly contagious virus that causes cold and flu-like symptoms. While RSV causes mild illness in most people, it can be deadly for young children and older adults, especially those with underlying medical conditions.
Abrysvo was found to be nearly 67% effective at preventing RSV cases with at least two symptoms and 86% effective against RSV cases with three or more symptoms in clinical trials. Arexvy was reported to be nearly 83% effective against RSV infections and prevented 94.1% of hospitalizations.
The clinical trial participants reported common side effects, including injection site pain, fatigue, muscle pain, headache, and joint stiffness. Overall, these vaccines have been very well tolerated.
"Both vaccines are protein subunit vaccines, which is a technology already well known to us and contains a harmless version of a protein found on the outside of the virus," said Hannah Nam, MD, an infectious disease specialist and assistant professor of clinical medicine at the University of California, Irvine.
The FDA noted that 10 cases of atrial fibrillation (irregular heart rhythm) were reported among Arexvy recipients within a month of vaccination, compared to four in the placebo group. Each group had approximately 12,500 participants.
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A few cases of autoimmune syndromes were observed among Arexvy recipients. Two patients developed a neurological disorder called acute disseminated encephalomyelitis after receiving influenza and RSV vaccines together at the same time, though researchers aren't sure whether either or both vaccines were the cause. There was also one case of Guillain-Barré syndrome, a rare neurological disorder that occurs when the immune system attacks its own nerves.
For Abrysvo, one case of Guillain-Barre syndrome and one case of Miller Fisher syndrome—a rare variant of Guillain-Barre syndrome—were reported out of the 19,000 individuals that received the vaccine.
"While both were rare events and have happened with other vaccines and infections, including the RSV infection as well, it is something that the FDA has asked the companies to study further," Nam said.
Many vaccines—including the flu shot and the Johnson & Johnson COVID-19 vaccine—can cause GBS as a rare side effect, according to Renuga Vivekanandan, MD, an associate professor specializing in infectious disease at Creighton University's School of Medicine.
But that doesn't mean there's cause for concern, she said, as the cases of GBS were very few. The typical protocol when a rare side effect is observed, she explained, is for the FDA to continuously monitor and collect data on vaccine side effects, which is what is being done with these RSV vaccines. There is also a vaccine adverse event reporting system (VAERS) where these cases can be reported.
"The vaccines have been approved after large trials with good outcomes to reduce severe disease in patients who might be at a higher risk for developing severe RSV infection," Vivekanandan told Verywell. "The best practice would be having an informed discussion with a primary care provider and making a collaborative decision."
The CDC estimates that RSV is responsible for at least 177,000 hospitalizations and 14,000 deaths among U.S. Adults each year, and these vaccines have the potential to save thousands of lives during flu season each year.
What This Means For You
If you or someone you love is over the age of 60, speak with your health care provider about whether one of these RSV vaccines is right for you once they're released later this year. These vaccines are considered safe and effective when it comes to preventing severe illness, hospitalization, and death from RSV in older adults.
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