During the classic cold season of autumn and winter, the number of respiratory illnesses increases. One of the infectious diseases that plays a role is transmitted by the respiratory syncytial virus (RSV). The RS virus is actually a well-known and common virus that many people can contract from time to time, because an infection does not produce long-term immunity. In most cases, you can get away with a mild cold.
Stiko recommends passive immunization of babies against the RS virus
The situation may be different for newborns and children: here, the RS virus is one of the most common pathogens causing respiratory diseases and is also one of the most common reasons why children in Europe end up in hospital. Protecting them was once complicated and expensive. Since autumn 2023, an antibody has been available with which they can be protected with a single dose during the first RSV season.
The Standing Vaccination Commission (STIKO) has now included this passive immunization of newborns and children in its vaccination recommendations: “In accordance with its standard operating procedure (SOP), the Standing Vaccination Commission (STIKO) has examined the data on Nirsevimab (Beyfortus; Sanofi) and decided that the monoclonal antibody (mAb) Nirsevimab is recommended for all newborns and infants, regardless of possible risk factors, in the 1st respiratory syncytial virus (RSV) season,” the RKI states in the Epidemiological Bulletin 26 | 2024 dated June 27, 2024.
The most important questions and answers about the Stiko recommendation.
Passive immunization of children at risk
Since fall 2023, nirsevimab (Beyfortus; Sanofi), a new monoclonal antibody that can protect infants from the pathogen in their first RSV season, has been available. Previously, high-risk infants had to receive the drug palivizumab injected into the muscle once a month during the RSV season – a total of five times.
Nirsevimab is approved as a more cost-effective prevention method that, unlike the previous drug, only needs to be injected once. There is still no active vaccination for children.
Why just a recommendation for newborns and babies?
STIKO’s recommendation only refers to passive immunization of newborns and children because they are particularly at risk of contracting the virus. In sensitive or immature lungs, the RSV pathogen is more likely to spread to the upper (nose, sinuses, throat) and lower (larynx, trachea, bronchi, lungs) respiratory tract than in mature lungs. Here, the pathogen can trigger spasmodic coughing or inflammation.
This is why babies and premature babies are particularly at risk: “Infants and newborns are particularly affected by RSV disease because, on the one hand, they are experiencing this infection for the first time in their lives. And with most pathogens, the first infection is more severe than the subsequent ones. In addition, newborns and babies have much smaller airways. The infection can cause swelling in the very small airways, which can easily lead to the oxygen supply to the lungs being blocked,” says Klaus Überla, Director of the Virological Institute at Erlangen University Hospital and President of STIKO.
When should immunization occur?
The antibodies are administered once to newborns and children. The timing of immunization depends on the time of birth. The newborn or infant should be protected during the RSV season, which mainly occurs between November and March: “Children born between April and September should receive the antibody in the fall, before winter. Children born between October and March should receive the antibody as soon as possible after birth, or at least before they are discharged from the hospital,” says Überla. Protection against RSV disease occurs immediately after administration of this antibody. The aim is to reduce the frequency of serious RSV disease in newborns and infants in their first RSV season.
Although giving antibodies protects babies in their first season from RSV, it does not prevent children from getting an RSV infection at a later date. However, this infection is usually significantly less serious because the respiratory tract has already become larger, says Überla: “The approval studies also show that a significant proportion of children who received the antibody were infected despite the antibody, but this infection without disease it also means that children themselves develop a natural immunity to the RS virus and ultimately experience less severe illness in later years.
How effective is passive immunization?
Passive immunization reduces hospital admissions by 80%, says Überla. Four out of every five hospital admissions due to RSV illness would be avoided this way. After all, statistically, one in every 56 children would have to be hospitalized in the first year of life due to RSV disease. A great burden for parents and children.
How tolerated is the antibody?
Controlled clinical studies involving almost 7,000 children showed very good tolerability. And the routine use of this antibody in other countries last winter did not raise any questions about the safety of this drug, Überla said.
Who pays for passive vaccination?
The requirements for costs to be covered by health insurance companies are met by a recommendation from STIKO. The Ministry of Health must now find a regulation that guarantees cost coverage, said Überla: “I hope that the issue of cost coverage will also be clarified in the autumn.”
How does immunization with antibodies work?
The administered antibodies spread throughout the body and attach to the surface of the virus. This connection means that the virus can no longer penetrate the cells of the treated child. This efficiently suppresses the spread of the virus.
Who is particularly at risk from RS virus?
People at high risk of severe disease progression due to the RS virus include children under six months of age and premature babies, children with previous lung disease or heart defects, adults over 65 years of age, and people with compromised immune systems.
How is the RS virus transmitted?
The RS virus is mainly transmitted via droplet infection, i.e. by sick people who cough and sneeze. If you inhale these droplets, the pathogens can penetrate the mucous membranes. But the virus can also spread via smear infection, for example via contaminated surfaces that a sick person has touched with their hands. Therefore – as with all infectious diseases – Hand hygiene is particularly important.
What are the symptoms of RSV infection?
An RSV infection can vary in severity. It usually starts with a runny nose and loss of appetite. There is also a sore throat, coughing and sneezing. Fever is also common. An upper respiratory tract infection caused by the RS virus cannot be clinically differentiated from other respiratory infections, according to the RKI.
“As the disease progresses, lower respiratory tract infections may also occur, with coughs containing mucus. These include inflammation of the fine branches of the lower respiratory tract (bronchiolitis) as well as pneumonia. narrow, making it difficult or very difficult for rapid breathing and shortness of breath to occur”, writes the Federal Center for Health Education (BZgA). Symptoms of an RSV infection in babies may include rapid, labored breathing, weakness, or difficulty feeding.
Why do some babies need to be hospitalized with RSV infection?
Treatment of an RSV infection can only be symptomatic. This is why babies in particular often have to be admitted to a hospital so that they can be ventilated in an emergency: “We assume that around two to three percent of all children with an RSV infection end up in a clinic and need oxygen or help there. In terms of nutrition, some of these children end up needing intensive care,” says Dr. Martin Wetzke from the Hanover Medical School.