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The Importance of RSV Immunization in Preterm Infants: Insights and Recommendations

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Zara Nwosu
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The Importance of RSV Immunization in Preterm Infants: Insights and Recommendations

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Respiratory Syncytial Virus (RSV) is a common and contagious virus that affects the respiratory tract. It can lead to severe infections such as pneumonia, particularly among infants. Preterm infants, in particular, face a disproportionately high risk of RSV-associated diseases, with an estimated 25% of RSV-related hospitalizations worldwide involving these infants.

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The Burden of RSV on Preterm Infants

According to a meta-analysis of 64 global studies, in 2019, there were approximately 1.7 million RSV-associated ALRI (Acute Lower Respiratory Infections) episodes and 533,000 RSV-associated hospital admissions. Alarmingly, these figures also included 3,050 in-hospital deaths and 26,760 RSV-attributable deaths among premature infants. These statistics highlight the urgency and significance of preventive measures against RSV, especially in preterm infants.

RSV Immunization: A Preventive Measure

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Recognizing the need for preventive measures, The Centers for Disease Control and Prevention (CDC) and the American Association of Pediatrics now recommend passive immunization of all neonates with monoclonal antibodies during the RSV season. The U.S. Food and Drug Administration (FDA) recently approved a vaccination for RSV in pregnancy, and the CDC's Advisory Committee on Immunization Practices has recommended RSV vaccination for all pregnant patients between 32 and 36 weeks of gestation who are anticipated to deliver during the RSV season if they are not planning nirsevimab for their infants.

Mistaken RSV Vaccinations: A Call for Caution

Despite these advancements, there have been instances where wrong RSV vaccines were administered to pregnant women and infants due to confusion by doctors and pharmacists. For instance, at least 128 pregnant women were mistakenly given the alternative vaccine Arexvy by GSK, and at least 25 children under age 2 received a vaccination. Arexvy has not been tested in pregnant women or children, and evidence from animal testing suggests it might exacerbate RSV infection in children younger than 2.

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Such mistakes underline the importance of proper education and awareness among healthcare professionals about the different types of RSV vaccines and their appropriate usage. In response to these incidents, the CDC has recommended that the children who mistakenly got either vaccine also be given nirsevimab, a monoclonal antibody that provides strong immune protection, while the RSV season lasts.

Equitable Distribution and Accessibility of RSV Vaccines

While advancements in RSV immunization are promising, it is crucial to address the challenges associated with cost, insurance coverage, and equitable distribution of targeted therapies. The current research and development of pharmaceutical products against RSV are still severely biased towards their use in high-income countries. This bias poses a significant challenge, considering that 92% of hospitalizations and 89% of in-hospital deaths were disproportionately clustered in developing countries in 2019.

It is essential to ensure that RSV-targeting monoclonal antibodies and maternal vaccines are accessible and affordable to all, regardless of their geographical location or economic status. Estimates suggest that these products could reduce the burden of RSV hospitalizations by as much as 80% when widely used, marking a significant step towards protecting preterm infants from the devastating effects of RSV.

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