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Ask Dr. Sears: RSV Protection

Q  My twin girls were born six weeks early and our insurance didn't approve us for the RSV shot, and now my girls have RSV. What terms do they go by and which babies qualify for the shot? What does RSV mean and how could I have kept them from getting it?

RSV (which stands for respiratory syncytial virus) is one of the most common viruses in infants under two years of age. In healthy infants, this virus is no more serious than the common cold. Yet, there are certain infants in a high-risk group, mainly premature babies, babies with congenital heart problems, or babies with compromised lung function, in whom RSV can be a serious, even life-threatening, condition.

There are certain characteristics about preemies that put them at high-risk for catching RSV. Premature birth interrupts the final stages of normal lung development, and this puts infants at risk for contracting serious RSV disease. These vulnerable infants have not yet developed a normal immune response nor do they have the lung capacity of a full-term baby. This makes it difficult for these infants to fight infection, and that's why RSV can turn very serious very quickly.

According to the American Academy of Pediatrics, each year around 125,000 children are hospitalized in the United States with RSV disease. In fact, RSV is the most common cause of bronchiolitis and pneumonia, and the number one reason for hospitalization of children under the age of two. The number of premature births is on the rise in the United States. With this rise comes an increasing number of infants that are more susceptible to serious RSV disease. Here's what you should know about RSV prevention.

Symptoms of RSV 

Initially, the symptoms of RSV may be similar to a cold. Symptoms may include: fever, runny nose, cough, difficulty breathing, difficulty eating, wheezing, rapid breathing, and a blue color around the lips. An infected, high-risk baby can get very sick very quickly. The highest months of RSV exposure are from fall through spring, and it is spread like the common cold virus: by sneezing, coughing, or hand-to-hand contact.

RSV protection 

Babies who are at-risk for RSV should get an injection of a preventive medicine called Synagis once a month at the beginning of the RSV season, usually five injections. Studies have shown that infants who are given this preventive medicine have a 55 to 78 percent reduced risk of being hospitalized for RSV than untreated infants. Synagis is not a vaccine, but rather a protein antibody that binds to the RSV virus and neutralizes it. Besides this medical protection from RSV, other home-health measures that parents can do to lessen the chance of their baby becoming infected with RSV are:

  • Insist that caregivers wash their hands before touching baby.
  • Wear a mask if you have a cold or when exposing baby to other children or people with cold symptoms.
  • Keep baby away from crowded places.
  • Do not smoke around baby.

If you have a baby in the following risk category, be sure to talk to your child's doctor about preventive medication.

Who should get RSV preventive medicine?

Because these injections are expensive, the Committee on Infectious Diseases of the American Academy of Pediatrics has devised guidelines on which infants should get this RSV preventive medicine. Here are the general guidelines:

  • All premature infants under 32 weeks of age at the start of the RSV season
  • All infants under two years of age with chronic lung disease
  • All infants under two years of age with certain types of congenital heart disease
  • All infants under two years of age with compromised pulmonary or immune function

Infants between 32 and 35 weeks of age at the start of the RSV season are in a sort of in a gray zone in which additional risk factors may make them candidates for these injections. This is the group your babies fit into. Infants between 32 and 35 weeks with the following risk factors should receive the RSV preventive-medicine injections:

  • Infants in daycare
  • Twins or multiple births
  • Infants who are exposed to tobacco smoke and other environmental air pollutants
  • Any medical condition that compromises breathing
  • Infants who have school-age siblings

While Synagis is expensive, it is very cost effective, which is why most insurance companies willingly cover it. The expense of hospitalization for RSV can be ten times the cost of this preventive medicine. Even though RSV is a common and serious illness in infants at risk, using the above medical and home-health preventive measures should lessen its severity.

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