Respiratory Syncytial Virus (RSV) | October 2023 | Clinical Corner

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October 1, 2023

 

RESPIRATORY SYNCYTIAL VIRUS (RSV)

BACKGROUND:

Respiratory syncytial virus (RSV) is a common virus that affects the lungs, making breathing difficult. It is also more common in the spring and fall seasons. The virus is common in children under 2 years, though people of all ages can get it. Illness caused by RSV is often more severe for young and premature infants, as well as older adults with poor health. It is no longer considered a children’s disease.

Each year in the United States, RSV causes approximately:

  • One million visits to a healthcare provider (non-hospitalization) among children younger than 5 years.
  • 58,000–80,000 hospitalizations among children younger than 5 years.
  • 100 – 300 deaths in children younger than 5 years.
  • 60,000 – 160,000 hospitalizations among adults 65 years and older.
  • 6,000 – 10,000 deaths among adults 65 years and older. 1

VACCINATIONS AND RECOMMENDATIONS:

  • Infants younger than age 8 months born during or entering their first RSV season (typically fall through spring) are recommended to receive one dose of Nirsevimab (50 mg for infants who weigh less than 5 kg and 100 mg for infants who weigh 5 kg or greater).
  • Children ages 8 to 19 months who are at increased risk for severe RSV disease and entering their second RSV season are recommended to receive one 200-mg dose of Nirsevimab.
  • Women between 32-36 weeks gestation may receive a single dose of Respiratory Syncytial Virus (RSV) vaccine.
  • Adults 60 years of age and older may receive a single dose of Respiratory Syncytial Virus (RSV) vaccine, using shared clinical decision-making.2

     

    EFFECTIVENESS:3

    Arexvy (GSK) - Adult

  • Reduced the risk of getting RSV-associated lower respiratory tract disease by 82.6% and the risk of having a severe disease by 94.1%.
  • Atrial fibrillation was reported in 10 people out of 12,500 who got the vaccine and 4 people out of 12,500 who received the placebo.
  • One person developed Guillain-Barre syndrome.
  • Two people developed Acute Disseminated Encephalomyelitis (ADEM). One died. 

    Abrysvo (Pfizer) - Adult

  • Reduced the risk of RSV-related lower respiratory tract disease with two or more symptoms by 66.7% and three or more symptoms by 85.7%.
  • One person got Guillain-Barre syndrome; another got a variant form of it.
  • Atrial fibrillation was reported by 10 people out of 17,000 who got the vaccine and 4 people out of 17,000 who got a placebo.

 

The FDA is requiring Pfizer and GSK to do post-marketing study on the risks of Guillain-Barre and ADEM. Both companies are voluntarily assessing the atrial fibrillation risk further.

 

There is currently no data on co-administration of the vaccines with other vaccines besides the influenza vaccine.

 

REFERENCES:

  1. https://www.cdc.gov/respiratory-viruses/whats-new/rsv-update-2023-09-22.html
  2. https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/disease-pop-immunization/rsv-vaccine.html
  3. https://www.webmd.com/vaccines/news/20230609/what-adults-need-to-know-about-the-new-rsv-vaccines