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1ïžâ£ Nirsevimab Implementation 2024-2025
- 2024 ACIP universal recommendation for infants
- Supply issues 2023-2024 (manufacturer scale-up)
- Birth-dose for infants born during season; later dose for infants born outside
- Insurance + cost considerations
- Replacing palivizumab in most cases
2ïžâ£ Maternal Abrysvo Considerations
- Given 32-36 wk gestation
- Alternative to nirsevimab in some scenarios
- Insurance coverage varies
- Donât give both routinely (one or the other)
- 2022 preterm signal in Abrysvo trial â investigated, no clear causation
3ïžâ£ RSV Vaccine ⥠60 yr Choice
- Arexvy, Abrysvo, mRESVIA equally effective
- Cost + availability + coadministration
- mRESVIA is mRNA (newest)
- Single dose initially; revaccination interval TBD (annual not currently recommended)
4ïžâ£ Bronchiolitis Severity Scoring
- Respiratory rate
- Retractions
- Wheezing
- Air entry
- Oxygen saturation
- Multiple scoring systems (Wang, RDAI)
- Used for triage + admission decision
5ïžâ£ Why Bronchodilators Donât Help RSV Bronchiolitis
- Pathophysiology: airway epithelium destruction + mucus + inflammation, not bronchospasm
- Trials show no benefit on outcomes
- Possible mild symptomatic relief in some patients (trial + observation)
- AAP 2014 + 2024: not routine
6ïžâ£ Why Steroids Donât Help
- Similar reasoning
- Trials negative
- Asthma exacerbation in older children + RSV trigger: steroid per asthma algorithms (not bronchiolitis)
7ïžâ£ Immunocompromise + RSV
- HSCT, lung transplant â severe pneumonia
- High mortality 20-40%
- Ribavirin (aerosolized or oral) + IVIG combination â limited evidence
- Bronchiolitis obliterans risk in lung transplant
- Surveillance + early treatment
8ïžâ£ COPD + RSV Exacerbation
- ~ 5-10% COPD exacerbations are RSV
- Treat as COPD exacerbation (steroid + bronchodilator + antibiotic if bacterial co-infection)
- Vaccination prevention now possible
9ïžâ£ å¥ä¿ / Taiwan
- å¥ä¿ Hospitalization + supportive care
- Palivizumab high-risk preterm å¥ä¿ limited indication
- Nirsevimab èªè²» (limited availability 2024)
- Adult RSV vaccines èªè²»
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¬è²» program development ongoing
- ç§é«åž« hint: è人 + èº/å¿æ
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â push RSV vaccineèªè²» if can afford; complement with flu + COVID + pneumococcal
10. Future + Pan-Pneumovirus Vaccines
- Combination flu + RSV + COVID + HMPV vaccines in development
- mRNA platform expansion
- Universal pediatric immunization timing optimization
- Reservoir-targeted (mouse vaccine for animal reservoir reduction â research)