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New Preventive RSV Shot Recommended for all Infants

Last year, pediatricians worried as we saw news stories about children hospitalized with RSV, a respiratory virus that can cause severe infection in some kids.

This year, while we remain concerned that RSV can affect many children, we are grateful that a vaccine is now available to protect babies from severe outcomes and hospitalization. In August 2023, the CDC Advisory Committee on Immunization Practices recommended nirsevimab for infants aged <8 months born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk of severe RSV disease entering their second RSV season.

Infants and older babies now can get nirsevimab, a monoclonal antibody designed to protect infants as well as young children who are at increased risk of severe outcomes from RSV. I encourage parents of infants to learn more about nirsevimab and how it can help.

Here are some commonly asked questions and answers about RSV.

What is RSV?

RSV, or respiratory syncytial virus, is a virus that normally affects the lining of the upper airway, such as the nose and throat. When the virus is limited to the upper airway, patients tend to experience congestion, a runny nose, coughing, sneezing, a sore throat and a fever.

Sometimes, RSV can cause more severe illness and affect the lower respiratory tract, such as the lungs. Symptoms of a lower respiratory tract infection may include wheezing, worsening cough, rapid or labored breathing, respiratory distress, bluish skin or fingernails and decreased urination. These are signs that parents or caregivers should call for medical advice, which could include bringing the child to urgent care or a pediatric emergency department.

Who is at High Risk for Severe RSV?

While RSV tends to be mild for most children, some children are at high risk for a severe course of the illness. Children at high risk include:

  • Babies born prematurely
  • Infants younger than 6 months of age
  • Children with asthma or other forms of chronic lung disease
  • Children with cystic fibrosis
  • Children with congenital heart disease
  • Immunocompromised children

Is RSV a Big Deal?

For some children, yes. Here are some statistics regarding RSV from the U.S. Centers for Disease Control and Prevention:

  • Approximately 68 % of infants are infected within the first year of life, and nearly all are by age 2.
  • Premature infants born at less than 30 weeks of gestation had hospitalization rates three times higher than infants born at full term.
  • Nearly 80 % of children hospitalized with RSV under age 2 had no underlying medical conditions.
  • Approximately 2-3 % of all infants will be hospitalized with RSV.
  • RSV-associated hospitalization rates are highest in children ages 0-5 months, and decrease as children grow older.

These statistics are among the reasons I urge parents and caregivers to take RSV seriously.

How Can I Prevent Severe RSV?

Nirsevimab is a monoclonal antibody product now available for all infants under 8 months born during or entering their first RSV season. (A monoclonal antibody works differently in the body from a vaccine but also creates immunity.)

Nirsevimab also is recommended for infants and children ages 8-19 months who are at increased risk for severe RSV disease and entering their second RSV season.

Infants born shortly before or during the RSV season, which is typically October through March, should receive nirsevimab within a week of birth.

The intramuscular injection is given in the baby’s thigh. According to the CDC, some babies develop a rash within two weeks of injection. Other side effects may include injection site reactions, such as sore or red thighs.

Protection from nirsevimab is expected to last about five months, roughly the time of RSV season.

Patients can get the RSV vaccine at the same time as other childhood vaccines, as well as when getting flu or COVID-19 vaccines (if they are old enough).

How Else Can I Protect My Child from RSV?

Even though most children end up catching RSV at some point, there are some steps parents and caregivers can take to reduce their risk, including avoiding contact with sick people and limiting time children spend in crowded spaces. Proper hand hygiene is also a helpful way to minimize spreading germs.

What if My Child Gets RSV?

Don’t panic. Most children get RSV at some point in childhood, and for most children, symptoms are no worse than other types of colds. Symptoms are usually worse around days 3, 4 and 5, and then start improving. It may take a few weeks before symptoms completely clear up.

Patients are most contagious 24 hours before a fever and while having a fever. The period of viral shedding during which infants are contagious is usually three to eight days but may last longer for some.

If your child is feeling unwell, rest and fluids can help. Parents of young children may need to suction their baby’s nose. Over-the-counter pain relievers, such as acetaminophen, can be given; be sure to read dosing instructions. If your child develops more severe symptoms, reach out to your healthcare team for advice.

The RSV vaccine can be a gamechanger for many children. I am confident that the vaccine is safe and effective, and the American Academy of Pediatrics agrees. Having your baby receive nirsevimab can go a long way toward preventing severe illness. If you have questions about nirsevimab, reach out to your pediatrician or ask about it at your next visit.

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