Robert Frenk, MD: 2024 was big year for RSV prevention

Robert Frenck, MD, professor of pediatrics in the Division of Infectious Diseases and director of Vaccine Research at Cincinnati Children’s Hospital, highlighted the significance of advances in respiratory syncytial virus (RSV) prevention during a discussion on maternal immunization and the monoclonal antibody nirsevimab (Beyfortus; Sanofi and AstraZeneca). Frenck emphasized the transformative potential of these interventions, comparing them to past successes in pediatric infectious disease prevention, especially as they became more readily available in 2024.

"I think that the RSV with the maternal immunization and then the nirsevimab is really a big deal," Frenck stated. Reflecting on historical parallels, he recalled the substantial reduction in rotavirus-associated hospitalizations following vaccine introduction. "Before that, we used to have kids that were just the whole wards in the hospital. The units in the hospital were full of kids who were having dehydration due to rotavirus-associated diarrhea, and now that's basically gone, or significantly decreased with the rotavirus vaccine." Frenck expressed optimism that maternal RSV vaccination and nirsevimab administration could yield similar outcomes in preventing severe RSV infections in infants.

Nirsevimab, approved by the FDA to prevent RSV in neonates and infants, has been recognized for its potential to reduce hospitalizations and severe respiratory illness in vulnerable populations. Frenck noted the promising reception of maternal RSV vaccines in his community, explaining, "About 40% of moms have said yes, they'd be interested in getting the vaccine. With 40% acceptance within the first year, that's actually a very high acceptance rate, and to me, very encouraging."

Frenck underscored the broader implications of declining immunization rates and the resurgence of preventable diseases. The re-emergence of vaccine-preventable illnesses follows predictable patterns when immunization coverage declines. "Every time they slip, we have the same answer... outbreaks," said Frenck.

Addressing vaccine hesitancy, Frenck acknowledged, "People talk about vaccines, [saying] 'these are vaccine-preventable illnesses, but these are just normal childhood illnesses, and kids get over it.'"

However, he stressed the unpredictability of severe outcomes.

"Most of the time, that's right, but I can't predict which kid is going to be the one to get real sick, and that's why we need to immunize everyone. The vaccines are really a dual kind of thing," said Frenck. "They protect you by giving you the vaccine, but then they also help protect people that can't get vaccinated because they have conditions where they're medically unable to get vaccinated, or they're too young that the vaccines don't work yet."

In his view, the development of RSV vaccines and monoclonal antibodies represents "a huge move forward" in safeguarding child health.

Reference:

Nirsevimab-alip FDA approved to prevent RSV in neonates, infants. Contemporary Pediatrics. Published July 2023. Accessed January 6, 2025. https://www.contemporarypediatrics.com/view/nirsevimab-alip-fda-approved-to-prevent-rsv-in-neonates-infants