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Respiratory syncytial virus (RSV) is the leading cause of infant hospitalization in the U.S., according to the CDC. But now there are two options -- a maternal vaccine and a monoclonal antibody for infants -- designed to protect the youngest kids from severe disease.

While many experts have welcomed the new tools they simply didn't have before, there has been some concern about the complexity of choices for parents, availability, and uptake.

First and foremost for physicians navigating the new landscape, it's about communicating with parents about the risks of RSV and the protection that is now available, said experts contacted by MedPage Today.

"Only last year, we saw this huge wave of RSV," said Ashlesha Kaushik, MD, a pediatric infectious diseases specialist at UnityPoint Health in Sioux City, Iowa, and a national spokesperson for the American Academy of Pediatrics (AAP). "It broke the seasonal cycle a little bit."

RSV is estimated to lead to between annually in U.S. children under the age of 5, she told MedPage Today.

"This is a bad disease," Kaushik said. "You don't want your child to be sick in the hospital with RSV. It is not a common cold."

Infants can become very sick, and it may not simply be coughing and sneezing, she said. "They can actually stop breathing because of the virus."

To date, there has been little in the way of treatment, she said. And these new options are now the best form of protection.

"That's why we should be talking to parents," Kaushik said.

Two Options Are Better Than None

In September, by an 11-1 vote, the CDC's Advisory Committee on Immunization Practices (ACIP) recommended that pregnant women receive a single dose of the prefusion F protein (RSVpreF) vaccine (Abrysvo) at 32 to 36 weeks' gestation to prevent lower respiratory tract RSV infection in their child after birth.

However, prior to the vote, committee members discussed at length how a recommendation for the maternal RSV vaccine would coexist with the recommendation it issued in August that the monoclonal antibody nirsevimab (Beyfortus) be given to all infants younger than 8 months born during or entering their first RSV season. (The advisory committee also voted to recommend a dose of the monoclonal antibody for children 8 to 19 months who are at increased risk of severe RSV and approaching their second RSV season.)

"I think the complexity is that the mother and the healthcare provider, actually we have options," committee member Pablo Sanchez, MD, of Nationwide Children's Hospital in Columbus, Ohio, who voted in favor of recommending the maternal RSV vaccine, said at the time. "I mean, if we only had the RSV vaccine to offer, it would be simple. We would just be saying, 'yes, they should get it,' but we do have options."

Ultimately, ACIP decided that it's good to have options, Kaushik said. And it is a choice of one or the other in most healthy populations.

Rolling Out the Options

Lori Handy, MD, MSCE, associate director of the Vaccine Education Center at Children's Hospital of Philadelphia, called it a "very exciting year" in terms of the new tools to protect infants.

At the same time, there can be logistical challenges to rolling out these options in such a short period of time, she said.

It's important to encourage individuals to talk with their care providers regarding the different options when it comes to access, insurance coverage, and implementation, she added.

As for supply, the CDC issued a health advisory in late October that included recommendations to protect infants from RSV during the 2023-2024 respiratory virus season.

Among the recommendations was prioritizing available 100-mg doses for infants at the highest risk for severe RSV disease: those less than 6 months of age and those with certain underlying conditions.

Overall, having two options is a "great opportunity" to be able to protect the youngest children, Handy said. "But it does come with a certain level of educational needs."

She said she doesn't necessarily view having options as a complexity, but rather a "reality that gets us to the most protected people."

For providers, Handy said, it's worth an extra few minutes of conversation.

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