EBB 415 - What is RSV? with the EBB Research Team

0:00Dr. Rebecca Dekker: Hi everyone, on today's podcast we're going to talk about what is RSV.

0:09Dr. Rebecca Dekker: Welcome to the Evidence-Based Birth Podcast. My name is Rebecca Dekker and I'm a nurse with my PhD and the founder of Evidence-Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com slash disclaimer for more details. Hi everyone. On today's podcast, we're going to talk about the topic of RSV or respiratory syncytial virus and how RSV impacts newborns and infants. Here in the United States, we just entered RSV season. RSV can spread all year, but it peaks during the fall and winter months in most places.

0:55Dr. Rebecca Dekker: We're hosting a special live training on October 27 for our evidence-based birth pro members, all about the two different shots that can be administered to prevent RSV. There is the RSV vaccine that can be given in pregnancy, depending on what time of year is and how far along you are in your pregnancy. And there is the RSV antibody shot that can be given to infants and some young children. So if you want to learn more about those two shots, you can attend our special training on the RSV vaccine and the RSV antibody shot by going to ebbirth.com slash membership and signing up for the evidence-based birth pro membership using our special discounted rate that's available only this October.

1:36Dr. Rebecca Dekker: In the meantime, on today's podcast episode, we're going to share the first one-third of that training in which Dr. Sara Ailshaar, our research coordinator here at EBB, talks about the background info on RSV. What is this virus? How does it affect babies and young children? How can we prevent the spread of RSV? And what was the difficult journey that scientists took to create an RSV vaccine for pregnancy? So I hope you enjoy today's episode and find it helpful. But if you decide you wanna expand your knowledge even further beyond what is presented in today's podcast, just go to evbirth.com slash membership and join today to get access to that live presentation on October 27, where we go into detail on these two shots, including who is eligible to receive them and the timing when they can be given, as well as the benefits and the risks.

2:31Dr. Rebecca Dekker: We will also have a live Q &A for our pro members after this training, where you can have your questions on these shots answered by myself and Dr. Aylshire. And as always, if you cannot attend one of our trainings live, the recording is always safe for you and your pro member library. So without further ado, I'm going to take you inside the first part of our training so you can get started right away with some background info on RSV. And if you prefer to watch and learn, the presentation slides that go along with this portion of the training are available in the YouTube video recording of this podcast.

3:03Awesome. We are very excited to talk with you about the

3:07Dr. Rebecca Dekker: evidence on the RSV shot. This is one of the most commonly requested topics for us to cover at EBV, and we've never covered it on the podcast or on the blog. So you all are the first to hear what we found as Sara did a huge project to dive into all this research for you. So with that, just a content note, whenever we're talking about immunizations, that does tend to get people a little overly excited. So please, let's all stay calm. We're here to talk about the history, the evidence, information we can bring to our clients. There is discussion on needles, blood, and contagious and potentially fatal diseases affecting children.

3:49Dr. Rebecca Dekker: Some of us may have had personal experiences with RSVs. So we know you're bringing that to this, but we're going to ask you to focus on the information today. So please be aware of your triggers, biases, and defensiveness, and separate the knowledge and the information we're sharing from your emotional response. If you do feel an emotional response, that's okay, but you might want to take care of yourself afterwards, go on a walk, do some deep breathing. And my first question for you all for the chat, let's get the discussion going in the chat. Have you ever met someone who was interested in getting the RSV shot in pregnancy.

4:24Dr. Rebecca Dekker: So give us a yes in the chat if you have or no, if none of your clients are interested in it. We'll see if there is a consensus. I see almost all yeses, a couple of no's. And yeah, I think this topic though is going to become, for those of you who have not had a client yet, it's coming because this is a fairly new intervention that is getting traction around the world. So we're going to start off by talking about what is RSV, and I'm going to turn it over to Sarah, who's going to talk about. Start by giving us some background. Thank you so much. Yeah, so before we get started talking a little bit about RSV, I thought it'd be useful for us to just take a moment and review some of the terminology around vaccines and other injections just to kind of get us all on the same ground, refresh our memories, and keep in mind what those distinctions are.

5:23So an injection is just using a needle to insert a medication into the body. It can be in a vein, it can be in your muscle, or into your subcutaneous tissue. And a lot of times we colloquially call that a shot. And immunization is a process that takes place in your body, where your immune system has learned how to identify and fight an infection. And vaccines are one pathway to immunization, not the only one, of course. Vaccines are medications that use a part of a virus or bacteria that can cause disease to train your body's immune system to fight off the disease and prevent illness. And the whole idea is that you get trained so that when it's really happening, your body knows what to do and you don't have to go through hopefully the illness at all, or at least not as severe as it could be.

6:14And then finally, an antibody injection is an injection where your body is provided with antibodies to help fight off or prevent a specific illness. And the difference between this and a vaccine is that a vaccine trains the body to produce its own antibodies, whereas antibody injection is just sort of a temporary gift of antibodies, eventually they wear off and the immune system doesn't really learn from the antibody injection how to create antibodies on its own. So with that covered, so what is RSV? RSV, well, first, there's been a lot of this in the news. We just pulled a couple of headlines.

6:56So yeah, if you check your news, you listen to NPR, you probably came across a story or two about RSV. so rsb is a really common illness it's easily spread it's respiratory meaning it affects our nose throat and lungs and most of the time it's not that big of a deal it causes an infection upper respiratory tract and in most people it will kind of present as a cold it affects people of all ages um it is something that we all encounter i think most children will have contracted RSV by the age of two. For example, super common, it's out there. However, in infants and older adults and people with certain health conditions, RSV can lead to really serious illness.

7:40For most part, in people who are generally healthy, RSV might be mistaken for a cold because it will infect you, but the infection would be more minor. You sneeze, you might cough, you might feel a little bit crummy. However, RSV can become really serious if it progresses to the lower respiratory tract. And that's something that can happen, you know, if the disease starts in the upper respiratory tract as you're breathing in, some of those infected cells can work their way down deeper into the lungs, and that's where it can become really harmful. And it can cause more serious illness like bronchiolitis or the infection of the bronchioles where your, you know, your are kind of getting the oxygen from the air to bring into your body or pneumonia, which I think

8:25Dr. Rebecca Dekker: we're all kind of familiar with. RSV in infancy can have a range of symptoms and young children are really where RSV can be really serious as well as with older adults. And it can range, right? It can look like a sneezy runny nose, like that cold that we've talked about. It can presents as wheezing or rapid breathing, a persistent, long-lasting cough. In young babies, it can look like a difficulty feeding. They're not feeling well. They're not breathing well. They don't want to eat necessarily. Grunting, nasal flaring, retractions, pale skin and bluish lips. Those are symptoms of a more serious infection that would require pretty urgent medical attention.

9:08And retractions, if you're not familiar, is when a person is trying to get oxygen in and they're really, you know, the diaphragm is pulling and it creates sort of like a vacuum. It's an indication that, you know, they might be having a hard time breathing. So you'll see kind of the sucking in of the skin around the neck, the collarbones and under the ribs. And here there's this little picture from AAP about what pale skin or bluish lips can look like because it can look different across different people. I just really like that they had this graphic and I thought it was useful for our talk. So a question for everybody here is, have you known somebody whose infant was hospitalized due to RSV?

9:47In my birth group, for example, I've had a couple of people whose babies went in and very thankfully, you know, it wasn't serious. They just got some oxygen support and were able to go home. Yeah, so some people here, healthy term kiddo, exactly.

10:02Dr. Rebecca Dekker: um yeah quite a few people are saying yes more than i thought and at least four people have said their own children recently so yeah it's it's been a big problem i know i have a friend who has an older child but because he has asthma he when he gets rsv he gets really sick and he'll get it sometimes once or twice a season and is always in the hospital for it um irene works in the nikki and says she sees it a lot yeah yeah now i have some some more painful stories in the chat too where i can it's one of those illnesses that can be when it's serious it can be really really serious um some child loss there which is just so tragic okay so rsb to infancy and some people brought stuff in the chat which i really appreciate which is that while certain babies who have certain health conditions, like prematurity, for example, they might have some lung illness or some effect on the lung, just sort of being a very preterm baby, babies with cystic fibrosis, you know, other heart lung issues can be more susceptible.

11:09Almost 80 % or approximately 80 % of the babies who are hospitalized with RSV are otherwise healthy infants who are born at term. So while, you know, there can be risk factors, kind of like what Dr. Decker was talking about of her friend's child who had asthma, just because a baby doesn't have a known health issue, just because a baby is born at term doesn't mean that, you know, they're going to necessarily not be at risk for potentially serious illness. One thing that's important about RSV in infancy is that rates tend to vary seasonally. And we'll talk a little bit about what that means. RSV can happen year-round, but the peaks are influenced by the seasons, by weather, by the climate.

11:48So in temperate regions, so the U.S., Europe, we tend to see RSV season peaks in the fall and the winter. And if you're in a temperate region in the southern hemisphere, it's going to peak during your fall and winter. In tropical regions, you tend to see RSV peaks during the rainy season. In the U.S., because we're a big country, there's a lot of climate variation, you tend to see RSV starting earlier in some regions than others. Generally speaking, it tends to start earlier in the southeast, and you kind of see it spread throughout the rest of the country. However, some parts of the U.S. have a little bit of a different seasonality, again, due to a difference in climate.

12:25So in Alaska, RSV season can be quite long. In places like Florida and Hawaii that have a tropical or subtropical climate, their seasonality differs as well. So if you're in a place like that, it can be useful to reach out to your local health authority and figure out when, you know, generally speaking, RSV season happens in your locale. And the next slide we have here is just a map of global seasonality, as well as duration, which I thought was really interesting. You just kind of see how it varies from place to place. During COVID-19, however, there was a bit of an unusual RSV season. RSV rates dropped during early 2020 lockdowns just because we weren't all breathing on each other.

13:11We were wearing masks. We were staying indoors. We were staying separated because humans are the only known carriers of RSV. There are similar illnesses in other animals, and we'll talk about that. We weren't gathering. We were masking, so we weren't giving it to each other. However, as lockdowns relaxed starting in mid-2020, you started to see an unseasonable RSV spike. So RSV was happening a lot in the summer. It was happening a lot when you wouldn't expect to see it. And again, we see seasonal trends. It doesn't mean it doesn't happen all year. But during COVID, we really saw some just strange patterns.

13:45Researchers had a few hypotheses about that, primarily just sort of like the difficulty in transmission due to us not being around each other. But also some researchers hypothesized exposure to COVID-19 could have made people more prone to contracting RSV or could have weakened people's immune systems and cause more serious RSV infections, which could have also explained some of the strangeness that people saw when it came to RSV post COVID. So how do you prevent RSV? Wash your hands, stay home if you're sick, avoid crowds, circulate fresh air if you're indoors with a lot of people. Masking in public can be beneficial, both if you have it.

14:26Don't spread it to other people. And if you don't have it, hopefully that barrier can prevent it. And then there are some seasonal actions that you can take for our purposes, which is getting a vaccine during pregnancy or for infants getting an antibody shot. But those aren't available year round. And we'll talk a little bit more about that. Something else that we thought would be really interesting to share would be a little bit of the background or the history on RSV. I think, you know, we have a general sense of like the flu and what that's about. But RSV seems like, at least for me, it felt like it just came out of nowhere one day, maybe around the time I became a parent.

15:05So RSV was first discovered in chimps. And it wasn't really the RSV that we have. It was an illness like RSV. The next year, a similar illness was discovered in human children. And that kind of is the origin of our understanding of what RSV is. About a decade later, initial RSV trials, vaccine trials began. But something that's unique about the structure of the RSV virus made it so that these trials were pretty disastrous. And RSV vaccine development stalled for a really, really long time. In the 80s and 90s, we saw research sort of pick up using animal models. RSV in humans is really, really similar to a type of RSV in cows, interestingly enough.

15:53So we developed some antibody treatments during that time period from that research. In the 2010s, we mapped the RSV proteins on the surface that allowed us to begin efforts to develop an RSV vaccine. And those RSV vaccines went to trial in the 2020s and first became available. They're really, really recent inventions and ways for us to fight this illness. So why did it take such a long time to develop a vaccine? So vaccines, you may recall, teach your body to identify an invader so it can learn how to fight it off. And with a vaccine, the immune system will either get a weakened version of the virus, a killed version or a partial version.

16:34And you tend to see more of the killed or the partial version in the contemporary vaccines we get today. That way that your body learns how to kind of fight this like weakened, this partial version about getting sick first. So that when you actually encounter the illness in the wild, your body knows what to do. and you don't have to go through that disease process, which can be so harmful.

16:57Dr. Rebecca Dekker: However, RSV has a lot of proteins on its surface. And some of those proteins are unstable, they change conformation. And when they change when they touch, you know, a person's cell, it changes shape, and there's no place for an antibody to latch on. And it's just it's a really tricky virus because of these shape shifting proteins. And that's kind of a very basic description, but just enough for our purposes. So why does this matter? In the 60s, like we said, they tried to develop a vaccine and they chose the F protein on the surface of the RSV virus to train the immune system to hopefully fight off RSV infection.

17:39However, researchers at the time didn't know that these proteins changed shape. Early vaccine trials were unethical by today's standards. This before we developed the standards that we use today for doing research with human beings at all. The research trials for RSV vaccine in the 60s primarily used Black, low-income, and foster children as their test subjects, and parents and guardians weren't really clear about what they were getting. The first RSV vaccine trial went really poorly. 80 % of the infants who received the trial vaccine were hospitalized. And that's because the vaccine trained the body to fight off the F protein and to attack it without realizing that it would change shape.

18:25So the body would just keep attacking, attacking, attacking, and not getting anywhere, causing really serious harm to the lungs from this sort of like runaway immune response. And two children died as a result of this vaccine trial, Ross Otto Hambrick and Victor King. I think it's important for us to remember their names because for a long time, they were kind of just forgotten and that's not right. And this caused the development of the vaccine to halt for only 20 years because it just went so poorly. However, today, RSV vaccines have benefited from us understanding how the RSV virus works, understanding the proteins on its surface, and they're able to target basically a stable version of the F protein, enabling our bodies to actually meaningfully and successfully fight off the illness using the vaccine, creating a useful and not a harmful immune response.

19:23And this resolves the problems of the first vaccine trial. The other thing that's important to note is that vaccine safety has changed quite a bit as we've gotten better at doing research. we've also gotten better at doing it ethically and keeping track of what we use. So in 1990, the FDA and the CDC developed VAERS, or the Vaccine Adverse Event Reporting System, to detect possible safety issues and vaccines that are already in use. It's a self-reported system, so it can and often does contain errors, but it's used as sort of like an alarm bell for people to go and investigate and see what's actually happening.

20:00Another thing that we have is vSafe, which is a program that's used to track the safety of several vaccines, so COVID, RSV, and for MPOX. So in general, what are the recommendations for the RSV vaccine? In the U.S., the vaccine recommendations are age-dependent or dependent on the presence of underlying conditions. There are three vaccines available for older adults. However, pregnant people are eligible for the RSV vaccine, but like somebody said in the chat, there was, there's some difference. There's some available difference when you can get it. But when they can receive this vaccine, you know, varies.

20:39It's not an annual vaccine, so you don't get it every year like the flu. And children and infants at this time are not eligible for any existing RSV vaccine. And Rebecca, you'll take it away. Yeah.

20:51Dr. Rebecca Dekker: So thank you, Sar, for that overview. It's so fascinating and important to understand the history. So I would like to know how many of your clients have been receiving the vaccine. You can give us a number or a percentage if that's something that they've shared with you. I know as SARS said, it does depend on the season, the time of year. So not everybody who's pregnant is eligible to get the vaccine. So we're seeing numbers from zero to 75%. 70%. Some doulas haven't been aware, so they don't know. Somebody said nearly all. Very low percentage. Everybody's getting at the local pharmacy, so our clinic doesn't know.

21:33Dr. Rebecca Dekker: No, but there's many inquiries. And we'll talk more about some of the guidelines on when you can get the vaccine in a minute. So there's been a lot of news reports about the RSV vaccine. You'll see it in United Kingdom and sometimes Australia called the jab instead of a shot. But there are a lot of moms whose infants have been hospitalized who are encouraging other parents to get vaccinated during pregnancy to hopefully avoid the frightening situations their children were in. And with that, I'm going to pause the training because we will be covering detailed evidence on the RSV vaccine in Pregnancy and the RSV Antibody Shot for Infants in our October 27th training with EBV Pro members.

22:23Dr. Rebecca Dekker: These injections are a complicated subject. They really deserve an in-depth class with the Q &A because there are a number of special rules for who can receive an RSV vaccine in pregnancy that depend on what time of year it is and how far along you are in your pregnancy. Many people will not qualify for the RSV vaccine during their pregnancy. This doesn't mean, though, that they have no options to protect their newborns and their infants during the first year of life when RSV infection can cause serious illness. Instead, those infants can receive a treatment, again, only on offer during certain times of the year to boost their immune system and to protect them against infection or to lower the risk that an infection could cause serious illness.

23:09Dr. Rebecca Dekker: So in our pro member training, we're going to share a ton of details and resources about all the different options so that you're prepared to help your clients understand how the time of year, their gestational age, and the different types of RSV prevention options that are available to them and their family. Thank you so much for listening or watching today, and I look forward to seeing you next week where we have a really big episode coming your way all about the topic of big babies. We've been doing a ton of research behind the scenes to update our evidence-based birth signature article on suspected big babies, and we'll be sharing that info with you right here on the EBB podcast next week in episode 416.

23:52Dr. Rebecca Dekker: I'll see you then. Bye. This podcast episode was brought to you by the evidence-based birth childbirth class. This is Rebecca speaking. When I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I've met countless parents who felt that they too were unprepared for the birth process and navigating the healthcare system. The next time I had a baby, I learned that in order to have the most empowering birth possible, I needed to learn the evidence on childbirth practices. We are now offering the evidence-based birth childbirth class totally online.

24:27Dr. Rebecca Dekker: In your class, you will work with an instructor who will skillfully mentor you and your partner in evidence-based care, comfort measures, and advocacy so that you can both embrace your birth and parenting experiences with courage and confidence. Get empowered with an interactive online childbirth class you and your partner will love. Visit evidencebasedbirth.com slash childbirthclass to find your class now.