By Brittany Grider, MD, Pediatric Hospitalist
It’s always a joyful moment when a new baby is born. Everyone in the family wants to come meet the new addition. A few days later, this precious little baby is struggling to breathe and needs to be in the intensive care unit (ICU) with respiratory syncytial virus (RSV) bronchiolitis.
RSV is a virus generally present in the winter, usually at its worst in January and February each year. We are starting to see cases of RSV in our community.
RSV is a respiratory virus that causes up to 240,000 deaths in children under the age of five worldwide each year. Babies under six months old are the most likely to need to stay in the hospital. In the United States, 0.5-1.7% of healthy children who become sick with RSV will die. The odds are worse for babies born premature, or if they have lung or heart disease, weakened immune systems due to cancer, immunodeficiency or developmental delay.
RSV generally looks like a common cold or allergies in healthy adults. Why is it so much worse in babies? Their immune systems are not fully developed, and they have never been exposed to this virus, so they are not able to mount a quick immune response to exposure to RSV. Also, their lungs are much smaller than an adult’s, so any inflammation of their airways is exponentially worse.
We are so very excited that there are now two new ways to protect our smallest family members from RSV:
Moms can get the Abrysvo vaccine during pregnancy. This works to protect the baby by having healthy moms build up their immune systems. Mom’s antibodies are transported across the placenta to the baby, and these antibodies protect the baby for four to six months after birth. This vaccine does need to be given at least 14 days before delivery so that there is time to build up those antibodies. This vaccine is usually recommended between 32-36 weeks of pregnancy
Babies (newborns up to eight months, and up to 19 months for babies who are at risk) can get the Beyfortus antibody after delivery. This is recommended for all babies under eight months going into RSV season whose mothers did not get Abrysvo, or who received it less than 14 days prior to delivery. This is a monoclonal antibody, much like Synagis, which protects the baby from RSV. Unlike what we give during pregnancy, Beyfortus is not a vaccine. Rather, this is a medication that introduces the antibiotics to the baby (much like if the mom is making antibodies that cross over the placenta) and allows for early recognition of the RSV particles. Beyfortus is expected to protect babies from RSV for at least five months.
These measures have been shown to decrease severe illness and hospitalization but may not prevent the mild “cold” and congestion associated with RSV. In addition to these interventions:
- Wash hands before interactions with the baby.
- Avoid sick contacts.
- Do not kiss babies.
These steps give us the best hope to prevent this serious illness in babies. Together, we can work to keep our little ones safe and healthy.
