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Transformation within any industry is hard — but it’s arguably even more challenging in healthcare. With so many stakeholders involved, it can take decades before progress is realized and then felt by those who matter most: patients. This is certainly true of respiratory syncytial virus (RSV), a common but serious illness that impacts 2 out of 3 infants by their first birthday.[i] Since the late 1990s, the only prophylactic tool available for RSV (besides behavioral measures like hand washing and staying home if you’re ill) has been exclusively available for infants born premature or considered very high-risk. This has in turn informed our perception of who is most vulnerable to severe RSV.
But, as a new collection of studies published by Sanofi in the Journal of Infectious Diseases (JID) starkly demonstrate, our historical focus on prevention for our highest-risk babies has left far too many behind. With 75% of the US’ RSV burden occurring in healthy, term-born infants,[ii] the call to action is clear: we must do better and more for all infants.
Understanding the immense impact of this virus on all infants, it is time to rethink our approach to RSV.
The RSV burden is more significant than previously known
The new body of research in the JID demonstrates that the burden of RSV on all infants is even more vast than previously known. While it confirms that RSV continues to be the leading cause of hospitalization in the US for all infants under the age of one, regardless of birth month, race/ethnicity or insurance status,[iii] it also found that the full magnitude of hospitalizations is likely underestimated due to historical limitations in testing and surveillance.[iv]
The analysis shows that more deaths from RSV disease are experienced by full term infants than by those born prematurely.[v] However, it also suggests that deaths outside the hospital related to RSV have been underreported[vi] — indicating that, similar to hospitalizations, the true mortality burden is not yet fully understood.
Healthy term infants with Medicaid insurance were found to be especially at risk for severe outcomes from RSV with about 2 times the risk of hospitalization compared to those with commercial insurance, and accounting for 62% of RSV hospitalizations and 56% of emergency department visits.[vii] Importantly, the analysis shows that a strategy to immunize all infants in the US has the potential to significantly decrease the health and economic burden associated with this very contagious virus, including an estimated 55% reduction in ER visits and 49% reduction in direct medical costs.[viii]
Moving forward with new knowledge on RSV
Ultimately, our findings in the JID illuminate the need to treat RSV as a public health threat that warrants a robust public health response in which prevention is available to all infants, regardless of background or socioeconomic status. For us to increase the urgency around RSV and pave the way toward immunization for all, we must broaden our collective understanding of the total disease burden. That begins with shifting the perception of “risk” for our most crucial stakeholder — providers.
As a pediatric infectious disease specialist, I know firsthand the essential role that pediatricians, OBGYNs, emergency room doctors, nurses, and others along the RSV care continuum play in educating parents and advocating for infant health. But I also know we’re only as effective as the information and resources made available to us.
With that in mind, it’s critical we energize providers who sit on the front lines, reminding them of the unpredictable and severe consequences RSV poses to all infants.[ix] It’s also critical that we sharpen their awareness of the preventive strategies presently or imminently available, including immunization. Armed with this new framework, providers can in turn educate new and soon-to-be parents, helping to build a robust, multi-stakeholder public health response.
As scientists and providers, it is our obligation to lay a foundation for a future where RSV is not only better monitored and diagnosed, but where all infants are protected. The stakes have never been higher, and the call to action never stronger, as we seek to usher in a new era of RSV prevention.
Explore the new research on RSV uncovered in the JID here.
References
[i] Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140(6):543-546. doi:10.1001/archpedi.1986.02140200053026.
[ii] Gantenberg JR, et al. Medically Attended Illness due to Respiratory Syncytial Virus Infection Among Infants Born in the United States Between 2016 and 2020. Journal of Infectious Diseases. 2022;226(S2):S164–74.
[iii] Suh M, et al. Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations,2009–2019: A Study of the National (Nationwide) Inpatient Sample. Journal of Infectious Diseases. 2022;226(S2):S154–63.
[iv] Suh M, et al. A Systematic Literature Review of the Burden of Respiratory Syncytial Virus and Health Care Utilization Among United States Infants Younger Than 1 Year. Journal of Infectious Diseases. 2022;226(S2):S195–212.
[v] Heidi Reichert, et. al. Mortality Associated with Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study from 1999-2018. Journal of Infectious Diseases. 2022;226(S2):S246–54.
[vi] Lauren C. Bylsma, et. al. Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review. Journal of Infectious Diseases. 2022;226(S2):S267–81.
[vii] Eric A. F. Simões. The Burden of Respiratory Syncytial Virus Lower Respiratory Tract Disease in Infants in the United States: A Synthesis. Journal of Infectious Diseases. 2022;226(S2):S143–47.
[viii] Alexia Kieffer, et. al. Expected Impact of Universal Immunization With Nirsevimab Against RSV-Related Outcomes and Costs Among All US Infants in Their First RSV Season: A Static Model. Journal of Infectious Diseases. 2022;226(S2):S282–92.
[ix] Arriola C, Kim L. Estimated Burden of Community-Onset Respiratory Syncytial Virus-Associated Hospitalizations Among Children Aged < 2 Years in the United States 2014-15. J Pediatric Infect Dis Soc 9, 587–595 (2020).