The experts interviewed for this article are Sanofi's paid partners.
Respiratory syncytial virus (RSV) lower respiratory tract infections are particularly concerning in infants due to their potential to cause severe respiratory illness and, while uncommon, can cause high hospitalization rates.1 To highlight the prevention strategies conversation, we sat down with two seasoned physicians, Dr. Chris Belcher -- a pediatric infectious disease specialist -- and Dr. Keisha Callins -- an obstetrician/gynecologist.
Following a joint presentation at The American College of Obstetricians and Gynecologists (ACOG) Annual Meeting earlier this year, they have come together again to champion collaboration between obstetricians and pediatricians to help increase awareness about pathways to help protect infants against RSV lower respiratory tract disease (LRTD). Their combined expertise offers invaluable insights into how healthcare providers can counsel patients about RSV prevention along the pregnancy to parenthood continuum.
Q: How do the roles of obstetricians and pediatricians intersect when it comes to the health of infants and children?
Dr. Belcher: An early significant intersection we saw was with group B streptococcal (GBS), where gynecologists and hospitalists/pediatricians typically linked arms to mitigate the chance of early onset GBS disease via intervention. Today, RSV prevention presents a similar opportunity for joint efforts.
Dr. Callins: Obstetricians are the main point of contact during the pregnancy and postpartum period. Since we already counsel patients regarding respiratory virus protection, we can easily initiate the discussion around RSV prevention options with expectant mothers and lay the foundation for the conversation with the pediatrician or neonatologist. If we present a united front, we can help families make the best decision for mom and baby.
Q: How do you underscore the severity of RSV and the importance of prevention to a new or expectant parent?
Dr. Callins: Patients benefit most from counseling that allows for informed and shared decision-making. I start by assessing their familiarity with RSV and prevention options. Many people think RSV can only cause serious health problems in premature babies or those with other health problems. But that is simply untrue -- approximately 75% of infants hospitalized for RSV are born healthy and at term with no underlying conditions.2
Dr. Belcher: It's important to tailor the conversation to the parents' level of understanding and emphasize the potential risks of the disease. I explain that even though RSV is a common respiratory virus, it can cause severe LRTD and require hospitalization.3,4 Any infant can be hospitalized in their first year.4 I've seen the full spectrum -- some infants require ventilators and even extracorporeal membrane oxygenation (ECMO).
Importantly, I underscore that it's not a question of if the baby will get RSV, but when. And, since the youngest babies remain at greatest risk of being hospitalized, it is essential we protect them as soon as possible.
Q: How has the introduction of Beyfortus® (nirsevimab-alip) 50mg and 100mg Injection changed the RSV landscape?
Dr. Belcher: is the first and only long-acting antibody approved by the U.S. Food & Drug Administration (FDA) to help prevent RSV LRTD in neonates and infants born during or entering their first RSV season and children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season. Beyfortus is contraindicated in infants and children with a history of serious hypersensitivity reactions, including anaphylaxis, to nirsevimab-alip or to any of the excipients. Please see below for Important Safety Information.
Beyfortus offers protection that extends through five months, the length of a typical RSV season, and remains the only approved RSV protection for infants regardless of whether they are born before or during the RSV season, at term or preterm, healthy or with underlying conditions. With , Beyfortus is administered depending on weight.
Dr. Callins: Moms appreciate the autonomy and agency afforded with options to help protect their baby. The Advisory Committee on Immunization Practices (ACIP) recommended routine use of Beyfortus last year and we have a growing body of data supporting the safety and efficacy of Beyfortus in preventing RSV LRTD. The endorsement from professional organizations like ACOG reinforces its value and should bolster confidence among both clinicians and parents.
In my opinion, with Beyfortus, we can help promote health equity in RSV LRTD prevention. We can counsel pregnant patients on the fact that if a baby is born during or just before RSV season (typically fall through spring but can vary by geography) 5,6 they can receive Beyfortus before they leave the hospital. This is deemed ideal timing by the Centers for Disease Control and Prevention (CDC), because hundreds of thousands of mothers and infants miss early recommended pediatric visits7 due to circumstances like employment, transportation, or where they reside.
Q: What advice do you have for other healthcare providers on improving collaboration for RSV prevention?
Dr. Belcher: In an ideal world, pediatricians and obstetricians are in regular communication, as a patient transitions from pregnant to parent. Collaborative discussions, even brief virtual ones, can make a big difference. The responsibility lies with us to share crucial health information with each other, like what immunizations the mother received while pregnant and what infant care conversations may have already been initiated. Relying on the patient to pass along this type of information is not only burdensome but can lead to gaps in care.
Dr. Callins: That's right! Hearing consistent messaging from the obstetrician and the pediatrician truly resonates with our patients. Expanding this unified and collaborative approach can support the mother-baby dyad by improving uptake of RSV prevention strategies, and ultimately helping reduce the burden of disease for babies, families, and communities.
INDICATION
Beyfortus is indicated for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in:
- Neonates and infants born during or entering their first RSV season.
- Children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.
IMPORTANT SAFETY INFORMATION
Contraindication
Beyfortus is contraindicated in infants and children with a history of serious hypersensitivity reactions, including anaphylaxis, to nirsevimab-alip or to any of the excipients.
Warnings and Precautions
- Hypersensitivity Reactions Including Anaphylaxis: Serious hypersensitivity reactions have been reported following Beyfortus administration. These reactions included urticaria, dyspnea, cyanosis, and/or hypotonia. Anaphylaxis has been observed with human immunoglobulin G1 (IgG1) monoclonal antibodies. If signs and symptoms of anaphylaxis or other clinically significant hypersensitivity reactions occur, initiate appropriate treatment.
- Use in Individuals with Clinically Significant Bleeding Disorders: As with other IM injections, Beyfortus should be given with caution to infants and children with thrombocytopenia, any coagulation disorder, or to individuals on anticoagulation therapy.
Most common adverse reactions with Beyfortus were rash (0.9%) and injection site reactions (0.3%).
Please see full .
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Dr. Keisha Reneé Callins, MD, MPH, is a Georgia-trained physician and public health professional. As an obstetrician/gynecologist with Community Health Care Systems, Inc. (CHCS), a federally qualified health center network, she is committed to providing women's healthcare services especially in rural and underserved areas of Georgia. She is the current Joy McCann Endowed Professor and serves on the faculty as Professor and faculty advisor for the OB/GYN Interest Group at Mercer University School of Medicine. Dr. Callins was compensated for her participation in this article.
Christopher Belcher, MD, is a board-certified Pediatric Infectious Disease specialist at Ascension St. Vincent in Carmel and Indianapolis, Indiana. Dr. Belcher also directs the Travel Medicine clinic for children, adults, and families, which prepares patients for overseas travel with a risk assessment, medications, and vaccines tailored to destination and itinerary. Dr. Belcher has been recognized in the Top Doctors issue of Indianapolis Monthly for over 20 years. He is also an instructor at Marian University College of Medicine. Dr. Belcher was compensated for his participation in this article.
References
- Reichert, H. et al. Mortality Associated With Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study From 1999 to 2018. J. Infect. Dis. 226, S246–S254 (2022). Esposito S, et al. RSV Prevention in All Infants: Which Is the Most Preferable Strategy? Front Immunol. 2022; 13: 880368. doi: 10.3389/fimmu.2022.880368.
- Esposito S, et al. RSV Prevention in All Infants: Which Is the Most Preferable Strategy? Front Immunol. 2022; 13: 880368. doi: 10.3389/fimmu.2022.880368.
- Shi T, McAllister DA, O'Brien KL, et al; RSV Global Epidemiology Network. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390(10098):946-958.
- Arriola CS, Kim L, Langley G, Anderson EJ, Openo K, Martin AM, et al. Estimated Burden of Community-Onset Respiratory Syncytial Virus-Associated Hospitalizations Among Children Aged <2 Years in the United States, 2014-15. Journal of the Pediatric Infectious Diseases Society. 2020;9(5):587-95.
- CDC. RSV Surveillance & Research. Centers for Disease Control and Prevention (2023).
- Rose, E. B., Wheatley, A., Langley, G., Gerber, S. & Haynes, A. Respiratory Syncytial Virus Seasonality - United States, 2014-2017. MMWR Morb. Mortal. Wkly. Rep. 67, 71–76 (2018).
- Nelson CB, Brady BL, Richards M, et al. Optimal site of care for administration of extended half-life respiratory syncytial virus (RSV) antibodies to infants in the United States (US). Vaccine. 2023;41(40):5820-5824. doi: 10.1016/j.vaccine.2023.06.089.
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