Research Helps Parents Prepare for RSV Vaccines for Children

Two novel strategies to protect infants from respiratory syncytial virus, or RSV, may soon be accessible in Canada, and a University of Toronto researcher hopes to guarantee parents can make informed decisions for RSV vaccines.

Even though the majority of children will get infected by age 2, “most parents do not know about RSV,” says Tiffany Fitzpatrick, an assistant professor at the Dalla Lana School of Public Health and a member of the Centre for Vaccine-Preventable Diseases.

She’s heard from parents who first found out about the virus, which has a seasonal rhythm similar to the flu and symptoms including coughing, wheezing, and fever, after their child got it. Although the majority of cases are minor, RSV can cause more serious illnesses such as pneumonia and is the top cause of newborn hospitalization in Canada and many other nations.

More RSV immunization options are being considered by Health Canada, including an antibody-based medication that might potentially be used to protect all infants from severe RSV sickness and a vaccine for pregnant women that would carry protection from parent to newborn. The potential impact of these new options on Canadians’ health and an already overcrowded health-care system is enormous.

“This could be really revolutionary,” says Fitzpatrick, who is also a scientist at Public Health Ontario.

That is, as long as parents have the knowledge they need to make an informed decision regarding vaccination and comprehend the severity of RSV – a problem Fitzpatrick intends to address with her research, which was recently funded by the Canadian Immunization Research Network.

New RSV immunization options are on their way to Canada

The novel RSV preventative medication and RSV vaccines have been in the works for quite some time. Despite more than 60 years of research, possibilities for shielding vulnerable people (such as infants) against the virus were restricted – until now.

Palivizumab, a monoclonal antibody therapy, is now the sole option for neonates at high risk of hospitalization (those born extremely prematurely, with heart or lung abnormalities, or in isolated communities with limited access to medical care). The medicine cannot treat RSV, but if injected once a month during RSV season, it can help prevent severe sickness.

However, palivizumab is expensive and must be injected every month – sometimes for up to six months – so it is normally reserved for high-risk infants. Nirsevimab, a longer-acting antibody-based medication, was recently approved by Health Canada, requiring only one injection per RSV season. Nirsevimab is predicted to be substantially less expensive than palivizumab, and it may eventually be a choice for all parents.

A vaccination for pregnant women to help prevent their newborns from illness is also in the works and could be approved as soon as later this year. For the first time, the vaccine, which was recently licensed in the United States for older persons, offers the potential of protection against RSV infection — not only sickness – to all babies.

Pfizer’s RSV vaccine, known as RSVpreF, would be administered to women in their late second or third trimester of pregnancy. The vaccine stimulates the pregnant woman to produce antibodies, which are then passed to the fetus, providing their child with some RSV vaccines. The RSVpreF vaccination was found to be more than 81% efficient at protecting infants from significant health concerns caused by RSV in a multinational, double-blind clinical trial with pregnant women reported in The New England Journal of Medicine.

Discussing RSV and vaccination with parents

Fitzpatrick is listening to parents and learning about their awareness of RSV and potential issues ahead of the launch of nirsevimab and Health Canada’s assessment of RSVpreF data. Her research will involve conducting interviews with parents across Canada and using the data to build customised educational materials that address questions and provide information that parents may require as they contemplate their future RSV immunization options.

“We need to start planning now to make sure that parents are anticipating this, and they have the information they need to be able to make that decision,” she says.

In addition to surveys and interviews, Fitzpatrick and her colleagues will work with vulnerable populations. For example, research suggests that certain living situations can influence a child’s risk of RSV.

“We know if a child is exposed to mould, or if they live in a crowded house, they’re much more likely to catch any respiratory virus and for it to become a much more severe disease,” Fitzpatrick says.

RSV also has a disproportionate impact on certain locations and demographics. Fitzpatrick’s study collaborators will focus on parents in Nunavut, which has the highest incidence of RSV hospitalization in the world.

“They’re going to be working with community partners there to understand the unique barriers and motivators for RSV immunization in Inuit communities,” she says.

Fitzpatrick hopes to have her study’s educational materials ready in time for next year’s RSV season, when nirsevimab and vaccines for pregnant women will hopefully be available.

“I hope this research provides parents with the information that they need to make the decision that’s right for them,” she says, noting that as a public-health practitioner, she ultimately hopes people decide to get immunized “so we can prevent as much RSV disease as possible.”

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