Amid early RSV surge, treatment options remain limited

Besides one preventive drug that can only be prescribed in some cases, there are no FDA-approved treatments for respiratory syncytial virus — which leaves healthcare workers with limited treatment options. 

Nationwide, hospitals are reporting capacity strains because of an earlier-than-expected flu season and a spike in RSV cases. The generic palivizumab is an approved preventive therapy for preterm babies who are 6 months and younger, and children 2 years and younger who are born with a chronic lung condition and some heart diseases. 

Other than that, supportive care is the only option for the virus that hospitalizes thousands of infants every year, according to the CDC.

"From a pharmacy perspective, there's not a whole lot that's available," Aaron Harthan, PharmD, a pediatric critical care pharmacist at OSF HealthCare's Children's Hospital of Illinois in Peoria, told Becker's. "So, it's just trying to provide supportive care and mitigate the complications from it."

Available care

Because there's a lack of treatments, the main supportive care techniques are providing oxygen, IV fluids and pain relief drugs. Most children who contract RSV recover from it, according to Rachel Orscheln, MD, the director of ambulatory pediatric infectious diseases at Washington University's St. Louis Children's Hospital. 

The rise in cases, though, is quickly snatching the available hospital beds at children's hospitals.

"Our teams are working hard to care for each child appropriately, including discharging them home when ready," Alexandra Clark, MD, division chief of general pediatrics at Loma Linda (Calif.) University Children's Hospital, told Becker's. "However, another child is waiting to fill that bed as soon as that happens."

This season, Dr. Clark's hospital is fighting an all-time high of pediatric emergency room visits and admissions.

Offseason surge

The number of RSV cases usually starts climbing in November, but the past few years have jumbled that trend. Since the start of the COVID-19 pandemic, there were two years of "almost no RSV," probably because of COVID-19 measures, Dr. Harthan said. 

Then, infections surged during summer 2021. 

"January into February would be kind of the typical peak," Dr. Orscheln said. "It was shifted way forward in 2021 into the summer, and then this year, it's early fall, which is a little atypical."

For the last month, Dr. Harthan said he's seen a "significant increase in overall bronchiolitis" cases alongside the RSV surge. RSV is the main cause of pediatric bronchiolitis and pneumonia infections in children 1 and under.

Why there isn't an RSV vaccine

Since the virus surpassed pediatric influenza cases in the mid-1900s, most vaccine candidates for RSV have failed to prove effective. In the 1960s, one of the first pediatric vaccines for the common virus backfired, and a 14-month-old and a 16-month-old died from it. There's been a "renaissance" of research for a potential RSV vaccine — GSK and Pfizer have recently reported wins in late-stage trials — but drugmakers' efforts can't meet the current issue.

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