Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and today we're offering an update on RSV and the recently approved new drug to prevent it. Joining me is Dr. Neela Sethi. She's a pediatrician on staff at Henry Mayo Newhall Hospital. Dr. Sethi, it's always a pleasure to have you join us. Today, as we get into this pretty exciting topic, give us a little refresher on RSV as we head into the fall.

Neela Sethi, MD: Absolutely, so RSV is like the bane of our existence as pediatricians, sometimes even more than COVID. And it's one of those things that sometimes people don't realize just how powerful of a virus it is and just how many hospitalizations occur because of RSV every year. So, RSV stands for respiratory syncytial virus.

It's a virus that really attacks the respiratory system of the most vulnerable, and generally speaking that's our premature population. So anybody really born under 36 weeks and the more preemie, the more vulnerable. What it does is, it's a nasty little virus because it starts with a cold and cough. And so you think, okay, this isn't too terrible, but it lands in the lungs and creates so much just congestion in general.

And what happens is, is that babies have trouble breathing because their nose is so congested and their chest is so congested that they can't figure out where to get air. The other thing that it does because it is so nasty, is it creates an asthma type picture and it literally creates a wheezing in babies. And what that does is make it so not only are their airways congested, and not only is their nose congested, but then you pair that with tightness in their chest and wheeze, and it makes them drop their saturation rate, and their O2 sats low very quickly, and that lands them in the hospital.

Host: How scary. So as you say, it's the bane of your existence for pediatricians. Now, the FDA recently produced a new drug that we mentioned, Beyfortus, to protect babies and toddlers from RSV. I'd like you to speak just a little bit about it, and while you're telling us about it, you're speaking to parents, and we get all these kind of vaccination questions anyway. So is this considered a vaccine? Tell us a little bit about this drug.

Neela Sethi, MD: Yeah, so Beyfortus, and I don't know if I'm going to be pronouncing the generic correctly because I never know exactly, but I've heard it called or nirsevimab. I've heard both in the hospital, so I'm not a hundred percent sure, but we'll follow up on that parents. But basically it is an FDA, just recently FDA approved vaccine, and it's a monoclonal antibody. So it's not the typical type of vaccine that we use out there, but it's an antibody. And what it does is it decreases the severity of RSV. So just like vaccines in general, it may not make it so that you don't get the illness at all.

 And it's kind of like the COVID vaccine in that you're still going to get all your exposures and these kids are still going to go to daycare and they're still going to get exposed to the virus. So when parents think about it, they can't think Oh, this is something that I'm going to get, and my kid is never going to get sick with RSV.

No, what that means is, is that when you get this vaccine, it creates antibodies that circulate in your bloodstream that help you fight RSV and give you and boost your immune system in a way to help you not have those nasty symptoms that we're talking about. So it just decreases severity of symptoms and really most importantly decreases the amount of hospitalizations and decreases death because that's the ultimate fear for all parents, is something happening to your baby that's very serious like that. And that's what this drug is here for. Now, previously we did have a vaccine for RSV and it was called Synagis. It's still available. It was really an excellent vaccine, but it was once a month through the whole season and it basically only worked and was approved for premature babies or babies with chronic lung disease or severe lung disease.

And it was extremely expensive for parents and it was very hard to get covered. So the rest of the parents out there that had kids with asthma or other types of lung issues that weren't considered chronic lung issues or weren't premature, would be frustrated thinking, well, my son gets really, really sick with illnesses. Why don't I qualify? So this is sort of the middle ground allowing us to give a option to these parents for newborns and infants that are entering into their first or even second RSV season from like birth to 24 months of age.

Host: So which of our children should take it? Should babies and toddlers get it? What are the recommendations for who it is safe for?

Neela Sethi, MD: So right now it's safe for children up to 24 months who basically are more vulnerable to the RSV season. So that includes basically, anyone that's had a history of immune deficiency, anyone with asthma, anybody preterm, anybody with health conditions, basically, it's a lot more flexible and what they're saying is that it's anyone that's basically vulnerable to a severe RSV season.

And that, for pediatricians, includes anyone that struggles with respiratory issues, from birth.

Host: That's so interesting, I'm wondering Dr. Sethi if as we learn more about this and see the RSV season that's coming up and we hear about an increase in COVID cases starting to rise again. Is this going to overlap and will this help you pediatricians and us parents not, you know, let our kids get quite as sick as we're about to see this twindemic coming around in the fall.

Neela Sethi, MD: Absolutely. That's exactly what we are so excited about and that we didn't really have an option for RSV for a regular, sort of quote unquote, normal average, toddler or infant out there. Then we were getting hit with the COVID season and it was just, I mean, it was absolutely crazy, Melanie, what was happening last fall.

I can't even explain it to you. When we hit that triple pandemic like they were calling it, we were in the midst of flu and RSV and COVID. I was admitting babies every other day, every third day. We ran out of albuterol. We ran out of O2 in our office. It was one of the most stressful seasons of my life.

I had never seen babies as sick as I had seen them, so that's long answer and the short answer is yes. This is going to be, as long as it's effective, which the studies look really positive. This is going to be a way for us to offer parents something that has never been offered before, where they can really and truly, feel more confident sending their kids to daycare, going back to work, not worrying as much about COVID in the midst of a really crazy RSV season as well.

Host: Well, you kind of just gave me chills and you know, with what you were describing last season. So now I think one of the bigger questions that you're going to get, that you probably already have gotten, is from parents that have questions about the safety, the testing, all of those things. What do you tell them when you say we've got this new drug to help prevent and reduce the severity of this RSV that's putting our children, our little babies, our most vulnerable in the hospital?

What do you tell them Dr. Sethi?

Neela Sethi, MD: Well, my favorite thing to say for this drug specifically, Beyfortus, is it was approved in the EU last year in October 2022, for exactly the prevention of RSV and proved to really, really help and to really be effective and to have a side effect profile that was really not terrible. So that makes me, just as a pediatrician, feel just less concerned and more reassured when you have something that's already been not only approved, but also in clinical practice a year ahead.

And again, this is an antibody. And so this is literally putting antibodies against this virus into babies, just like when you had monoclonal. We had the ability to give monoclonal antibodies during COVID and everyone was standing in line for hours on hours in these tents trying to get antibodies in their system to fight COVID.

This is providing that to kids where we're literally giving them passive immunity safely to protect against RSV. It's very, very unprecedented. It's a game changer for pediatricians, and I just think that it's a blessing that we're going to be able to offer it to American families.

Host: Well, see, that's the thing, right? People are coming up with these life saving medications and you pediatricians who are the gold standard, you are the ones helping to raise our children and keep them safe, which is no mean feat. And we love you so much for it, are telling us that this is safe. We have to listen to you and believe you because that's what you're here for, and the passion that pediatricians have for our children just cannot be matched by any other physicians, in my own personal opinion. Dr. Sethi, last word, speak to parents about RSV, this upcoming fall season, and Beyfortus, what you want them to hear, what you want them to know.

Neela Sethi, MD: What I want parents to hear is, is that RSV can be a very minor virus. And so I do hear parents saying, well, my kid had RSV and it wasn't that big of a deal. Well, guess what? It's just like COVID. Some people can get COVID and really have minimal symptoms, but there are cases where COVID was life threatening. And that is true of RSV as well. If it hits an infant, and that infant is vulnerable, just like we talked about, has chronic medical issues, has immunodeficiency, is premature, has asthma, just in general is a wheezer, it can be life threatening. And this Beyfortus drug is a single dose, long acting antibody that literally can prevent lives. It's never been done before. So yes, could it be a minor virus? Absolutely. But by giving this vaccine to your child, could you prevent something very, very serious? Yes, you can. And just like what you said, Melanie, which warms my heart, there are people out there that are developing these drugs and studying these vaccines, spending their life, and putting their blood, sweat and tears in this.

 And these are the people that we can trust. These are the people that know what they're talking about and that are in it for the right reasons, just as I'm getting up every day trying to save lives.

Host: Well, I couldn't agree more and I, I think of the people that invented Gardasil as one of those things. I mean, it's just amazing to me really what goes on in the scientific community. And Dr. Sethi, thank you so much for joining us and telling us about that. And you can learn more about Beyfortos at FDA.gov. You can also visit the free health information library at library at henrymayo.com for so much great information that you absolutely can trust. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.