This is the season we gather together with family and friends. Thanksgiving kicks off the gathering season with young and old sitting down around tables sharing great food and fellowship. For many of us the gathering season lasts into February with groups of us sitting around the TV watching the Super Bowl and for college basketball fans into March.
These holiday celebrations and other gatherings are great opportunities to strengthen family bonds and friendships. It’s priceless that a great grandmother can spend time with her grandson sharing a conversation about how much more delicious the cranberry sauce is this year. Unfortunately they may also be sharing more than just conversation. Tragically it is the very young and very old that are most likely to suffer the worst consequences when they get infected with the bugs that are out there during the gathering season.
The good news is that we now have vaccines that help protect the young and the old against threats like influenza, COVID-19, and bacterial pneumonia caused by some bacteria. Getting vaccinated does not guarantee that a person will not get infected with the bug, but getting vaccinated dramatically lowers a person’s risk from suffering from some of the more severe consequences of being infected.
Starting with the 2023-2024 season we have been able to offer babies, older people, and those with certain chronic health problems protection against a very common virus – RSV. This is a virus that many parents and grandparents know all too well – seeing their children or grandchildren wheezing and gasping for air. We now know that not just young children can end up being hospitalized or killed from an RSV infection. We have learned that older people are also susceptible to having a severe RSV infection.
For babies we have 2 different ways we can provide them with protection against RSV. A vaccine can be given to moms to protect their babies against RSV during their first months of life. Multiple medical groups including The American College of Obstetricians and Gynecologists are recommending all receive this vaccine once between their 32nd and 36th week of pregnancy sometime between September through January.
We also have for infants an injection that contains antibodies against RSV to prevent severe disease. This antibody injection is available for infants less than 8 months old that are born during or entering their first RSV season and for infants and children aged 8 to 19 months who are at increased risk of severe disease entering their second RSV season. The antibody injection is generally not needed if mom was vaccinated during pregnancy.
Most children will have had a RSV infection in their first few years of life. Most of the time an RSV infection will result in mild illness – often resembling a bad cold. The percentage of RSV infections that result in hospitalizations is low. However since almost all children will get RSV, the virus causes a significant number of hospitalizations and deaths in children.
In the United States annually there are an estimated 58,000-80,000 hospitalizations among children younger than 5 years old. RSV kills around 100 – 300 children younger than 5 years old most years in the United States. Children with chronic health problems are more likely to be hospitalized with RSV infections. However the majority of kids that are hospitalized were previously healthy (as is the case with young children hospitalized with COVID-19). Stated in another way; chronic health problems such as diabetes and heart problems place a child at higher risk for being hospitalized with RSV or COVID-19 infections, however previously healthy young children still are at some risk of being hospitalized with RSV or COVID-19.
RSV has increasingly been recognized as a cause of serious illness in older adults. An estimated 60,000-160,000 hospitalizations occur annually in the US among adults 65 years and older with 6,000-10,000 deaths each year.
Attempts to make a vaccine against RSV started way back in the 1960’s. A major roadblock to the development of RSV vaccines has to do with the structure of the vaccine’s target. The target of the RSV vaccines is a viral surface protein referred to as the fusion protein (F protein). This protein is involved with the entry of the virus into our cells. The problem had been that the protein changes its configuration. In 2013 a process was developed to “freeze” the protein into its pre-fusion configuration. To learn more about this science watch this video (fast forward to about the 11 minute mark).
In the video researcher Barney Graham discusses how the protein changes and that causes an important epitope to be lost. The concept of an “epitope” is extremely important to understanding how our immune system works and how vaccines are developed. An epitope is a small portion of the virus (or other pathogen) that the immune system recognizes. The body does not recognize the whole virus, just small pieces of viral proteins. Check out this short video describing an epitope visually.
The technology pioneered by Barney Graham also was a key in the development of the COVID-19 vaccine and he has been recognized as one of the main architects of the COVID-19 vaccines. This video describes some of that process and how based on decades of research they were able to develop a vaccine so quickly.
The adult RSV vaccine is recommended for those over the age of 75 and others at risk for more severe disease. If you got a RSV vaccine last year and are not immunocompromised – you do not need to get one this season – it looks like they give a person good protection for at least 2 years. Two other vaccines against viruses – the influenza and COVID-19 vaccine are recommended annually for all over the age of 6 months every year.
We also have vaccines against common bacterial causes of respiratory infections. Babies are routinely vaccinated against common bacterial causes of pneumonia through the Pneumococcal and Haemophilus (Hib) vaccines. They are protected against whooping cough with the pertussis vaccine.
Adults can also be vaccinated against pneumococcal bacteria. Pneumococcal vaccines for adults have been available for many years and many older adults and others at risk for severe disease have already been vaccinated. In the last few years new vaccines for pneumococcal vaccines have been developed and guidelines on their use are evolving. In a future article I will go into these changes.
Enjoy the gathering season. Make it a great season for all. I am ever so grateful that we have the tools to prevent tragedies during this gathering season. I encourage all to take advantage of all that we have available to keep everyone healthy.
Thanks for listening. Please share.
Russ
Any opinions stated here should be attributed solely to myself and do not necessarily reflect those of any organization I am a member of or of my employer. As always you should consult with a medical provider regarding personal medical concerns – this article is just for informational purposes and is not intended as personal medical advice.