The new infant and maternal immunisations have been met with enthusiasm by patients and clinicians alike.
Be opportunistic to get all eligible pregnant women and infants vaccinated against RSV, experts say.
The push comes off the back of a successful vaccine launch resulting in substantial drops in hospitalisations and illness.
Panellists discussed the recent enthusiasm for these newly approved vaccines, as well as the complexity of navigating differing programs across the country, at a recent Immunisation Coalition webinar.
RSV was the most common reason young Australian infants were hospitalised in the first six months of life, Professor Peter Richmond, chair of the session and paediatric immunologist in Perth, told the webinar.
“We estimate that there are probably 10,000 hospitalisations due to RSV in Australia each year, and the highest incidence is in those children under six months of age,” he said.
“This is a really important condition that causes a lot of trauma and morbidity to children and their families, so I think it’s really important that we do everything we can to prevent this occurring.”
Hospitalisations weren’t the only concern though.
“We also know that RSV can cause long-term complications in terms of susceptibility to chest infections and recurrent wheezing illnesses throughout preschool children,” Professor Richmond said.
The success story
Australia has seen major success in combating RSV harms, thanks to vaccine programs.
“Last year, the take-up was incredibly well received by a lot of parents,” said Dr Sarah Chu, a Brisbane-based GP and travel medicine expert.
This was notable given the challenges that had emerged in the pandemic, which had made some parents lose confidence in vaccines, said Dr Chu, a member of the Immunisation Coalition.
She pointed to recent findings in the MJA showing that Queensland saw a 69% reduction in the hospitalisation of infants under six months of age as a result of this program.
Dr Leon Levitt, a GP and obstetrician, said recent successes meant it was a “no brainer” to promote the vaccine again this year.
“My experience was that people were very enthusiastic, and also it depends on the enthusiasm which you put to the selling of it and explaining what it is,” he said.
Drawcards for parents included the fact that nirsevimab (Beyfortus, Sanofi)was an antibody rather than an antigen vaccine, and it would cover the child for the winter, he said.
Dr Levitt said that just in the last few weeks, the number of patients in his clinic who have had both the maternal vaccine and/or the child vaccine was much greater than the previous year.
“That’s a total game changer really for RSV,” he said.
Eligibility
From February, all women were eligible for Abrysvo (Pfizer) between 28 and 36 weeks of gestation as part of the National Immunisation Program.
Nirsevimab also became state-funded for eligible infants in all states and territories this year.
Programs did vary, however, so Dr Chu encouraged doctors to visit the Immunisation Coalition website’s RSV page to find out what was available in their state.
Dr Chu also highly encouraged doctors to talk about RSV while their patient was pregnant.
“It simplifies things so much more to give a maternal vaccination to the mother, and we’ve got the additional benefits of protecting mum as well as having her pass through the protective antibodies through the placental transfer,” she said.
Pregnant women should ideally be vaccinated before 36 weeks to ensure they have at least two weeks for the antibodies to have crossed over to the baby.
It was also important to consider conditions the mother might have that impede the optimal transfer of antibodies, Dr Chu said.
This included if the mother was immunosuppressed or had an ECMO or other procedure that reduced antibody production and transfer.
Related
If there was less than two weeks between the mother being vaccinated and the baby’s arrival, doctors could consider giving the baby nirsevimab, Dr Chu said.
“So always start with the maternal vaccination, but as part of the whole conversation I guess we talk about vaccine choice, and some people may not want to have the maternal vaccine and then may opt for nirsevimab when the baby is born instead,” she said.
Most babies and infants were eligible to be vaccinated at birth if the mother hadn’t had Abrysvo at least two weeks before birth, if she had a condition that suppresses the immune system or if the baby had a high-risk condition, Dr Chu said.
High-risk conditions included:
- Preterm birth before 32 weeks gestational age
- Having a haemodynamically significant congenital cardiac disease
- Significant immunosuppression, such as
- Malignancy
- Solid organ transplant
- Haematopoietic stem cell transplant
- Inborn errors of immunity associated with T cell or combined immunodeficiency, such as severe combined immunodeficiency (SCID)
- Chronic respiratory disease
- Chronic lung disease requiring ongoing oxygen or respiratory support
- Cystic fibrosis with severe lung disease or weight for length under the 10th percentile
- Neurological conditions where they may need respiratory support, or their lungs weren’t working as well
- Chromosomal abnormalities such as Trisomy 21 or other genetic conditions that increased the risk of severe RSV disease
These conditions meant that the baby would be eligible and recommended to receive nirsevimab irrespective of whether the mother was vaccinated, Dr Chu said.
Although she noted that some states and territories restricted the vaccine to certain seasons.
Dr Levitt said it was important to “be opportunistic”.
“Take every opportunity to find every mother and every baby and talk to them [about RSV vaccination],” he said.
If the mother wasn’t sure whether she or the baby was vaccinated, Dr Levitt said he would err on the side of giving the baby nirsevimab to make sure they were protected.
This wouldn’t do any harm if the mother had, in fact, been vaccinated, Professor Richmond agreed.
“It just gives you a bit of extra protection,” he said.
“You just get more antibodies and there’s no evidence that there’s any increased reaction.”
