RSV, a little-known but widespread virus, has been identified as the leading cause of infant hospitalizations in both the US and Europe. While many individuals perceive it as a typical cold, it can have severe consequences for newborns and the elderly. Symptoms of RSV include rapid breathing, chest cave-in, and wheezing or crackling sounds due to inflammation in the bronchial tubes or fluid accumulation in the lungs. Breathing and feeding become more challenging, particularly for infants who are already vulnerable.
However, public awareness regarding RSV and its impact is strikingly low. Approximately 64 million people worldwide contract RSV each year, resulting in an estimated 160,000 deaths. RSV is the most prevalent cause of lower respiratory tract infections in young children globally, claiming the lives of roughly 13,000 infants under six months old and approximately 101,000 children before the age of five. In the UK alone, RSV causes 33,500 hospitalizations and 20 to 30 deaths in children under five every year, surpassing the burden of flu on the NHS.
Currently, preventing RSV entirely is challenging due to its highly contagious nature. The virus spreads easily through coughing, sneezing, and contaminated surfaces, making any infant susceptible. Medical interventions have traditionally been relied upon to support sick infants, such as providing oxygen. Nevertheless, the past two years have witnessed significant scientific advancements in reducing RSV-related illness and mortality.
The first breakthrough is the approval of a monoclonal antibody drug called nirsevimab in the UK and US. Nirsevimab offers temporary immunity to RSV, and in clinical trials, it demonstrated 77% effectiveness in reducing hospitalizations and medical interventions. Independent studies revealed that infants who received a single dose of nirsevimab experienced an 83% reduction in hospital admissions compared to those who received standard care.
The second breakthrough is the approval of an RSV vaccine for pregnant women in the US and UK. Clinical trials found that the vaccine, administered between weeks 24 and 36 of pregnancy, was approximately 82% effective in preventing severe disease in infants within the first three months of life.
These new preventive measures represent a remarkable advancement in combating RSV. However, integrating these treatments into healthcare systems like the NHS poses challenges. The main barrier is the high cost of these interventions, with nirsevimab priced between $300-500 per dose and the maternal vaccine at approximately $320 per dose. Negotiations with pharmaceutical companies are necessary to reduce costs and ensure accessibility.
Several high-income countries have taken steps to implement these preventive measures in their immunization programs, but the cost challenge remains. Low-income areas, where the majority of RSV-related deaths occur, confront an even greater struggle to access these treatments.
Nonetheless, the availability of these new tools brings hope. Swift and effective implementation of nirsevimab and the RSV vaccine has the potential to eliminate RSV-related hospitalizations in young children, offering relief to both families and healthcare systems. This represents yet another triumph for scientific progress.
– Prof Devi Sridhar, chair of global public health at the University of Edinburgh