Did you know that “nearly every child will get RSV by the time they are 2 years old?” (Centers for Disease Control and Prevention [CDC], 2024b,).

Laura Kubin, PhD, RN, CPN, CHES, CNE

What is RSV?

Respiratory syncytial virus (RSV) is a common virus that affects the lungs of hosts; about 97% of children are affected by RSV (American Lung Association, 2021). Most people may mistake this for a common cold, or have no symptoms at all. However, infants less than 6 months of age, premature infants, and older adults with poor health are at risk for more severe illness that can lead to bronchiolitis or pneumonia (American Academy of Family Physicians, 2024; CDC, 2024b). These illnesses result in somewhere between 50,000-80,000 hospitalizations of children annually, and twice that for older adults (CDC, 2024c; CDC, 2024b). The symptoms of RSV in infants include a progressive worsening of runny nose, cough, and decreased eating or drinking (CDC, 2024b). Infants less than 6 months old will also present with irritability, decreased activity, and apneic periods (CDC, 2024b). Interestingly, RSV is not associated with fever (CDC, 2024b). RSV infections are seasonal, and typically occur in late fall to winter months in the U.S. However, according to the American Medical Association (AMA), the COVID-19 pandemic disturbed the seasonal nature of RSV, and it has not returned to predictable pre-pandemic patterns (2023). This is relevant because it disrupts the ability to prepare for and prevent typical RSV illnesses, which includes timing of vaccinations.

Prevention for Infants

Synagis

Prevention for infants with high-risk conditions, palivizumab (Synagis) is a medication that can be given to prevent RSV. This medication is a monoclonal antibody given monthly to about 2- 3% of infants considered high risk for RSV (AMA, 2023). High risk infants include: very young infants (typically < 6 months); infants born prematurely; American Indian and Alaska Native children; children with chronic lung (including cystic fibrosis), heart, or neuromuscular diseases; and children who are immunocompromised (CDC, 2024b). More widespread presence of infant’s receiving the RSV antibody (as discussed below) will decrease the demand for Synagis because once the antibody has been received, infants no longer need additional protection (AMA, 2023).

Infant Immunization

Immunization is now an option to prevent RSV in infants and young children. There are two strategies for immunizing infants against RSV. The first is a maternal vaccine given to the pregnant mother, the second is to give antibodies to the infant after birth (CDC, 2024b). Infants will not need both strategies. There is only one vaccine approved for use in pregnant mothers, Abrysvo by Pfizer. This vaccine is recommended for mothers who are in weeks 32-36 of pregnancy during the months of September through January (CDC, 2024b). This vaccination will protect the infant for 6 months after birth. If the pregnant mother has received the vaccine before, she should not receive it again, instead, the baby should be immunized after birth. Side effects of the Pfizer Abrysvo vaccine include pain at the infection site, headache, and nausea (CDC, 2024b). The CDC does report a possible risk of preterm birth and preeclampsia, but states these risks are under further study (CDC, 2024b).

If an infant’s mother was not vaccinated during pregnancy or the infant was born less than 14 days after maternal immunization, then the infant should receive the RSV antibody, nirsevimab. Nirsevimab is not a vaccine, but a monoclonal antibody that, instead of activating the infant’s immune system, is an antibody that protects against RSV (CDC, 2024b). Nirsevimab provides protection for 5 months; therefore, should be given within 1 week of the baby’s birth if they are born between October and March (CDC, 2024b). Older infants, 8-19 months of age who are at high risk can also receive nirsevimab (CDC, 2024b). In addition to pain, redness and tenderness at the site, infants are at risk of hypersensitivity to the injection. According to the AMA, “nirsevimab was shown to be 79% effective against RSV medically attended lower respiratory tract illness and 80% effective at preventing hospitalization” (2023). The American Academy of Pediatrics (AAP) has developed a very helpful algorithm to guide the decision-making process related to nirsevimab administration (AAP, 2024).

Adult Immunization

There are three vaccines currently approved by the Federal Drug Administration for use in adults 60 years and older against RSV. The current CDC recommendations are that adults aged 60-74 at high risk should receive the vaccination, and all persons 75 years or older should be vaccinated. Adults at highest risk for RSV include those with chronic cardiac, lung, liver, hematologic, and neuromuscular diseases, as well as those with severe obesity, immunocompromise, and living in nursing homes (CDC, 2024c; CDC, 2024d). Despite the alteration in the seasonal quality of RSV, vaccination is still recommended to occur between August and October; however, the AMA recommends getting the vaccine as soon as it is available (AMA, 2023; CDC, 2024a; CDC, 2024d). All of the vaccines are single dose and protection is reported to last 2 years, but is still being studied (CDC, 2024a; CDC, 2024d). Available vaccines include: GSK’s Arexvy (RSV F protein antigen), Pfizer’s Abrysvo (RSV F protein antigen), and Moderna’s MResvia (mRNA). Side effects of the vaccines include fatigue, fever, headache, nausea, vomiting, muscle and joint pain, and fainting (CDC, 2024a; CDC, 2024d). There is a risk of serious neurologic conditions like Guillain-Barre Syndrome (GBS) following immunization and this risk is still being analyzed. However, the CDC calculates the risk of being hospitalized from RSV to be “significantly higher” than a potential risk of GBS (CDC, 2024d). Respiratory syncytial virus (RSV) is a widespread infection that significantly impacts infants and older adults, with a particular risk for severe respiratory illnesses. Prevention strategies have Society of Pediatric Nurses | www.pedsnurses.org evolved with the introduction of vaccines and monoclonal antibody treatments providing critical protection for high-risk infants. For adults, especially those aged 60 and older, vaccines offer a promising defense against RSV, though certain side effects and risks, such as Guillain-Barré Syndrome, warrant continued monitoring. As research progresses and new immunization methods become available, the hope is to reduce the annual burden of hospitalizations due to RSV. Nursing efforts must continue to promote awareness and timely administration of these preventative measures, especially in populations most vulnerable to the severe effects of RSV.

References

American Academy of Family Physicians. (2024). Respiratory syncytial virus (RSV) vaccines and therapeutics.

https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/disease-pop-immunization/rsv-vaccine.html

American Academy of Pediatrics. (2024). Nirsevimab administration visual guide

https://downloads.aap.org/AAP/PDF/Nirsevemab-Visual-Guide.pdf

American Lung Association. (2021). RSV and infants: A respiratory disease that can be deadly.

https://www.lung.org/blog/about-rsv-and-infants#:~:text=RSV%2C%20or%20respiratory%20syncytial%20virus,severe%20and%20even%20life%20threatening

American Medical Association. (2023, Oct 12). RSV vaccines: Questions patients may have and how to answer

https://www.ama-assn.org/delivering-care/public-health/rsv-vaccines-questions-patients-may-have-and-how-answer

Centers for Disease Control and Prevention. (2024a). Healthcare providers: RSV vaccination for adults 60 years of age and over.

https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html

Centers for Disease Control and Prevention. (2024b). RSV in infants and young children.

https://www.cdc.gov/rsv/infants-young-children/?s_cid=SEM.GA:PAI:RG_AO_GA_TM_A18_RSV-Parents-Brd:rsv%20vaccine%20for%20babies:SEM00085&utm_id=SEM.GA:PAI:RG_AO_GA_TM_A18_RSV-Parents-Brd:rsv%20vaccine%20for%20babies:SEM00085&gad_source=1

Centers for Disease Control and Prevention. (2024c). RSV vaccine guidance for older adults.

https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/older-adults.html

Center for Disease Control and Prevention. (2024d). Vaccines for older adults.

https://www.cdc.gov/rsv/vaccines/older-adults.html