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New York Public Health Now
From Hospital Beds to Healthy Homes: The Power of RSV Vaccination
For a long time, RSV has sent too many babies to the hospital—but new breakthroughs in vaccine science are turning the tide.
New York State Department of Health Commissioner Dr. Jim McDonald puts on his pediatrician coat for this episode of New York Public Health now - he and Executive Deputy Director Johanne Morning explores why prevention matters, while also offering practical advice for parents and families during RSV season.
If you have an idea for topics we should discuss, please let us know: PublicHealthNowPodcast@health.ny.gov
Hello, and welcome to New York Public Health now it's Dr. Jim McDonald, Commissioner of the New York State Department Health. We're going to be talking about respiratory syncytial virus today. RSV. Let me welcome my co-host, Johanne. How are you today?
Johanne Morne:I'm doing great. Thanks so much, Dr. McDonald, and I'm excited for the audience. You should know we're going to change it up a little bit today. We have a special guest, and our guest is Dr. McDonald.
Jim McDonald:We're going to talk about RSV. It's something that is near and dear to us as public health professionals. And I think I'll just start with that, Johanne. You're the Executive Deputy Commissioner of the largest state health department in the United States. When we talk about RSV, just curious what comes to your mind, because you deal with this quite a bit.
Johanne Morne:So there are a number of things that come to mind, but the first thing I'll say, and I know we were talking earlier today about how beautiful the season is, right? So when I think RSV, I think of a particular season, and I also think of it as part of a larger group; Covid, flu, etc. So for me, probably one of the biggest and best things that we can do as a department is think about prevention. How do we prevent individuals from getting RSV?
Jim McDonald:That's right, and I think so, just to make sure we're on the same page of what RSV is. It's a virus and it causes an infection in respiratory tracts, and when you think about an infection in respiratory tracts, why are babies more vulnerable? Babies are more vulnerable because their respiratory pipes, if you will, their bronchioles, are much smaller than adults. So when you cause swelling in a bronchiole, a little breathing tube inside these babies, the swelling makes it harder for babies to breathe. So babies not just have a runny nose, not just a cough, but they wheeze. Wheeze is that turbulent noise that babies make. You can hear it, generally only with a stethoscope, because their airways are swollen, and RSV does that. Now, Johanne, I know you're not a doctor, but can you tell me what drugs you treat RSV with? And this is not a trick question, but can you tell me what drugs you treat RSV with? And the answer is?
Johanne Morne:I honestly can't say that I know the answer, but I think there are no drugs to treat RSV.
Jim McDonald:That's exactly right! It wasn't a trick question. There are no drugs to treat RSV. This is one of those things where, strep throat, we have penicillin RSV. We don't have a drug for RSV. What we have is, if you need oxygen, we can give you oxygen if you're dehydrating because you can't drink, we can give you IV fluids. If your respiratory system is failing, we can put you on a ventilator. But there's not a particular drug that treats RSV. This is why prevention is so important.
Johanne Morne:I was just going to say, Well, it sounds like prevention is key then. So I have a few questions. One, what's the difference between RSV and whooping cough?
Jim McDonald:Yeah, so whooping cough, which is caused by a bacteria called Bordetella pertussis, and it's another vaccine preventable disease, but Pertussis is really what whooping cough is, and whooping cough used to be called the 100 day cough, not a trick question here. Do you know why it was called the 100 day cough?
Johanne Morne:I don't know why it's called 100 day cough, because it lasts 100 days?
Jim McDonald:Yeah, there we go.
Johanne Morne:No, I had whooping cough, I can tell you that much.
Jim McDonald:Well, you know, and whooping cough is one of those great things that we really do, again, prevent, but it's like there's not a drug to treat whooping cough either. There's a drug, macrolide antibiotics to help prevent the spread of it, but RSV, that's a viral infection, again, not a treatment, but it is preventable now. And that's one of the reasons why we're doing an episode on it, because it's preventable now.
Johanne Morne:So what about the person who's pregnant? Is there something they can do to help protect their unborn child?
Jim McDonald:Yeah, so this gets to part of why it's preventable now. So keep mind, I'm an old pediatrician. Thank you, I don't look like one. Having said that, as a pediatrician for the last 35 plus years, one of the things that's interesting about RSV is now it's preventable multiple ways. It's preventable by someone getting a vaccine while they're pregnant. So if you're pregnant anywhere between 32 and 36 weeks of pregnancy, in other words, seventh, eighth month of pregnancy, you can get the RSV vaccine. The person who's pregnant develops antibodies. They pass those antibodies on to their newborn, and the newborn enjoys the protection. But if you missed that opportunity, there's two vaccines, two different vaccines you can choose to give the newborn. These two vaccines, which came out, one in 2023, and one came out just this last year, [they] really offer eight months of protection. What's different about the vaccines that came out now, the first one that came out was called Beyfortus® brand name, generic name is nirsevimab. And I have to admit, nirsevimab rolls off my tongue easily now, but it's one of those things where it's like all these monoclonal antibodies, they take a little... you have to go through phonics to learn how to pronounce them. It's just tough, right? But when you look at these monoclonal antibodies, they last for about 6-8 months, which is about how long you need to get babies through the season. And babies are at risk because their pipes are smaller, their breathing tubes are smaller. RSV is one of the more common reasons why babies end up in a hospital, because babies are very vulnerable. That first year life, babies are very vulnerable to RSV. What's exciting about this to me, though, is, you know, as I go throughout the hospitals throughout New York State, and I travel a lot, you know what I'm hearing from the hospitalists who work in the children's hospital is we're just not seeing RSV nearly as much. And there's national data to show this, right? Like, what we're seeing from Centers for Disease Control and Prevention is this vaccine is very effective. You're really seeing much lower numbers of babies ending up in the hospital from RSV. This is a good thing. No one wants a baby in the hospital, and we don't want to have babies in our hospitals. We want babies at home growing up to be healthy children. That's what we're looking for.
Johanne Morne:So I guess I'm going to age myself a little bit Is RSV new? Because as a kid, my mother would always say, "you're going to get a cold." She never said "you're going to
Jim McDonald:Yeah. So RSV has been around quite a long time, get RSV." and it usually starts in October. You know, RSV is pretty predictable that way. Usually we see RSV start in October, then peak in November, and then go away by December. Part of why that's important is context. It's not really new, but it's gotten more popular. We talk about it more now, and part of why we talk about it's because now there's something we can do to prevent it. It's also one of the things Covid did is make other viruses something we would talk about. It is the most common reason why babies end up in the hospital for pneumonia. But I'm excited about it being preventable. Part of why I'm excited about being preventable is, as a pediatrician, it's not super rewarding when you can't treat someone to make them better. You have to just wait. Like one of the things I would see all the time with babies in the hospital, they'd be in the hospital 3, 4, 5 days. There's very little we can do for them other than the supportive care. The IV fluids, the oxygen. It's a very stressful time for the baby, very stressful time for the parents. So when you can have something to prevent the child from having a problem like this, it's a beautiful thing. And these are very safe vaccines. We're just not seeing adverse effects from the vaccines, and the first one came out in [20]23 but we're seeing really nice results for this. That's part of why I'm so excited about it. And I mentioned earlier, one things about being an old pediatrician is, I remember when the most common form of meningitis was Haemophilus Influenza type B, but because of the vaccine that came out in the 80s, it really, virtually disappeared. You know, we see it now, but really not that often. But then the most common reasons why babies end up in the hospital for meningitis was strep pneumococcus or pneumococcal vaccine. But when the Prevnar vaccine came out, we saw that really, almost virtually disappear. Really nice success with that. And you know, it's interesting to me, like one things I used to see was the most common reason why babies ended up in the hospital in the springtime, late winter, was rotavirus, you know, vomiting and diarrhea, gastroenteritis, dehydration. That vaccine came out in the 90s, and we saw that really diminish in numbers. And one of the things I've had the privilege of seeing in my career is, this is now going to be the fourth disease that used to be the most common reason somebody ended up in the hospital for a reason that we might see really diminish in numbers. And I think this just speaks to the power and efficacy of prevention through vaccines.
Johanne Morne:Well, it also speaks to, I would say, you know, the importance and the essential work of public health, right? Particularly, and this is why I'm so glad that we have these conversations, the ability for us to educate other people about, you know, number one, what is RSV in this example? And then number two, certainly the benefits of the vaccine. But I also like that you touched on the fact that there are no adverse effects. And so really, getting vaccinated only can have a benefit.
Jim McDonald:That's what I see. And I think it's really one of those things where it's for a limited population, people who get the RSV vaccine, either you get it when you're pregnant between 32 and 36 weeks, or you get it as a newborn, you might get it in the hospital before you go home, or you might get in the pediatrician's office, but really a new and important tool that we have now to prevent one of the most common reasons why people end up in the hospital. So that's going to wrap it up for today's episode of the New York Public Health Now podcast. We talked about RSV, RSV vaccines, how to prevent it today, and if you would like to prevent it, maybe talk to your health care provider. If you're someone who's pregnant, get it towards the end of your pregnancy. If you have a newborn, ask about getting it in the hospital, or when you go to your pediatrician when they're in the first couple weeks of life. And by the way, if you have a topic you think we might want to talk about, you can send us an email. We'd love to hear from you at PublicHealthNowPodcast@health.ny.gov.
Johanne Morne:And to hear the latest New York Public Health Now episode on your favorite podcast player app like Apple podcasts, Overcast, Spotify, YouTube and Google podcasts, search by our podcast title, New York Public Health Now or by keyword NYSDOH, then tap the subscribe or follow button to be notified when we release a new episode, which is about every other week.
Jim McDonald:So For the New York Public Health Now podcast, I'm your state health commissioner, Dr Jim McDonald.
Johanne Morne:I'm Johanne Morne.
Jim McDonald:And thank you for listening!
