After months of planning, the Neonatology and Pediatric Hospitalist Groups, in collaboration with Inpatient Pharmacy and the Women and Children Department Leadership Team, proudly announced the roll out of Beyfortus on Monday, Oct. 23, at Salem Health.
RSV causes respiratory tract infections that can lead to severe illness among infants, especially those born prematurely, with congenital heart disease or with immunocompromising conditions. In the United States, RSV is the leading cause of hospital admission for all infants.1
Last year, hospital admissions for pediatric RSV-related illnesses soared to unprecedented levels. In November 2022, Oregon hospital admissions related to RSV peaked with 479 admissions per 100,000 people in children under one year of age, compared to the previous year of 196 RSV admissions per 100, 000 people.2 The nationwide surge of RSV-related hospital admissions in 2022 rocked the pediatric world, taxing already fatigued healthcare workers and overwhelming hospital resources, including ICU bedspace.
Until recently, the only prevention against RSV was palivizumab (Synagis), a monoclonal antibody prescribed for preterm infants or infants with certain types of heart disease. Due to the narrow criteria for Synagis administration, most infants born in the United States did not qualify for RSV prevention, leaving them more vulnerable to severe respiratory infections secondary to RSV.
In July 2023, the US Food and Drug Administration (USFDA) approved nirsevimab (Beyfortus), a long-acting monoclonal antibody that provides passive immunity against RSV with expected protection lasting 5 months.3
According the American Academy of Pediatrics (AAP), Beyfortus is expected to reduce the risk of severe RSV-related illness by about 80%.3 Starting with the 2023 to 2024 RSV season, the AAP recommends all infants less than 8 months of age who are born during the RSV season, or who are entering their first RSV season, receive one dose of Beyfortus. Infants who are eight to 19 months old with severe risk for RSV-related illness should also receive a second dose of Beyfortus before their second RSV season.3
In August 2023, the U.S. Food and Drug Administration also approved the first maternal RSV vaccination, Abrysvo, which has been endorsed by the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG) for the prevention of RSV-related illness among infants. Maternal vaccination with Abrysvo is recommended between 32 and 36 weeks gestation during RSV season.4 Either maternal RSV vaccination with Abrysvo, or infant immunization with Beyfortus should be offered to prevent severe RSV disease — however, the rollout of Beyfortus in Oregon and across the United States has been challenging due to high cost and high demand.
The expense of Beyfortus, currently set at $495 per dose, is a significant factor inhibiting hospital dosing prior to discharge. In the U.S., about 90% of hospitals do not receive federal funding to administer childhood vaccines due to lack of participation in the federally funded Vaccines for Children Program (VFC).5 This program provides vaccines at no cost to those who are Medicaid eligible, uninsured or underinsured, American Indian or Alaska Native. In the state of Oregon, Salem Health is the only VFC-participating hospital, creating a unique opportunity for Salem Health to offer RSV prevention to those born in our community.
1. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advirosry Committee on Immunizatino Practices. Centers for Disease Control and Prevention. Accessed October 20, 2023. https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm
2. RSV-NET Interactive Dashboard. Centers for Disease Control and Prevention. Accessed October 2021. https://www.cdc.gov/rsv/research/rsv-net/dashboard.html
3. Nirsevimab Frequently Asked Questions. American Academy of Pediatrics. Accessed October 20, 2023. https://www.aap.org/en/patient-care/respiratory-syncytial-virus-rsv-prevention/nirsevimab-frequently-asked-questions/
4. Healthcare Providers: RSV Vaccination for Pregnant People. Centers for Disease Control and Prevention. Accessed October 20, 2023. https://www.cdc.gov/vaccines/vpd/rsv/public/pregnancy.html
5. Treatment to protect infants from RSV faces obstacles in Oregon. Oregon Public Broadcasting. Accessed October 21, 2023. https://www.opb.org/article/2023/10/02/drug-availability-infants-oregon-rsv-lung-infection-beyfortus-nirsevimab/