RSV Vaccines: Which One Is Right for Your Patient?

The Cribsiders highlight the latest breakthrough vaccine products to protect kids and adults from RSV.
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-- TRANSCRIPT --
Christopher J. Chiu, MD: Welcome to The Cribsiders, for a video recap of our recent podcast, "RSV Immunizations."
Justin L. Berk, MD, MPH, MBA: For those who don't know us, we are the pediatric medicine podcast, bringing you interviews with leading experts, clinical pearls, and practice-changing knowledge, and answering lingering questions about core topics in pediatric medicine.
Today's topic is a timely one: RSV immunizations. Our guest was Dr Buddy Creech. We talked with him not only about pediatric RSV immunizations but also about adult immunizations. We partnered with the Curbsiders internal medicine podcast and the IDSA's Let's Talk ID podcast to talk about all of the different RSV immunization options across the lifespan.
Chiu: What's the story on the new RSV immunizations?
Berk: Let's start with pediatrics, since we are The Cribsiders and our primary audience is pediatric clinicians. Bronchiolitis is a major burden in pediatric patients; it's the number-one cause of hospitalizations, and RSV is the number-one cause of bronchiolitis.
But we haven't had many ways to prevent RSV infections. Until this year, our only tool was a monoclonal antibody, palivizumab (Synagis). It can help prevent RSV, but it's a monthly injection, and the criteria for use in high-risk patients is confusing. Palivizumab has been shown to protect patients who have been on oxygen for a while or who have congenital heart disease.
Now we have a new monoclonal antibody, called nirsevimab ( Beyfortus).
Chiu: What's so special about nirsevimab?
Berk: Although it's a monoclonal antibody like palivizumab, it has a longer half-life. Rather than lasting only 20 days, nirsevimab lasts for 5 months. That means a one-time injection covers the entire bronchiolitis season. It does this by targeting the prefusion F protein of the virus. The monoclonal antibody attaches to the virus before it fuses with your cells. That's a significant advantage over palivizumab.
Chiu: So, it lasts longer. But does it work?
Berk: This was a huge question. And it turns out that it does. The MELODY trial basically showed that nirsevimab was associated with a 75% decrease in lower respiratory tract infections requiring medical attention among full-term babies who were otherwise healthy. There was also a trend toward a reduction in hospitalization rates, by 60%, but this wasn't statistically significant.
Our expert, Dr Creech, and the pediatric community felt that the data showing benefit were so clear that we needed to immediately begin giving nirsevimab to infants who meet the criteria.
Chiu: Which children should be getting it?
Berk: That's the big story. The latest AAP recommendations basically say the data are so good that we should give nirsevimab to all infants under the age of 8 months and high-risk infants (congenital heart disease, oxygen dependence) under the age of 19 months.
Chiu: When we talked with The Curbsiders and the ID podcast, we also discussed adult RSV vaccines. Why should pediatricians care about the adult vaccine products?
Berk: This is a great question, and Dr Creech made a few good arguments. First, if adults don't become infected with RSV, they won't transmit it to their children. As a public health benefit, vaccinating adults will help prevent RSV infections broadly.
Transcript in its entirety can be found by clicking here:
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