Infants bear the brunt of RSV hospitalizations, UBC study finds

Infants younger than six months old get hit the hardest with respiratory syncytial virus, or RSV, making up almost half of all patients hospitalized for the illness in Canada, according to a new study from the University of British Columbia.

The peer-reviewed study, published recently in the Lancet Regional Health: Americas journal, found that infants under six months made up 45 per cent of the almost 29,300 patients hospitalized for RSV in Canada from 2017 to 2023.

That’s because infants’ immune systems are still developing, their bodies are very fragile and they don’t have any antibodies to fight off the virus, study lead author Nirma Khatri Vadlamudi told The Tyee. Vadlamudi led the study during her post-doctoral research at UBC’s faculty of medicine and now works as an assistant professor at the University of Florida.

Vadlamudi is calling on the province to expand its RSV vaccination programs to protect infants during cold and flu season when RSV cases spike.

Katrina Bellavance also wants the government to do more to protect infants from RSV.

The Albertan mother spent four days in hospital with her daughter in 2023 after the infant caught RSV.

Bellavance, who was not involved in the study, said her youngest caught RSV after her two older children brought it home from school.

It seems like school-aged kids bring home 20 colds per year, Bellavance said, and at first, this one just seemed like a bad cold. She tried to quarantine her infant as best she could, but it was difficult.

She said her daughter, who was seven weeks old at the time, got really sick really fast, going from fussing to struggling to breathe in one evening.

They rushed her to the hospital, where an intake nurse immediately recognized the severity of the situation.

“Within minutes there were 15 people in the room caring for her,” Bellavance said.

Her daughter spent four days in hospital, often hooked up to an oxygen line while she struggled to breathe.

“She’s always been a lively baby but she barely cried while in hospital because she didn’t have the energy,” she said. “When she was awake she’d lie on my chest and look around. She had no spark, nothing like her normal little self.”

Bellavance said she wishes she could have immunized her daughter, but nothing was available at the time. Health Canada approved Abrysvo, a vaccine parents can take, and nirsevimab, an antibody that provides temporary immunity, later that year.

Currently in B.C. there are two ways an infant can be immunized against RSV.

Pregnant people can pay $300 out of pocket for Abrysvo, an RSV vaccine for pregnant people, if their baby will be born during cold and flu season. The parent’s body will produce RSV antibodies — proteins that help fight off germs — and transfer them to their infant through the placenta, giving them passive immunity that wanes by about six months of age.

Infants born prematurely or with pre-existing health conditions also qualify for the B.C. RSV immunoprophylaxis program and can be given a monoclonal antibody medication called nirsevimab, sold under the brand name Beyfortus. This isn’t technically a vaccine but it does give the infant antibodies through an injection that help the tiny patient’s developing immune system fight off an infection for about five months.

In an email, a spokesperson for the Provincial Health Services Authority said around 4,000 infants at moderate to high risk for an RSV infection will be immunized through the RSV immunoprophylaxis program, which can include a dose of Abrysvo for the pregnant parent and a dose of nirsevimab for the infant.

Abrysvo is available for free for pregnant First Nations people.

“This is thought to provide the best combination of cost-effectiveness and reduction in RSV-related disease in young children,” the spokesperson said, adding that health-care providers can refer children to the program if they meet the criteria for being high-risk.

But it’s not just kids with pre-existing health conditions getting hit hard by RSV. A 2016 Ontario study found that more than 80 per cent of children under two years old hospitalized for RSV were otherwise healthy.

Vadlamudi said more needs to be done to protect extremely young and vulnerable patients from RSV. She is calling on the province to fully fund the parental vaccine and the antibodies so all parents who want to protect their children are able to do so.

She said B.C.’s current programs protect about 16 per cent of those who need it.

“Without expanding the programs we won’t be able to address increasing health equity issues, where some people who cannot afford to pay out of pocket will miss out,” she said.

Bellavance agreed, saying, “It seems so amazing that we have this option but multiple provinces aren’t offering it.”

In an email, the Ministry of Health told The Tyee its RSV immunoprophylaxis program follows the advice of Canada’s National Advisory Committee on Immunization, Canada’s Drug Agency and provincial child health experts.

“These groups consider a comprehensive range of factors when developing their recommendations, including (but not limited to) the burden of illness, vaccine efficacy and safety, cost-effectiveness, implementation feasibility, ethics and equity,” the ministry said.

When The Tyee asked if the ministry would consider expanding the program after reading the study, the ministry said it wouldn’t change this year’s program but that it reviews eligibility criteria and what immunizations are offered annually.

It’s important to remember that hospitalizations show only the “tip of the iceberg” of total RSV cases, Vadlamudi said, adding studies have shown kids who catch RSV are three times more likely to develop asthma later in life.

“So there can be long-term consequences,” she said.

When infants are struggling to breathe they will also struggle to feed, and feeding is “crucial for fighting infection,” she said. Infants “don’t have a lot of buffer room” because they’re so small, she added.

Vaccines save health-care dollars

According to the study, the annual average cost of RSV-related health care in Canada is $66.3 million. About half this cost goes to caring for infants under six months.

For these tiny patients, a stay in a hospital ward can start at $8,000 and go over $80,000 for cases needing ventilation in an intensive care unit, Vadlamudi said.

It’s “heartbreaking to see little babies needing mechanical ventilation,” she said.

Families also shoulder “enormous” costs during an infant’s hospital stay. Parents may have to miss work, juggle care for other kids, travel to a different city or town for a hospital stay and pay for their own accommodation, she said.

Bellavance said her husband helped look after their other kids and brought her food while she, also sick with RSV, stayed with their youngest in hospital.

She said they were lucky to have flexible working schedules, adding, “I don’t know how most people would manage.”

The Ministry of Health said manufacturers decide whether or not their product can be privately purchased.

Pfizer made the parental vaccine Abrysvo available for private purchase for around $300.

Sanofi Pasteur, which makes nirsevimab, was working on making its product available for private purchase for $750 per dose, but the ministry said it doesn’t know if this has happened yet.

— This article was originally published by The Tyee