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Should I Be Worried About The Respiratory Syncytial Virus (RSV)?

"We're not necessarily seeing RSV cause more severe disease this year than what we've typically seen, and it still is only a small percent of infected children that are requiring hospitalization," says Kristin Moffitt, M.D., an infectious disease expert at Boston Children's Hospital in Massachusetts. "But when so many children are infected at once, it leads to larger numbers of hospitalizations."

With that said, infants in particular may be experiencing more severe complications, notes Dr. Keren. "We're seeing a lot more infants admitted with severe bronchiolitis due to RSV," he says.

It's worth noting that even children who must be admitted to a hospital for treatment typically recover without further complications and are discharged within three to four days. Infants at higher risk for more severe disease may require longer hospital stays and medical interventions, such as intubation.

"The overwhelming majority of children with an RSV infection do very well and can be managed at home with fever medicine and attention to hydration," notes Dr. Moffitt.

What's Different About RSV This Year?

The early arrival of common respiratory viruses like RSV is "anything but typical," says Dr. Keren. In years prior, he notes that hospitals generally would see RSV infections rise in the fall and winter months, but this year the disease arrived early in April.

Dr. Keren also notes that hospitals are seeing a greater volume of RSV cases this year. "During the pandemic, there were a few cohorts of infants born who, due to social distancing and masking, probably didn't get exposed to these respiratory viruses, including RSV," explains Dr. Keren. "They were not able to build up an immune defense, leaving them vulnerable to more severe disease because they don't have that prior experience seeing that virus."

A Convergence of COVID-19, Influenza and RSV: Is This a Real Threat?

As we move further into the fall and approach the winter season, there are growing concerns about a possible convergence of COVID-19, influenza and RSV infections overwhelming hospitals. In regard to these viruses, Dr. Moffitt says it's difficult to predict what might happen next.

"For example, RSV cases may plateau early this year given how much transmission is ongoing right now, because with each RSV infection, people build up immunity to subsequent RSV infections," she says. "There are a lot of dynamics at play here that include population-level immunity to these viruses." So while Dr. Moffitt says it's possible that these three viruses will peak simultaneously, it's "not at all a given."

"What we're seeing right now is probably—I hope—the peak of the RSV epidemic curve," adds Dr. Keren. "There's a sense that maybe the number of cases we had this month is the same as the number last month, which would be a good sign…And so we're hoping that RSV will blow through and be on the decline at the time that flu is peaking."

Three Shots This Fall? What To Know About Getting The RSV, Flu And COVID Vaccines

The RSV season generally starts in the fall and peaks in the winter, but last year's struck a bit early. "So, my recommendation would be to get the RSV vaccine as soon as it's locally available," Presti says. 

Pfizer, the manufacturer of one of the RSV vaccines, expects its shot will be available in the late summer or early fall; GlaxoSmithKline, the manufacturer of the other, is working on a similar timeline. (And there's little difference between the two approved shots, Presti adds, so again, it comes down to what's on hand.) 

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One thing you will want to consider is spacing the RSV vaccine out from your flu and COVID vaccines. For one, Schaffner says, "I don't think there are too many people who want to get three [shots] at the same time."

And in studies, the influenza antibody response was better when the flu and RSV vaccines were given separately, Schaffner explains, though more information on RSV vaccine co-administration is expected soon.  That said, the COVID-19 boosters and flu shots can be given together — and last year, often were — so there's no need to make separate trips for the clinic or pharmacy for those.

How often will you need the three vaccines?

The influenza vaccine is one you need every year, ideally by the end of October, the Centers for Disease Control and Prevention (CDC) says. And remember: Adults 65 and older should get the high-dose version for stronger protection. (The CDC estimates that 70 to 85 percent of flu-related deaths occur among adults 65 and older.)

The COVID-19 vaccine schedule is still in flux, though many experts are in favor of moving to an annual shot in the fall as the virus settles into a more seasonal pattern. For now, older adults should pay attention to recommendations from health officials and stay up to date on their boosters. The CDC recently gave the OK for adults 65 and older to go back for a second dose of the bivalent booster.

As for RSV, Schaffner says the duration of protection from the vaccine has yet to be determined. "Early data indicate that the protection may extend beyond one year," he said, meaning an annual shot might not be necessary. "That said, stay tuned for further developments."

If getting three shots this fall seems like a lot, consider the alternative, Presti says. A vaccine is "a whole lot less of a stress on your immune system" than getting infected and seriously ill from one, or all, of these common viruses. "I understand that people are tired of it, but it's sort of something we should think about getting used to as just a way of preventing disease and keeping ourselves healthy."

The Long-awaited RSV Vaccine

Two vaccines to protect against respiratory syncytial virus (RSV) are now available for those over age 60, but a vaccine to protect young children is still in development. "The Long-Awaited RSV Vaccine" provides an update on RSV vaccine research. The article is published in the Journal of Interferon & Cytokine Research.

Infection with the highly contagious RSV can cause severe lower respiratory tract disease. RSV infection is particularly dangerous in infants and young children and in the elderly.

After decades of trying to develop an RSV vaccine, two pharmaceutical companies have finally proved successful. The U.S. Food and Drug Administration granted approval of Glaxo SmithKline's vaccine on May 3, 2023, and approved Pfizer's vaccine on May 31, 2023, both for use in adults over the age of 60.

"A single administration of prefusion stabilized F protein vaccine formulations provided high levels of protections against RSV-related lower respiratory tract disease," state the co-authors, John Altman, from Emory University School of Medicine, and Barry Rouse, from The University of Tennessee, College of Veterinary Medicine.

Approaches to protect newborns and very young children have generally focused on vaccination of pregnant women. The authors provide up-to-date information on ongoing vaccine trials, as well as on other RSV vaccines in development.

"This is a tremendously important advance, not only for the control of RSV, but also for vaccine design in general," says Journal of Interferon & Cytokine Research Editor-in-Chief David L. Woodland, Ph.D.

More information: John D. Altman et al, The Long-Awaited Respiratory Syncytial Virus Vaccine, Journal of Interferon & Cytokine Research (2023). DOI: 10.1089/jir.2023.0076

Citation: The long-awaited RSV vaccine (2023, July 21) retrieved 29 July 2023 from https://medicalxpress.Com/news/2023-07-long-awaited-rsv-vaccine.Html

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