Join us for a compelling discussion on the latest episode of "& So Much More," as we delve into all things RSV with Dr. Travis Engel. RSV, short for Respiratory Syncytial Virus, is a common and potentially dangerous virus that affects infants and children.
Dr. Engel explains how our region often experiences an RSV surge before other areas in the United States and how being in a warmer climate doesn’t ensure you’re in the clear.
Additionally, Cami and Dr. Engel have a frank conversation about vaccines and discuss the new, single-injection RSV vaccine, Beyfortus, and how it helps prepare your child’s body to fight RSV if they contract the virus, even reducing the likelihood of hospitalization by 75%.
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Transcript
Cami Smith:
Hi and welcome to & So Much More. I'm your host Cami Smith, and I'm here again with Dr. Travis Engel, who we love having on to speak into what is happening right now in our health system. So Dr. Engel is the Chair of Pediatrics here at Centra, and you have spoken into RSV last year, which I think was one of the years where we saw such a huge increase in our area and it sounds like we're seeing that again. You just came from the hospital. What does it look like?
Dr. Travis Engel:
Yeah, I was actually late to this because we had so many kids at the hospital right now. So the difference between this year and last year really is that, last year, we saw that increase in that surge so early, July, August, September. This year we are surging at, I think, what people would consider a more appropriate time or a more expected time. So I almost was a little bit cautious in thinking, "Wow, maybe we made it through this year without a huge surge," and now here we are, as November hits, seeing what I think is more of a typical surge in RSV, but still clinically significant and that kids are still pretty ill.
Cami Smith:
Yeah. I thought it was so interesting as I was looking up the new vaccine that we're going to talk about today, and you're going to give some insight into what that is, what that really is, but some of the statistics that are out there, and even for our area, I did not realize that the southeast is where those first cases will come every single year, year after year. Obviously, I mean we see it here, but it's not something that the rest of the US really deals with in a huge way. Is that true?
Dr. Travis Engel:
So RSV has a pretty significant clinical burden for children across the country.
Cami Smith:
Okay.
Dr. Travis Engel:
Right. Absolutely. We do see that this wave or this surge travels across the country-
Cami Smith:
Oh, I see.
Dr. Travis Engel:
... at a different speed, so we may realize it here a little bit earlier than some other regions, but RSV really does have a significant clinical burden for children, particularly children less than two years of age across the nation. As we talked about before, I trained for residency in Chicago. I did additional critical care training in Kansas City and really cut my teeth medically in Dallas, Texas, and we saw RSV surges in all of those areas, although the timing may be a little bit different. It's definitely a winter virus though.
Cami Smith:
So we see that firsthand and I think that's important for those you who are listening to know that, if you're in a warmer climate, you're not in the clear. It is so important for you to be prepared and to be cautious and to take some of the steps to protect your kids. We're not going to talk about this specifically today, but an older age group as well really need to be careful and to protect themselves.
So some of these statistics that I found, and this is from the CDC website, so among the age group of children younger than five years old, 1 million non hospitalization visits every year for RSV, 80,000 hospitalizations for that same age group, and then almost 300 deaths per year. I mean, that's such a heartbreaking statistic, and at the same time, when I see what's available, what we're going to talk about today, it makes that so much more encouraging, kind of like a big sigh of relief, like there's something you can do.
So they're saying that there's this new vaccine, but tell me about it. What is this new vaccine?
Dr. Travis Engel:
So it's a new formulation of a tool that we've had available for a long time. A vaccine, typically when we think of a vaccine, that is given to someone and it induces the body's normal immune response as if they had been exposed to that pathogen, so things like the flu vaccine, your MMR, your hemophilus influenza vaccine, our body treats those as like, oh, I've been exposed to this, I need to generate some antibodies to it and have those at the ready if I see this again. Beyfortus, which is what we'll talk about primarily today, but also SYNAGIS, which was another formulation available earlier and still available now, both helpful for the prevention of RSV, are really what we call immuno prophylaxis, in that they don't trick our body into thinking that it has the infection. In fact, there's something called monoclonal antibodies, which really is just giving our body a dose of antibodies that can help tag the RSV virus when it enters our body.
So I think a good analogy is if you have the ability to produce a hundred thousand troops to fight RSV, but you have to wait until you get RSV to deploy those a hundred thousand troops. If you get Beyfortus or SYNAGIS, it's like putting 50,000 troops at the front lines waiting to fight, and it gives you a little bit of a headstart if you get RSV. Your body will still have some clinical symptoms and your body will still generate its own antibody response and have to fight that illness off, but the big takeaway is that our clinically significant lower respiratory tract disease requiring hospitalization, goes down significantly, almost by 75%.
Cami Smith:
Oh, wow. That's a huge number.
Dr. Travis Engel:
When you talk about 80,000 children being hospitalized, theoretically, if we had good immuno prophylaxis with SYNAGIS or Beyfortus, Beyfortus specifically are the numbers we're talking about today, theoretically 60,000 out of those 80,000 could be prevented from having to be hospitalized. If you carry that out one step further, we would likely see a reduction in the amount of children who die from RSV.
Cami Smith:
And that's the heart of all of this is we want to protect our kids. So having this available I think is huge, but what would you say to parents who come in and they're cautious against vaccines. Because, well, first of all, it's so much information to digest and so you're injecting your child and it's like, "I want to know everything there is to know." What do you say to those parents who are just very cautious or apprehensive?
Dr. Travis Engel:
A couple things. Number one, I understand it, as a parent myself, to be cautious, apprehensive and questioning about any medication vaccine, immuno prophylaxis. Anything that we do for our children, we want to make sure it's the right decision and sometimes the idea of what's the right decision is really hard. Because theoretically, you could go through a whole RSV season and not get RSV. You don't know if it's going to impact your family, but when it does, my advice to patients is you want to stack the deck in your favor as much as you can. And this is a tool to do that.
With that being said, no medication, no treatment that we have comes without potential risk. Although this, the risk is pretty non-existent from what we've seen, in the long... Now, we don't have necessarily long-term outcomes or long-term immuno prophylaxis tracking at this point. That's going to be years in the making, but the study groups that it was utilized in have all fared very well without any difference in adverse outcomes based on either placebo or standard of care, which would be no immuno prophylaxis at all. That being said, we talked a little bit before when we had exchanged emails about discussing this topic that immuno prophylaxis is also available for mothers who were pregnant too, and that did actually have a very small increase. They said it wasn't statistically significant, but it is present for preterm labor.
So I want to point that out and mention that because number one, it is present. Number two, when you look at the numbers, basically 4.5% of the group that got the immuno prophylaxis injection, the monoclonal antibody, had an incidence of preterm labor. About 3.5 to 3.7% I think in the placebo or the non-treatment group had preterm labor, so the difference was very small, and there's a lot that goes into that, that I think requires us digging into the data a little bit.
The other thing I'll say in talking with my colleagues who are in obstetrics and gynecology, the recommendation to get that shot for mothers was between 32 and 36 weeks gestation. So if you're really concerned about that, which I think is reasonable, if you get that injection closer to 36 weeks gestation, you really are pretty close to being term-
Cami Smith:
To being full term.
Dr. Travis Engel:
Yeah, exactly, and that mitigates some of that risk.
Cami Smith:
Yes.
Dr. Travis Engel:
If your baby was to be born at 37 or 38 weeks, you're really looking at a overall, straightforward birth, right? At least with regards to timing of gestation. So I felt like that recommendation was actually really prudent, and I liked that. And the thought is if you pass those antibodies onto your baby, again, you stack the deck in favor of your baby if you get RSV during that winter season.
I wanted to put that out there. Obstetrics and gynecology, certainly not my wheelhouse and not my specialty, but newborn healthcare is, and anything we can do to help, what we call, cocoon those babies and prevent RSV infection and those around them and give them passive immunity through mom for RSV infection is critical.
Cami Smith:
So important. I love how that advice is taking into consideration the patient in such a personal way. It's addressing, not just the fear but the data, and giving a solution to it. Thank you for sharing that. I think that's going to be really helpful for those who are listening. So you mentioned that SYNAGIS was previous, that's something that has been available. And then how do you say again, Beyfortus?
Dr. Travis Engel:
Beyfortus, yeah.
Cami Smith:
Beyfortus. So Beyfortus is here now, and so if a parent's coming in, how do you explain the difference between the two?
Dr. Travis Engel:
That's a good question, and really, in terms of how the medications work, there's not a major difference. They're both monoclonal antibody therapies and both are still available. With that being said, Beyfortus, which is nirsevimab, it has a longer half-life, and that really is why I think they opened this treatment up to the vast majority of patients, was that it only required a single injection to protect you throughout the entire respiratory season. Whereas SYNAGIS, which had been available previously and still is, was really isolated to high risk patient populations, mostly preterm children who had evidence of chronic lung disease or congenital heart defects, some sort of intrinsic lung disease such as cystic fibrosis, poor growth and development, and then interestingly enough, indigenous peoples like Alaskan Natives and Native Americans have a higher incidence of clinically significant disease from RSV. So they fell into that subset of patients that we wanted to provide SYNAGIS protection with.
Beyfortus and SYNAGIS, both theoretically provide the same amount of protection because they're both monoclonal antibodies. In fact, I know some neonatology groups that are going towards providing Beyfortus over SYNAGIS just for the simplicity of it, because it's a single injection, it doesn't require the monthly visit for five months to get that protection. So typically, these kids would be discharged from the neonatal intensive care unit, they would get their first dose there, then they would come back to their PCP in a month and get another dose, and it was a lot to coordinate.
Cami Smith:
It's a lot. Yeah.
Dr. Travis Engel:
And theoretically, the more you're in the office, the more exposure you potentially have.
Cami Smith:
Yes. Yes.
Dr. Travis Engel:
So this is just one more reason that I think it's very practical to get this and why they extended that recommendation to otherwise healthy newborns who are at just the general risk of clinically significant RSV.
Cami Smith:
Yeah. You mentioned earlier that there's a shortage currently. So what does that impact?
Dr. Travis Engel:
I think the origin of the shortage really is this season we have the whole bucket of children. It's just been approved basically July into August, so now we have everyone potentially getting this at once, versus going into next year we'll have this rolling pool of patients who are born, they get it, and then they're born and they get it, and that's a more natural progression for manufacturing it. So there is a surge of patients who are eligible now. With that being said, the demand is high in some cases and the need for it is high, so there is a little bit of a shortage, and I know a lot of primary care doctors have been having issues getting significant supply. They're only getting a few doses at a time because it's being rationed and the recommendation has been save it for the patients who are more critical. That population we had discussed earlier.
With that being said, if you're offered this at your pediatrician's office and it's something that fits with the care you want for your child, if it's offered to you, I would jump at the chance to get it knowing that it might not be available later in the season.
I will say personally, and I know that what's right for my family isn't right for everyone else, but Beyfortus both for my wife when she was pregnant with our youngest, and for our youngest during the respiratory season, if he fit into the population that it was approved for, we without a second thought would've done it for them. My wife is a pediatric ICU nurse, we've seen how serious this can be for children.
Cami Smith:
I love that advice because you're in it. You see it every day. You came from it just now and we've got to get you back to it. But to have advice from someone who is on those front lines is really invaluable, and so I encourage you all to... CDC's got some great information and so do the research, find out if this is what's best for your family, but also take into consideration this frontline perspective of what is available and what you can do to protect right now. Thank you so much for your time. Was there anything else? Any thoughts swirling you want to throw into the pod?
Dr. Travis Engel:
Yeah, as you know, I always have some final parting thoughts too so. One other thing I do want to mention, and this is not borne out in the data yet, but it bears discussion. Early infection with RSV, especially infection with RSV and development of bronchiolitis requiring hospitalization, we know is a risk factor for developing asthma, lower airway obstructive disease later in life as children get older. I do not know how decreasing the burden of RSV infection is going to impact those numbers, but I cannot fathom how it would impact them negatively. So I want parents to think about this, not only in terms of I don't want my child in the hospital with RSV this season, but I don't necessarily want the downstream potential effects of having early RSV infection such as asthma, increased lower respiratory tract infections, et cetera.
I can't guarantee that that's going to be a realized benefit of this, but I anticipate that it might be. So again, I'll put on my speculative hat for a minute and just say that that's one more reason why I would've factored it into my consideration when I was talking about my own child.
Cami Smith:
Absolutely. I did not know that. You think about asthma, I mean millions of people live with asthma, but it is a very limiting... Is it technically a disease?
Dr. Travis Engel:
Yeah.
Cami Smith:
Yeah, limiting disease, and so to think you can save your child from that, that's a big deal.
Dr. Travis Engel:
Or potentially reduce the burden of it-
Cami Smith:
Absolutely.
Dr. Travis Engel:
... the burden of severity is huge because once we get out of that RSV age range, that two and under age range where it's really significant, then asthma really becomes the next biggest respiratory issue that children are admitted for. So if one leads to a decrease in the other, that would, I mean, they're going to slowly push me out of a job, which I would love.
Cami Smith:
Yes.
Dr. Travis Engel:
That would be a good reason.
Cami Smith:
Well, thank you so much for your time and we've got to get you back over to the hospital. And thank you all for listening and we hope you guys take this knowledge and apply it and join us next time on & So Much More.