RSV

Introduction

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Pediatric RSV Prevention Overview

• Title: Pediatric RSV Prevention: Critical Insights for the Nurse Practitioner

• Featuring: Wheel of KNOWLEDGE Challenge!

• Activity Chair: Andrea M. Kline-Tilford, PhD, CPNP-AC/PC, FCCM, FAAN

• Supported by an educational grant from Sanofi US during NAPNAP's National Conference.

Continuing Education

• Continuing education for this activity is provided by the National Association of Pediatric Nurse Practitioners.

• Activity is supported by educational grant from Sanofi US.

The Burden of Pediatric RSV

• Presenter: Andrea M. Kline-Tilford, PhD, CPNP-AC/PC, FCCM, FAAN

• Affiliation: University of Michigan Health, Ann Arbor, Michigan.

Financial Disclosures

• No relevant financial relationships to disclose.

History of RSV

• Timeline:

  • 1840: Clinical descriptions of infantile pneumonias possibly linked to RSV.

  • 1940: Seasonal epidemics of bronchiolitis described.

  • 1950-1960: Virus causing URIs in chimpanzees identified as chimpanzee coryza virus.

  • 1960s: Virus isolated from children, renamed RSV due to multinucleated cell formation.

  • 2000s: RSV identified as the cause of seasonal epidemics of upper and lower respiratory tract infections in infants worldwide.

RSV Data Overview

• RSV Characteristics:

  • Ubiquitous and highly contagious.

  • Annual epidemics in the US occur in winter and early spring.

  • Most important cause of bronchiolitis and pneumonia in infants, leading to hospitalization.

  • ~2/3 of infants infected by 1 year; nearly 100% by age 2.

  • Increased recognition of RSV infections in adults with significant morbidity and mortality, especially in those over 65 or with COPD.

U.S. Statistics on RSV Impact

• Burden in U.S. Infants:

  • Total RSV Cases: ~2,680,000 infections per year.

  • Hospitalizations: 33,000-80,000 annually.

  • 400,000 office/clinic visits caused by RSV.

  • RSV was leading cause of infant hospitalization from 2009-2019, accounting for ~9% of all newborn hospitalizations.

Risk Factors for Severe RSV

• Children most at risk for severe RSV:

  • Premature birth

  • Chronic lung disease

  • Congenital heart disease

  • Neuromuscular disease

  • Immune deficiencies

• Adults >65 also at risk.

Global Impact of RSV

• More children under 1 year die from RSV than any other pathogen except malaria.

• Notable burden statistics and comparison with diseases like malaria.

RSV and Hospitalization Data

• Hospitalization peaks in winter.

• Rates of hospitalization observed from 2011-2022.

Recommendations for RSV Prevention

• New guidelines for immunoprophylaxis and maternal vaccinations.

• Recommendations for nirsevimab and palivizumab to prevent RSV among high-risk infants.

Preventive Strategies

• Types of immunoprophylaxis:

  • Active immunization via vaccines.

  • Passive antibody approaches, including monoclonal antibodies and maternal vaccinations.

  • Specifics on recommended dosing and patient populations eligible for preventative treatment.

Current Vaccination Strategies

• Recommendations for maternal RSVpreF vaccine administration during specific gestational weeks.

• Usage of nirsevimab and palivizumab.

Emerging Vaccine Options

• Current research on new vaccines such as Clesrovimab and the efficacy of ongoing clinical trials.

Behavioral Factors Influencing Immunization

• Vaccine hesitancy, the impact of parental attitude toward vaccines, and overcoming barriers to vaccination.

Conclusion and Future Directions

• Need for heightened awareness and education regarding RSV prevention strategies.

• Encourage healthcare providers to recommend vaccination and proactive treatment to mitigate RSV in at-risk populations.

Voice recording lecture notes

RSV

Overview of RSV Hospitalizations

• RSV (Respiratory Syncytial Virus) continues to pose a significant health burden, with slight increases in hospitalizations observed in 2014, 2015, and 2020.

• More than 70% of hospitalizations due to RSV occur in otherwise healthy children, indicating that healthy infants can still experience severe illness.

Recent Study Findings (2022 Outbreak)

• Study Population: 600 infants in the ICU across 39 US states during the RSV outbreak.

• Key Findings:

  • Over 80% of hospitalized infants had no underlying medical conditions.

  • More than 70% of these infants were full-term.

  • Identified risk factors: Age under 3 months and prematurity were significant factors for requiring invasive ventilation.

Hospitalization Data by Age Group

• Examined RSV-related hospitalizations in children under 2 years, segmented into age categories:

  • 0 to 2 months, 3 to 5 months, 6 to 11 months, and 12 to 23 months.

• Gestational Age Impact: Infants born at or below 37 weeks accounted for the highest hospitalization rates.

Risk Factors for ICU Admission

• Infants needing ICU stay or mechanical ventilation are primarily those with:

  • Prematurity: Nearly one-third required ICU admission.

  • Chronic Lung Disease and Congenital Heart Disease: Similar rates of ICU admission as infants with prematurity.

  • Full-term infants generally had lower rates of requiring intensive care resources.

Long-term Impact of RSV Infection

• A cohort study involving 124,000 children under one year assessed the long-term impact of RSV infection on respiratory health:

  • Infants with documented RSV infection in their first year showed a higher incidence of recurrent wheezing or asthma in subsequent years.

  • 25% of children with commercial insurance and 35% with Medicaid exhibited these symptoms if they had RSV compared to those without documented RSV.

Prevention Strategies for RSV

• Vaccination Methods:

  • Vaccination during pregnancy for passive antibody transfer to infants.

  • Direct administration of long-acting antibodies to infants for early protection.

• Benefits of infant vaccination and potential combination strategies are ongoing areas of research.

Current Options for RSV Prevention

• Palivizumab:

  • Established treatment requiring monthly administration and prior authorizations.

• Nirsevimab:

  • New long-acting antibody providing a single dose for first-year infants and selected high-risk groups in their second year.

• Maternal Vaccine: Approved vaccine for administration during pregnancy to provide protection for infants.

Official Guidance (ACIP Recommendations)

• Nirsevimab is recommended for all infants under 8 months at the start of RSV season and for high-risk infants in their second year.

  • Patients with chronic lung diseases, cystic fibrosis, and certain ethnic backgrounds, like American Indians and Alaska Natives, are identified as higher risk.

• If validated maternal vaccination occurred, nirsevimab is generally not required unless specific criteria are met.

Efficacy of RSV Prevention Products

• Protection levels vary based on the stringency of desired outcomes, with about:

  • 70%-80% protection for all medically attended lower respiratory infections.

  • Higher percentages for severe cases requiring hospitalization or intubation.

• Initial data on maternal vaccines showed significant protection, though some concerns over preterm delivery rates were noted in certain populations.

Preventing Hospitalizations

• Real-world effectiveness of immunizations can reduce RSV hospitalizations by 90% or more.

• Various studies indicate high effectiveness across multiple countries, with reductions in hospitalizations seen in many European nations, ranging from 60%-80%.

Case Study: Chile's National Program

• Chile implemented a national program administering Herceptin to nearly all infants, achieving up to 98% coverage among 200,000 infants.

• The program effectively eliminated RSV-related deaths, leading to significant applause during the presentation by the Chilean health official.

Impact of Nirsevimab

• Real-world data shows that nirsevimab can significantly protect against RSV, aligning with results from preclinical studies.

• Additional emphasis on the importance of maternal vaccinations and their relation to infant health was highlighted.

Vaccine Safety Concerns

• Audiovisual statements reveal public hesitance about vaccine safety, influenced by social media and misinformation.

• Common concerns include:

  • Long-term safety of vaccines

  • Recommendations from healthcare providers not being clear about RSV vaccinations during pregnancy.

• Importance of clear communication from healthcare providers to encourage vaccinations.

Awareness and Accessibility Challenges

• Recognizing that addressing parental hesitancy requires improved communication regarding the importance and safety of vaccines.

• Emphasizing shared concerns about child safety to build trust with hesitant parents.

Future Treatments and Vaccines

• Introduction of new monoclonal antibodies, such as clasorbimab, showing promise against RSV.

• Other vaccine developments include intranasal and mRNA options, targeting older infants and toddlers.

Recommendations for Healthcare Providers

• Strong recommendations for maternal vaccination and addressing vaccination needs among grandparents who often care for infants.

• Continuous engagement with both patients and parents is essential to overcome vaccine reluctance.

Strategies for Enhancing Immunization Rates

• Initiatives aimed at improving immunization rates must address barriers, including:

  • Lack of awareness about vaccines

  • Parental and clinician hesitancy

  • Access to vaccination centers

Effective Communication Approaches

• Use motivational interviewing strategies to bridge gaps in understanding about vaccines:

  • Acknowledge parental concerns without judgment.

  • Share experiences and trusted information to reframe their views on vaccinations.

• Use visual tools like Venn diagrams to highlight common goals regarding child safety.

RSV Season Timing

• RSV seasons vary geographically, affecting vaccination timelines. State health departments often provide insights into local RSV seasons.

• Monitoring local health alerts can help healthcare providers plan immunization timing accordingly.

Partnership and Collaboration

• Collaborating with clinics, birth centers, and utilizing electronic health records can streamline communication about RSV immunizations.

• Engaging community health groups and prenatal health classes in the education of parents can improve awareness.