Baby, It’s Cold Outside
Welcome to the Winter of 2024 -- a winter where newborn babies can now be protected from the scourge of Respiratory syncytial virus (RSV) -- the leading cause of infant hospitalization in the US. Each year in the United States, an estimated 58,000–80,000 children younger than 5 years are hospitalized due to RSV. And the younger the age, the higher the risk of hospitalization and associated complications. Two to three out of every 100 infants under 6 months are hospitalized with RSV every year.
Respiratory virus season runs annually from October to May. \During this period, temperatures tend to drop, and people spend more time inside, increasing their risk of exposure.
The good news is that, unlike previous winters, this one can be different – and better. Why? Because now there’s an FDA-approved vaccine for pregnant women and an immunization that can be given to infants that provide immediate protection against RSV and lasts at least 5 months. For infants, this new treatment, nirsevimab isn’t a vaccine. In a more traditional fashion, babies receive protection directly from antibodies via passive immunity. Protection is immediate and is 91%-98% effective at preventing RSV-associated hospitalizations. The American Academy of Pediatrics recommends all infants be protected from RSV.
The bad news is that not all newborns will have equal access to this important advance in pediatric health – (particularly urgent for infants at higher risk including children born prematurely and have chronic lung disease, those who are immunocompromised, American Indian and Alaska Native children). Even though immunizations are covered by the federally funded Vaccines for Children program, many hospitals haven’t adopted the RSV immunization as standard operating procedure. This “red lining” of infant health must not stand.
In order to ensure access, irrespective of financial constraints, to this important new tool in our pediatric healthcare armamentarium, a recent article by experts from the George Washington University School of Nursing and Children's National Hospital calls for more regular and robust communication and collaboration between insurers and healthcare providers. One major challenge isn’t cost, but logistical and systemic. The already over-loaded workload in hospital pediatric wards -- especially during the busy autumn season – is a very real impediment. Pediatrics staff, already bustling with other procedures and vaccinations for other illnesses, now face the added task of administering another inoculation. Recognizing the problem is a good start – but it’s not enough.
According to the authors, “From logistical hurdles to financial barriers, these issues need to be addressed to ensure the successful rollout of this preventive measure. One such challenge lies in the integration of nirsevimab administration into the existing healthcare framework, especially during the busy autumn season.” Successful integration of RSV vaccination and immunization requires effective systems at multiple touchpoints for mothers and babies including obstetric practices, hospital newborn nurseries, neonatal intensive care units, and outpatient pediatric practices.
And, of course, there’s government bureaucracy. Per the Journal of Health Management and Practice article, the patchwork of state legislations regarding the consent process for nirsevimab administration creates disparities in access. Some states have simplified consent procedures, while others have more complex systems that could delay its widespread adoption. Coordinated efforts between state health departments are essential to streamline these processes, ensuring timely access for all eligible children.
Another important strategy, perhaps THE most important strategy, is to empower the parent. Knowledge is Power. RSV-prevention education should be incorporated into parenting classes and visits to the OB/GYN’s office. Parental education is parental power.
“For, in the final analysis, our most basic common link, is that we all inhabit this small planet, we all breathe the same air, we all cherish our children’s futures, and we are all mortal.” -- John F. Kennedy
Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest and a Visiting Professor at the University of Paris School of Medicine
Camilia R. Martin, MD, is of Chief of Neonatology and Professor of Pediatrics, Weill Cornell Medicine
