Preventing RSV in the Most Vulnerable Population

The infant is admitted into the ICU after being diagnosed with RSV. The young family is fearful and surprised as they are not familiar with the virus and how serious the situation has become in a quick period of time, seemingly overnight. All they know is their baby has a heavy ongoing cough, struggling to breath, and is crying and inconsolable.

Sadly, there has been no FDA approved antiviral RSV treatment says Octavio Ramilo, MD, chair, Department of Infectious Diseases, St. Jude Children’s Research Hospital, and it is more about keeping patients comfortable until they emerge from the severity of the virus. “The treatment is mostly supportive,” Ramilo said. “We provide oxygen to the baby; if the baby cannot take enough breast milk or bottle we support with IV fluids, and we suction the secretions.”

Ramilo explains the average patient spends 2 to 3 days in the hospital and in cases where the infant is admitted to the ICU, it can be 7 to 9 days in the hospital.

“But even when they go home, they continue to cough, not to sleep well, so recovery is slow. So it could be very challenging for the baby and for the family,” Ramilo stated.

Currently, RSV is the number one reason why infants are admitted to hospitals. According to the CDC, 58,000-80,000 children younger than 5 years are hospitalized due to RSV infection annually.

These aforementioned hospital scenarios might begin to slowly decrease, starting this year. The recent FDA approval of nirsevimab-alip (Beyfortus) may help prevent RSV in the infant population. Nirsevimab is the first prophylactic product indicated for the prevention of RSV lower respiratory tract disease (LRTD) in newborns and infants born during or entering their first RSV season, and for children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.

“I think this could be a game changer, because it could be a very effective way—based on the data that we learned from the clinical studies—[showing it was] very, very effective in preventing hospitalizations, and severe lung infections. So we hope this is going to be a major, major change,” Ramilo explained.

Nirsevimab has been called a ”passive immunization product” that is not a vaccine, but a monoclonal antibody, which has a different mechanism of action.

In an interview with Contagion, Ramilo goes into detail about the challenges clinicians face with managing infants with RSV, and the hope behind what this new monoclonal antibody might do in preventing severe RSV and hospitalization.