From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape.  

Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in  Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress.

Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations.

The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. 

“Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa.

Impact on families

Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. 

According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner.

The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families.

Long-term burden of respiratory illnesses

Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.”

This chronic burden reinforces the necessity of early intervention.

RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems.

The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by  ambulance. 

New tools to prevent RSV 

With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. 

The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. 

“Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar.

Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV.

This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families.

Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP).  “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. 

Challenges in implementing technologies

Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. 

For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers.

Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres.

The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding.

Pivotal moment

The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said.  

Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. 

Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. 

The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health.

This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD.

Susan Hepworth is executive director of the  National Coalition for Infant Health.

Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation