“Never seen it this bad”: RSV’s toll—and outlook for a vaccine

Marc Zarefsky , Contributing News Writer

The rise in respiratory syncytial virus (RSV) has Paul Offit, MD, thinking back to early 2020 when COVID-19 entered the United States. At that time, there were no monoclonal antibodies, no antiviral agents and no vaccines to fight against the SARS-CoV-2 virus.

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"All we had was the ability to restrict our contact with other people," said Dr. Offit, director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia. "So we masked, we social distanced, we isolated, we quarantined, we closed schools, and we closed business."

What that also did, Dr. Offit said, was eliminate respiratory viruses like influenza and RSV, at least for that time period. With people no longer following the same guidelines that were prevailed in 2020, RSV and influenza have returned with a vengeance, causing a "tripledemic" along with the continued fight against COVID-19.

"I've been an infectious disease expert now for 40 years and have never seen it this bad," he said.

Dr. Offit talked about trying to avoid the spread of RSV during the holiday season and the promise of potential treatments in a recent episode of “AMA Update.”


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RSV is an easily transmitted virus that often spreads through small droplets from sneezing or coughing. It didn't spread in 2020 because much of the general public wore masks and practiced physical distancing—a reality that no longer exists today.

"Think about what we did to avoid it," Dr. Offit said. "We had to pretty much never leave our house. People are living and working and playing as normal, and so these viruses are going to circulate. There's really no way around it."

That having been said, Dr. Offit said there are still best practices to follow to help limit the spread of RSV during the holiday season. Children should remain home if they are sick and not interact with other family members, particularly elderly adults, who are more likely to die from RSV than children.

The Centers for Disease Control and Prevention (CDC) estimates there are between 58,000 and 80,000 annual hospitalizations among children under 5 due to RSV, and about 100–300 deaths each year. There are 60,000–120,000 hospitalizations each year and between 6,000 and 10,000 deaths among adults older than 65 because of RSV, the CDC says.

The public has also grown accustomed to testing for COVID-19, but Dr. Offit cautioned against using a negative COVID-19 test as the only measurement for a person's health.

"If you're sick, you should try and stay home," he said. "If you can't stay home and you have a respiratory infection, at least wear a mask when you're out so that you don't infect others."

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There is no vaccine to combat RSV at this point, though efforts to make one started back in the 1960s. Dr. Offit said that recombinant DNA technology—which is used to develop flu vaccines—is being used in an effort to develop an RSV vaccine as well.

Dr. Offit's hope is that the technological advancements will mean more treatment options will become available sooner rather than later.

"I think we'll have a vaccine for pregnant women soon because you want to protect children in those first six months of life, especially premature children," he said. "I think we'll have a vaccine for young children soon, and I think we'll have a vaccine for adults, including elderly adults relatively soon—I would think within the next few years."

AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.