New data shows RSV shots prevent ‘most dangerous’ respiratory infection for newborns

When Katrina Bellavance’s seven-week-old daughter kept coughing, the Calgary mom unzipped her newborn’s pajamas and noticed that the skin around her little ribs was pulling inward with every breath.

“In that moment, we knew we had to get him to the hospital as quickly as possible,” Bellavance said, recalling that fateful night in 2023.

Their daughter was diagnosed with respiratory syncytial virus, or RSV, and spent several days in the hospital on oxygen before recovering. The common but dangerous infection destroys the delicate respiratory systems of infants, causing difficulty breathing, wheezing, swollen lungs, pneumonia, and in rare cases, death.

RSV may not be a household word for many families, yet it is “the No. 1 cause of hospitalization every year in children during the first year of life,” said physician-researcher Dr. Jesse Papenberg of Montreal Children’s Hospital.

But those horror stories from parents may one day be a thing of the past. There are now several ways to prevent severe RSV in newborns, including powerful monoclonal antibody shots — and real-world data from less than two years of global use shows surprising results.

Medical experts say the question now is whether Canada can expand and expand access to shots that are unavailable to many families across the country.

‘One of the greatest single advances’

RSV has remained a serious threat for a longer time than many other respiratory diseases.

“Decades after effective vaccines were developed against other childhood infections, RSV remained invincible,” wrote Dr. Jake Scott, clinical associate professor of infectious diseases at Stanford University School of Medicine. In a recent editorial His team’s latest research highlights the vaccine’s effectiveness.

“He just changed. The change happened so quickly that many people didn’t understand the magnitude of it.”

Scott’s recent review of more than 500 global studies, Published in the New England Journal of MedicineFound that antibody shots reduced infant RSV hospitalizations by more than 80 percent. (The vaccine given to mothers during pregnancy, although less effective, still provides significantly higher protection to infants, studies have shown.)

The findings represent “one of the largest single advances in respiratory virus prevention in decades,” Scott wrote.

In Spain, pediatric intensive care units in Madrid reported about 90 percent less RSV admissions, while Chile’s national program sees a decline in hospitalizations about three-quarters,

Here in Canada, Papenberg’s research from quebec It’s estimated that more than half of common RSV-related hospital and ICU admissions were stopped last season after the province launched a universal infant antibody shot program.

He told CBC News that frontline teams really saw a difference in the number of patients. Papenberg said the shots helped relieve some of the “condensed and intense pressure” that RSV puts on the typically fragile pediatric health care system, which can lead to surgeries being postponed because there are not enough ICU beds available.

Access, uptake varies across Canada

Last season marked Canada introduces new list of RSV shots for the first timeThat includes vaccines for pregnant women and older adults, as well as nersevimab, a one-time antibody shot that protects infants throughout the RSV season. Made by AstraZeneca, the shot is distributed in Canada by Sanofi under the name Befortus.

But the methods used to roll out these shots across the country initially varied, and remain the same more than a year later.

More territories are offering universal antibody shot programs this season, while British Columbia, Alberta, New Brunswick and Newfoundland and Labrador remain holdouts, offering covered shots only to high-risk infants.

Ontario, meanwhile, is the only province that provides funding for both antibody shots and maternal vaccines for all infants. Data from the first year of its program showed that about seven out of 10 newborns received nersevimab at birth before being discharged from health care facilities.

But rates varied widely among hospitals, ranging from 32 to 90 percent.

in Quebec, data shown About eight in 10 newborns received nersevimab during the RSV season, while coverage was lower among infants born before the season started.

“We have two products that are very, very effective in protecting young infants from the most dangerous respiratory infections that can happen,” said Dr. Jeffrey Pernicka, an associate pediatrics professor at McMaster University in Hamilton.

But the logistics of actually implementing these shots, he said, “is a more complicated thing than the science.”

Ontario data show that the most commonly reported reason for not vaccinating infants was parent or caregiver refusal. Pernicka said the timing of births is also a challenge: It’s harder to get babies born in the spring and summer back to the hospital to get an RSV shot in the fall.

“I hope that as the years go by, we will get better,” he said.

Many provinces still vaccinate only high-risk infants

Other doctors say widespread access is an even bigger concern, given the patchwork approach between provinces.

BC Health officials told CBC News there are no plans to expand its RSV program this season beyond those set aside for moderate- to high-risk infants. The statement said the shot “can still be obtained on a private-payment basis,” though availability is at the discretion of the manufacturer.

In Alberta, where there are no plans to offer antibody shots beyond high-risk infants, provincial health officials told CBC News a “cost-effectiveness and feasibility analysis” is underway to inform decisions for next season.

Given how common RSV is in an infant’s first year of life, it is important to prevent infection throughout the population, stressed pediatrician Dr. Cora Constantinescu, clinical associate professor at the University of Calgary.

“I feel very disappointed when I see a child being brought to the hospital, to the ICU, with severe RSV,” she said. “Some infants require ECMO (extracorporeal membrane oxygenation, a form of advanced life support) to survive—which is essentially bypass of the lungs.”

Equitable access is important, Constantinescu said, including greater transparency on the costs of regional RSV vaccination programs. (The list price of nirsevimab in Canada is closer to $1,000.)

Pediatric hospital stay for RSV could cost more than $8,000: study

Other research suggests that the costs associated with preventing infant RSV infection may be far greater than the cost.

A new study from the University of British Columbia and BC Children’s Hospital Research Institute published in November Lancet Regional Health – AmericasThe vision calls for nearly 30,000 hospitalizations across Canada between 2017 and 2023.

The research team found that infants under six months of age accounted for more than four in 10 RSV-related hospitalizations, and this was almost half the estimated $66 million average annual cost of RSV hospitalization. The average cost per hospital stay ranges widely, from $8,000 for a routine admission to more than $80,000 for infants on ventilation in the ICU.

Although research is ongoing to determine the cost-effectiveness of these devices, it is already clear that “preventing this infection would be a better approach in the long run,” noted study author Nirma Khatri Vadlamudi, now an assistant professor at the University of Florida.

Their study showed that more than eight in 10 hospitalized children had no known risk factors – even healthy infants are vulnerable to the virus – while other research shows that children who are hospitalized early with RSV have a higher risk of developing asthma later in life.

“This is not without long-term consequences,” Vadlamudi said.

Calgary mom Bellavance says you can’t put a price on avoiding the terror of RSV infection. She hopes more babies in her province will eventually have the option to get the vaccine her daughter didn’t get when she got sick in 2023.

“I think it should be accessible,” she said. “Staying even four or five days in hospital with an infant has a very significant impact on the family.”