Respiratory syncytial virus, or RSV, isn’t always top of mind during the colder months. It’s often overshadowed by flu season, or winter waves of COVID-19.
But the reality is, this viral infection — which usually causes the common cold — can be a major driver of severe illness in vulnerable groups. Older adults and newborn babies are among those most at risk, leading to serious cases of pneumonia, a high number of seasonal hospitalizations, and an estimated 118,000 annual global deaths.
“RSV is a very common infection, but it is the leading cause of respiratory infections and hospitalizations among Canadian infants,” noted Wasem Alsabbagh, a drug effectiveness researcher and an associate professor in the University of Waterloo’s school of pharmacy.
The good news? Canada is among the countries offering a broader slate of protective products to ward off RSV infections this fall and winter.
Multiple RSV vaccines for adults are rolling out in the months ahead, along with two monoclonal antibody shots to provide protection for infants.
Yet how to access the various shots will depend on where you live, with some provinces covering certain options and not others. Here’s what Canadians need to know:
What’s available this year to protect against RSV?
Older adults now have access to two approved vaccines, called Arexvy and Abrysvo. Guidance from the National Advisory Committee on Immunization (NACI) recommends RSV vaccination for any adults aged 75 and up, and those aged 60 and up who are residents of nursing homes and other long-term care facilities.
In January, the Abrysvo vaccine was also approved for pregnant women to provide protection to newborns through the passive transfer of maternal antibodies.
While NACI guidance suggests that pregnant individuals can consider getting the shot before or during the RSV season — which typically starts in late October or November — the advisory body stressed the importance of monoclonal antibody options and recommends the country move toward “a universal RSV immunization program for all infants.”
There are now two monoclonal antibody products rolling out for infants: A recently-approved option called nirsevimab, and an older one called palivizumab. Both injections contain laboratory-made proteins which mimic the immune system’s natural defences.
While the older monoclonal antibody was given on a monthly basis to high-risk infants, Alsabbagh said, nirsevimab is a one-and-done shot that provides protection through the whole RSV season.
Health Canada has approved the first respiratory syncytial virus (RSV) vaccine for pregnancy to protect infants from birth to six months of age. Pfizer Canada’s bivalent vaccine, Abrysvo, is the second approved for seniors over 60.
So how do I access these shots?
Here’s where things get a little messy.
While there’s now a range of approved options in Canada, actually accessing these shots will depend on where you live and if you’re willing to pay — as each province is taking a different approach to this first major round of RSV immunization campaigns.
“Different provinces have different recommendations and the products aren’t available everywhere yet, so there is some confusion,” said gynecologist-obstetrician Dr. Isabelle Boucoiran, a member of the Infectious Diseases Committee of the Society of Obstetricians and Gynecologists of Canada.
For older adults, the RSV shots aren’t publicly-covered in most provinces, meaning many seniors who want a dose will have to pay out of pocket.
Seniors in long-term care and community care facilities in Prince Edward Island will likely be among the first groups to get the shot covered this fall, with broader access down the line, the province’s chief public health officer Dr. Heather Morrison told CBC News earlier this summer.
Meanwhile in Ontario, free shots are also being provided only to high-risk seniors, such as residents of long-term care, organ transplant recipients, and people experiencing homelessness.
But for someone 60 and up who doesn’t qualify, the province says those individuals “can still purchase the vaccine with a prescription from their family doctor or other primary care provider,” with insurers sometimes covering all or part of the cost.
Dr. Caroline Quach-Thanh, a microbiologist and pediatric infectious disease specialist, says this new medication should lead to a marked decrease in emergency room visits and hospitalizations.
Ontario and Quebec are also the only two provinces currently rolling out fall immunization programs for newborns, which will provide all infants with the new monoclonal antibody shot — for free — by early November.
“I’m optimistic that next year, and in the years ahead, we’ll see the other provinces start to roll out these programs, too,” said Tiffany Fitzpatrick, a scientist with Public Health Ontario and an assistant professor with the University of Toronto’s Dalla Lana School of Public Health.
For pregnant women who’d prefer to get an RSV vaccine during the third trimester before delivery, rather than waiting for a monoclonal antibody shot for their newborn, experts say many should expect to pay out of pocket.
In most provinces and territories there will be no free infant RSV programs at all this season, for either the shots given during pregnancy or directly to newborns, noted Boucoiran.
As for the costs, the Canadian list prices for the new monoclonal antibody shot nirsevimab, and the vaccine approved for both seniors and pregnant individuals, Abrysvo, are $952 and $230 per dose, respectively.
If you’re unsure what’s available to you, or what you’d have to pay, experts suggest talking to your family physician, a pharmacist, or another primary-care provider to see which options exist in your area.
Are the shots worth it?
“These new products that we have coming out this year are really going to be revolutionary for preventing what’s quite a burdensome and, I think, underappreciated, respiratory virus — especially for little kids and older adults,” said Fitzpatrick.
A growing body of data backs that up, showing that these vaccines and antibody shots are all highly effective.
Arexvy and Abrysvo both appear to result in similar reductions in RSV-associated hospitalizations for adults 60 years of age and older, say federal health officials.
In one clinical trial published last year, Arexvy proved more than 80 per cent efficacy in preventing lower respiratory tract disease caused by RSV, while a U.S. Federal Drug Administration analysis found it had an efficacy level of 94 per cent for preventing severe disease.
When given to pregnant women in the weeks before giving birth, the vaccine leads to a nearly 60 per cent reduction in RSV-associated hospital admissions for infants, and cuts medically-attended RSV respiratory tract infection in half, notes the Canadian Immunization Guide.
Studies also show nirsevimab — the newest monoclonal antibody option — is both safe and effective at preventing serious RSV infection in newborns, and protects babies even better than the vaccine given during pregnancy.
The shot has been shown to reduce RSV-related hospital admissions by upwards of 80 per cent, according to federal figures, and is linked to an 80 per cent reduction in medically-attended RSV respiratory tract infections in healthy infants.