This episode of HealthConnections discusses vaccines to help prevent another triple pandemic as the winter approaches and thus the rise of influenza, COVID-19 and RSV. Dr. Carole Myers, a professor emeritus in the University of Tennessee College of Nursing, talks with Dr. Megan Edwards, a public health officer of the Knox County Health Department.
WUOT’s Carole Myers: Dr. Edwards, since RSV is the least familiar of the three illnesses of concern. Let's begin there. What is RSV? And why are we concerned about it?
Megan Edwards: Certainly, I'd love to start with a little bit of a story to get you ready. Every fall and winter, a very familiar scenario is played out in millions of doctor's offices and emergency rooms across the country and across the world. A worried family brings in their sick infant, she's only about two months old and she's rapidly breathing with severe congestion. Her parents recall that her grandparent was hospitalized last week with a COPD exacerbation, but it wasn't the flu. On examination, his infant is breathing 40 times a minute. You can see her struggling with every muscle that she has to take a deep breath. This is RSV. RSV can also be that grandparent who is in the hospital still struggling to breathe because of this severe congestion and respiratory inflammation.
Okay, so we have infants and their grandparents being affected by the same virus?
Yes, absolutely. So RSV stands for respiratory syncytial virus. It was described first in the 1950s and researchers have been working ever since to try to find a way to prevent it. Right now, treatment is only supportive. It's lots of oxygen. It's some suctioning and it's waiting that long wait. There are over 2 million outpatient visits and more than 80,000 hospitalizations of children last year. Older adults also had 150,000 hospitalizations and up to 10,000 deaths were attributed to RSV just last year.
So it sounds like a major public health problem.
It's a major public health problem and a major reason for pediatric hospitalizations and for adult disease.
Are there vaccines available now to protect against RSV?
Yes, I'm so excited about this season, we finally have something to prevent some of these heart aches. So, the first vaccine that I'd like to talk about is the one that's available for adults. The RSV vaccine available for adults is indicated for those over the age of 60 and with underlying lung conditions, things like asthma or COPD. This is already available in pharmacies across the nation and people are already getting vaccinated.
What about children?
So for those tiny infants, the ones that really don't have a way of making a good immune system, we have two different ways to protect them. The first of which is a vaccine given to pregnant individuals between 32 and 36 weeks of gestation. This allows for the antibodies to be produced and then transferred to the fetus via the placenta. The infant is born and has good long lasting immunity for about five or six months after birth. This vaccine has just now been approved for use in the United States. This vaccine for pregnant individuals has been shown to reduce the risk of RSV hospitalization in their infants by 57%. For the first six months after birth, the second immunization is even cooler. So this isn't even a vaccine. It's a passive immunization that is given to the infant after birth. This immunization is called nirsevimab. Nirsevimab is a monoclonal antibody, so a man-made antibody that we give to the baby, the baby's immune system doesn't have to do any work to have the protection of this antibody. This new immunization has been approved for all infants, eight months of age and younger who are entering their first RSV season. It's also available for older infants who may have immuno-compromising conditions or increased risk for that second season. We hope to have this on the shelves in early October.
So let's turn our attention to COVID. What do we need to know about COVID vaccines this year?
COVID vaccines this year have been updated to include the X BB variant of the omicron virus. So these are the ones that are circulating right now and we're hoping to have good coverage for these COVID vaccines. As we had last year we have Pfizer and moderna which are the mRNA vaccines. We also now have Novavax. Novavax is a vaccine that's been made similarly to how previous vaccines were made with proteins and adjuvants. So this is something that is great for people who are just not ready to try that mRNA.
So we've talked about RSV and COVID. Let's go to number three. What are the key points about this year’s flu vaccine?
Influenza vaccines are now available and are expected to be very effective against this year's variant. These are most effective if they're received in the month of October. This gives your body enough time to build antibodies but not lose any before the season of flu hits really late November, December and then January. I was reminded recently that influenza vaccine does more than just prevent against influenza itself, it can prevent the complications that follow. Many people may not realize that influenza-like illnesses can precipitate or start off a cardiac event like a stroke or heart attack. Just getting a flu vaccine can prevent as many heart attacks as taking a statin medication or a blood pressure medication.
Let's talk now Dr Edwards about someone getting these vaccines for their infants or for themselves. Tell us a little bit about where to go. And how these vaccines are administered. I understand some of them are combined now?
I think we hoped that some would be able to be combined this year. We're not quite ready to combine flu or COVID vaccines yet, but you can still get both of them at the same time. We just encourage you to get one in one arm and one than the other. Flu and COVID vaccines are going to be available in your local pharmacies and at the doctor's office. We will have vaccines available for those who are uninsured and underinsured at the Knox County Health Department. Many people are running into the fact that COVID vaccines now cost money. If they have health insurance, health insurances are covering it, but if they don't we encourage them to reach out to their health departments.
Okay, so we've talked about flu and COVID, remind me about RSV please.
Certainly RSV because it is so new, we're waiting for these with bated breath. So we anticipate that the monoclonal antibodies should be ready in pediatrician offices and in hospitals within the next month or so. The Maternal RSV vaccine is also in committee right now being ready to be administered to people who are pregnant.
As we think about fall and we get concerned about fall because we're heading into winter where we're indoors more and there's an uptick in respiratory infections. Are there other vaccines that we need to include in the recommendations for this fall?
For those who qualify, a pneumonia vaccine is not a bad idea.
As we close up, are there any parting words that you have for our listeners, Dr. Edwards?
I just wanted to express my excitement and the excitement of the entire medical community about the RSV vaccines that we have available and the difference this could make in the lives of older adults as well as the lives of infants.
This transcript has been lightly edited for content.
