As cooler weather arrives, so does a rise in seasonal illnesses. One in particular is drawing concern from health experts for its impact on young children.
As cooler weather arrives, so does a rise in seasonal illnesses. One in particular is drawing concern from health experts for its impact on young children.
“RSV peak season is upon us,” said Dr. Juanita Mora, an allergist, immunologist and National Medical spokesperson for the American Lung Association.
Cases of RSV, or respiratory syncytial virus, typically spike from October through March and the illness is especially dangerous for infants and toddlers.
“One out of every two babies who gets RSV will be hospitalized,” Mora said.
That troubling statistic is why doctors are urging parents to take steps to protect their children from the highly contagious virus. RSV can cause severe respiratory issues in infants, whose lungs are still developing.
“A baby can’t handle all the phlegm that’s being produced by this virus as it hits their lungs,” Mora explained. “It causes them to have trouble breathing, and they start using their little muscles in the chest to try to breathe, and their neck as well, too.”
Parents should be alert to early signs of RSV, which often resemble a common cold but can quickly escalate.
“One is shortness of breath or wheezing,” Mora said. “The other is signs and symptoms of dehydration.”
Fatigue, fewer wet diapers and poor feeding are also red flags that a child may need medical attention.
There are now tools to help protect infants from RSV.
“There are two ways to protect these babies: one is by giving the RSV vaccine to pregnant moms, the other is by giving a monoclonal antibody shot to babies from birth to eight months,” she said.
The vaccine for moms is administered between 32 and 36 weeks of pregnancy, passing immunity to the baby for the first six months of life. The monoclonal antibody shot offers direct protection to infants, and is also recommended for high-risk children up to 19 months old.
Mora said that prevention doesn’t stop with babies and parents, emphasizing that it should extend to grandparents and caregivers.
“An RSV vaccine also exists to basically protect those greater than 65 years and over,” she said. “So we have to protect the whole village.”
Health officials also recommend frequent handwashing, masking when sick and keeping ill children home from day care or school to help reduce the spread of RSV.
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(CNN) — Parenting is not for the faint of heart. It can take new parents a beat or two to fully tune in to what their baby’s cries could mean. So many small but consequential decisions need to be made on a daily, if not hourly, basis. There are also questions. Many questions.
At a time when misinformation abounds, pediatrician Dr. David Hill is the calm voice of reassurance and reason, grounded in science. He encourages new parents to ask their baby’s pediatrician questions, including about any advice they find on the internet.
“People come to me with stuff all the time,” Hill said, noting the importance of forging a solid parent-pediatrician relationship. That trust, he said, is what’s “going to steer us through this swamp of misinformation and disinformation that’s out there right now.”
Hill is a father of five in a blended family who has been in practice for more than 25 years. He has been the associate medical editor of the American Academy of Pediatrics’ book “Caring for Your Baby and Young Child: Birth to Age 5, 8th edition,” and is slated to be the editor-in-chief for the next edition. He also cohosts the academy’s podcast “Pediatrics On Call.”
“The question I get the most often from new parents, and even those who have been at it for a while is, is this normal?” Hill told CNN Chief Medical Correspondent Dr. Sanjay Gupta recently on his podcast, Chasing Life.
“As somebody who’s seen probably over 10,000 children … it is a joy for me to almost always be able to reassure, and be like, ‘Yeah. That’s fine. They do that. Kids do a lot of weird things, and they do a lot of things at their own pace,” Hill said. “Normal can be all over the map.”
You can listen to the podcast’s full episode here.
Hill said he strongly urges parents to seek out trusted, reliable sources for guidance. “Sources of information that have been validated, that use real data,” he said. “And honestly, talk to your child’s doctor — develop that relationship, because that’s what we’ve dedicated our lives to doing.”
Hill works closely with the AAP on the organization’s parent-facing information. “I do that because I know, over decades of experience, how dedicated everybody in that group is to making sure we get this right, including being willing to get egg on our faces and say, ‘You know what? We were wrong,’ when we were wrong,” Hill said. “And that’s really critical. Anybody who’s never wrong, I don’t trust, because none of us is perfect.”
During the decades Hill has been in practice, he has witnessed some of the babies he saw at the start of his career become parents themselves. During that time, he has also watched the science of child health evolve.
“What I tell these new parents is sometimes the complete opposite of what I said when they were babies!” he said via email.
Here are the five biggest changes Hill has seen over his career.
Safe sleep practices
Sleep guidelines literally flipped in 1994, when Hill finished medical school. That year, the National Institute of Child Health and Human Development launched the first “Back to Sleep” campaign urging parents to put their baby to sleep on their back. Before then, parents had been told to put an infant to sleep on the belly to avoid aspiration.
But that’s not all. The US Consumer Product Safety Commission banned drop-side cribs from the marketplace in 2011 and warned against inclined sleepers in 2019, Hill said. And the Safe Sleep for Babies Act, signed into federal law in 2022, outright banned the sale of drop-side cribs and crib bumpers that could potentially suffocate infants.
He noted that in 1990, there were 154 sudden unexpected infant deaths per 100,000 babies, a number that fell 44% to a low of 86 in 2011. (It has since gone up to 100 deaths per 100,000 in 2022).
“While some of those deaths are from mysterious or unavoidable causes,” he said, “many could still be prevented by following all the safe sleep guidelines, including not only placing infants on their backs to sleep, but never co-sleeping (and) avoiding soft bedding.”
Advice to prevent food allergies
Complete avoidance is out, and small exposures are in.
“I still remember in 2015 searching all the drawers in our practice for outdated infant feeding handouts that, if parents followed them, could put their babies at increased risk of developing life-threatening food allergies,” Hill said. “These handouts told parents to avoid giving their infants and toddlers anything containing peanuts or eggs until they turned at least 2 years old, even 3 if they had eczema or a family history of allergies.”
But, Hill said, in 2015, the results of the LEAP trial confirmed what some earlier studies had suggested: “That it wasn’t early peanut exposure that had caused a doubling of peanut allergies in the preceding decade. It was the advice in these handouts!” he said.
Now parents and guardians are advised to introduce peanut-containing products and eggs along with other solid foods in the first year of life, as soon as babies are safely taking solids, usually around 6 months of age.
Preventing babies from having any exposure to potential allergens apparently left their immune systems oversensitive when they finally did encounter them later on.
Umbilical cord care
Umbilical cords used to be treated with a messy (for doctors) purple “triple” dye — an antiseptic to keep bacterial infections at bay. Now, the recommendation in well-resourced countries and communities is to let the cord dry on its own — and to keep a close eye on it.
“The purpose of the dye was to prevent potentially dangerous infections of the umbilical cord and surrounding tissues (omphalitis),” Hill said. “Then, a few brave souls, perhaps fed up with their dry-cleaning bills, decided to see what would happen if we used alcohol instead of the dye. It turned out … nothing.”
Hill said the next step was to just let the cord dry on its own, taking care not to trap it in a wet or soiled diaper for extended periods and to avoid soaking it at bathtime. That practice is where the guidance stands today.
Some known risk factors for omphalitis, Hill said, include low birth weight, prolonged rupture of membranes or prolonged labor, maternal infection, nonsterile delivery or home birth, and improper cord care.
“If you see the skin around the belly button turning red or notice an unusually foul discharge, get your baby seen,” he advised.
What about bathing? Should new parents avoid baths until the cord falls off? “Advice on this one varies, but it’s not clear there’s any more danger from a brief immersion than from a sponge bath,” he said.
New and better vaccines
The vaccination schedule for infants and children has been updated throughout the years as new shots become available, offering better protection against childhood scourges.
“My dad is also a pediatrician, and I grew up hearing horror stories of babies suffering from meningitis and sepsis. It seems my dad was always dashing off to the hospital to perform spinal taps,” Hill recalled. “This started to change, however, in 1985, when a vaccine against Haemophilus influenza B, one of the most dreaded infections of childhood, came out.
“In training and early in my career, I saw awful infections from another bacteria, pneumococcal pneumonia. These infections became much rarer in 2000, when the first pneumococcal vaccine for children came out,” he said. “Since then, that vaccine has expanded from covering seven subtypes of pneumococcus to covering as many as 23.”
Just in the past year, Hill said he witnessed another infantile infection he dreaded, RSV, or respiratory syncytial virus, plummet in frequency and severity thanks to both vaccines for expectant mothers and antibody injections for babies.
Considering the big picture
Another change involves a paradigm shift in the way pediatricians think about health and well-being, Hill said.
“In pediatrics, one of those tectonic shifts hit in 1998, the year I started practice and the year the ACEs Study came out,” he said, referring to a study that looked at adverse childhood experiences. Those potentially traumatic events include physical, emotional and/or sexual abuse; the death of a parent; mental illness; or violence or substance abuse in the household, any of which can create toxic stress in a child, leading to changes in brain development and affecting future mental, physical and emotional health.
“Many people had noticed that traumatic events in childhood … seemed to impact later health,” Hill said. “The ACEs Study measured and quantified the extent and duration of these effects, and the results were more dramatic and longer-lasting than anyone had guessed.”
An explosion of research followed, Hill said, which led to a new approach in pediatrics.
“Every child faces stressful events, some severe enough to impact their health. But the safe, stable, nurturing relationships that children build with the adults around them can protect them,” he explained. “Understanding these interactions inspires trauma-informed care, an effort to work with families to address the stresses in their lives and to build those emotional connections that can help their children thrive.”
Under this approach, Hill said, pediatricians pivoted from asking “What’s wrong with you?” to asking “What happened to you, and how can we help?”
“A key concept here is the ‘good enough parent,’” he said. “No parent is perfect, but perfection is not required to be safe, stable, and nurturing.”
As a parent himself, Hill said that thought “brings me a sigh of relief.”
Q: Is one day isolation sufficient to stop forward transmission of COVID-19?
A: People with COVID-19 could potentially transmit it to others well beyond a day after developing symptoms or testing positive. New guidance from the CDC advises people to isolate until they have been fever-free and with symptoms improving for at least 24 hours, and then take precautions for five days, which covers the period when “most people are still infectious.”
FULL ANSWER
The Centers for Disease Control and Prevention on March 1 updated its guidance on preventing the spread of respiratory viruses, consolidating advice on a range of common respiratory illnesses including COVID-19, flu and respiratory syncytial virus, or RSV.
Since December 2021, the agency had recommended individuals isolate for at least five days after developing symptoms of COVID-19, or after a positive test if asymptomatic. After five days, the agency recommended various symptom-based criteria for leaving isolation combined with additional continued precautions, such as masking.
The new guidance drops the standard minimum of five days of isolation in favor of a symptom-based approach. The agency advises people to stay home and away from others when they are sick with a respiratory virus. People can cease isolation if, over a period of 24 hours, their overall symptoms have been improving and they have been fever-free without using fever-reducing medications.
Many people have had questions about what the new guidance means for people who have COVID-19. Some, like our reader, have referred to the idea that the guidance means only one day of isolation is needed. “do you agree with Biden that one day isolation for covid is fine and dandy??” asked one person on X, formerly known as Twitter.
But that’s not what Biden or the CDC is recommending.
“It’s not saying isolate for 24 hours,” epidemiologist Ronit Dalmat, a research scientist at the University of Washington, told us, referring to the CDC guidance. “It’s saying if you have a fever, absolutely stay home” until it has been gone for 24 hours, and also stay home until other symptoms are improving.
Nor does the CDC say people are guaranteed not to spread COVID-19 or other respiratory illnesses after their symptoms have improved. “Keep in mind that you may still be able to spread the virus that made you sick, even if you are feeling better,” the guidance says. “You are likely to be less contagious at this time, depending on factors like how long you were sick or how sick you were.”
The guidance recommends continuing to take precautions for five days after resuming normal activities. These include physical distancing, testing, improving air quality, using good hygiene and wearing a well-fitting mask, such as an N95 or KN95.
“The total number of days of precautions when sick, that is, a period of staying home and away from others plus 5 days of additional actions, covers the period during which most people are still infectious,” the CDC wrote in an FAQ.
“That whole period could be quite a while,” Dalmat said. “That could be 10 days for some people.”
The CDC said in background materials accompanying the new guidance that it looked at data from countries and states that had adopted similar policies for COVID-19 isolation and had not seen “clear increases in community transmission or hospitalization rates.”
“The updated guidance on steps to prevent spread when you are sick particularly reflects the key reality that many people with respiratory virus symptoms do not know the specific virus they are infected with,” the CDC said. The agency noted that its survey data indicated less than half of people with cold or cough symptoms would take an at-home COVID-19 test.
Some on social media have misinterpreted the guidance as an admission that it was always reasonable to liken COVID-19 to the flu, as was done early in the pandemic despite the marked difference in the diseases’ severity.
But the new CDC guidance acknowledges the continued seriousness of COVID-19 while also detailing the ways in which treatments, vaccines and population immunity have improved outcomes for people with the disease.
“COVID-19 remains a greater cause of severe illness and death than other respiratory viruses, but the differences between these rates are much smaller than they were earlier in the pandemic,” the CDC said. The agency explained that the risks are reduced due to the availability of COVID-19 treatments and population immunity to the virus, both from vaccination and prior infection. The agency also said that long COVID remains a risk, although the prevalence appears to be falling.
The Science on COVID-19 Transmission
Whether someone transmits COVID-19 depends on multiple factors. These include a person’s infectious viral load, but also the susceptibility of the people the infected person encounters and the precautions taken.
There’s no one-size-fits-all answer to how long a particular individual will shed infectious virus and how much they will shed. “Everybody has a slightly different ability to control the amount of virus in their system, which is a part of what makes the virus shed,” Dalmat said. Variation in how people’s bodies fight a virus affects “how much virus you are putting in the world that is infectious.”
There’s evidence that a relatively small number of people who shed particularly high levels of the virus over the course of their infections have been responsible for a disproportionate number of COVID-19 cases, and many people with COVID-19 do not infect others.
However, according to the CDC, the data on the typical overall length of shedding has not significantly changed, even as new variants of SARS-CoV-2 — the virus that causes COVID-19 — have arisen. “Even as the SARS-CoV-2 virus has continued to evolve, the duration of shedding infectious virus has remained relatively consistent, with most individuals no longer infectious after 8-10 days,” the agency said.
The CDC accompanied this statement with a figure showing data collected by the Respiratory Virus Transmission Network from five U.S. sites between November 2022 and May 2023 (see below). One line on the graph (light blue) shows how often researchers were able to isolate and grow — or culture — virus from people with COVID-19.
Trying to culture the virus that causes COVID-19 from a respiratory sample — a laborious process used in research — indicates whether someone is carrying infectious virus. The figure shows that the proportion of people with culturable virus began to increase two days before symptoms begin, or before a positive test for those who were asymptomatic, peaking around one to two days after symptom onset. After that, the rate began falling, with around one-third of people having culturable virus at day five. By day 10, the percentage had dropped to around 10%.
A different study, published in 2023 in the International Journal of Infectious Diseases, combined data from multiple studies done in people diagnosed with COVID-19 in 2021 and 2022. The average duration of shedding of culturable virus was just over five days from symptom onset or first positive PCR test, whichever came first.
Another metric for assessing infectiousness in people with COVID-19 is viral load, often measured as the amount of viral materials, such as RNA or proteins, found in a respiratory sample. A 2023 study published in Clinical Infectious Diseases found that median viral load for people diagnosed with COVID-19 peaked around three or four days after symptoms started. The study assessed people seeking testing for respiratory infections between April 2022 and April 2023.
Someone who is shedding infectious virus may or may not transmit it to others. One factor is that the average person is less susceptible to infection today than they were early in the pandemic, Dalmat said.
“Even if the person is producing the exact same amount of virus today as they could have three years ago, the people on the other end on average are less likely to get infected,” Dalmat said, explaining that today more than 98% of the population has had some exposure to COVID-19 itself, COVID-19 vaccines or both.
When people do get infected, the cases tend to be less severe.“Among the people who get infected with COVID these days, on average it is much rarer that it turns into a very serious illness,” Dalmat said, while also acknowledging that a lot of individuals “are still very vulnerable.” People at elevated risk for severe disease include those who are elderly or immune compromised.
While the CDC guidance harmonizes suggested precautions for COVID-19 and other common respiratory viruses, there are differences in the details of how COVID-19 and other respiratory viruses are spread.
The new guidance is meant to be a general rule of thumb but does not apply to health care settings or cases where there is an outbreak of a disease that requires special instructions, the CDC said. The CDC also said the agency is working on specific guidance for schools, which should be available prior to the 2024/2025 school year.
Masks, Tests and Other Precautions
Isolating from other people when sick is a key way to reduce one’s risk of spreading COVID-19. But the CDC guidance lists additional ways to reduce the chances of spreading a respiratory illness.
Masks can help prevent the wearer from spreading a respiratory virus. They can also protect others from inhaling a virus, particularly well-fitting masks such as N95 or KN95 respirators, the guidance says. Individuals can take measures to improve their hygiene and the air quality in their surroundings and maintain physical distance from others, such as by avoiding crowded spaces.
The CDC still recommends testing to help high-risk people who are sick determine whether to seek treatment for a specific virus. For instance, someone with COVID-19 may benefit from receiving Paxlovid within five days of when their symptoms start. The guidance also lists tests as a tool that can help people decide when they need to take precautions to avoid spreading disease.
At-home rapid antigen tests can be helpful for people who are recovering from COVID-19 and want to see if they still have infectious virus, Dalmat said. In their research, she and her colleagues found that among people who tested positive for COVID-19 on a rapid antigen test, subsequent negative antigen test results were “very, very highly correlated to whether you had infectious virus or not,” she said. That means people with COVID-19 who start to test negative on rapid antigen tests as they get better likely are no longer at risk of infecting others.
However, the CDC cautions that rapid antigen tests early in the course of a person’s infection often miss COVID-19. People who are sick should be taking precautions regardless of test results, Dalmat said. “They shouldn’t test and have a negative test be the end of it,” she said.
The authors of the Clinical Infectious Diseases study, which measured viral loads over the course of infection, wrote that “our data in combination with others’ suggest that symptomatic individuals testing positive for SARS-CoV-2 by PCR currently may not reliably test positive on a rapid antigen test until the third, fourth, or even fifth day of symptoms.”
The CDC guidance says people can end isolation when they have been fever-free and their symptoms have been improving for at least 24 hours. Dalmat cautioned that the definition of improving symptoms is somewhat ambiguous.
“Symptoms improving can mean different things to different people,” Dalmat said, adding that people should make sure their symptoms are truly getting better. “If your symptoms are not really improving – not kind of plateauing but really improving — you should continue to stay home and continue to take whatever measures you are taking in your household.”
Editor’s note: SciCheck’s articles providing accurate health information and correcting health misinformation are made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation.
In the wake of the COVID pandemic, more and more people are insisting that RSV is yet another new virus. But it isn’t. If you haven’t heard of it before, it’s simply because you were lucky enough never to get it.
Respiratory Syncytial Virus, commonly known as RSV, has a nuanced history that underscores its impact on global health, particularly in children and the elderly. The disease is notorious for causing respiratory tract infections, ranging from mild cold-like symptoms to severe respiratory distress.
RSV Discovery and Initial Research
The discovery of RSV dates back to the late 1950s when it was first isolated from chimpanzees with respiratory illness, hence its initial name, “chimp coryza agent.”
Shortly after, similar viruses were isolated from children with respiratory infections, confirming the virus’s ability to infect humans and its role in pediatric respiratory diseases.
The Shift in Understanding
Initial research focused on RSV as a cause of illness in infants and young children, where it was identified as the leading cause of lower respiratory tract infections, such as bronchiolitis and pneumonia.
However, over the years, the scope of understanding expanded, recognizing it as a significant cause of respiratory illness in adults, especially the elderly and those with underlying health conditions. This highlighted the virus’s broad impact across age groups.
Vaccine Development Efforts
One of the most challenging aspects of RSV history involves vaccine development. In the 1960s, a formalin-inactivated RSV vaccine trial resulted in worsened outcomes upon natural infection, leading to severe disease and, tragically, fatalities in some vaccinated infants.
This setback significantly impacted future vaccine development strategies and underscored the need for a deeper understanding of RSV immunology.
Treatment for the disease has evolved, focusing on supportive care and, in some cases, the use of antiviral medications or monoclonal antibodies in high-risk groups.
Efforts to develop a safe and effective vaccine have continued, with several candidates now in late-stage clinical trials, promising hope for future prevention strategies.
The Ongoing Challenge of RSV
RSV remains a significant health challenge globally, with millions of children under five years old hospitalized each year due to related illnesses. The seasonal nature of the disease, with annual epidemics in colder months, underscores the ongoing need for effective prevention and treatment strategies.
Current research into RSV seeks not only to develop safe and effective vaccines but also to better understand the virus’s transmission dynamics, pathogenesis, and long-term impacts on health.
As science advances, the hope is to reduce the burden of RSV through improved prevention, early detection, and innovative treatments.
Nationally, the number of flu cases has decreased. But in some Southern states, flu activity is still high, including in Dallas County, Texas, where almost 20% of tests are positive. Omar Villafranca reports.
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Flu cases are surging nationwide and 27 children are among those who have died this flu season. One hospital shares ways to be on the lookout for respiratory issues. Janet Shamlian reports.
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COVID-19 and flu are rising across California, sparking new warnings from health officials to take precautions as the wider winter holiday season looms.
The uptick is modest and not wholly unexpected — wintertime surges have been an annual occurrence since the coronavirus first emerged. But experts say lagging uptake of the latest reformulated vaccines has left some populations particularly vulnerable to severe health outcomes that are largely preventable at this point.
Over the week that ended Dec. 9, 2,449 Californians were newly admitted to hospitals with a coronavirus infection, up 40% over the last month, according to federal data.
California was considered to have “high” viral illness activity level as of Dec. 9, among the worst designations in the country, the U.S. Centers for Disease Control and Prevention said.
As of Dec. 9, California was considered to have a “high” level of flu-like illness, which includes viral illnesses such as COVID-19 and respiratory syncytial virus, or RSV.
(U.S. Centers for Disease Control and Prevention )
“Respiratory illness activity is rapidly increasing across the United States,” the CDC said in a bulletin Thursday afternoon. “Millions of people may get sick in the next month or two, and low vaccination rates mean more people will get more severe disease. Getting vaccinated now can help prevent hospitalizations and save lives.”
A rise in viral illness is expected this time of year, but the prevalence of COVID-19 adds a considerable health burden that didn’t exist before the pandemic. COVID-19 remains the primary cause of new respiratory hospitalizations and deaths nationally, causing 1,000 fatalities a week.
“COVID is still causing the most number of cases, the most number of hospitalizations and the most, unfortunately, number of deaths that we’re seeing week over week,” Dr. Mandy Cohen, director of the CDC, said in an online discussion Tuesday. “So while we all wish we could leave COVID in the rearview mirror, it is still here with us, and so we need to make sure we are continuing to take it very seriously.”
Cohen last week urged people to take precautions such as getting vaccinated, avoiding people who are sick and staying home when ill, regular hand-washing, improving air ventilation and wearing a mask.
“And get tested, so you know what you have and you can get treatment,” she said. “Getting tested and treated early can prevent you from getting severely ill, being hospitalized and can potentially save your life.”
Relatively speaking, COVID-19, flu and another ailment — respiratory syncytial virus, or RSV — aren’t at the heights they were this time last year, when their simultaneous circulation spawned a “tripledemic” that stressed healthcare facilities across the state, especially children’s hospitals.
Kaiser Permanente Southern California began noticing more COVID-19 illness starting in mid-November, with the rise accelerating after Thanksgiving, said Dr. Nancy Gin, regional medical director of quality and clinical analysis for the health system.
Coronavirus levels in Los Angeles County wastewater were at 38% of last winter’s peak for the week that ended Dec. 2, the most recent data available. That’s exactly the same as the height seen late this summer, when the region experienced a prolonged uptick in infections.
The latest figure signals a “medium” level of concern, as defined by L.A. County health officials.
In the San Francisco Bay Area, coronavirus levels in the San Jose watershed’s sewage have been at a “high” level for weeks.
Rising viral levels in wastewater is “like the canary in the coal mine,” said Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert. Higher concentrations could be followed by more illness, potentially severe enough to require hospital care.
“I’m just worried that it’s going to translate into hospitalizations around Christmastime,” he said.
Chin-Hong said he’s particularly concerned about seniors who haven’t received their updated vaccinations this autumn. Among Californians ages 65 and older, just 27% have received the latest COVID-19 vaccination that became available in September. Uptake is even lower in Los Angeles County — 21% — but higher in the Bay Area, where it’s around 40% in the most populous counties.
Seniors who have not gotten the latest vaccine are “the population we’re seeing in the hospital,” Chin-Hong said, and, especially those who are older than 75, “the population that’s dying.” It’s also likely that many of those who are dying aren’t getting anti-COVID drugs in time.
Flu vaccination rates are slightly lower than they were at this time last year, according to data shared by the CDC. As of early November, 36% of U.S. adults had received their flu shot, compared with 38% at that time last year. And for RSV, just 16% of adults ages 60 and older had received the newly available vaccine as of Dec. 2.
Alarmed by low vaccination rates, the CDC issued a health advisory on “the urgent need to increase immunization coverage for influenza, COVID-19 and RSV.” The agency asked healthcare providers to strongly urge immunizations, noting that “low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity … could lead to more severe disease and increased healthcare capacity strain in the coming weeks.”
The CDC recommends virtually everyone ages 6 months and older get the latest flu and COVID-19 vaccinations. Adults ages 60 and older are also eligible to be vaccinated against RSV, which can be especially risky for older people with heart disease. There are two vaccines available for older adults: Abrysvo, made by Pfizer; and Arexvy, made by GSK.
The CDC also recommends the Abrysvo vaccine for pregnant people and immunizing babies against RSV with an antibody known as nirsevimab, also known by the trademarked name Beyfortus.
The agency is also urging doctors to recommend antiviral drugs for flu and COVID-19, such as Tamiflu and Paxlovid, for eligible patients. These “antiviral medications are currently underutilized, but are important to treat patients, especially persons at high-risk of progression to severe disease with influenza or COVID-19, including older adults and people with certain underlying medical conditions,” the CDC said.
Such antiviral drugs “are most effective in reducing the risk of complications when treatment is started as early as possible after symptom onset,” the CDC said.
So far, hospitals in Southern California and the Bay Area appear to be in fairly stable shape. More people are becoming ill, but so far, many aren’t needing to be hospitalized, Chin-Hong said.
Kaiser Southern California has been noticing more people ill with COVID-19 in its clinics and urgent care centers, “but they’re not landing in the hospital nearly as much compared to last year, certainly compared to two years ago,” Gin said. “Time will tell if the numbers that we see continue to go up.”
The health system, which serves 4.8 million members and operates 16 hospitals throughout the region, has observed a bit of a rise in the use of ventilators and intensive care units related to COVID-19, “but it’s certainly nothing dramatic,” Gin said.
But cases of influenza type A virus nationally “are really shooting up quite a bit. We are seeing that as well,” Gin said.
As for RSV, levels rose steadily from the end of September through mid-November. In the last few weeks, however, that virus seems to have flattened out at “less than half of what we saw last year at this time, at least by our testing numbers. So that’s a good sign,” Gin said.
Increasing coronavirus transmission is probably being assisted by waning immunity from past infections and older booster shots.
Officials are also monitoring the rapid rise of the JN.1 subvariant. Because of its unusually high number of mutations, this subvariant — described as a closely related offshoot of the BA.2.86, or Pirola strain — might be able to more easily infect people who had previously caught an older version of the coronavirus or haven’t yet received an updated shot.
Nationally, JN.1 is estimated to account for about 21% of coronavirus cases for the two-week period that ended Dec. 9, up from 8% in the prior two-week period. It’s the fastest-growing subvariant being tracked.
JN.1 is on the ascent while the current most dominant subvariant, HV.1, is declining. A descendant of the XBB subvariants that were dominant over the summer, HV.1 was estimated to account for 30% of coronavirus specimens for the most recent two-week period, down from 32% in the prior comparable period.
The rise of the new subvariant should encourage people, especially those who are older, to get the new vaccine, as outdated booster shots or natural immunity from past infections may not be protective enough. The new vaccine will replenish antibodies, Chin-Hong said, which will be especially important for at-risk people.
“Most people have gotten a previous infection, like during the summer, with one of the XBBs,” Chin-Hong said. The rise of JN.1 “just makes the clock tick faster before they’re more susceptible [to another coronavirus infection]. In other words, if the XBBs were the main game in town, you might have had a little bit more time before you would get infected again.”
The CDC said available vaccines, tests and antiviral medication continue to work well against JN.1.
Health officials in Warren County, Ohio, this week reported they are seeing a pediatric pneumonia outbreak, with at least 145 children diagnosed with the respiratory illness since August. Most of the children did not require hospitalization, and there is no evidence of a connection to a similar outbreak of respiratory illnesses in China, officials said. Meg Oliver has details.
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The demand for the Beyfortus RSV antibody shot has been so high that the CDC recommends doctors only give it to their most vulnerable patients. Mark Strassmann has more.
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RSV season is ramping up, and doctors are hoping a new shot to prevent the virus in young children will ease the caseload this year. However, some pediatricians are facing challenges getting supply.
The CDC and FDA have approved the Beyfortus antibody shot, from drugmakers AstraZeneca and Sanofi, to prevent respiratory syncytial virus in babies from birth to 8 months old, or in children up to 24 months old with severe risk factors.
RSV is the leading cause of hospital admissions in children younger than 1 year old.
Dr. Lauren Fitzpatrick, the medical director of the pediatric unit at Luminis Health Anne Arundel Medical Center, says pediatricians were optimistic the drug could help reduce cases after a record year in 2022.
“We thought that this was groundbreaking, that this could be our game-changer, that we could potentially really reduce the risk of patients being admitted for RSV,” she told CBS News. “I think there was our hopes, and then there was our reality,”
“There was not an infrastructure in place to roll out this vaccine, or monoclonal antibodies, so even though we have families that are requesting it, we can’t meet their demands.”
A big complication right now is the cost, at nearly $500 a dose. While the shot is expected to be covered by most insurance plans, providers have to order supplies before knowing how much they’ll be reimbursed.
“As pediatricians, we’re angry,” Fitzpatrick said. “It feels like we have an opportunity that may be missed.”
And as a mom, Fitzpatrick knows firsthand how important this shot is. Her youngest, now 5, struggled with RSV at 9 months old.
“It was a very hard time,” she said. “I don’t want this to be dollars and cents. This is my kid’s life. But for a lot of the insurance companies, it’s dollars and cents.”
Earlier in the summer, the American Academy of Pediatrics sent a letter to the CDC and the Centers for Medicare and Medicaid Services urging federal leaders to make sure the shot could be distributed widely and equitably.
The CDC recently announced pediatricians will be able to get paid for counseling families about the drug in addition to administering the product.
Fitzpatrick says she would also like to see insurance companies provide more clarity on how they will cover the expensive shot.
“These are small practices that don’t have that type of capital to invest,” she explained. “If there were some type of plan in place that the insurance companies could work with the practices to either expedite their reimbursement or provide some funding ahead of time, that would be helpful.”
Molly Fleenor, who is expecting her second daughter in December, the peak of RSV season, says she hopes the confusion is resolved by then.
“It shouldn’t be a guessing game,” Fleenor said. “It should be pretty black-and-white and should be accessible and available to as many people as possible, if not everybody.”
Fleenor will also be eligible for the new RSV vaccine for pregnant women in their third trimester, to help protect her baby.
Doctors are recommending either that shot for mom or the immunization for the newborn. Fleenor is still deciding between the two, but knows she wants the protection.
“RSV can be very scary,” she said. “It can take a turn really quickly and make children really sick.”
The American Academy of Pediatrics recommends that all infants whose mothers did not receive the maternal vaccine receive the new preventive antibody, especially those at high risk for RSV.
WASHINGTON — Updated COVID-19 vaccines may be getting a little easier for adults to find but they’re still frustratingly scarce for young children. Health officials said Thursday the kid shots have started shipping — and reminded most everyone to get a fall flu shot too.
About 2 million Americans have gotten the new COVID-19 shot in the two weeks since its approval despite early barriers from insurance companies and other glitches, according to the Department of Health and Human Services.
For the first time, the U.S. has vaccines to fight a trio of viruses that cause fall and winter misery. But health officials worry that shot fatigue and hassles in getting them will leave too many people needlessly unprotected.
“We need to use them,” Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, said Thursday. “Right now is the right time.”
A flu vaccination and that updated COVID-19 shot are urged for just about everyone, starting with babies as young as 6 months.
Also this year, a vaccine against another scary virus called RSV is recommended for people 60 and older and for certain pregnant women. And for babies, a vaccinelike medicine to guard against that respiratory syncytial virus is expected to arrive next month.
“These vaccines may not be perfect in being able to prevent absolutely every infection with these illnesses, but they turn a wild infection into a milder one,” said Dr. William Schaffner of Vanderbilt University and the National Foundation for Infectious Diseases.
Some things to know:
This year’s vaccine is updated to protect against newer versions of the constantly evolving coronavirus. Already there’s been a late summer jump in infections, hospitalizations and deaths. And so far the new vaccine recipe appears to be a good match to the variants currently circulating.
Protection against COVID-19, whether from vaccination or from an earlier infection, wanes over time — and most Americans haven’t had a vaccine dose in about a year. Everyone 5 and older will need just one shot this fall even if they’ve never had a prior vaccination, while younger children may need additional doses depending on their vaccination and infection history.
The rollout’s start has been messy. This time the government isn’t buying and distributing shots for free. Now drugstores, doctors’ offices and other providers had to place their own orders, and sometimes canceled appointments if supplies didn’t arrive in time. Some people had to wait for their insurance companies to update the billing codes needed to cover them or risk paying out of pocket.
Manufacturers Pfizer and Moderna have shipped millions of doses, and say there’s plenty of supply — and in recent days, more appointments have started opening, at least for people 12 and older. In a Wednesday meeting, insurance companies told HHS Secretary Xavier Becerra they’ve largely resolved the paperwork issues blocking some patients’ vaccinations.
The shots are supposed to be provided free in-network to the insured. For the uninsured or underinsured, CDC has opened what it’s calling a “bridge” program to provide free shots at certain sites.
Adult doses got shipped first, CDC’s Cohen said. Doses for the under-12 set have begun shipping, and “the supply is filling out,” she said.
Drugstore chain CVS said its doses for ages 5 and older began arriving last week, although supplies vary by location, while its MinuteClinic locations anticipate opening appointments for tots as young as 18 months in the coming days.
As for pediatricians, they’ve had to guess how many doses to buy up-front while waiting to learn how much insurance companies would reimburse them for each shot, said Dr. Jesse Hackell of the American Academy of Pediatrics. He said early parent demand is heartening but that pediatricians expect to spend lots of time this fall explaining to hesitant families how important COVID-19 vaccination is even for healthy children.
In Redmond, Washington, Ania Mitros got herself, her husband and her 13-year-old vaccinated pretty easily but despite calls to multiple pharmacies and clinics can’t find anyone to tell her when shots for her 8- and 11-year-old will be available. “There need to be clear expectations,” she said.
Fewer Americans got a flu vaccine last year than before the coronavirus pandemic –- a discouraging gap that CDC hopes to reverse.
People need a flu vaccine every fall because influenza also mutates each year. Like with COVID-19, flu is most dangerous to older adults, the very young and people with weak immune systems, lung, heart or other chronic health problems, or who are pregnant.
There are multiple kinds of flu vaccines, including a nasal spray version for certain younger people. More important, three kinds are specifically recommended for seniors because they do a better job revving up an older adult’s immune system.
Yes, although one in each arm might be more comfortable.
RSV is a cold-like nuisance for most people, and not as well-known as the flu. But RSV packs hospitals every winter and kills several hundred tots and thousands of seniors. The CDC says already, RSV cases are rising in the Southeast.
RSV vaccines from GSK and Pfizer are approved for adults 60 and older.
Drugstores have adequate supplies but some seniors are reporting hurdles such as requirements to get a prescription. That’s because the CDC recommended that seniors talk with their doctors about the new vaccine. Cohen said it was meant just for education about a virus that people may not know much about.
“We want folks to … get access to the vaccine as quickly as possible,” she said.
The FDA also has approved Pfizer’s RSV vaccine to be given late in pregnancy so moms-to-be pass virus-fighting antibodies to their fetuses, offering some protection at birth. The CDC is recommending that pregnancy vaccinations be offered between September and January, when RSV tends to be most common.
There’s no vaccine for children but babies whose mothers didn’t get vaccinated in pregnancy may get an injection of lab-made antibodies to guard against RSV. Called Beyfortus, the one-dose shot from Sanofi and AstraZeneca is different than a vaccine, which teaches the body to make its own infection-fighting antibodies, but is similarly protective. Cohen said it should be available in October.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
NEW YORK — U.S. health officials on Friday recommended RSV vaccinations for moms-to-be, a second new option to protect newborns from serious lung infections.
The shots should be given late in pregnancy but only during RSV season, the Centers for Disease Control and Prevention said.
“This is another new tool we can use this fall and winter to help protect lives,” said CDC Director Dr. Mandy Cohen in a statement.
Cohen signed off after a CDC advisory panel backed the vaccine. The only opposition came from a panel member who found the recommendation “incredibly complicated.”
A month ago, the agency recommended another option for infants to guard against severe RSV: lab-made antibodies given to babies younger than 8 months before their first RSV season. A single dose is given to babies by injection after they are born.
Most infants will likely only need protection from one — either the mom’s vaccine or the antibodies — but not both, Cohen said.
There is no head-to-head study that answers which is more effective, and no published research on how safe it is to give both. And they are both expensive, although the cost will be ultimately covered by insurance.
The RSV vaccine, made by Pfizer, should only be given between 32 weeks and 36 weeks of pregnancy. The shot prompts the moms-to-be to develop virus-fighting antibodies that pass through the placenta to the fetus. Protection in newborns likely drops after 6 months of age, so the shot is for use between September and January in most of the U.S., to coincide with the time of year when RSV infections tend to be most common.
A baby born in April, for example, may not have much immunity left from the mother’s vaccination by the time the fall RSV season comes around.
“It really depends on when the due date is as to how impactful this vaccination will be,” said Dr. Grace Lee, chair of the CDC advisory panel.
RSV, or respiratory syncytial virus, is a common cause of coldlike symptoms. A surge last year filled hospitals with wheezing children, but far more U.S. seniors are hospitalized and die from the virus.
Two new vaccines were recently approved for Americans age 60 and older. There isn’t a vaccine for children.
Some CDC panel members who ultimately supported the recommendation expressed reservations. Available data suggests the antibodies are a more cost-effective — and probably longer-lasting — way to prevent severe illness in infants. Several also balked at the $295-a-dose price Pfizer has been charging for the same RSV vaccine for seniors, called Abrysvo.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Every fall, when the air turns chilly and the leaves red, pediatric ICUs begin preparing for the onslaught of the virus known as RSV. Not flu, not COVID, but RSV, or respiratory syncytial virus, is the No. 1 reason babies are hospitalized, year after year. Their tiny airways can become inflamed, and the sickest ones struggle to breathe. RSV is deadly on the other end of the age spectrum too, killing 6,000 to 10,000 elderly Americans every year.
For decades though, there was no way to stop the virus’s seasonal tide. The quest for a vaccine always came up short. And then suddenly, the vaccines started working.
This year, doctors have not just one but multiple new shots to prevent RSV. Three gained FDA approval in rapid succession in recent months: an antibody shot for infants called nirsevimab, a form of passive immunization for babies too young to get proper vaccines; a vaccine from Pfizer for both adults over 60 and pregnant mothers, who can pass the immunity on to their babies; and finally, a vaccine from GlaxoSmithKline also aimed at adults older than 60. Together, these herald a new era for RSV.
That these three new RSV shots are coming out at once is no coincidence. They succeed where others failed because they all target a specific weak spot in the virus, first identified in 2013. This strategy of finding a virus’s most vulnerable points applies to other pathogens too, and experts say it can revolutionize the design of vaccines for other diseases. In fact, it was quietly used to make the COVID vaccines from Pfizer and Moderna. Scientists had originally perfected the idea with RSV, only to repurpose it for the COVID vaccine, which raced ahead, given the urgency of the pandemic. This year, though, the shots are coming for RSV.
“We’re in a really good position, finally, after more than 65 years,” says Asunción Mejías, an infectious-diseases doctor at St. Jude Children’s Research Hospital.
The first attempts to make an RSV vaccine began not long after the virus’s discovery, in 1956, but an early trial ended so catastrophically that it had a chilling effect for decades.
It had started off with promise. The early vaccine was modeled after a successful one for polio, in which the virus is inactivated with a chemical called formalin. But when infants given the early RSV vaccine later caught the virus, a whopping 80 percent had to be hospitalized—compared with only 5 percent in the control group. Two of the babies died, their lungs ravaged. The vaccine did worse than offer no protection; it made the disease more severe. “It was such a disaster,” says Ann Falsey, an infectious-diseases doctor at the University of Rochester. Scientists spent years piecing together why—the vaccine riled up the wrong part of the immune system in very young babies—but they got no closer to making a vaccine that worked. The field was stuck.
Then, in 2008, a serendipitous meeting led to an eventual breakthrough. A young, freshly minted Ph.D. named Jason McLellan, who studies the structure of proteins, began a new job at the National Institutes of Health to work on HIV vaccines. The lab he had joined, on the fourth floor, had run out of room, though, so he got put in another, on the second. There, he ran into Barney Graham, a virologist who had been trying to solve the puzzle of RSV since the 1980s. He convinced McLellan that this virus was worth a look too.
By then, scientists had at least homed in on a plausible vaccine target. Much as COVID uses spike protein to infect cells, RSV uses a protein—called F for “fusion”—to physically fuse the virus particle to a human cell. F comes in two forms, though: an extremely unstable prefusion state and a far more stable postfusion state. And once it switches to the postfusion state—which can also happen spontaneously— “it can’t come back,” McLellan told me.
When RSV vaccines are manufactured, all the F protein eventually switches to the postfusion state. But the antibodies against postfusion F weren’t very effective. McLellan soon figured out why. He found that extremely potent neutralizing antibodies bind to a specific site—the very tip of the prefusion F—that is lost when the protein rearranges into its postfusion form. With that, Graham told me, “you lose ten- to 1,000-fold potency.” An effective RSV vaccine would need to target the prefusion F.
The team knew what to do, but had a practical dilemma: How to stabilize F in its prefusion form, so the team could put it in a vaccine? McLellan rejiggered the protein slightly, adding molecular “staples” and filling a hole in the protein structure. These changes froze F in its prefusion shape. When the team tested this version of the vaccine in mice, the results could not have been clearer. The vaccine induced the highest levels of neutralizing antibodies Graham had ever seen in his three decades of studying RSV. “This is it,” McLellan remembers thinking.
Soon, pharmaceutical companies came calling, and the race was on. (The experts in this article—like nearly everyone who works on RSV vaccines—have all received research grants, consulted for, or worked in some other way with one or more of the companies developing shots for RSV.) Today, Pfizer’s and GlaxoSmithKline’s newly approved RSV vaccines target the prefusion F protein, as does nirsevimab, the antibody shot for infants from AstraZeneca and Sanofi. Both the vaccines and the antibody shot trigger immunity against RSV: Vaccines stimulate the immune system to make its own antibodies, and nirsevimab is a direct infusion of antibodies.
Trials for all three shots were already under way when the coronavirus pandemic hit. But because RSV nearly disappeared during social distancing, the trials got delayed. Meanwhile, McLellan and Graham devised a similar molecular trick to stabilize COVID’s spike protein, which Pfizer and Moderna later used in their vaccines. (The stabilization wasn’t make-or-break for COVID, as it was for RSV, though—AstraZeneca’s COVID vaccine was effective despite not having this modification.) But unstable fusion proteins are found in many different classes of viruses beyond RSV. McLellan, now at the University of Texas at Austin, is working on shots against the prefusion structure of other stubborn viruses such as cytomegalovirus and Crimean-Congo hemorrhagic fever. (Graham is now a professor at Morehouse School of Medicine.) This approach—called structure-based vaccine design—could unlock new ways of targeting once-elusive viruses.
For RSV, this fall and winter will be a test of how well the shots fare in the real world. As the adage goes, vaccines don’t save lives; vaccinations do. Falsey, the University of Rochester doctor, specializes in studying RSV in the elderly, and she worries that too few Americans over 60 will get the new vaccines this year. A CDC advisory panel decided that elderly Americans can get the vaccines through “shared clinical decision-making” with their doctors but did not go as far as to fully recommend vaccination, which would have triggered private insurers to cover the shots under the Affordable Care Act. Out of pocket, they can cost more than $300. The vaccine for pregnant women, meanwhile, has FDA approval, but the same CDC panel is voting today on whether to recommend it. The panel will likely scrutinize a possible link to premature births, which has shown up before with RSV vaccines.
Nirsevimab, the antibody shot for infants, has gotten a full-throated endorsement, though, and it’s poised to have the biggest impact this season. It replaces an existing RSV-antibody shot called palivizumab, which is not widely used. Palivizumab targets a less potent site that is on both the pre- and postfusion F, and it needs to be administered up to five times a season (compared with once for nirsevimab), at a cost of some $1,500 a dose. For these reasons, it’s been reserved for the highest-risk babies, such as preemies with underdeveloped lungs. But most babies who end up hospitalized were healthy to begin with, says St. Jude’s Mejías, so the older shot didn’t put much of a dent in overall hospitalizations.
Nirsevimab is meant to be more widely used: The shot is approved for all infants in their first RSV season. “It’s going to change the way we manage and treat RSV,” Mejías told me. It should be available for babies starting in October. And if all goes according to plan, pediatric ICUs could be a little quieter this winter.
In an ideal version of this coming winter, the United States would fully revamp its approach to respiratory disease. Pre-pandemic, fall was just a time for flu shots, if that. Now, hundreds of millions of Americans have at their fingertips vaccines that can combat three cold-weather threats at once: flu, COVID, and, for a subset of us, respiratory syncytial virus. If everyone signed up to get the shots they qualified for, “it would be huge,” says Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital. Hospital emergency rooms and intensive-care units wouldn’t fill; most cases of airway illness would truly, actually feel like “just” a common cold. “We would save tens of thousands of lives in the United States alone,” Levy told me.
The logic of the plan is simple: Few public-health priorities are more pressing than getting three lifesaving vaccines to those who need them most, ahead of winter’s viral spikes. The logistics, however, are not as clear-cut. The best way to get vaccines into as many people as possible is to make getting shots “very, very easy,” says Chelsea Shover, an epidemiologist at UCLA. But that’s just not what we’ve set up this fall lineup of shots to do.
Convenience isn’t the only issue keeping shots out of arms. But move past fear, distrust, or misinformation, solve for barriers such as insurance coverage, and getting a vaccine in the United States still means figuring out when shots are available and which you qualify for, finding and booking appointments, carving out the time to go. For adults, especially, who don’t routinely visit their doctor for wellness checkups, and whose workplaces don’t require vaccines to the extent that schools do, vaccination has become an onerous exercise in opt-ins.
Bundling this year’s flu, COVID, and RSV vaccines into a single visit could, in theory, help ease the way to becoming a double or triple shotter. “Any time we can cut down on the number of visits for a patient to take care of them, we know that’s a big boost,” says Tochi Iroku-Malize, the president of the American Academy of Family Physicians. But the easiest iteration of that strategy, a three-in-one shot, similar to the MMR and DTaP vaccines of childhood, doesn’t yet exist (though some are in trials). Even the shorter-term solution—giving up to three injections at once—is hitting stumbling blocks. Pharmacies started receiving flu vaccines earlier this summer and are already giving them out to anyone over the age of six months. RSV vaccines, too, have hit shelves, and have been approved for people over the age of 60 and those 32 to 36 weeks pregnant; so far, however, they are being offered only to the first group. And although nearly all Americans are expected to be eligible for autumn’s updated COVID vaccines, those shots aren’t slated to make an appearance until mid-September or so, according to Kevin Griffis, a CDC spokesperson.
Timing two or three shots together isn’t a perfect plan. Get them all too early, and some people’s protections against infection might fade before the season gets into full swing; get all of them too late, and a virus might beat the vaccine to the punch. Respiratory viruses don’t coordinate their seasons: Right now, for instance, COVID cases are on a sharp rise, but flu and RSV ones are not. Some data on the new RSV vaccines also suggests that co-administering them with other shots might trigger slightly worse side effects, or mildly curb the number of antibodies that the injections raise. Still, Levy argues that those theoretical downsides are outweighed by known benefits. “If someone is at clinic in the fall, they should get all the vaccines they’re eligible for,” he told me. Getting a slightly less effective, slightly more ornery shot a few months early is better than never getting a shot at all.
All of that supposes that people understand that they are eligible for these shots. But already, family-medicine physicians such as Iroku-Malize, who practices in Long Island, have been fielding queries about the RSV vaccines from confused patients. Some new parents, for instance, have gotten the impression that the RSV vaccines are designed to be administered to infants, which isn’t quite right: Babies are the target of protection for the shots for pregnant people, but only because they temporarily inherit antibodies—not because they can get the injections themselves. Regulators also haven’t yet nailed down how often older adults might need the shot, though the current thinking is that the vaccine’s protection will last at least a couple of years. “It’s very hard to tell people, ‘I don’t know,’” says Jacinda Abdul-Mutakabbir, an infectious-disease pharmacist at UC San Diego.
Other parts of the RSV-shot messaging are peppered with even more unknowns. The CDC has yet to release its final recommendation for pregnant people; for people over 60, the agency’s language has been “noncommittal,” says Rupali Limaye, a behavioral scientist at Johns Hopkins University. Unlike past guidelines that have straightforwardly recommended flu shots or most doses of the COVID-19 vaccine, RSV guidance says that eligible people may protect themselves against the virus—and are urged to first consult a health-care provider, which not all people have. The wishy-washiness is partly about safety: A few rare but serious medical events cropped up during the RSV vaccines’ clinical trials, including abnormal heartbeats and neurological complications. None of the experts I spoke with had qualms about recommending the shots anyway. Even so, some private health-insurance companies have seized on the CDC’s watered-down recommendation—and the fact that the agency hasn’t yet included RSV in its annual vaccine schedule for adults—as an excuse to not cover the shot, leaving some patients paying $300-plus out of pocket.
For any of these shots, viral reputation matters too. Despite hospitalizing tens of thousands of Americans each year, especially at age extremes—numbers that, in some years, nearly rival those linked to flu—RSV is a lesser-known winter disease. People tend to take it less seriously, if it’s on their radar at all, Abdul-Mutakabbir told me. Which bodes poorly for future RSV-shot uptake. Annual flu shots have been recommended for 13 years for every American over the age of six months for 13 years. And still, just half the eligible population gets them in any given year. People tend to dismiss shots as subpar interventions against a disease that they don’t much fear, Limaye told me. With COVID, too, “people think it’s gotten mild,” she said. Only 28 percent of American adults are currently up to date on their COVID vaccine. And although older people have historically been more vigilant about nabbing shots, even vaccines against shingles—a notoriously painful disease—have reached just over a third of people who are 60-plus.
To establish fall as an immunity-seeking season, shots would need to become an annual habit, ideally one easy to form. Mandates and financial incentives do prod people toward vaccines, but smaller nudges can persuade people to take initiative on their own. Some strategies may be as simple as semantic tweaks. Studies on HPV and flu vaccines suggest that telling patients they are “due” for a shot is better than offering it as an optional choice, says Gretchen Chapman, a behavioral scientist at Carnegie Mellon University. Otherresearchsuggests that carefully worded text-message reminders can evoke ownership—noting that a shot is “waiting for you,” or that the time has come to “claim your dose.” Noel Brewer, a behavioral scientist at the University of North Carolina at Chapel Hill, also thinks that vaccine deliverers could take inspiration from dentists who gently dog their patients with phone calls and postcards.
Other interventions could be aimed at streamlining delivery. Government funding could make shots more available in rural regions, ensure access for those who lack insurance, and help local health departments offer shots in churches and hair salons, or even bring them door to door. More schools and workplaces, too, might try boosting uptake among students and employees. And although most shots are already given within the health-care system, there’s sludge to clear from that pipeline too. Better universal recordkeeping could help track people’s vaccination status through their lifetime. Kimberly Martin, a behavioral scientist at Yale, is researching ways to revamp medical training to help health-care providers earn their patients’ trust—especially among populations that remain marginalized by systemic racism. “The single biggest impact on vaccine uptake,” Brewer told me, “is a health-care provider recommendation.”
An ideal vision of a fall in the future, then, would be turning vaccines into a default form of prevention—a more typical part of this country’s wellness workflow, says Saad Omer, the dean of the Peter O’Donnell Jr. School of Public Health, at UT Southwestern. After getting their vital signs checked, patients could have their vaccination status reviewed. “And then, if they’re eligible, you vaccinate them,” Omer told me. It’s a routine that pediatricians already have down pat. If adult health care follows suit, regular immunization is a habit we may never have to outgrow.
A panel of U.S. health advisers is recommending that babies get a new drug to protect them against a respiratory virus
ByCARLA K. JOHNSON AP Medical Writer
FILE – This illustration provided by AstraZeneca depicts packaging for their medication Beyfortus. On Thursday, Aug. 3, 2023, a panel of outside advisers to the Centers for Disease Control and Prevention recommended that babies get the drug to protect them against a respiratory virus that sends tens of thousands of American children to the hospital each year. (AstraZeneca via AP, File)
The Associated Press
Infants should get a new drug to protect them against a respiratory virus that sends tens of thousands of American children to the hospital each year, heath advisers recommended Thursday.
An infection with RSV is a coldlike nuisance for most healthy people, but it can be life-threatening for the very young and the elderly. There are no vaccines for babies yet so the new drug, a lab-made antibody that helps the immune system fight off the virus, is expected to fill a critical need.
The drug, developed by AstraZeneca and Sanofi, is expected to be ready in the fall before the RSV season, typically November through March. In the U.S., about 58,000 children younger than 5 are hospitalized for RSV each year and several hundred die.
A panel of outside advisers to the Centers for Disease Control and Prevention recommended the one-time shot for infants born just before or during the RSV season and for those less than 8 months old before the season starts. They also recommended a dose for some 8- to 19-months-olds at higher risk of a serious illness from RSV.
The CDC director was expected to sign off on the panel’s recommendations.
The drug, to be sold under the brand name Beyfortus, is expected to cost $495 per dose, and to be covered by insurance. Panelists acknowledged that it will be a challenge at first to give the shot and for providers to be reimbursed by insurers.
In May, the Food and Drug Administration approved two RSV vaccines for older adults from GlaxoSmithKline and Pfizer. In August, the FDA is expected to make a decision on approving Pfizer’s vaccine for pregnant women, with the aim of passing along protection to their newborns.
Although the new drug is not a vaccine, the expert panel also supported including it in Vaccines for Children, a government program providing free immunizations. The American Academy of Pediatrics is urging hospitals to stock Beyfortus so that newborns can get it during RSV season before they go home.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
WASHINGTON — U.S. officials on Monday approved the first long-acting drug to protect babies and toddlers against a respiratory virus that sends tens of thousands of American children to the hospital each year.
RSV is a cold-like nuisance for most healthy people, but it can be life-threatening in the very young and the elderly.
The Food and Drug Administration approved the injection for infants and children up to 2 years old who face increased risk of severe RSV.
“Today’s approval addresses the great need for products to help reduce the impact of RSV disease on children, families and the health care system” said FDA’s Dr. John Farley in a statement.
Last year, a surge in RSV cases flooded U.S. hospitals with wheezing children. There are no vaccines for babies yet, though Pfizer and other companies are working on them.
AstraZeneca’s drug, to be sold under the brand name Beyfortus, is a laboratory-made version of an antibody that helps the immune system fight off RSV. Under the FDA approval, babies — including preterm infants — can receive a single injection to protect against their first season of RSV, which typically lasts about five months. Children up to age 2 can receive another dose to protect them during their second season facing the virus.
Beyfortus, which will be marketed in the U.S. by Sanofi, is already approved in Canada, Europe and the U.K. Sanofi did not immediately announce the U.S. price of the treatment.
FDA officials approved the drug based on three studies showing Beyfortus reduced the risk of RSV infection between 70% and 75% among infants and children 2 and younger.
Advisers to the Centers for Disease Control and Prevention will meet early next month to recommend exactly who should get the drug.
A similar antibody drug won FDA approval more than 20 years ago, but it’s only recommended for high-risk babies and requires monthly injections. Pediatricians say the drug is underutilized and they expect the longer-lasting effect of AstraZeneca’s shot to improve uptake.
In the U.S., about 58,000 children younger than 5 are hospitalized for RSV each year and several hundred die.
After decades of setbacks for RSV research, drugmakers have made big strides this year, launching the first vaccines against the virus. In May, the FDA approved two RSV vaccines for older adults from GlaxoSmithKline and Pfizer. In August, the FDA is expected to make a decision on approving Pfizer’s vaccine for pregnant women, with the aim of passing along protection to their newborns.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
The Centers for Disease Control and Prevention on Thursday recommended that adults ages 60 and above receive a single dose of RSV vaccines from Pfizer and GSK after consulting their doctors.
Outgoing CDC Director Rochelle Walensky signed off on the recommendation, which an advisory panel of outside experts made last week. That endorsement says seniors should work with theirhealth-care providers to decide if taking a shot is right for them.
The CDC said the shots are expected to be available to the public this fall, when respiratory syncytial virus – along with Covid and the flu – typically begins to spread at higher levels.
“These vaccines provide an opportunity to help protect older adults against severe RSV illness at a time when multiple respiratory infections are likely to circulate,” the CDC said in a statement.
The virus is a common respiratory infection that usually causes mild, cold-like symptoms, but more severe cases in older adults and children. Each year, RSV kills 6,000 to 10,000 seniors and a few hundred children younger than 5, according to CDC data.
Walensky’s decision comes a month after the U.S. Food and Drug Administration approved the vaccines, making them the world’s first authorized jabs against RSV.
Spokespeople for Pfizer and GSK did not immediately respond to requests for comment.
Both companies last week unveiled late-stage clinical data suggesting that their respective vaccines generally maintain protection against RSV after one season of the virus, which in the U.S. typically lasts from October to March.
But the panel raised concerns about the lack of efficacy data on subgroups of the elderly population at the highest risk of severe RSV.
Dr. Michael Melgar, a CDC medical officer who evaluated data on both shots, said during an advisory panel meeting that adults ages 75 and older and those with an underlying medical condition are underrepresented in phase three clinical trials from both companies.
He said seniors with weak immune systems were excluded from the trials altogether.
Both companies said studies on those populations are ongoing.
The CDC panel also raised concerns about the price of the shots, which could limit their accessibility to some Americans.
GSK said it will price its vaccine between $200 and $295. Pfizer said it will price its shot between $180 and $270.
The companies declined to guarantee the pricing.
Pfizer has also developed a vaccine to protect newborns from RSV.
An FDA advisory panel last month backed that shot, but raised safety concerns over premature births that may be tied to the jab. The FDA is expected to make a final decision on that vaccine in August.
The committee unanimously said the vaccine efficacy data was sufficient. Ten of the advisors said the safety data on Pfizer’s shot was adequate, while four said it was not.
“If the vaccine actually lives up to the data we’ve seen today, I can guarantee many infants and their parents will breathe easier in the coming years,” said Dr. Jay Portnoy, medical director at the Children’s Mercy Hospital in Kansas City, after voting in favor of the safety and efficacy of the shot.
Dr. Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia, said he doesn’t believe there is enough data that indicates the safety of the vaccine is “reassuring.”
“If you’re in any sense risking premature births with this vaccine, I think there’ll be a big price to pay,” said Offit, who voted against the shot’s safety data.
Adam Berger, the director of clinical and healthcare research policy at the National Institutes of Health, voted in favor of the shot’s safety and efficacy, but said Pfizer’s post-marketing studies need to examine the risk of premature births.
Post-marketing refers to studies conducted on a product after it receives FDA approval.
The FDA typically follows the advice of its advisory committees but is not required to do so. The agency is slated to make a final decision on the shot in August, right before RSV season in the fall.
If approved, Pfizer’s jab would become the world’s first vaccine that protects infants against RSV, a goal scientists have been working toward for decades.
The FDA earlier this month approved the first RSV shot for adults ages 60 and older from GlaxoSmithKline. The agency is expected to make a decision within weeks on Pfizer’s other RSV shot for that same age group.
RSV is a common respiratory infection that causes cold-like symptoms. Older adults and younger children are particularly vulnerable to more severe RSV infections.
Each year, the virus kills 6,000 to 10,000 seniors and a few hundred children younger than 5, according to the Centers for Disease Control and Prevention. About one out of every 100 children younger than 6 months of age with an RSV infection may need to be hospitalized, the CDC said.
Pfizer’s shot for infants is administered to expectant mothers in the late second or third trimester of their pregnancy. The single-dose vaccine triggers antibodies that are passed to the fetus, which provides it with protection against RSV from birth through the first six months of life.
A phase three trial found Pfizer’s shot was nearly 82% effective at preventing severe disease from RSV in newborns during the first 90 days of life. The shot was also about 70% effective during the first six months of the baby’s life.
But the advisory panel’s concerns stemmed from safety data in that trial.
A slightly higher number of premature births occurred among mothers who took the shot compared to those who received a placebo: 5.7% versus 4.7%, respectively.
Both Pfizer and the FDA said the difference does not appear to be statistically significant.
Most infants, even when born prematurely, were also delivered after 34 weeks of pregnancy, just a few weeks shy of their due dates.
But Dr. Hana El Sahly, who chairs the FDA advisory committee, said “even if it is late preterm delivery, the fact that we’re putting them into preterm delivery while we’re sitting here debating the matter intellectually is not trivial.”
Premature deliveries aren’t a new issue when it comes to RSV vaccines for infants.
Pfizer’s rival GSK halted its own trial on its RSV shot for newborns after noticing concerning data on preterm births and neonatal deaths, or when a baby dies during the first 28 days of life.
Offit also said GSK’s trial is “hanging over” Pfizer’s own RSV shot for infants.
“If GSK truly abandons a program on a similar, almost identical vaccine, that is going to hang over [Pfizer’s] program,” he said during the meeting. “I think it does need to be addressed.”
Portnoy added preterm deliveries could potentially dampen the benefits of the shot.
“The problem is if the child is born earlier, that also reduces the efficacy of the treatment because earlier birth means less antibodies are transferred,” he said. “So, this is a very complex thing because now the harm actually makes the benefit less so. There’s an interaction between the two.”
But some panel members cast doubt on whether there’s a clear causal relationship between the vaccine and preterm births.
“Am I concerned about the preterm birth imbalance? Yes. Am I convinced that it’s real? No,” said Dr. Daniel Feikin, a scientific advisor and respiratory diseases consultant, who voted in favor of the shot’s safety.
Representatives from Pfizer also pushed back on the safety concerns, emphasizing the benefits of the shot outweigh the risks.
“Certainly, in our eyes, there is no definitive evidence to suggest there is a risk of prematurity,” said Dr. William Gruber, Pfizer’s senior vice president of vaccine clinical research and development. “So the question is, do you hold hostage the potential benefits of the vaccine for something which you have no statistical significance at this point?”
Some of the participants’ children also had low birth weights and experienced developmental delays, the FDA staff review said.
Most of the more than 3,000 mothers who received the shot in the trial experienced mild to moderate adverse reactions, according to the FDA staff’s review of data.
The most common reactions were fatigue, muscle pain, headache and pain at the injection site. Most reactions resolved within three to four days after vaccination, the staff review noted.
Travelers have a host of pathogens to dodge this winter, including the “tripledemic” of infections caused by Covid-19, flu and RSV (respiratory syncytial virus).
But there are steps people can take to reduce their chances of getting sick, say health specialists at Spain’s SHA Wellness Clinic.
The key is to develop “a resilient immune system that can defend itself from attack by viruses and bacteria,” said Dr. Vicente Mera, SHA’s head of genomic medicine.
“The most important thing is nutrition,” Mera said.
But drastic dieting isn’t necessary, he added.Rather, travelers can simply eat whole, plant-based foods, which can help decrease inflammation, he said.
Fiber in plant-based foods also helps the gut microbiome “fight pathogens that enter or are activated through the digestive tract,” he said.
Dr. Vicente Mera, Melanie Waxman and Philippa Harvey of SHA Wellness Clinic in Alicante, Spain.
Source: SHA Wellness Clinic
Eating a nutrient-dense diet is the top recommendation from Melanie Waxman, an integrative nutrition specialist and eating coach at SHA Wellness Clinic.
That means eating “lots of vegetables, whole grains, fresh herbs, beans, sea vegetables, fruits, nuts, seeds and fermented foods,” she said.
What to pack on a plane
Waxman said travelers should snack on alkaline foods to combat acidity that is commonly caused by air travel. She recommended these easy-to-pack foods:
Toasted nori snacks: “Great for travelling as they are light and easy to carry in small packs. Nori is alkaline and provides a good source of vitamin C, as well as omega-3 fatty acids, protein and minerals.”
Instant miso soup: “Contains all the essential amino acids … and restores beneficial probiotics to the intestines … great for flights and in hotel rooms as you only need to add boiling water to the sachet.”
Spirulina powder: “Packed with calcium and protein. It has a high chlorophyll content … is especially beneficial after spending hours in airplane cabins. The flavor can be strong so add it to a refreshing vegetable juice … [or take] as a capsule.”
Plum balls: “A wonderful travel companion, as they are extremely alkaline, full of minerals that help increase energy, aid digestion, boost immunity and improve liver functions … the balls come in a container and are easy to pack in a cabin bag.”
A fermented plum, called umeboshi in Japanese, can be added to a cup of tea on a flight. It is a “very sour plum that has been fermented for at least three years,” said SHA Wellness Clinic’s Melanie Waxman.
Tomophotography | Moment | Getty Images
Breakfast
Waxman recommends drinking one tablespoon of apple cider vinegar mixed with a glass of water before breakfast. The vinegar is “a powerful immune booster … full of probiotics,” she said.
For breakfast, a “wonderful” choice is oatmealtopped with berries, chia seeds and flax seeds, she said.
“Oats actually help the body produce melatonin more naturally,” she said. “Oats contain amino acids, potassium, B vitamins, magnesium and complex carbs … berries pack a punch of vitamin C, and the seeds provide extra omega-3 and protein.”
Jet lag
To combat jet lag, Waxman recommends taking more vitamin C.
She recommends eating sauerkraut, both before and after flying. “Fermenting cabbage causes the vitamin C and antioxidant levels to skyrocket,” she said.
Fresh vegetable juice is also great for immunity and jet lag recovery, she said.
Moderate exercise strengthens the immune system, Mera said.
But “30 minutes a day is more than enough,” he said. “Prolonged intense exercise can suppress the immune system.”
To avoid suppressing the immune system, travelers shouldn’t exercise to the point of exhaustion, said Dr. Vicente Mera, head of genomic medicine at SHA Wellness Clinic.
Westend61 | Westend61 | Getty Images
Examples of beneficial exercise include running, walking, swimming and cycling, he said.
Studies indicate that certain supplements — such as vitamin C, vitamin D, zinc, garlic, echinacea and green tea — may strengthen the body’s immune response, Mera said.
But, he said, they’re not necessary for everyone.
“It only compensates for nutrient deficiencies, which usually occur when nutrition is inadequate, or the immune system is very depressed,” he said.
To strengthen the immune system, Waxman also suggests Epsom salt baths (“magnesium is easily absorbed through the skin”), using essential oils (“especially lavender, eucalyptus or tree tree oil”), drinking plenty of water and cutting back on alcohol, caffeine and sugar.
Mera added that relieving stress and anxiety is critical to immune health. He recommends meditation, yoga, tai chi and mindfulness to better manage emotions.
Philippa Harvey, head of SHA’s traditional Chinese medicine department, said travelers should start taking steps to strengthen their immune systems about a week before traveling.
“In TCM when someone is healthy and happy we say they have good qi, pronounced ‘chee’” she said.
She recommends eating foods that are in season, especially garlic and ginger in the autumn and winter.
She also recommends exercise and acupressure to stay healthy.
“Before we travel, a nice brisk walk in fresh air is the simplest solution,” she said.
Concerns about illness or inflation aren’t stopping Americans from hitting the roads and airports this holiday season. But a massive winter storm might.
Forecasters predict an onslaught of heavy snow, ice, flooding and even tornadoes from Thursday to Saturday in a broad swath of the country, from the Plains and Midwest to the East Coast. A surge of Arctic air will follow. The Christmas weekend could be the coldest in decades.
The blast of frigid weather began hammering the Pacific Northwest Tuesday morning, and is expected to move to the northern Rockies, then grip the Plains in a deep-freeze and blanket the Midwest with heavy snowfall, forecasters say. By Friday, the arctic front is forecast to spread bone-chilling cold as far south as Florida.
Authorities across the country are worried about the potential for power outages and warned people to take precautions to protect the elderly, the homeless and livestock — and, if possible, to postpone travel.
The northern-most regions of the U.S. could see wind chills approaching 70 degrees below zero (minus 57 Celsius) — cold enough to leave exposed skin frostbitten in a matter of minutes. The heaviest snow is expected in Idaho, Montana and Wyoming, according to the National Weather Service, and frigid wind will be fierce across the country’s mid-section.
For travelers, an early sign of trouble came Tuesday in Seattle, where a winter storm caused at least 192 flight cancellations, according to the FlightAware tracking service. Greyhound also canceled bus service between Seattle and Spokane.
Airlines offered travelers the option of choosing new flights to avoid the bad weather. Delta, American, United and Southwest waived change fees at airports that might be affected.
The Transportation Safety Administration expected Dec. 22 and Dec. 30 to be the busiest days at U.S. airports, with traffic expected to be close to pre-pandemic levels.
Airports said they would work hard to stay open. Chicago’s O’Hare and Midway airports said they have 350 pieces of equipment and 400,000 gallons of pavement de-icing fluid between them to keep runways and taxiways clear.
The weather added uncertainty to what was expected to be a busy travel season. Earlier this month, AAA estimated that nearly 113 million people would travel 50 miles from home or more between Dec. 23 and Jan. 2. That’s 4% higher than last year, although still short of the record 119 million in 2019.
Most planned to travel by car. About 6% will travel by air, AAA said. Either way, many travelers could find themselves hastily changing their itineraries.
Joel Lustre originally planned to drive from Bloomington, Indiana, to McGregor, Iowa, on Thursday. But he shifted his work schedule, and his wife cancelled an appointment so they could leave Wednesday and beat the storm.
Kurt Ebenhoch, a consumer travel advocate and former airline executive, said the fee waivers for inclement weather that airlines began offering about 20 years ago give consumers valuable time ahead of a storm to figure out alternate days and routes.
But consumers need to read the fine print carefully. Delta, for example, is currently waiving any difference in fares for rebooked travel that happens before Dec. 25 for flights out of the Pacific Northwest. But if the flights are rebooked to a date after Dec. 25, passengers may have to pay the fare difference.
Ebenhoch said passengers have the right to ask the airline to book them on a different airline’s flight if there are no options that meet their needs. And if the airline cancels the flight, consumers have the right to a full refund, not just credits for future travel.
The urge to travel and visit family and friends over the holidays appeared to outweigh concerns about illness. The Centers for Disease Control and Prevention said coronavirus cases and deaths have increased in recent weeks, and the trio of COVID-19, seasonal flu and respiratory syncytial virus (RSV) continues to stress the health care system.
William Karr was traveling Monday from Los Angeles to Minneapolis, where he planned to meet up with his sister and then drive to Iowa. Karr said he would wear a mask on the flight to avoid getting sick over the holidays, but he has taken other flights unmasked.
“I think the precautions sort of go out the window at a certain point, and people are willing to catch COVID if it means they’ll be home with their families,” Karr said.
Inflation also didn’t seem to be cutting into holiday travel demand. The average round-trip airfare rose 22% to $397 in the second quarter of this year — the most recent period available — according to U.S. government data. That was higher than overall U.S. price inflation, which peaked at 9% in June.
Stacie Seal, who was flying Monday from Los Angeles to her home in Boise, Idaho, said her family had opted to visit Disneyland using two free companion tickets, which are earned through airline credit cards.
“If I had to buy the tickets without a companion fare, I’d probably pause and think about the price now,” she said.
Lindsey Roeschke, a travel and hospitality analyst with Morning Consult, a market research company, said travelers appear to be cutting back in other ways.
In a recent survey, Morning Consult found that 28% of U.S. travelers were planning a one-day trip for the holidays, up from 14% last year. There was also an uptick in the number of people planning to stay with friends or family instead of at hotels. Roeschke thinks higher prices were a factor.
“Inflation is still playing a role,” Roeschke said. “It’s not keeping people from traveling, but it’s maybe shifting the way they actually travel.”
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Associated Press News Associate Amancai Biraben contributed from Los Angeles.
