Approach to Prevention of Respiratory Syncytial Virus Disease in Infants by Passive Immunization

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2024 Dec 5

PMID 39638376

Authors

Winnie Siu

April Killikelly

Marina I Salvadori

Elissa M Abrams

Affiliations

Soon will be listed here.

Abstract

Objective: To support family physicians in discussing respiratory syncytial virus (RSV) immunizations with patients.

Sources Of Information: Information was obtained through a literature review on the burden of RSV disease in infants; observational studies; randomized controlled trials; evidence presented by review agencies; product monographs; and National Advisory Committee on Immunization statements.

Main Message: There are now 3 options available for preventing severe RSV disease in infants: the monoclonal antibody palivizumab, the long-acting monoclonal antibody nirsevimab, and the new RSVpreF vaccine administered during pregnancy. Only a small number of infants at high risk of severe RSV disease are eligible for palivizumab. Nirsevimab has received Health Canada authorization for all infants and RSVpreF has received authorization for all pregnant women and pregnant people. There are multiple considerations for the use of each product, including authorization; availability; timing of administration; health status and social determinants of health of the infant; efficacy and effectiveness; safety; patient preference; and cost. The National Advisory Committee on Immunization has recently issued guidance on the use of RSV immunization products for infants.

Conclusion: Family doctors should be aware of the indications, relative benefits, and recommendations for the 3 RSV immunization products to have informed discussions with patients, taking into account the preferences and circumstances of the pregnant woman or pregnant person or of the parent and infant.

References

Domachowske J, Madhi S, Simoes E, Atanasova V, Cabanas F, Furuno K . Safety of Nirsevimab for RSV in Infants with Heart or Lung Disease or Prematurity. N Engl J Med. 2022; 386(9):892-894. DOI: 10.1056/NEJMc2112186. View

Zhu Q, McLellan J, Kallewaard N, Ulbrandt N, Palaszynski S, Zhang J . A highly potent extended half-life antibody as a potential RSV vaccine surrogate for all infants. Sci Transl Med. 2017; 9(388). DOI: 10.1126/scitranslmed.aaj1928. View

Simoes E, Madhi S, Muller W, Atanasova V, Bosheva M, Cabanas F . Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of.... Lancet Child Adolesc Health. 2023; 7(3):180-189. PMC: 9940918. DOI: 10.1016/S2352-4642(22)00321-2. View

Gebretekle G, Yeung M, Ximenes R, Cernat A, Simmons A, Killikelly A . Cost-effectiveness of RSVpreF vaccine and nirsevimab for the prevention of respiratory syncytial virus disease in Canadian infants. Vaccine. 2024; 42(21):126164. DOI: 10.1016/j.vaccine.2024.126164. View

Buchwald A, Graham B, Traore A, Haidara F, Chen M, Morabito K . Respiratory Syncytial Virus (RSV) Neutralizing Antibodies at Birth Predict Protection from RSV Illness in Infants in the First 3 Months of Life. Clin Infect Dis. 2020; 73(11):e4421-e4427. PMC: 8662775. DOI: 10.1093/cid/ciaa648. View

Lopez-Lacort M, Munoz-Quiles C, Mira-Iglesias A, Lopez-Labrador F, Mengual-Chulia B, Fernandez-Garcia C . Early estimates of nirsevimab immunoprophylaxis effectiveness against hospital admission for respiratory syncytial virus lower respiratory tract infections in infants, Spain, October 2023 to January 2024. Euro Surveill. 2024; 29(6). PMC: 10853977. DOI: 10.2807/1560-7917.ES.2024.29.6.2400046. View

Griffin M, Khan A, Esser M, Jensen K, Takas T, Kankam M . Safety, Tolerability, and Pharmacokinetics of MEDI8897, the Respiratory Syncytial Virus Prefusion F-Targeting Monoclonal Antibody with an Extended Half-Life, in Healthy Adults. Antimicrob Agents Chemother. 2016; 61(3). PMC: 5328523. DOI: 10.1128/AAC.01714-16. View

Dieussaert I, Kim J, Luik S, Seidl C, Pu W, Stegmann J . RSV Prefusion F Protein-Based Maternal Vaccine - Preterm Birth and Other Outcomes. N Engl J Med. 2024; 390(11):1009-1021. DOI: 10.1056/NEJMoa2305478. View

Moro P, Gallego R, Scheffey A, Fleming-Dutra K, Hall E, Zhang B . Administration of the GSK Respiratory Syncytial Virus Vaccine to Pregnant Persons in Error. Obstet Gynecol. 2024; 143(5):704-706. DOI: 10.1097/AOG.0000000000005551. View

10.

Moore D, Sinilaite A, Killikelly A . Summary of the National Advisory Committee on Immunization (NACI) statement update on the recommended use of palivizumab to reduce complications of respiratory syncytial virus infection in infants. Can Commun Dis Rep. 2023; 48(7-8):363-366. PMC: 10324882. DOI: 10.14745/ccdr.v48i78a08. View

11.

Abrams E, Doyon-Plourde P, Davis P, Brousseau N, Irwin A, Siu W . Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. Can Commun Dis Rep. 2024; 50(1-2):1-15. PMC: 10949905. DOI: 10.14745/ccdr.v50i12a01. View

12.

Ares-Gomez S, Mallah N, Santiago-Perez M, Pardo-Seco J, Perez-Martinez O, Otero-Barros M . Effectiveness and impact of universal prophylaxis with nirsevimab in infants against hospitalisation for respiratory syncytial virus in Galicia, Spain: initial results of a population-based longitudinal study. Lancet Infect Dis. 2024; 24(8):817-828. DOI: 10.1016/S1473-3099(24)00215-9. View

13.

Moline H, Tannis A, Toepfer A, Williams J, Boom J, Englund J . Early Estimate of Nirsevimab Effectiveness for Prevention of Respiratory Syncytial Virus-Associated Hospitalization Among Infants Entering Their First Respiratory Syncytial Virus Season - New Vaccine Surveillance Network, October 2023-February 2024. MMWR Morb Mortal Wkly Rep. 2024; 73(9):209-214. PMC: 10932582. DOI: 10.15585/mmwr.mm7309a4. View

14.

Zylbersztejn A, Pembrey L, Goldstein H, Berbers G, Schepp R, van der Klis F . Respiratory syncytial virus in young children: community cohort study integrating serological surveys, questionnaire and electronic health records, Born in Bradford cohort, England, 2008 to 2013. Euro Surveill. 2021; 26(6). PMC: 7879500. DOI: 10.2807/1560-7917.ES.2021.26.6.2000023. View

15.

Wingert A, Pillay J, Moore D, Guitard S, Vandermeer B, Dyson M . Burden of illness in infants and young children hospitalized for respiratory syncytial virus: A rapid review. Can Commun Dis Rep. 2021; 47(9):381-396. PMC: 8448381. DOI: 10.14745/ccdr.v47i09a05. View

16.

Kampmann B, Madhi S, Munjal I, Simoes E, Pahud B, Llapur C . Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023; 388(16):1451-1464. DOI: 10.1056/NEJMoa2216480. View

17.

Simoes E, Center K, Tita A, Swanson K, Radley D, Houghton J . Prefusion F Protein-Based Respiratory Syncytial Virus Immunization in Pregnancy. N Engl J Med. 2022; 386(17):1615-1626. DOI: 10.1056/NEJMoa2106062. View

18.

Coma E, Martinez-Marcos M, Hermosilla E, Mendioroz J, Rene A, Fina F . Effectiveness of nirsevimab immunoprophylaxis against respiratory syncytial virus-related outcomes in hospital and primary care settings: a retrospective cohort study in infants in Catalonia (Spain). Arch Dis Child. 2024; 109(9):736-741. PMC: 11347209. DOI: 10.1136/archdischild-2024-327153. View

19.

Griffin M, Yuan Y, Takas T, Domachowske J, Madhi S, Manzoni P . Single-Dose Nirsevimab for Prevention of RSV in Preterm Infants. N Engl J Med. 2020; 383(5):415-425. DOI: 10.1056/NEJMoa1913556. View

20.

Moro P, Scheffey A, Gallego R, Jones J, Hall E, Zhang B . Incorrect Administration of Adult RSV Vaccines to Young Children. Pediatrics. 2024; 153(6). DOI: 10.1542/peds.2024-066174. View