Since May of 2023, two vaccines for Respiratory Syncytial Virus (RSV) infection have been approved by FDA. If not familiar with RSV, friends would start asking the questions, “What could this virus do to me?” “How dangerous this virus is?” “Do I really need to concern about it?” etc. Having been always intelligent, my friends need to know about the virus before taking the vaccination.
Key facts:
- RSV disease affects people in every country, young and old. —It is a globally prevalence cause of lower respiratory tract infection in all age groups (WHO).
- The risk in different age groups is different. RSV infection in infant and young children could be fatal. People aged 65 years or older have higher hospitalization rate and the mortality rate among frail elderly is similar to influenza. Most people take one week or two to recover after RSV infection (WHO).
- RSV is the leading reason that babies are hospitalized in the United States (CDC Update on RSV and new vaccine recommendation, Sept. 2023).
- Symptoms are similar to flu. Running nose; decreased appetited; coughing; sneezing; fever; wheezing (CDC).
- RSV is highly contagious. RSV season is typically in fall and winter (CDC).
The Numbers* :
Each year in the United States, RSV causes approximately 1 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.
*CDC: Update on RSV and New Vaccine recommendation
The worry of “tripledemic”
COVID-19,influenza and RSV infections, all are from the highly contagious viruses. The three diseases start and surge similarly from fall through winter. Therefore, public health experts have been worrying that the surge of case numbers might overwhelm hospitals during fall and winter seasons. Individually speaking, when all three viruses loom concurrently in winter, the probability of one of the viruses sneaking onto you would be multiplied as you hang out in a supermarket. if we have the vaccination against those viruses in October each year, our immune-protection peaks in 2 months. Hence, we are able to gain the maximum protection during the peak of the viral spreading season.
–COVID-19, Flu and RSV are all respiratory viruses. They all spread through droplets from coughing. There are some differences. COVID-19 virus can also spread through aerosols. RSV can spread through the touching of contaminated surfaces (Ref. C. Macmillan, Tripledemic: What Happens when Flu, RSV and COVID-19 Cases Colliide?” Jan, 2023. Yalemedicine.org). The ways of prevention are similar, if not all the same, such as wearing mask and washing hands.
— Unlike COVID-19 and influenza, currently, no anti-viral medications available for RSV adult patients. To treat the infection of COVID-19 virus, we have the highly effective antiviral drugs paxlovid, molnupirvir and remdesivir. To fight influenza virus, we have the anti-viral drugs available such as oseltamivir, zanamivir, baloxavir and peramivir. However, there is none of anti-viral drugs recommended by CDC to combat RSV for adult patients. Most cases of RSV disease have mild symptoms, and go away in 1-2 weeks. For infants and young children, FDA has approved two RSV antibody products, nirsevirmab and palivizumab, to prevent severe RSV disease. CDC does not use the term “for RSV treatment”. By nature, those antibodies should be able to neutralize the virus if a baby is infected. However, for elderly or people of high risk primary have to rely on vaccination for protection against RSV.
—Some of us may have the experience of seemingly intractable coughing for a week after weeks in a winter season. There have been times when people resort to antibiotics for any type of infectious illness. Repetitive courses of antibiotics such as amoxicillin, azithromycin or levofloxacin etc. do not provide any signs of symptomatic improvement. It is because antibiotics are for bacterial, having no effects on viruses. COVID-19,Flu and RSV are respiratory viruses. Those viruses, as well as bacteria, cause nearly indistinguishable symptoms. It is impossible to diagnose each of them simply based on symptoms. Identifying which viral infection is necessary to opt to an effective medication. At present, there are home diagnostic kits and lab tests available not only for COVID-19, as we all know, but also for flu and RSV. The opinion is that, to save the all the troubles, my friends would be better to take all the available vaccines, targeting COVID, flu and RSV. If aged 65, or 19-64 but having the pre-existing conditions (see below, the same for the high risk of RSV), those friends should get a pneumococcal vaccine as well.
RSV vaccines
Arexvy (made by GSK) and Abrysvo (made by Pfizer). CDC recommends that adults age 60 years and older may receive RSV vaccination, using shared clinical decision-making. This means that healthcare providers should discuss with those individuals about if a RSV vaccine is appropriate for them. Physicians, nurse practitioners and pharmacists are among those healthcare providers. Simply saying, friends may conveniently have RSV vaccination in a pharmacy like flu. But unlike COVID or flu, for which vaccinations are routinely recommended, healthcare providers would ask questions for discretion, ensuring the best health benefits from a RSV vaccine.
- Arexvy and Abrysvo both are approved for the prevention of lower respiratory tract disease caused by RSV in individuals 60 years of age and older.
- In addition, ABRYSVO is approved for pregnant individuals at 32 through 36 weeks gestational age for the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus (RSV) in infants from birth through 6 months of age.
- Abrysvo is bivalent, meaning that it protects against both subtypes of RSV A and RSV B. Although Arexvy is technically not bivalent, trials showed it protected against both the A and B strains of RSV.
- Administration of RSV vaccine on the same day with other adult vaccines is acceptable.
Both RSV vaccines are currently approved as a single dose with more than 80 % efficacy in the firs RSV season after vaccination. Clinical studies are being carried out to decide whether boosters or annual vaccination are required.
The people are most likely to benefit from RSV vaccination
Adults ages 60 years and older who are at higher risk for severe RSV disease include:
- those with chronic medical conditions such as:
- lung diseases (e.g., chronic obstructive pulmonary disease, asthma)
- cardiovascular diseases (e.g., congestive heart failure, coronary artery disease)
- neurologic or neuromuscular conditions
- kidney disorders
- liver disorders
- hematologic disorders
- diabetes mellitus
- moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment)
- those who are frail
- those of advanced age
- those who reside in nursing homes or other long-term care facilities
- Those whom a health care provider determines have the increased risk of severe respiratory disease
The final comment
The attempts of developing a RSV vaccine started as early as 1960s, It has taken more than 60 years to today’s success of having the vaccines approved. What does this tell us? The multitude of discretion for the safety and efficacy of the vaccines for people from research scientists, FDA and CDC is nothing but tremendous.
Resource:
Respiratory-syncytial-virus-disease , who.org. int
Frequently Asked Questions About RSV Vaccine for Adults, CDC.gov
Update on RSV and new vaccine recommendation, Sept. 2023. CDC.gov
Tripledemic: What Happens when Flu, RSV and COVID-19 Cases Collide?” C. Macmillan, Jan, 2023. Yalemedicine.org
PurenHealthInfo.com 