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RSV injections for infants and babies
RSV is a highly contagious seasonal virus that infects the lungs and breathing passages of people of all ages, with case-counts peaking in the fall and winter. Last year, the virus arrived early and threatened to overwhelm hospitals.
Dr. Scott Hadland, chief of adolescent and young adult medicine at Massachusetts General Hospital for Children, said that because of their young age, babies’ lungs are still developing, and they are particularly at risk for infection. According to the Centers for Disease Control and Prevention, RSV causes 58,000 to 80,000 hospitalizations each year among children younger than 5.
In July, the Food and Drug Administration approved a new injection for all babies under 8 months. Beyfortus is not a vaccine but a monoclonal antibody — an injection that contains lab-produced proteins that act as antibodies. Vaccines are different because they prompt the body to produce its own immunity. “With vaccines it is like someone is handing you the ingredients to make a cake, and with monoclonal antibody injections someone is just handing you the cake,” said Dr. Aaron Bornstein, a pediatrician at Middleboro Pediatrics.
All infants under 8 months should get Beyfortus, once it becomes available, for their first RSV season, according to the CDC. High-risk children, such as premature babies or babies with heart infections, can receive a second dose going into their second RSV season. After their first two seasons with the injection, children are expected to gain the natural strength to fight the virus, Hadland said.
He recommended all babies and infants receive the RSV injection at the same time as the flu vaccine.
“The idea here is that every infant, because they’re young, is at risk, so every infant should get this vaccine,” Hadland said.
Beyfortus is not yet available, but AstraZeneca, its manufacturer, said in a statement in July that children would be able to receive Beyfortus ahead of the 2023-2024 RSV season.
RSV vaccines for patients over 60
People at the opposite end of the age spectrum are also vulnerable to respiratory illnesses like RSV, because the immune system can weaken as we age. As a result, each year 60,000 to 120,000 people 65 and older are hospitalized with RSV and 6,000 to 10,000 die, according to the CDC.
Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, said there is no formal recommendation for how to space out flu, COVID, and RSV vaccines, but he would advise people over 60 to wait a few weeks in between COVID or flu and RSV shots.
“My own advice to people is they can get the COVID and flu vaccines together, but because the RSV vaccine is new, people should wait a couple of weeks in-between and get it on a different day,” Sax said. “This is because we really don’t know how people will feel right after. In the clinical trial, there were some side effects from the vaccine but nothing severe.”
Sax recommends patients only get the vaccine after consulting with their doctors.
Arexvy is available in major retail pharmacies across the United States right now, and some hospital clinics and doctor’s offices will have the shots soon.
Flu shots are available now, but experts recommend most people wait until September or October to make sure the protection lasts through the end of flu season, which can extend into April and May .
However, the CDC says pregnant people who are in their third trimester should get the flu vaccine before September so their babies are protected from influenza at birth, when they are too young to be vaccinated.
Children ages six months to eight years who have never received a flu vaccine should be vaccinated twice. They should receive their first dose as soon as the vaccine becomes available, and their second dose at least four weeks later.
Last season people who received flu shots were 40 percent to 70 percent less likely to be hospitalized for the infection, the CDC estimates.
People will have to wait a few more weeks to receive updated COVID-19 vaccines that are well matched for current coronavirus variants. But once COVID boosters are available, doctors recommend patients get it with their flu shot, after Sept. 1.
In June, the FDA’s Vaccines and Related Biological Products Advisory Committee unanimously voted that the fall 2023 COVID booster should be a monovalent vaccine that targets the XBB.1.5 strain of the Omicron variant. The COVID boosters currently available are bivalent vaccines that target the original coronavirus strain and an earlier Omicron variant, and some say they are less effective against the most dominant strains that are circulating.
EG.5, known as “Eris,” is the most common and fastest growing COVID-19 subvariant in the United States, responsible for around 17 percent of new COVID cases. Eris is similar to XBB.1.5, but it carries one mutation to its spike protein, which is the part of the virus that the booster targets.
Moderna said Thursday its updated vaccine proved effective in tests against EG.5.
Moderna, Pfizer, and Novavax are all expected to offer COVID boosters this fall.
Carly Pflaum, press officer for the FDA, said the new COVID vaccines are expected to be available in mid- to late-September, pending regulatory action by the FDA and recommendation from the CDC.
When should you get each vaccine?
For those receiving all three vaccines, doctors recommend you do not get all of them at once.
Instead, doctors say you can get both the updated COVID booster and the flu shot at the same time, ideally in September or October, but people over 60 who are eligible should wait a few weeks to get the RSV injection to avoid potential side effects.
Pregnant people who are in their third trimester of pregnancy should get their flu shot before Sept. 1 so that their baby is immunized because newborns will be too young to receive the vaccine for the season in the first few months of life.