Prophylactic Shortage Worsened RSV Hospitalization in Kids in 2021

As a result of the COVID-19 pandemic, respiratory syncytial virus (RSV) surges in young children occurred outside the usual November–March season, when immune-based prophylactic is available to protect children at high risk for severe illness. In 2021, RSV season began in May, leaving kids without a prophylactic until September due to a lack of drug availability and challenges with insurance authorization for off-season administration.

During this time, pediatric hospitalizations for RSV in 2021–2022 spiked and remained higher than normal throughout 2022, making up 45 percent of all pediatric RSV hospitalizations in the past five years, according to a report from Ann & Robert H. Lurie Children’s Hospital of Chicago published recently in JAMA Health Forum.

Congenital heart disease, prematurity, and chronic lung disease of prematurity place children at high risk for RSV severity and hospitalization. Typically, these children are given an RSV prophylactic once a month from November to March—the usual RSV season.

“Our findings underscore the need for a more fluid policy on RSV prophylactic availability so that we can start protecting children at high risk as soon as we see cases rising in the community,” said Jennifer Kusma, MD, MS, a pediatrician at Lurie Children’s and instructor of pediatrics at Northwestern University Feinberg School of Medicine. “Given the recent RSV peaks at unusual times of the year, these kids need access to the prophylactic when the virus actually hits, as opposed to only in November through March.”

Kusma and colleagues analyzed data on RSV hospitalizations in children younger than two years at 40 children’s hospitals between July 2017 and November 2022. They noted shifts in the RSV seasonality pattern during the pandemic. High-risk children represented a larger proportion of hospitalizations during the time between seasons. Children with public insurance constituted the most significant proportion of hospitalizations, and even larger during off-season periods.

“Although the American Academy of Pediatrics guidelines encouraged off-season RSV immunoprophylaxis authorization, in 2021 the RSV surge was missed by the time RSV immunoprophylaxis was covered and available,” said Kusma. “Going forward, we need to do much better in order to protect high-risk children from RSV hospitalizations.”

- This press release was originally published on the Ann & Robert H. Lurie Children's Hospital of Chicago website