Many hoped that newly approved vaccines and antibody treatments would immediately usher in broad-based protections for babies against respiratory syncytial virus infection, but the numbers show that this is not yet the case.
As of Nov. 1, the county’s vaccination registry recorded 43,940 doses of RSV vaccine administered, with 99 percent received by adults age 60 and older. Only 280 doses were administered to women of child-bearing age.
Research shows that the virus, often called RSV, is the leading cause of hospitalization for infants younger than one year and can also be deadly for older adults, especially those suffering from chronic medical conditions.
This is the first year when adults age 60 and older and women in their third trimesters of pregnancy have the option of receiving a RSV vaccine, which was approved by the U.S. Food and Drug Administration this summer.
The U.S. Centers for Disease Control and Prevention concurred in late September, setting the stage for a rash of pregnant women to begin receiving the RSV vaccine, called Abrysvo, in the 32nd to 36th weeks of their pregnancies as soon as October.
But electronic vaccine records, which medical providers are mandated to use, show that, so far, the older folks have had a far-higher uptake.
As respiratory illness season approached, it looked like there would be a fail safe for babies, but it has faltered.
Over the summer, the FDA also approved a second new drug called nirsevimab that targets RSV in newborns. A monoclonal antibody, nirsevimab, sold under the brand name Beyfortus, is a shot filled with copies of protective antibodies similar to those that a vaccinated mother’s immune system would generate and pass over the placenta to help protect a baby after birth.
But the CDC recently warned on Oct. 23 that Beyfortus has been in limited supply, causing the public health agency to push for giving the doses that are available to those younger than 6 months of age and to those “with underlying conditions that place them at highest risk for severe RSV disease.”
Just 142 doses have been administered locally, according to county records.
“We just started giving it like Oct. 1, and we’re already running out,” said Dr. Mark Sawyer, an infectious disease specialist at Rady Children’s Hospital.
The availability of Abrysvo, the RSV vaccine approved for pregnant women, does not appear to have reached full availability yet, he said.
Some medical practices, he added, may be taking it slow because health insurance companies may not yet have declared whether they will cover the cost of the vaccine — estimated to be about $300 per dose — in the first year of its market availability.
“A lot of OB practices have been reluctant to invest a lot in the vaccine until they’re sure they’re going to be reimbursed,” Sawyer said.
Locally, availability for pregnant women appears to be a bit spotty with Sharp Rees-Stealy medical group indicating that it started vaccinating some of its pregnant women in October and UC San Diego Health saying that there is still logistical work to finish before vaccination begins.
Sawyer predicted that there may be some reluctance among pregnant women to receive a newly approved vaccine against a virus that is not as familiar as others such as influenza or coronavirus.
“Pregnant women historically are reluctant to do new things, to take new medications or vaccines, during pregnancy because, for decades, we’ve told them to stay clean of everything while they are pregnant,” Sawyer said. “That is a residual hanging with us even though we are now routinely recommending vaccines for influenza, pertussis and COVID during pregnancy.”
But local obstetricians say they have encountered plenty of interest.
Dr. Cynthia Gyamfi-Bannerman, a perinatologist and chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at UC San Diego Health, said she has found plenty of interest among her patients.
“Many pregnant women have asked me during their visits, ‘when can I get this vaccine?’” Gyamfi-Bannerman said. “I think people are very interested, very excited.”
Dr. Shadi Omidi, an obstetrician and gynecologist at Sharp Rees-Stealy who works in the medical group’s Del Mar office, said that about 90 percent of the pregnant women she has offered the vaccine to in October have accepted.
Given the recent push-back in some circles against the coronavirus vaccine, and the fact that this vaccine is brand new, Omidi said she though there might be more reluctance.
“I haven’t had as much resistance as I thought I would,” Omidi said. “I’d say most women are open to it; I don’t know if maybe it is because last year we had a pretty bad year for RSV, it was in the news a lot, with so many people talking about how dangerous it is for newborn babies.”
Every year, an estimated 58,000 to 80,000 children age 5 and younger are hospitalized in the United States after picking up a respiratory syncytial virus infection, and between 100 and 300 of those die. The burden falls heaviest on infants in their first six months of life.
