RSV Prevention for Infants: Nirsevimab & Maternal Vaccine

Respiratory syncytial virus (RSV) is a common respiratory virus that can be dangerous for infants. This episode of Your Checkup provides essential information about RSV, exploring new prevention methods like the monoclonal antibody nirsevimab and the maternal RSV vaccine. We discuss how they work, who should consider them, and their safety profiles. Tune in to learn how to safeguard your baby from this potentially serious virus.

Takeaways

• RSV is a common respiratory virus that can severely affect infants.
• Nersivimab is a new immunization option for RSV prevention.
• The immunization is effective in reducing hospitalizations by 80-90%.
• Maternal antibodies can provide temporary immunity to infants.
• The BreezVow vaccine is recommended for pregnant individuals to protect infants.
• RSV season typically runs from September to March.
• Parents should consult healthcare providers about RSV immunization options.
• The conversation highlights the importance of patient education in healthcare.

Keywords

RSV, immunization, healthcare, pediatric care, respiratory virus, vaccines, maternal antibodies, health education, patient care, family medicine

Chapters

• 8:00 The Learning

Transcript

Ed Delesky, MD (00:03)
Hi, welcome back to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky a family medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:17)
and I'm Nicole Aruffo. I'm a nurse.

Ed Delesky, MD (00:18)
And we

are so excited that you were able to join us here again today. Lots to chit chat about. If you're interested in the actual content, skip ahead a little bit. We like to leave a little chapter marker where you can jump ahead to see what actually we're talking about today.

Nicole Aruffo, RN (00:33)
Or like, don't be a loser and stay for the whole thing.

Ed Delesky, MD (00:36)
And stay for the whole thing. Well, let's see. We're drinking our poppies here again.

Nicole Aruffo, RN (00:41)
Yeah, always our poppy. It's our reward.

Ed Delesky, MD (00:44)
feeling good about that. Oh, gosh, where to start? We ate. Well, I was going to say we ate Thai food. went out, we sat at a bar, got diet cokes and ate Thai food. Yep. You're you like the Pad Thai. I like the drunken noodles. Mm Well, we got this Thai sausage bit too, which was absolutely delicious.

Nicole Aruffo, RN (00:54)
yeah, that was good. Pad Thai is so good.

like peanut sauce is so good.

Ed Delesky, MD (01:12)
I'm kind of blanking. There were definitely more things that I wanted to talk about here.

Nicole Aruffo, RN (01:16)
Should we talk about what we're consuming?

Ed Delesky, MD (01:21)
yes. Well, we gobbled up. Well, you tell us. I'm sure it'll be gobbled up.

Nicole Aruffo, RN (01:25)
Well, we gobbled up Tell Me Lies, which was so good. Season one and two.

Ed Delesky, MD (01:28)
One and two

Very interesting.

Nicole Aruffo, RN (01:36)
So good.

Ed Delesky, MD (01:36)
No, it's so good. Don't watch it with any young children.

Nicole Aruffo, RN (01:40)
I don't remember the book being like that good. The first season was based off the book and then the second season they just like went rogue.

I can't read the book a long time ago and it was like fine, but the show just like sucks you right in

Ed Delesky, MD (01:59)
Did like, so did you recognize some of the characters from the book to the show? Were they kind of what you imagined they would be or is it was it different?

Nicole Aruffo, RN (02:07)
Honestly, I read the book a while ago.

Ed Delesky, MD (02:10)
So not too sure. Gotcha. All right. Yeah, there's that. And what have we moved on? yeah. I don't know how thrilled I am about sharing this one.

Nicole Aruffo, RN (02:24)
Well, it kept popping up on like our suggested things to watch. So I've seen it, but I haven't done a rewatch ever. I don't think if not for like a very long time, but we took the plunge and we dove into Desperate Housewives.

Ed Delesky, MD (02:41)
Desperate Housewives, which for the longest time when I was growing up confused me for like Real Housewives of insert place here and Desperate Housewives. Now realizing that Desperate Housewives is just this drama television show. It's pretty interesting. Yeah, I'm studying womanly culture by watching this. This is very interesting to me. So we're going to keep going with it. I mean, we're going to. I remember how I wanted to jump on to here.

about discussing and singing what we're going to have tonight.

Nicole Aruffo, RN (03:14)
do you want to tell them?

Ed Delesky, MD (03:15)
Fat

rigatoni, fat rigatoni. Eat straight out the pot. Eat straight out the pot. Which is the song that we sing whenever we're going to eat. Fat rigatoni. don't you tell us a little bit about the fat rigatoni?

Nicole Aruffo, RN (03:26)
Fat Reggaetonie. Makeup songs for a lot of things.

Well, the fat rigatoni is just a spicy vodka sauce with spicy Italian sausage. And then the pasta is a fat rigatoni, not like the regular rigatoni. You have to get like the special extra fat one. And there you have fat rigatoni. It really pleases me that

Ed Delesky, MD (03:38)
Not just a spicy

Extra fat.

Nicole Aruffo, RN (04:00)
All of Eddie's favorite things to eat are like the simplest things. And he acts like, made this gourmet meal. And it's quite literally the most easy thing. Fat rigotini, spaghetti, meatballs. What else do you like? I mean, you like everything.

specifically those two.

Ed Delesky, MD (04:20)
Yeah, I just can't wait.

Nicole Aruffo, RN (04:23)
Yeah, we're gonna probably start making it after this.

Ed Delesky, MD (04:27)
I think we will. That, I haven't decided if we're going to the gym or not. It gets so dark out so early. it's going to be pitch black.

Nicole Aruffo, RN (04:34)
By the time we're done this it's gonna be dark.

I Pelotoned already. Me and Olivia Motto had an 8 a.m. date. Well she's been doing like live 8 a.m. on Sunday classes recently. I think starting like a few months ago or so.

Ed Delesky, MD (04:54)
It's a big commitment to get up, get to the studio to do that. I mean, we just walked to the next.

Nicole Aruffo, RN (04:58)
Well

she used to do, I forget what day of the week, but like 6am ones. my god. But she doesn't do them anymore.

No one does 6 a.m. The earliest is like at least for Like here is 630. Hmm, like the England people will have like 430 and stuff, but

Ed Delesky, MD (05:19)
I feel like there's so much more I wanted to say too. I mean, to that end, I'm on 99 out of a hundred and I'm kind of saving that next one. I think I'm going to do my first live ride.

Nicole Aruffo, RN (05:29)
You should, they're fun. And then you like log on a couple, or log on, I don't know, I guess that's the term. You join it like a couple minutes early and they're like talking to everyone, you know? It's like a BTS, you like feel cool. You're like in a live class. Behind the scenes.

Ed Delesky, MD (05:44)
What is a BTS?

Behind the scenes. You know, the H kind of makes me think there should be an H in there in the acronym. For sure. Yeah. But like behind the scenes, the is so like minuscule in the whole.

Nicole Aruffo, RN (05:53)
but it's a T.

acronym behind

Ed Delesky, MD (06:03)
Right. would say B H T S. Right. Because like behind is one word. Two syllables, one word.

Nicole Aruffo, RN (06:05)
now BTS.

Should we tell everyone our latest decision that we made?

Ed Delesky, MD (06:17)
If for me.

Nicole Aruffo, RN (06:18)
of three hours ago.

Ed Delesky, MD (06:21)
about Thanksgiving? Yeah. Yeah, this is going to be a hoot.

Nicole Aruffo, RN (06:28)
We're hosting Thanksgiving.

Ed Delesky, MD (06:31)
Yeah, we're going to see how this goes. A marriage, a union of the two families under one roof. And I mean, look, hit us up in the comments, not the comments, the show message. What do call them? The fan mail hit us up in the fan mail because.

Nicole Aruffo, RN (06:47)
hope for okay so like we texted my brother and his girlfriend and she answered us about her plans. think he's gonna answer via fan mail tomorrow. We're gonna get an answer on if he's coming with us or if he's gonna go with like if they're on her family or like what they're doing. Yeah. She sounded like she didn't know yet.

Ed Delesky, MD (06:56)
How will he answer?

We can't quite capture everyone from my family, but I think we'll get some.

Nicole Aruffo, RN (07:12)
I

mean, it might just be like us and our parents.

Ed Delesky, MD (07:16)
But who knows? I'll get like a bunch of major players and it'll be great and it'll shake it up and wish us luck. We're going to take all the help we can get though. No, I don't know what that big was either. No, hopefully everyone's OK upstairs. We have neighbors on the third and fourth floor.

Nicole Aruffo, RN (07:35)
Let's see. I feel like we haven't given an update. I feel like those are all the updates.

Ed Delesky, MD (07:40)
Yeah, we really flew in here late in the evenings on the days that we record and then kind of leave it where it is. We were all meat and potatoes last time. We're giving you a little bit of extra fat up here up front today.

Nicole Aruffo, RN (07:55)
We got my wedding ring. Yeah. Picked it out. We did. No wedding plans.

Ed Delesky, MD (07:58)
Yeah.

Don't remember those.

Nicole Aruffo, RN (08:02)
We got the ring. Well, we put money on the ring so they can start making it eventually.

Ed Delesky, MD (08:11)
And huge win for the Profs this weekend. Go Profs. I to go see them with my dad. my gosh. Yeah, that was awesome. Love D3 football. Love my alma mater. It's a great day to be a Prof. Now that I have some sort of a...

Nicole Aruffo, RN (08:18)
D3 football.

Ed Delesky, MD (08:27)
platform to say that out loud.

Nicole Aruffo, RN (08:29)
boy. All right.

Ed Delesky, MD (08:33)
What are we going to talk about today? I think we have. So hopefully, let's see what time that was so I can inform anyone in the beginning and re-record that if you're interested. Skip to this time. So what are we going to talk about today,

Nicole Aruffo, RN (08:34)
We've bored the people enough with our life.

Today we're talking about RSV prevention. So we have an episode about flu RSV type tings, but now we're talking this episode will be mainly about the vaccines. They're always a hot topic.

Ed Delesky, MD (09:04)
Always a hot topic. We're giving you the straight details because this is all relatively new. think it's only been around two seasons or so. And we'll review the highlights here. Tell me what is just in case someone didn't listen to that last episode. So what is respiratory syncytial virus otherwise known? Yeah, I'm asking. Just like in case someone didn't listen to the last episode and.

Nicole Aruffo, RN (09:25)
Are you asking me? Yeah.

So for those of you who are not loyal listeners and have not listened to our previous episodes, RSV is a very common respiratory virus that affects our lungs and all the little breathing tubes, I guess, for lack of a better description. For like adults, older kids, teenagers, it's just like a bad cold, but it really more severely affects infants.

Ed Delesky, MD (10:00)
can most common symptoms are coughing, wheezing, fever. And you can see a lot of difficulty breathing in infants, which is usually the thing that leads families to present to the hospital to have their infant taken care of. So that's why this can be so scary. Either one of us could tell war stories. You probably have more of them than I do of the sheer number of children that end up in a hospital with respiratory distress from this.

in a pediatric hospital. I mean, you probably saw them get overrun.

Nicole Aruffo, RN (10:33)
I mean, yeah.

I have nothing else to elaborate on that, sucks.

Ed Delesky, MD (10:39)
Yeah, no, it stinks. It's scary to have a kid in the hospital. It's expensive to have a kid in the hospital. It's very disruptive. And I'm saying all of this to highlight that decreased hospitalization is one of the goals here. in light of all of this, this tough situation where you have this incredibly common virus that's kind of everywhere is really dangerous for little kids. If you couldn't hear that was our intern in the background. Somewhere along the way.

a immunization was developed and it's called Nersivimab. And it really offers some sort of defense against RSV before it happens. And so Nersivimab is a monoclonal antibody, specifically not a vaccine, which is a very niche thing. I think you're going to hear a lot of people say it's a vaccine. This might be just.

It's the colloquial thing. It's an immunization. Yeah. And so it's a monoclonal antibody. And that works a little bit differently from a vaccine where vaccines help promote the immune system in a specific way. But a monoclonal antibody is ready made in a way that it actually gets at the virus from the get go. Antibodies already put in straight to target the antibody. Can you

elaborate for us because I was kind of running off there. Who is this specific vaccine? See, I just did it. Who is this specific immunization for?

Nicole Aruffo, RN (12:11)
So very common for preemies and then because they're just like kind of their own special category, especially going into RSV season. then typically and again, this is newer. So right now it's typically babies who are eight months or younger going into their first RSV season. And then there are like certain conditions that a infant or like younger child

even between like eight to 19 months may qualify or benefit for that that you and your doctor can talk about.

Ed Delesky, MD (12:48)
So off the top of your head, generally, when is RSV season?

Nicole Aruffo, RN (12:55)
RSV season's like September, October to like, I mean, how far you want to stretch it, March.

Ed Delesky, MD (13:02)
I think I was seeing March reading about the.

Nicole Aruffo, RN (13:04)
I'd say

that. I agree. So there are. But then sometimes it gets weird and you're like the middle of July and you're like, what's happening? Yeah, that happened. Why is the hospital on divert? Because all these kids have RSV.

Ed Delesky, MD (13:15)
So these things change. So the recommendations for the immunization will probably change. there are important things to think about. So what I want to highlight here is that there are, of course, different dosing information for different sized children, which I'm not going to bore you with the details of that, but that's one key piece here. But the other is the data. Like, what do these immunizations actually accomplish? And I really want to emphasize that it's

really effective. mean, we're seeing that in real world data, it's reducing hospitalizations and preventing them in 80 to 90 % of the time, which is astounding. There's a huge stress on the system that this immunization is helping. And so in clinical trials, when they're actually studying the drug, they are looking at 79%. They call it efficacy, which is like when you're in this experimental stage, how effective is it?

79 % in preventing medically attended RSV associated lower respiratory tract infection. What does that mean? You show up to a doctor, you show up primary care, you show up in the hospital urging care to get help. And they're saying it's 80 % effective in the trial in reducing hospitalization. It's living somewhere around there in the real world. I mean, this is incredible.

Nicole Aruffo, RN (14:38)
And it's like, cause even up until like not that like a few years ago, this was something that was really only offered to like preemies, like little tiny babies in the NICU. And they had to be, you know, a week, like a corrected age at this going into this or going into this, had to be like a certain corrected age going into your first RSV season and have like,

I forget what the qualifying diagnoses were. bunch, but. It like very selective. No, it wasn't a bunch.

Ed Delesky, MD (15:12)
it's like very niche, sorry. Very niche, very tiny amount of diagnosis.

Nicole Aruffo, RN (15:15)
And like we're tough to get very expensive. So like you had it was this whole thing of having to get it approved for those little Nikki babies, but

Ed Delesky, MD (15:25)
You did mention expensive. mean, I don't have it written down here or maybe we'll get to it later. This is very expensive, which is a downer. It's a big bummer. Yeah. But like anything, I mean, the first maybe it's just nice that there's finally something that if people are interested.

Nicole Aruffo, RN (15:36)
if your insurance covers it.

I also, okay, this is just purely like my observation. I just, how do I want to say this without offending anyone? It seems like people are like parents specifically, maybe ones who are like not thrilled about vaccinating their children for like the quote unquote, like required ones or like the standard ones, but then they're like,

Ed Delesky, MD (15:47)
That's what we're here for.

Nicole Aruffo, RN (16:12)
very much so about the RSV one. really? I just find it very interesting.

Ed Delesky, MD (16:18)
the immunization. Maybe it's because you can see it. Like you can physically see how common it is. And it's hard to imagine what polio is like. I'm not trying to reason with people, but like I can imagine that that's a line of. And they're like, out of sight, out of mind, why would I worry about measles, mumps and rubella? Right, I didn't pass away from measles, mumps or rubella because my mother got me vaccinated.

Nicole Aruffo, RN (16:33)
Yeah, it's like a thing that like doesn't exist, so.

Probably because you can die.

Ed Delesky, MD (16:48)
And I went to school. So all of that is very exciting. We talked about near seven mad, but we're kind of going to take a pivot here because there's a really interesting phenomenon when it comes to maternal antibodies. So for the first couple of months or so, after a mom gives birth to a baby, the antibodies from the moms stick around in the baby for a period of time. It's really a wonderful thing.

really cool. And until the baby gets, starts getting vaccines, they're really sensitive to the world around them. So this mechanism is taken advantage of when we think about vaccinating mothers and then using that to establish immunity in an infant for a period of time thereafter. So there's actually a different vaccine called a Breeds Vow that is an RSV vaccine.

for pregnant individuals. And so it's different from your 7Mab. It's a Breezevo, which has a different name. We're going to kind of refrain from using the brand name here, I guess. But you can look it up on your own. And this vaccine specifically works by, like I said before, allowing in pregnancy the mother to transfer protective antibodies to their babies through the placenta. I've done too much talking here. Can you pick up and tell us

when moms are getting recommended to get this vaccine.

Nicole Aruffo, RN (18:23)
Moms are typically getting it at some point between 32 and 36 weeks of their pregnancy. So then this allows it to start working and then that timing will allow the antibodies to be passed on the baby going into RSV season. So you kind of have this head start.

Ed Delesky, MD (18:41)
Yeah, it's typically offered or should be thought of or offered between September and about January because those are the couple of months preceding is the beginning or nearing ish the end of RSV season. And notably this, you like we kind of explained before, the immunity wanes over time. And so this will last the infant through their first RSV season, which is something to consider.

All right. Lots of great information here. This is very new. I mean, it's about two years old. I there are other things out there that people consider to be new, like SGLT inhibitors, like Giardian or GLP agonists like Ozempic. And they're like, they're so new. And they've been around for decades. This one actually belly up. This is actually new. So that probably leaves people with some concern, I imagine. Right. That.

it's so new. Do I want to be the first one in line? We saw this with COVID. I think it's safe and effective. I'm casting this thing because I feel like people probably have this perspective, but it's been studied. It's safe and effective. And that's something that I wanted to say out loud. Before we do that, let's talk a little bit about the right time, because it's probably going to be a one or the other. Either the mom's going to get it.

or the baby can get it. They're not gonna need both. So that's one thing. And you, whoever's listening, your loved one, or...

Nicole Aruffo, RN (20:15)
neighbor.

Ed Delesky, MD (20:17)
should go talk to the person who's taking care of you as you are pregnant or your infant. Have this conversation with them. But we're just here to make you aware that something now exists that didn't before. Great. Do have any feelings about those things?

Let's keep cooking then. So I got safety here. Obviously people are going to have concerns. We kind of teased out this in the last few minutes. Can you take us through for Neur7Mab, the infant immunization, what sorts of side effects or adverse reactions could be seen? Or in general, what safety considerations?

Nicole Aruffo, RN (20:59)
I mean there's always a side effect of temporary soreness at the injection site. Sure. Obviously you're injecting something into your muscle. Yeah. That happens. Yeah.

Ed Delesky, MD (21:06)
That hurts. Sometimes.

Normal. For a baby too, I guess. But they get stuff. They get the hepatitis B vaccine. It happens. Boom. Done. Normal.

Nicole Aruffo, RN (21:18)
I with everything there's always a small risk of an allergic reaction But that's not really something anyone can predict unless you already know that you're allergic to something in it Sometimes fatigue and headache with the maternal one but Nothing too serious nothing that like, know, you'll be fine in a day or two. Yeah

Ed Delesky, MD (21:39)
safe and effective, which is awesome. It can be given with other vaccines during the same visit, including live vaccines. So obviously, of course, discuss that with your own doctor. But this is all information from the CDC. We're not doing anything novel here. We're just collating all that information for you. So as we're talking about RSV here, I think it's important that we remember what the important signs and symptoms are to consider when.

You should take your child to go seek medical attention and you can find that in our other episodes colds and RSV. So now let's let's take a you know we gave you the information. Let's just take some time and have a conversation about it. I mean how cool is this that there's finally some tool that can be used. Right. mean like 30 children on one service in the hospital for one resident admitting 10 a night.

asking the ICU to see a couple of them because they're not breathing too well, like all the time in this season. Like it's bad. And to have something that could lower that tide a little bit, I just think that's amazing. So thank you for coming back to another episode of your checkup. Hopefully today you were able to learn something about the RSV vaccine or immunization for yourself, a loved one.

Nicole Aruffo, RN (23:00)
or neighbor.

Ed Delesky, MD (23:02)
Please find us on Instagram, email us at yourcheckuppod at gmail.com and send us some fan mail if you'd like to get in touch with us.

Nicole Aruffo, RN (23:11)
Yeah, Frankie, let us know if you're coming for Thanksgiving or not.

Ed Delesky, MD (23:15)
And most importantly, stay healthy, my friends.

Nicole Aruffo, RN (23:17)
Make

your biscuits if you are. I'm Nicole Aruffo

Ed Delesky, MD (23:19)
My name is Ed Delesky Thank

you and goodbye. Bye.

This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor and make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (24:08)
I am not your nurse.