Babies should now receive injections of new active ingredient

There is a new active ingredient against RSV respiratory infections that should be given to babies immediately after birth. This “vaccine” reduces the likelihood of severe disease by 80%. But will Switzerland receive the active ingredients on time?

Bruno Nellwolf/ch media

The dreaded RSV season is about to begin. The first baby infected with respiratory syncytial virus has been hospitalized at the Children's Hospital of Eastern Switzerland. Over the past two winters, Swiss children's hospitals have not only been overwhelmed with young respiratory syncytial virus patients, but waves of infection have spread around the world.

“RSV is the most common reason for hospitalization of infants in winter. At certain times last December, our wards were almost full of infants infected with RSV,” says Anita Niederer-Loher, an epidemiologist at the Children's Hospital of Eastern Switzerland.

During the coronavirus pandemic, things have been quiet about the contagious virus. Coronavirus hygiene measures prevented children from becoming infected. RS virus is usually spread through droplets and aerosols in adults and older children, who usually only get a cold even after infection.

The situation is different in newborns: Affected babies develop shortness of breath and are unable to drink water normally. In addition to fever and middle ear infections, lower respiratory tract inflammation and mucus buildup and even pneumonia are most common in children under two years of age.

The younger the baby, the higher the risk

That's why infected babies receive oxygen in hospitals and, depending on the severity of the illness, a stomach tube is used to provide them with fluids. Some babies also become more severely ill and require treatment in an intensive care unit. The younger the baby, the greater the risk of serious illness from RSV infection. All babies are at risk, even those who are healthy.

Now, the active ingredient Nirsevimab, sold under the name Beyfortus, is giving parents hope. This monoclonal antibody is injected during the first week of life. “Beyfortus reduces the possibility of RSV infection by about 80%,” says Niederer-Loher. Deborah Wallrabenstein from the Children's Hospital Basel confirms: “The active ingredient has very good efficacy and excellent security.”

The Federal Commission on Vaccination (Ekif) and the Federal Office of Public Health (BAG) recommend this active ingredient “because babies often suffer from RSV infections during the first winter. And because the risk of hospitalization is high, especially in the first few years of life.” months,” said Christoph Berger of the Children's Hospital of Zurich.

Babies often become infected with RSV during their first winter.Image: Shutterstock

Before Beyfortus, there was already a similar active ingredient called Synagis. However, the effect of this method is not long-lasting, so it must be sprayed five to six times during the RSV season. In addition, each jar sells for more than 1,000 francs. Therefore, this is only used in particularly fragile babies. Beyfortus, on the other hand, only needs to be sprayed once per season.

Now, for the first time, hospitals are giving the shot to children as young as a few days old. Babies born during RSV season will be given Beyfortus shortly after birth. Because the risk of serious infection is high. If born between April and September, the active ingredient is injected only at the beginning of the RSV season, which lasts from October to March.

RSV not yet protected in Switzerland Beyfortus

Beyfortus was approved in the EU in November 2022 and in Switzerland just a year later. Switzerland is lagging behind and there is no RSV protection for babies here. After all, it is now clear that health insurance companies will bear the cost of this “RSV vaccination”. The price is also known; a one-time dose is 396 francs. Pediatricians hope that the vaccine ordered from Sanofi will arrive in Switzerland from mid-October.

“Demand for Beyfortus is very high in Spain and France,” Niederer said. In these countries, up to 90% of infants can be vaccinated. This shows a very high level of acceptance among parents, even though France is a country with widespread skepticism about vaccinations. In Switzerland, epidemiologists expect parental acceptance to be about the same. However, she fears that not enough doses will be available and that Switzerland could soon experience a shortage of the active ingredient.

There are already shortages in Germany, which has recommended Beyfortus since June. The pharmaceutical company explained that the delivery bottleneck will last until at least October 11. A spokesperson for the German Professional Association of Pediatricians said that this is tantamount to a slap in the face for timely immunization in the upcoming cold season.

“It's not a vaccine, it's a drug”

Meanwhile, epidemiologist Niederer-Loher is troubled by the ubiquity of “RSV vaccinations.” “It's not a vaccine, it's an antibody, an injectable drug,” the senior doctor said. This is important: Vaccination triggers our immune system to respond. Vaccines contain viral components that stimulate our bodies to produce antibodies that can fight off attacking viruses when threatened.

Beyfortus is a drug, not a vaccine.Image: trapezoid

Beyfortus, on the other hand, contains injectable antibodies that have been completed. These monoclonal antibodies protect babies immediately after injection. This is because antibodies directly neutralize the virus during infection. Unlike active vaccination or infection, the immune system does not have to produce antibodies itself. Therefore, the baby is protected immediately, rather than days later as with vaccinations.

Because it is a medication rather than a vaccination, symptomatic vaccine side effects such as fever are eliminated. Therefore, Beyfortus is very well tolerated; redness or swelling may occur at the injection site.

But Pfizer also has an active RSV vaccine called Abrysbo. However, this is only allowed for use by the elderly, in other countries it is also allowed for use by pregnant women, but not by children. Because the risk of more severe RSV disease increases again with older age, Abrysbo vaccination is targeted at older adults. But it can also indirectly help young children.

Pregnant women get whooping cough vaccine

“The idea of ​​vaccinating pregnant women is the same as getting a whooping cough or flu shot. After vaccination, the mother develops antibodies and passes them through the placenta to her child. “As a result, it protects against serious infection during the first few months of life,” said Burg. Jay said. “However, Ekif still does not recommend that pregnant women be vaccinated with Abrysbo this winter, and health insurance companies are not covering any costs. “

Moderna's mRNA vaccine mRESVIA, also designed to prevent RSV infection in older adults, has just been approved by the European Medicines Agency (EMA). In Switzerland, Swissmedic is currently reviewing the application for approval and has therefore not made a recommendation yet. (aargauerzeitung.ch)