Fighting RSV: Physicians Say New Antibody Shot Could be Game Changer

By Ashley Antle

Last year, Cook Children’s Medical Center experienced the worst respiratory syncytial virus (RSV) season since before 2017, with the peak hitting in October 2022 when hospital admissions for RSV rose above 300. At the same time, Cook Children’s Emergency Department and Urgent Care Centers were overwhelmed with RSV cases, seeing 500+ patients a day. Nationally, RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control.

But future RSV seasons could look different, thanks to a new tool in fighting the virus.

In July, the U.S. Food and Drug Administration approved Beyfortus™ (nirsevimab-alip), a one-time monoclonal antibody injection for the prevention of severe RSV.

The injection is not technically a vaccine, as it does not provide lifetime immunity, nor is it a treatment. Beyfortus is a temporary antibody boost to a child’s immunity to get them through their highest RSV risk period, according to Nicholas Rister, M.D., an Infectious Diseases physician at Cook Children’s Medical Center. The American Academy of Pediatrics recommends Beyfortus for infants 8 months old and younger entering their first RSV season and children up to 19 months at increased risk for severe RSV and entering their second RSV season. In Texas, the RSV season typically begins in the fall and stretches through the winter months.

Cook Children’s doctors say the new RSV monoclonal antibody shot could be a game-changer when it comes to reducing severe infections and hospitalizations, and it's been a long time coming.

“The last time someone tried to develop an RSV treatment for infants that was preventative, I had not even started medical school,” Dr. Rister said. “So the fact that we now have a treatment option for infants for the first time in like 20 years for one of the most prominent diseases on the planet. That's so huge.”

While this particular use of monoclonal antibodies for the prevention of severe RSV is new, Dr. Rister says monoclonal antibodies have been used for hundreds, if not thousands, of indications for over a decade.

Clinical trials of Beyfortus show it reduces the risk of hospitalization for RSV by 75%, which could take a huge burden off of hospitals during peak respiratory virus season.

“We're talking about a disease that, during some respiratory seasons, is more than half of the admissions to the hospital,” Dr. Rister explained. “If you even drop that by half, which this is claiming to be able to do more than that, we're talking about massive reductions in the number of children getting sick enough to end up in the hospital, and massive reductions in the burden at the hospital during respiratory seasons, which hopefully will lead to even better care for the community at large.”

A welcome relief

It’s a welcome relief for Karen Schultz, M.D., medical director of Pulmonology at Cook Children’s. During peak RSV season, it’s not unusual for her to consult on five to 10 new babies with RSV each day in the Pediatric Intensive Care Unit (PICU). The new antibody shot could drop that number significantly.

“It’s good for our clinicians’ work-life balance during these very busy months, but it’s even better for these babies and families to not have to be in the PICU,” Dr. Schultz said.

As a neonatologist in Cook Children’s Neonatal Intensive Care Unit (NICU), Darryl Miao, M.D., cares for babies at particularly high risk for severe RSV due to their prematurity, underdeveloped lungs and other risk factors like congenital heart disease. He says the new antibody shot gives him more confidence that the babies discharged from the NICU won’t end up back in the hospital with RSV.

“I'm excited that all the data shows that there's less hospitalizations, less morbidity, and makes babies better able to fight off RSV in their first year of life.” Dr. Miao said. “I do expect to see less hospitalizations all across the board, including from our NICU population after discharge. That part is really exciting.”

When Vanessa Charette, M.D., a pediatrician at Cook Children’s Pediatrics Fort Worth – Magnolia, had her first child 17 years ago, RSV was one of her top concerns for her baby. As a physician, she knew all too well how sick the virus can make little ones.

“As much as I had the ability to control things, I tried to have him so he would not be a newborn in the winter during RSV season,” Dr. Charette said. “I was so concerned about him getting the virus in the first month of life that I tried to have a baby that would be delivered in the spring rather than later in the year.”

As both a mom and physician, Dr. Charette is thrilled that the new RSV monoclonal antibody can potentially release parents from this burden.

“We’ve been waiting on something, and I think many families have been waiting on something, like this,” she said. “Maybe they’ve had an older child who had RSV and now they’re having their third baby and maybe they’re worried about their new baby getting RSV. It can be the most severe respiratory illness that babies have in their first year of life, and to finally have a tool to prevent it, that’s exciting.”

What parents need to know

We asked each of these physicians to share with us the most important thing they want parents to know about the RSV monoclonal antibody injection when considering it for their child. Here’s what each of them had to say.

Dr. Miao: “I would say, first of all, that it's not a vaccine. It's actually an antibody, and a similar mode of protection against RSV as one that has been on the market and used for NICU babies for 10+ years. The difference between the two is Beyfortus is one injection that will last about five months, which is usually the entirety of the RSV season, as opposed to a monthly injection of the other throughout RSV season. Beyfortus is also recommended for healthy children, unlike the other which is reserved for our highest risk NICU babies.”

Dr. Schultz: “The safety profile of the new antibody shot, when they have done comparative studies with a similar drug we’ve used for a lot of years and has been very safe, is the same. I know that's a big concern for any parent with a new medicine. What are the side effects? But they were really few and far between. They were mainly really mild things like redness at the injection site. There weren't any significant deterrent symptoms or side effects.”

Dr. Charette: “The main thing we hope to see is that the youngest babies, especially our babies less than six months, won’t be as sick and, therefore, won’t be as at-risk for needing hospitalization should they get RSV. They can still get RSV despite having gotten this injection but with much less severity. That is important, not only for the baby's health, but it also obviously helps alleviate parents' fears when their child is diagnosed with RSV.”

Dr. Rister: “I think the most important thing parents need to know is that they need to talk to their pediatrician about it. There is some nuance with this, even though it's generally being recommended for all children, so everyone needs to talk to their pediatrician about their child specifically. Does their child have extra risks? I would just hate to think someone's not having this conversation because it has such a big role in the safety and health of children going forward, especially those young infants, for the first time in decades.”

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