THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
A maternal RSV vaccine has gained approval from the FDA, and that is excellent news. Excellent. Why? Let’s find out.
An acronym for respiratory syncytial virus, RSV is one of the biggest terrors pediatricians in the United States face. And the fact that almost all children will have been infected with the virus by the time they reach age 2 only justifies the fear health practitioners have of the virus. The CDC even estimates that up to 80,000 children below 5 are hospitalized due to RSV. Worse still, among children below 12 months, the risk of severe infection is high, especially in the first six months of life. Considering the threat the virus poses, you would think a vaccine would have been manufactured and approved, but not quite.
Before I make a foray into how to prevent and manage RSV, let me briefly overview what RSV is. As the name strongly suggests, RSV is a respiratory virus, and it typically causes mild, cold-like symptoms. RSV symptoms will generally appear around four days to a week of exposure to the virus. These symptoms include congested or runny nose, appetite loss, fever, sneezing, sore throat, headache, coughing, and wheezing.
For the majority of individuals who have it, full recovery can be expected in seven to ten days. However, among infants and adults above 60, the risk for severe illness is much higher. Among children below 12 months, RSV is the single most common cause of bronchiolitis and pneumonia, with both of these conditions bringing to the table high risks of respiratory and health complications.
With all of that said, I think this is a safe point to get into the management and prevention of the infection. If a condition poses a high risk to the health of individuals, especially infants, one of the first things health authorities do is to explore the feasibility of an effective vaccine. After the drama of the last three years, I can understand how many Americans are disinterested in the idea of vaccines, but vaccines have existed long before COVID and will exist after COVID.
The RSV vaccine has been in the development pipeline for years, but there was little significant breakthrough until a few weeks ago when the FDA approved a maternal RSV vaccine. I know what you’re thinking – if a vaccine is just being approved, how has RSV been prevented over the years? Well, there are monoclonal antibodies that confer protection to children from serious illness with RSV. However, monoclonal antibodies are not vaccines.
I could write a whole article detailing the differences that exist between monoclonal antibodies and vaccines, but the summary is this: monoclonal antibodies are a type of passive immunity, while vaccines are a type of active immunity. And before you ask, active immunity is preferred because it lasts longer, much longer. With monoclonal antibodies for RSV, the immunity weakens over time, and they are pretty much useless as treatments for children who already have the infection.
So, you can see why it comes as excellent news that a vaccine has finally gained approval from the FDA. Moreover, the vaccine is maternal, meaning the child does not have to be inoculated, and protection can be developed right from the womb. This is the same strategy employed with the Tdap vaccine for tetanus, diphtheria, and pertussis, which has recorded success over the years.
The vaccine’s name is Abrysvo, a Pfizer product, and its exact effectiveness score in preventing severe infection in infants is 82%, which is high enough for the FDA to give their seal of approval. Although Pfizer states that side effects like fatigue, headache, nausea, and pain at the injection site were commonly reported among women who took the vaccine, there is no serious or lasting concern with these side effects.
While the Advisory Committee on Immunization Practices (ACIP), a body of the CDC, still needs to pass a resolution before the vaccine can be readily available on pharmacy shelves, everything is expected to be in order before fall when RSV infections are high.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist & Board Certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ & House call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants#:~:text=Today%2C%20the%20U.S.%20Food%20and,through%206%20months%20of%20age.
- https://www.washingtonpost.com/health/2023/08/21/maternal-rsv-vaccine-pregnancy-abrysvo/
- https://www.cdc.gov/rsv/index.html
- https://abcnews.go.com/Health/fda-approves-1st-maternal-rsv-vaccine-protect-infants/story?id=102431686
- https://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098
