RSV and Pregnancy Vaccination: What You Need to Know
More Programs and Publications Featuring Dr. Rodney Rohde
In this program:
What’s essential for pregnant patients to know about RSV risks and RSV vaccines? Medical laboratory scientist Dr. Rodney Rohde discusses risks of preterm births, infant mortality, and RSV complications as well as recommendations about RSV vaccination recommendations to protect pregnant mothers and their unborn babies.
Transcript
Interviewer:
Dr. Rohde, there are socioeconomic groups that are more likely to have premature births. What is the associated risk between RSV and premature births?
Dr. Rodney Rohde:
Yeah, this is a really important topic. As you know, in the last few months we've seen some new opportunities and tools for RSV, both in vaccines and monoclonal antibodies. And when you look at RSV, respiratory syncytial virus disease, we know that that's a significant cause of mortality and respiratory failure, really among infants, primarily in low income regions of developing countries, probably we think potentially that's because of limited availability of diagnostic testing and access to overall healthcare. So that's always a concern. And then when you look at developed countries, mortality tends to be lower and more rare, but it can occur in high risk infants with some of the comorbidities that we'll describe. So RSV can increase the risk of preterm birth, and is really more dangerous for premature babies.
And there is a 2023 study when I was doing a quick look in the literature that reports pregnant people with RSV are roughly three-and-a-half times more likely to deliver early than those without the infection. And we all know that premature babies, in other words, those that are born usually before 35 weeks, and are six months or younger, when RSV seasons starts, are at a much higher risk of severe RSV disease, because their lungs are underdeveloped, their respiratory systems are still developing. And if they get RSV, Deandre, they can develop bronchiolitis, which is kind of an inflammation of the small airways in the lungs, pneumonia, which is an infection of the actual lung. So preterm babies with RSV can be roughly three times more likely to actually die from this virus than full term babies. So they also have a higher risk of hospitalization, being in the ICU and overall respiratory failure. So early preterm infants just have an overall higher risk of hospitalization than really all infants, even as they go into their second year of life. So really, really important to kind of try to prevent that.
Interviewer:
It's like you said, because preterm infants do have lung underdevelopment since that's the last thing to develop while they're in gestation. Can this still affect their development altogether of their lungs, like will it take even longer for their lungs to develop? Will they have the RSV infection?
Dr. Rodney Rohde:
Right. So we know that RSV can really complicate the development of lungs. We see that infants and children primarily who have really more severe cases of RSV before the age of 2 are likely to have changes to their overall lung structure and function. And that can really mess with you later in life. So we know severe early life RSV infection is associated with things like wheezing, childhood wheezing, different types of worsening viral, respiratory viral infections, allergies, and even asthma that can really compromise lung function. And on a personal note here, my son, who is now 25 years old, when he was born, he was born on New Year's Eve, and, of course, RSV season. And within two weeks, he was diagnosed with RSV, and he's fine now, but we had some scares even in his teenage years where he had asthma attacks. And so he actually had to be put on fluticasone propionate and salmeterol (Advair) and some other types of medications to deal with that. So fortunately, he outgrew it, but it can be a complication for almost any early child in that development of the lung.
Interviewer:
Wow. So I know we're talking about the risk for the infant, but let's talk about the mothers for a little bit. So are there a risk to the mother in getting RSV vaccinations during their pregnancy?
Dr. Rodney Rohde:
Yeah, it's always important to talk about these things, especially in today's world with vaccines being kind of on everybody's lips and concerns. And so generally, RSV vaccination is really safe for pregnant people. There are some minor potential side effects. For example, and this is kind of typical. You can have injection site pain, you can have some headaches, you may have muscle pain, nausea. There are some other safety outcomes that ACIP, FDA, and CDC always monitor really for any vaccine. There's really no strong causation for any real major side effects for this other than the ones I mentioned. Another thing to kind of think about in this conversation with pregnant mothers, I think it's really important to talk about is that the American College of Obstetricians and Gynecologists absolutely recommend the Pfizer RSV vaccine. Again, we're not recommending any particular vaccine here, but there are three types of vaccines available for RSV.
This one's known as Abrysvo, and it's for people between 32 to 36 weeks of pregnancy during the RSV season. So that's September through January. And what that does is it gives the mother's body enough time to create antibodies before giving birth. And so you have transplacental protection, and then the vaccines are very effective at preventing illness in that infant, and it lasts till about six months after birth. The other kind of cool development in the past six months, maybe a year, I can't remember the actual date, but there's a new monoclonal called nirsevimab (Beyfortus), which you can give after the child is born for immediate passive protection. So now, you can kind of tag team it before the birth and even after birth if you have severe risk with that child. And then like anything if you know you have severe complications from past vaccinations or other issues like that, then you absolutely should visit with your OB/GYN or your primary care physician to kind of create a plan for you, if you may not be able to receive the vaccine.
Interviewer:
So is this a once in a lifetime vaccine, or do you do it per pregnancy?
Dr. Rodney Rohde:
I'm pretty sure you can do it per pregnancy, but again, with that question, I would definitely consult with your OB/GYN and your primary care physician to make sure there's no issues with secondary comorbidities with antibody development. Sometimes you can develop some problems in that way, but I believe it's able to be used over and over again.
Interviewer:
Okay. Because I'd also wonder how would it affect the mother if they had to take it very immediately, if they had very back-to-back pregnancies as to maybe a pregnancy two years apart or three years apart.
Dr. Rodney Rohde:
Right. I don't know if they have that research available, to be honest with you. So that would definitely be something to keep an eye. It's brand new. Again, I believe it's within the last six months, maybe even the last four months. So certainly want to keep the FDA, the CDC, ACIP, all those organizations are keeping an eye on the ongoing development of those types of questions.
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